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hem/onc > anemia pt 2 > Flashcards

anemia pt 2 Flashcards

1
Q

idiopathic autoimmune suppression of ALL hematopoiesis

A

aplastic anemia

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2
Q

benzene, chemo, hepatitis, radiation exposure, and pregnancy all can cause…

A

aplastic anemia

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3
Q

pallor, purpura, petechiae can be seen in…

A

aplastic anemia

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4
Q

hepatomegaly and splenomegaly is typically not seen in aplastic anemia because…

A

no hemolysis happening

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5
Q

hypocellular aspirate can be seen in

A

aplastic anemia

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6
Q

eltrombopag (promacta) is tx for…

A

mild aplastic anemia
boosts RBC AND WBC production

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7
Q

what is the general tx for mild aplastic anemia

A
  1. bone marrow growth factors
    - multilineage
    - erythropoietic
    - myeloid
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8
Q

tx for severe aplastic anemia (2)

A
  1. bone marrow transplant
  2. immunosuppression - more ppl that cannot undergo bone marrow transplant
    - ATG, cyclosporine
    - steroids used with ATG to reduce SE
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9
Q

anemia due to CKD, chemotherapy, myelodysplasia can be given this medication

A

epoetin/darbepoetin

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10
Q

which has a longer half-life, darbepoetin or epoetin?

A

darbepoetin
3x of epoetin

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11
Q

contraindication for epoetin/darbepoetin

A

HTN
BBW: CV stuff, thrombosis stuff, cancer

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12
Q

common SE of epoetin/darbepoetin

A

HTN, thrombosis

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13
Q

anemia that have abnormalities in heme synthesis and mitochondrial function

A

sideroblastic anemia

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14
Q

inability to incorporate iron into protoporphyrin IX

A

sideroblastic anemia

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15
Q

how is sideroblastic anemia inherited/congenital?

A

X-linked (MC)
autosomal recessive
mitochondrial

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16
Q

cause sideroblastic anemia is more commonly…

A

acquired
- often part of general myelodysplastic snydrome
- chronic alc
- meds - mostly abx

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17
Q

s/s of anemia, pallor of conjunctiva, palmar creases can be seen in

A

sideroblastic

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18
Q

what must be ordered to make sideroblastic dx?

A

bone marrow aspirate

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19
Q

iron deposits in mitochondria encircling the nucleus can be seen in

A

sideroblastic
ringed sideroblasts

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20
Q

what is the MC cause of anemia worldwide?

A

iron deficiency

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21
Q

how much iron is overall absorbed?

A

10% overall normally in acidic environment

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22
Q

name the major iron transporter that releases iron from cells

A

ferroportin

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23
Q

what promotes ferroportin breakdown and inhibits iron release

A

hepcidin

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24
Q

what type of med can decrease iron absorption

A

antiacids

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25
Q

5 causes of iron loss

A
  1. diet
  2. increased requirements - pregnancy, lactation, growth spurt
  3. chronic blood loss - periods, GI bleeds
  4. decreased absorption - gastritis, chronic disease
  5. iron sequestration

chronic intravascular hemolysis/hemoglobinuria - chronic iron loss

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26
Q

heavy periods and GI bleeds (ulcers, IBD, cancer, chronic ASA/NSAID use) can cause what type of anemia

A

iron deficiency anemia

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27
Q

celiac spue or crohn’s disease can cause what type of anemia

A

iron deficiency

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28
Q

presentations of:
- smooth tongue, brittle nails, koilonychia, cheilosis
- Pica
- restless leg syndrome
is indicative of…

A

iron deficiency

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29
Q

plummer-vinson syndrome can be seen in…

A

iron deficiency
leads to dysphagia

30
Q

what happens to iron levels during iron deficiency

A

TIBC - increase
transferrin saturation - decrease
iron - decreased
ferritin - decreased

31
Q

what is the common iron replacement therapy

A

ferrous sulfate 325 mg orally 3x daily on empty stomach

32
Q

what happens to Hct and reticulocytes during iron replacement therapy

A

Hct - halfway to normal in 3 weeks, baseline in 2 months
reticulocytes - rises in 4-7 days, peak in 1-1.5 weeks

33
Q

pt that cannot tolerate or absorb iron orally reside to…

A

parenteral - generally IV infusion
- iron dextran - older form of parenteral iron and has more risk for serious reactions
- newer preparations is more safe and faster

34
Q

proinflammatory cytokines that decreases iron absorption and availability is caused by…

A

inflammation/infection anemia

35
Q

failure to secrete enough EPO is caused by… (disease)

A

anemia of CKD
EPO secreted by kidneys*

36
Q

decreased EPO secretion mainly seen in decreased hormone secretion states (thyroid, testosterone cortisol) is caused by…

A

anemia of endocrine disorders

37
Q

cholesterol deposits in RBC membrane that shortens RBc survival and inadequate EPO secretion can be seen in…

A

anemia in chronic liver disease
deposits can increase RBC size (macrocytic)

38
Q

decreased protein intake that leads to decreased EPO is caused by…

A

anemia of starvation

39
Q

3 causes of anemia of the elderly

A
  1. resistance to EPO
  2. decreased EPO secretion
  3. chronic low-level inflammation
40
Q

what medication can be given for anemias of chronic disease

A

EPO

41
Q

what converts methylmalonyl-CoA to succinyl-CoA and homocysteine to methionine

A

B12

42
Q

what helps with absorption of B12

A

intrinsic factor in stomach
secreted by parietal gastric cells

43
Q

what is absorbed in the terminal ileum

A

B12-intrinsic factor

44
Q

B12 is stored in the…

A

liver

45
Q

7 causes of B12 deficiency

A
  1. diet - vegan, alc, elderly
  2. decreased intrinsic factor
  3. pancreatic insufficiency
  4. transcobalamin II deficiency
  5. meds
  6. competition for B12
  7. decreased absorption of B12
46
Q

pernicious anemia and gastric surgery can cause…

A

B12 deficiency

47
Q

metformin, proton pump inhibitors, and colchicine can cause…

A

B12 deficiency

48
Q

blind loop syndrome can cause…

A

competition for B12 = B12 deficiency
bacterial overgrowth of small bowel

49
Q

surgical small bowel resection and Crohn’s disease can cause…

A

decreased absorption of B12 = B12 deficiency

50
Q

presentation of B12 deficiency

A
  1. anemia
  2. GI - anorexia, nausea, glossitis, angular cheilitis
  3. fatigue
  4. neuro - gradual onset
    - initial: peripheral paresthesias
    - later: problems with balance and proprioception
    - severe: may affect cerebral function

can see non-heme symptoms before anemia mainfests

51
Q

lab findings of B12 deficiency

A

MCV - increased (megablasts)
MCH - increased
MCHC - normal

52
Q

tests for pernicious anemia

A
  1. anti-intrinsic factor antibodies
    - antiparietal cell antibodies
    - gastrin levels
  2. gastric biopsy
  3. Schilling test
53
Q

5 tx for B12 deficiency

A
  1. B12 injection
  2. oral B12
  3. folic acid
  4. transfusion (rare)
  5. dietary counseling
54
Q

what is the response during B12 tx

A

reticulocytosis in 1 week
CBC normal in 2 months

55
Q

cyanocoalamin is used for

A

B12 deficiency

56
Q

contraindications for ferrous sulfate

A
  1. allergy to rx
  2. hemochromatosis
  3. hemolytic anemia
57
Q

contraindication for cyanocobalamin

A

allergy

58
Q

maintenance monitoring for cyanocobalamin

A

CBC and B12 level every 3-6 months

59
Q

what coenzyme converts homocysteine to methionine

A

folate

60
Q

5 causes of folate deficiency

A
  1. diet (MC cause)
  2. increased folate requirement
    - pregnancy
    - chronic hemolytic anemia
    - exfoliative skin disease
  3. inhibition of reduction to active form (methotrexate)
  4. excess folate loss (hemodialysis)
  5. decreased absorption of folate
    - tropical sprue
    - concurrent B12 deficiency
    - meds
61
Q

phenytoin, sulfasalazine, trimethoprim-sulfamethoxazole can cause…

A

decreased absorption of folate = folate deficiency

62
Q

what metabolite is absorbed in the duodenum

A

iron

63
Q

what metabolite is absorbed in the jejunum

A

folate

64
Q

presentation of folate deficiency

A

similar to B12 but NO NEUROPATHY

65
Q

response to folate deficiency tx

A

reticulocytosis in 1 week
CBC normalized in 2 months

66
Q

SE of folic acid

A

malise, nausea
allergic rxn - malaise, flushing, erythema, rash, bronchospasms

67
Q

diverse group of disorders categorized by excessive growth of one or more hematopoitic stem cell lines

A

myeloproliferative disorders

68
Q

myeloproliferative disorders can see an increase in: (4)

A
  1. polycythemia vera - all hematopoietic cells
  2. essential thrombocytosis - platelets
  3. myelofibrosis - collagen, fibrous tissue in marrow
  4. chronic myelogenous leukemia (CML) - granulocytes
69
Q

instead of pallor, ruddy facial features (plethora) can be seen in…

A

myeloproliferative disorder - polycythemia vera

70
Q

tx for myeloproliferative disorders

A

usually myelosuppression

hem/onc (13 decks)

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