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Blood and Lymph > Blood MDT > Flashcards

Blood MDT Flashcards

1
Q

Congenital anemia is suggested from the patient’s what?

A

Personal and family hx

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2
Q

Poor diet may result in which deficiencies?

A
  • Folic acid
  • Iron
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3
Q

What is a more common cause of iron deficiency in adults?

A

Bleeding

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4
Q

What hematocrit level defines anemia in males and females?

A

Males= <41%(hgb 13.5 g/dL)
Females = <37% (hgb 12g/dL)

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5
Q

Physical sx of anemia

A

Mucosal changes such as smooth tongue

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6
Q

What labs should be drawn for anemia?

A

CBC with diff
Iron
Hgb electrophoresis (to evaluate alpha or beta thalassemia)

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7
Q

What iron value indicates iron deficient anemia?

A

<12mcg/L

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8
Q

When and where should patients with anemia be referred?

A

Referred to internal medicine if cause is not identified

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9
Q

What is the most common type of anemia worldwide?

A

Iron deficient anemia

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10
Q

What can cause iron deficient anemia?

A

Menstruation, pregnancy, frequent blood donations, ASA and long term NSAID use

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11
Q

Why should IDCs be aware of anemia in males?

A

Male do not menstruate so anemia is likely due to a disease process

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12
Q

Physical findings of iron deficient anemia

A

Smooth tongue, brittle nails, cheilosis (cuts on mouth)

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13
Q

What will iron deficient patients crave?

A

Specific foods (such as ice) often not rich in iron, also called pica

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14
Q

Treatment for iron deficient anemia?

A
  • treat cause of blood loss
  • Ferrous sulfate 325mg 3x per day for 3-6 months
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15
Q

When would parenteral iron be used?

A

Intolerance of oral iron due to GI disease and continued blood loss cannot be corrected
Dosage derived from hematologist

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16
Q

Essentials of dx of Vitamin B12 deficiency

A
  • Macrolytic anemia
  • Macro-ovalcytes and hypersegmeneted neutrophils on peripheral blood smear
  • serum B12 level <100pg/ml
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17
Q

Where is in the diet is vitamin b12 present?

A

Animal origin

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18
Q

What is the daily absorption of vitamin B12

A

5mcg

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19
Q

The liver contains how much stored vitamin B12?

A

2000-5000mcg

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20
Q

Which diet is likely to lead to vitamin B12 deficiency

A

Vegan

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21
Q

Late stage vitamin B12 patients will present how?

A

Pale, with paresthesia and difficulty with balance and neuro findings

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22
Q

What will show on a blood smear of a vitamin B12 deficient patient?

A

Megaloblastic anemia (large RBCs) and macro-ovalocyte with hypersegmented neutrophils

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23
Q

What B12 serum level indicates deficiency?

A

Overt deficiency = <170 pg/ml
Symptomatic = <100 pg/ml

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24
Q

Treatment for Vitamin B12 deficiency?

A

IM injection of B12 daily for a week, weekly for a month and then monthly for life

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25
Q

Disposition of late stage vitamin B12 deficiency?

A

MEDEVAC, refer to hematologist

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26
Q

What 3 mechanisms reduce loss of blood from blood vessels?

A

Vascular Spasm
Platelet Plug Formation
Coagulation

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27
Q

Describe vascular spasm

A
  • Smooth muscle of a blood vessel wall contracts
  • Caused by damage to smooth muscle and reflexes initiated by pain receptors
  • Can be maintained for several minutes to hours
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28
Q

Describe platelet plug formation

A
  • clumping of platelets around damage
  • can stop bleeding completely if hole in blood vessel is small enough
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29
Q

Describe coagulation

A
  • Formation of prothrombinase
  • Conversion of promthrombin into thrombin
  • Thrombin converts soluble fibrinogen into insoluble fibrin threads
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30
Q

What are intrinsic pathway key factors

A

12, 11, 8, 9

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31
Q

What are extrinsic pathway key factors

A

7

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32
Q

What factors do the pathways converge?

A

10, 5, 2

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33
Q

Which factors are vitamin K dependent?

A

2, 7, 9, 10

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34
Q

What labs are used to measure intrinsic pathway?

A

PTT

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35
Q

What labs are used to measure extrinsic pathway?

A

PT

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36
Q

Hemophilia A is a congenital deficiency of which coagulation factor?

A

8

37
Q

Hemophilia B is a congenital deficiency of which coagulation factor?

A

9

38
Q

Those with congenital deficiencies are at risk of developing antibodies to which factors?

A

8 and 9

39
Q

Older patients with congenital deficiencies are at risk of what infections from contaminated blood products?

A

HIV and Hep C

40
Q

What is Disseminated Intravascular Coagulation (DIC)?

A

Systemic process with potential of causing thrombosis and hemorrhage

41
Q

In DIC, what happens to the processes of coagulation and fibrinolysis within the vasculature?

A

They become abnormally activated

42
Q

A variety of initiating procoagulants may contribute to DIC including?

A

Tissue factor (TF)

43
Q

What are common bleeding manifestations of DIC?

A

Petechiae, ecchymosis, blood oozing from wound sites, intravenous lines, catheters, mucosal surfaces and venous thromboembolism (VTE)

44
Q

Major principal of treating DIC?

A

Treat underlying cause

45
Q

Labs should be done for DIC?

A

PT, PTT, INR
CBC

46
Q

G6PD is commonly linked to which patient population?

A

American Black men, 10-15%

47
Q

What are Heinz bodies?

A

Oxidized hgb denatures and forms precipitants

48
Q

What happens to Heinz bodies?

A

Heinz bodies cause membrane damage which leads to removal by the spleen

49
Q

Which anti malaria drug should not be given to patients with G6PD?

A

Primaquine

50
Q

G6PD patients may have what in their RBC smear?

A

Bite cells

51
Q

What stain can reveal Heinz bodies in a peripheral blood smear?

A

Cresyl Violet, they are not visible on the usual Wright-Giesma stained blood smear

52
Q

Treatment of G6PD patients?

A
  • no treatment required, avoid oxidants
53
Q

What is the shape of RBCs in patients with sickle cell

A

Sickle rather than biconcave disc

54
Q

The rate of sickling in patients with sickle cell trait is influenced by what?

A

Concentration of hemoglobin S

55
Q

What population carries the hemoglobin S gene?

A

8% of American blacks and 1 of 400 American black children will be born with sickle cell

56
Q

Physical findings/sx of patients with sickle cell

A

Jaundice, hepatosplenomegaly, poorly healing ulcers over the lower tibia
Acute painful episodes of the bones that last hours to days with low grade fever

57
Q

Labs for patients with sickle cell

A

CBC with dif
Blood Smear

58
Q

What is the hematocrit of patients with sickle cell?

A

20-30%

59
Q

What may the results of a blood smear from a patient with sickle cell show?

A

Irreversibly sickled cells comprising of 5-50%
Nucleated red blood cells and Howell-Joly bodies and target cells

60
Q

What supplement may assist sickle cell patients?

A

Folic acid 1mg po daily

61
Q

What complications can sickle cell lead?

A

Chronic multisystem disease leading to organ failure that may result in death

62
Q

With supportive care, what is average life span of those with sickle cell?

A

40-50years

63
Q

Screening test for sickle cell reveals what percentage of hemoglobin is hemoglobin S?

A

40%

64
Q

Acute lymphoblastic leukemia (ALL) occurs at what ages and percentages?

A
  • 80% of acute leukemia in children
  • 20% of adult acute leukemia
65
Q

Acute myeloid leukemia (AML) occurs at what age?

A

Median age of 60 years old

66
Q

Blasts in peripheral blood is in what percentage of patients?

A

90%

67
Q

Bone tenderness in patients with leukemia is present particularly where?

A

Sternum, tibia and femur

68
Q

DDx of acute leukemia

A
  • Viral infection such as Mono
  • Pertussis
  • Other 1 myeloproliferative diseases
    • hairy cell leukemia, lymphomas, chronic
      Lymphocytic leukemia
  • Anemia
  • hypothyroid
  • SLE
69
Q

What is the hallmark of acute leukemia?

A

Pancytopenia with circulating blasts

70
Q

What percentage of blasts are required to make a dx of acute leukemia?

A

20%

71
Q

Patients with ALL may have what on a chest radiograph?

A

Mediastinal mass

72
Q

Disposition of acute leukemia?

A

MEDEVAC
Referral to Hematologist

73
Q

Chemotherapy cures what percentage of patients with leukemia?

A

35-40%

74
Q

Bone marrow transplant is curative in what percentage of leukemia patients?

A

50-60%

75
Q

What is leukocytosis?

A

High white cell count relative to normal physiologic numbers

76
Q

What is leukopenia?

A

Low total white cell count (<4400cells/microL)

77
Q

Elevated neutrophils is called?

A

Neutrophilia

78
Q

What could cause neutrophilia?

A

Infection
Inflammation
Metabolic disease
Stress

79
Q

What percentage of whites and blacks get benign ethnic neutropenia?

A

4.5% Blacks
0.7% Whites

80
Q

Leukopenia can be caused by what viruses?

A

Hepatitis, HIV, Epstein-Barr. Parasitic and rickettsial infections

81
Q

Leukopenia can be caused by which deficiencies?

A

Vitamin deficiencies (B12, Folate, Copper)

82
Q

What is thrombocytopenia?

A

Abnormally low amount of circulating platelets

83
Q

Risk of spontaneous bleeding does not typically increase until when?

A

Platelets fall below 10,000-20,000/mcl unless the patient has abnormal platelets

84
Q

Hallmark sx of thrombocytopenia?

A

petechia

85
Q

What is thrombocytosis?

A

Abnormally high amount of circulating thrombocytes (>450,000)

86
Q

What are the 2 categories of thrombocytosis?

A

Reactive thrombocytosis
Autonomous thrombocytosis

87
Q

Autonomous thrombocytosis is primarily what etiology?

A

Cancer of bone marrow etiologies

88
Q

Median age of thrombocytosis?

A

50-60years of age

Blood and Lymph (6 decks)

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