Blood Disorders Flashcards
Which type of anemia has low MCV, low ferritin, and increased TIBC (transferrin)?
Iron deficiency
“We’re running out of ferries because we have no iron”
Which type of anemia has low MCV, high/normal ferritin, and decreased TIBC (transferrin)?
Anemia of chronic disease
What’s a blood side effect from TMP-SMX?
Thrombocytopenia
What are some causes of low platelets?
- Heparin, TMP-SMX
- Infex
- B12/folate deficiency
- Pregnancy
- ITP
- Hypersplenism
- DIC
- TTP/HUS
- Malignancy
What’s the diff between TTP/HUS and ITP?
TTP has altered mental status
When is thrombocytopenia severe?
If less than 50,000
What are the 3 categories of hyponatremia?
- Hypovolemic
- Euvolemic
- Hypervolemic
What category of hyponatremia is from diuretics, dermal losses, GI losses, pancreatitis, and hyperaldosteronism?
Hypovolemic
What category of hyponatremia is from SIADH, pregnancy, hypothyroidism, or primary polydipsia?
Euvolemic
What category of hyponatremia is from acute HF or cirrhosis?
Hypervolemic
What is pseudohyponatremia?
Hyperglycemia, elevated lipids, high serum protein
What could be causing the symptoms of nausea, headache, confusion, malaise/weakness, seizures, and coma?
Hyponatremia
What could cause a urine osmolality greater than 100?
ADH release
In true hyponatremia, what’s the serum osmolality level?
Low
What can happen when you go from low to high?
The pons will die (osmotic demyelination syndrome)
What’s the goal increase in sodium correction in 24h?
8mEq in 24h
What’s the calculation for sodium correction in hyponatremia?
(Fluid Na-Serum Na)/(TBW+1)
What’s TBW in males?
60% of weight
What’s TBW in females?
50% of weight
What’s the treatment for SIADH?
Fluid restriction, salt tablets, tolvaptan
What might cause hypernatremia?
Sweat, GI losses, diabetes insipidus, osmotic diuresis
What does a urine osmolality of 600+ indicate?
Hypernatremia
What urine osmolality threshold applies to diabetes insipidus?
Less than 300
What 2 populations are more likely to get hypernatremia because they cannot manage their fluid intake as well?
- Very young
2. Very old
What’s the goal amount of decreasing Na in correcting hypernatremia (per day)?
No more than 10mEq per day
How do you calculate the total water deficit?
Water deficit = TBW x [(Serum Na/140)-1]
How do you calculate the rate of water correction for hypernatremia?
Rate of correction = Water deficit x [10mEq/(Serum Na-140)]
What can cause hypokalemia?
- Alkalosis
- Hypothermia
- GI losses
- Renal losses
- Vol replacement with low K
- Insulin
- Low magnesium
What EKG changes are present in hypokalemia (3)?
Flattened T waves, U waves, QT prolongation
How do you differentiate between renal and non-renal causes of hypokalemia?
24-hour urine potassium:
<20: nonrenal
>20: renal
Is oral or IV potassium replacement preferred unless K<2.5?
Oral
What can cause hyperkalemia?
- Acidosis
- Exercise
- DKA
- Kidney failure
- K-sparing diuretics
- ACEi
- NSAIDs
- Hypoaldosteronism
- False elevation (hemolysis of blood in tube)
Does hyperkalemia cause tachy or bradycardia?
Bradycardia
What 4 EKG changes can occur due to hyperkalemia?
- Peaked T waves
- Lengthened PR
- QRS widening
- Sine wave pattern
How can you remove potassium from the body?
Kayexalate, loop diuretics, or dialysis; stabilize the heart with calcium gluconate
What is ADAMST13 associated with?
TTP
What diagnosis does fibrinogen level help with?
DIC
What infex can cause HUS?
Shiga toxin (STEC)
Does ITP have schistocytes on peripheral smear?
No
What’s the difference between TTP and HUS?
HUS has kidney damage
What’s the first step of treating hyperkalemia?
Calcium gluconate
