Anemias/Leukemias/Lymphomas Flashcards
What is anemia?
reduction below normal of erythrocytes, hemoglobin, or volume of RBCs caused by variety of factors: blood loss, bone marrow failure/impaired production or hemolysis/destruction of RBCs
What is normal TIBC
250-450
What is normal serum iron?
50-150
What are erythrocytes?
most common type of blood cell. and the main means of delivering o2 to the body tissues via blood flow through the circulatory system.
What is MCH and what is norm value?
- expression of the average amount and weight of Hgb contained in a single erythrocyte.
norm: 26-34
what does low MCV mean?
iron deficiency anemia or thalassemia
what does high MCV mean?
B12 or folate deficiency**, alcoholism, liver failure, and drug effects
what does Normocyte mean?
anemia of chronic dz, sickle cell dz, renal failure, blood loss and hemolysis
what is MCHC and what is norm?
proportion of each RBC occupied by Hgb as a percentage (more accurate measure than MCH)
-norm is 32-36%
Iron deficiency anemia:
microcytic, hypo chromic ( <32% MCHC) anemia due to an overall iron deficiency.
iron loss exceeds intake so that storage is depleted and decrease in iron available for RBC formation
What causes iron deficiency anemia?
blood loss, inadequate iron intake, impaired absorption of iron
What are S & S of iron deficiency anemia?
- slow in onset
- pica*** (unusual food cravings such as ice, clay etc
- dyspnea and mild fatigue
- headache
- palpitations
Laboratory and diagnostics of iron deficiency anemia
low mcv low mchc (hypo chromic) low rbc low serum iron low serum ferritin (stores of iron) high TIBC (the capacity for more iron is high) high RDW
treatment for iron deficiency anemia
ferrous sulfate 300-325 mg 1-2 hours after meals
- iron should not be taken with antacids as they interfere with absorption
- taking iron with Vit C increases absorption
What is Thalassemia?
genetically inherited disorders resulting in abnormal Hgb production, microcytic and hypo chromic anemia
not common in western european descent**
middle eastern, african and asian = common
what is different lab values will you expect in Thalassemia vs. iron deficiency anemia?
same: low mcv, low mchc
different: normal TIBC, normal ferritin (capaccity and stores are normal)
decreased alpha or beta hgb chains
management of Thalassemia
no tx for mild forms
-RBC transfussion/splenectomy for more severe forms
what is contraindicated in Thalassemia?
Iron. can lead to iron overload
Folic acid deficiency
A macrocytic, normochromic anemia due to folic acid deficiency
Cause of Folic acid deficiency
inadequate intake/malabsorption of folic acid (needed for RBC production)
What is a unique finding of folic acid deficiency anemia and pernicious anemia?
glossitis (big beefy red tongue)
Labs and diagnostics of folic acid deficiency
mcv elevated
mchc normal
serum folate decreased
RBC folate < 100 ng/ml
Management of folic acid deficiency
folate 1mg orally
foods high in folic acid
pernicious anemia
a macrocytic, normochromic anemia d/t deficiency of intrinsic factor, which results in malabsorption of B12
Labs and diagnostics of pernicious anemia
increased MCV
serum B12 decreased < 0.1 mcg/ml
anti-IF (intrinsic factor) and anti parietal cell antibody test affirms a deficiency
Anemia of Chronic dz:
MCV normal
MCHC normal
Serum iron and TIBC low (binding capacity)
Serum Ferritin is high > 100 ng/ml (stores)
Sickle cell anemia
Chronic hemolytic anemia that is genetically transmitted characterized by sickle cell shaped RBCs
What factors precipitate sickling?
hypoxia, infections, high altitudes, dehydration, physical or emotional stress***, surgery, blood loss, acidosis
what are common S & S of sickle cell dz
-delayed growth and development
increase susceptibility to infections
what does peripheral smear show in sickle cell dz?
distorted sickle-shaped RBCs
how to treat acute sickle cell
fluids (dehydration)
analgesia (morphine or dilaudid)
and oxygen (hypoxemia)
What are leukemias?
neoplasms arising from hematopoietic cells in bone marrow
what constitutes most leukemias in adults?
Acute-nonlymphocytic leukemia (ANL) and acute myelogenous leukemia (AML)
long term survival 40%
what is the hallmark of ALL
pancytopenia with circulating blasts
all of the labs are down
What is the hallmark of chronic lymphocytic leukemia?
lymphocytosis**
most common leukemia in adults
med survival is 10 years
Chronic myelogenous leukemia
philadelphia chromosome seen in leukemic cells in hallmark of dz
S & S of leukemias
cbc with subnormal RBCs and neutrophils
- elevated ESR
- peripheral blood smear usually distinguishes acute and chronic leukemia but bone marrow aspiration is required to confirm diagnosis
Management of leukemias
- chemo
- bone marrow transplant
- control symptoms
what is Stage 1 lymphoma
-dz localized to 1 lymph node or 1 spot
stage 2 lymphoma
-more than 1 lymph node group involved; confined to one side of the diaphragm
stage 3 lymphoma
-lymph nodes or the spleen involved; occurs on both sides of the diaphragm
stage 4 lymphoma
liver or bone marrow involvement
Non-hodgkin’s lymphoma
often presents with lymphandenopathy
- most common neoplasm ages 20-40
- less predictable pattern of spread than hodgkin’s
- adv stage dz is usually apparent
Hodgkin’s Dz
- more common in younger males
- cervical adenopathy*** and spreads in a predictable fashion along lymph node groups
What differentiates Hodgkin’s dz from non-hodgkin’s?
reed-sternberg cells
what is used to locate and stage hodgkin’s dz?
MRI
CT
biopsy and histopathologic exam confirms diagnosis
management of Hodgkins
- radiation
- chemo
- bone marrow transplantation
S/S of pernicious anemia
what you would expect with anemia +
-glossitis, + neuro signs (romberg, babinski, loss fine motor control, paresthesias)
of the 4 above anemias which is the most important one to ask about alcohol intake?
Folic acid deficiency anemia
Normo-Normo anemia is?
anemia of chronic dz
Macro-normo is
folic acid deficiency and pernicious anemia
Sickle cell anemia, most common complaint
aching joint pain
when do you biopsy a lymph node?
any lymph node tht is > 1cm not a/w infection and lasting 4-6 weeks should be biopsied
