CBC 2 Flashcards
what is main DDx in ertethrocytosis
- increased mass
2. relative - decreased plasma
what to measure to assess red cell mass
EPO
low - RBC prod. indep of EPO
high - EPO driven
2 causes of high RBC and low EPO
- polycythemia vera - bone marrow myeloproliferative disorder
- mutation of EPO-r gene
2 general causes of high EPO with high RBC
- hypoxia
- high altitude
- abnormal Hb - increased EPO production
- CA
- renal cysts
- doping
Sx of high RBC
HA
- redness
- SOB
- numbness and tingling
3 treatments of polycythemia vera
- phlebotomy or chemo
- ASA to prevent thrombosis
- JAK2 inhib
treatment of EPO mutation
phlebotomy
what is first question in leukopenia
isit real?
- cultral variations
- which leukocytes
3 cause of neutopenia and critical levels
- low prod
- incr. dest
- sequest
below .5 is major risk of infection
4 causes of low production
- DRUGS
- bone marrow dis
- benign cyclic neutopenia
- congenital
2 causes of destruction
autoimmune
alloimune
cause of sqesuestration
Felty’s seen in RA
what is febrile neutopenia
- ANC 38.3 - immed. ABs
3 types of neutophilia
- demarginalziation - push into blood - exercise, stress, indfection
- reactive
- left shift and out of marrow - malignancy in marrow
4 causes of lymphopenia
- infections
- Chemo/drugs
- congenital
- mild is common on CBC
2 types of lymphocytosis
- reactive
- viral
- stress
- smoking - lymphoid malig
what is first questionn in lymphocytsis
- polyclonal or monoclonal
3 causes of eosinophilia
- alleric
- paracytic infection
- malig.
3 causes if monocytosi
- chronic infections
- chronic inflammation
- malig
2 questions in thrombocytopenia
- is it true?
- bleed Hx
- blood film - other line affected?
2 causes of pseudothrombocytpenia
- clumping
2. satellitism
3 features of throbopenia
- disorder of PRIMARY hemostatis
2. no Sx until
what to ask for on Hx and Phx
- bleeding Hx
- recent infection (HIV, hep)
- systemic Sx
- other autoimmune
- past med, surg, transfusion
- fam Hx
- alc
exam - petechiae
- nodes
cutoff for levels and treatments of platelets
50 - don’t need to treat
4 causes of low platetle prod.
- primary marrow disorder
- marrow toxin - alc and drugs
- infection
- B12 or folate def.
2 main classes of platelet dest.
- immune
- infections, drugs, ITP, HIT, HIV - non-immune
- DIC, TTP
2 immune types
- primary ITP
- diagnosis of exclusion - secondary
- viral
- SLE
- drug - heparin
- post transfusion
4 investigations for ITP
- repeat CBC
- review film to look at platelets
- HIV and hep testing
- thyroid, liver, renal testing
what is ITP
- immune mediated early destruction
- inappropriate TPO response
- plats. less than 20 typically
treatment of ITP
immed - steroids, IVIG
longterm - splenectomy, immune supression
5 non-immune cause of plate dest.
- drugs
- DIC/sepsis
- mechanical
- TTP clotting activation
- pre-eclampsia
what is TTP
thrombotic thromobocytopenia pupura
- high platelet consumption
- high mortality
- clots in small vessels and uncontrolled VWF
- bleed and clot
3 causes of thrombocytosis
- reactive
- infection/inflammation
- marrow inflammation - malignancy
- redistributive
main microcytic
- Fe #1
- Thal
- sideroblastic
2 main causes of Fe def,
- blood loss
- menstrual then GI - diet def.
5 lab tests for Fe
- ferritin
- TIBC up
- high transferritin
- lowe serum iron
- microcytic hypochromic cells on smear
3 way to Tx Fe def.
- oral Fe replacement
- paraenteral replacement
- transfusion
main issue in thal
inheritied inadequate production of a or B chain of Hb
2 main types of thal
a - can be sever to carrier depending on number of gene loci
B - most often in mediteranian
Sx of B thal
- severe anemia
- massive hepatospleno
- expansion of marrow space- distorted bones
- growth retard
Dx of thal B
- electrophoresis - high HbF
2. smear - microcytic hypochromic anemia
4 classes of a thal
- silent carrier - one loci
- trait - two loci
- mild and no Tx - HbH - 3 loci
- sig anmeia - all 4 - death
what is sideroblastic
abnormality in RBC production
- hereditary or acquired
-
2 main normocytics
- anemia of chronic disease
- may also be microcytic - aplastic
what is mech in anemia of chonic disease
chronic infection leads to cytokine release which have suppressive effects on production
what is aplastic
bone marrow makes none - pancytopenia
5 main causes of aplastic
- idiopathic
- rads
- meds
- viral
- chemical
3 Tx of aplastic
- bone marrow transplant
- transfusion
- immunsupression
2 main macro causes
- B12 def
2. folate def.
