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AGPCNP Board Prep > Ch4: Hematology > Flashcards

Ch4: Hematology Flashcards

1
Q

viral infection blood cell

A

lymphocytes

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2
Q

bacterial infection blood cell

A

neutrophils

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3
Q

allergic reaction blood cells (2)

A

eosinophils, basophils

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4
Q

blood cell that cleans up debris, will be elevated in patients who have started to turn the corner on recovery from an infection or injury

A

monocytes

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5
Q

if there is bleeding, this blood cell will be elevated in response

A

platelets

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6
Q

suspected type of anemia: pt presents with dizziness, tachycardia, low BP

A

acute blood loss (uncommon in primary care)

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7
Q

why can chronic low-volume blood loss cause iron deficiency anemia?

A

iron from the RBCs wasted via blood loss cannot be recycled. clinically significant blood loss can be as little as a few mL/day.

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8
Q

suspected type of anemia: chronic PPI use

A

IDA or B12 deficiency anemia

PPIs associated with B12 and iron malabsorption

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9
Q

long-term use of metformin is associated with malabsorption of….

A

B12 (deficiency

= macrocytic anemia)

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10
Q

normal RBC lifespan

A

90-120 days

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11
Q

normal Hgb to Hct ratio

A

1:3 (1 g Hgb to 3 percentage points Hct)

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12
Q

Hgb 10, what is the expected Hct?

A

30%

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13
Q

Hgb 12, what is the expected Hct?

A

36%

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14
Q

what happens to the Hgb:Hct ratio in severe dehydration?

A

Hct goes up (hemoconcentration)

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15
Q

Normal MCV

A

80-96 fL

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16
Q

MCV

A

mean corpuscle volume (size of the RBCs; average volume of the RBCs that are in circulation)

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17
Q

microcytic definition

A

MCV <80 fL

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18
Q

normocytic definition

A

MCV 80-96 fL

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19
Q

macrocytic definition

A

MCV >96 fL

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20
Q

MCH, MCHC

A

mean cell hemoglobin (average mass of Hgb per RBC)

mean cell hemoglobin concentration (average concentration of Hgb per RBC)

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21
Q

hemoglobin makes up ___% of the RBCs volume

A

90%

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22
Q

normal MCHC

A

31-37 g/dL

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23
Q

hypochromic MCHC

A

<31 g/dL

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24
Q

RDW

A

RBC distribution width (variation in red blood cell size)

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25
Q

which lab value is the index of variation in RBC size?

A

RDW

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26
Q

normal RDW

A

11.5-15% (0.115-0.15 proportion)

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27
Q

abnormal RDW

A

> 15% (>0.15 proportion)

elevated

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28
Q

Likely the earliest laboratory indicator of an evolving microcytic or macrocytic anemia

A

RDW

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29
Q

anisocytosis

A

abnormal variation in RBC size (indicated by the RDW)

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30
Q

normal reticulocyte percentage

A

1-2%

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31
Q

the body’s normal response to anemia is to attempt correction via increasing the number of….

A

reticulocytes (new young RBCs)

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32
Q

normocytic normochromic anemias: MR B CALM

A
  • marrow failure
  • renal failure (chronic)
  • blood loss (acute)
  • chronic disease**
  • aplastic anemia
  • leukemia
  • metastasis (cancer)
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33
Q

most common reason for normocytic normochromic anemia in primary care

A

anemia of chronic disease

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34
Q

if the cell is normal size (normocytic), it is always the same….

A

color (normochromic)

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35
Q

most common etiologies of microcytic anemias with elevated RDW (2)

A
  • lead toxicity (mostly children)

- iron deficiency**

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36
Q

most common reason for microcytic anemia in primary care

A

iron deficiency anemia

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37
Q

expected findings for iron deficiency anemia on CBC

A
  • low Hgb
  • low Hct
  • low RBCs
  • low MCV
  • low MCHC
  • increased RDW
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38
Q

single BEST test for iron stores in suspected iron deficiency anemia

A

ferritin

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39
Q

most common causes for microcytic anemias with normal RDW

A

thalassemia minors

  • alpha thalassemia minor (trait)
  • beta thalassemia minor (trait)
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40
Q

at risk groups for alpha thalassemia (1)

A

asian, african

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41
Q

at risk groups for beta thalassemias (3)

A

mediterranean, middle eastern, african

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42
Q

expected findings for thalassemia on CBC

A
  • low Hgb
  • low Hct
  • elevated RBCs
  • low MCV
  • low MCHC
  • RDW normal
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43
Q

next step test when you suspect thalassemia on a routine CBC

A

hemoglobin electrophoresis for evaluation of hemoglobin variants

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44
Q

major differences between iron deficiency anemia and the thalassemias minor on CBC

A

IDA = low RBCs, elevated RDW

thal = normal to elevated RBCs, RDW normal

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45
Q

most common causes for macrocytic, normochromic anemias with elevated RDW: FAT RBC

A
  • Fetus (pregnancy)
  • Alcohol excess
  • Thyroid (hypo)
  • Reticulocytosis
  • B12 and folate deficiency
  • Cirrhosis and chronic liver disease
46
Q

most common reason for macrocytic anemias in primary care (3)

A
  • folate deficiency
  • alcoholism
  • b12 deficiency
47
Q

young, new RBCs are [smaller vs. larger] than mature RBCs

A

immature = larger

48
Q

next step test when you see macrocytic anemia on a CBC

A

serum vitamin B12 and folate

49
Q

expected findings for B12 or folate deficiency anemia on CBC

A
  • low Hgb
  • low Hct
  • low RBCs
  • elevated MCV
  • normal MCHC
  • elevated RDW
50
Q

drug-induced macrocytosis without overt anemia can be caused by…. (3)

A
  • alcohol excess
  • anticonvulsants (carbamazepine [Tegretol], phenytoin [Dilantin])
  • methotrexate

alcohol is the most common

51
Q

expected findings for a drug-induced macrocytosis on CBC

A
  • normal Hgb
  • normal Hct
  • normal RBC
  • elevated MCV
  • normal MCHC
  • normal RDW
52
Q

alcohol levels that can cause macrocytosis

A

5 or more drinks per day for males, 3 or more drinks per day in female

53
Q

if a medication is causing macrocytosis but not anemia, do you need to always discontinue the drug?

A

no

54
Q

how marked is the macrocystosis in alcohol- or drug-induced macrocytosis?

A

modest

55
Q

CBC returns:

  • RBCs WNL
  • Hgb WNL
  • Hct WNL
  • MCV elevated
  • MCHC WNL
  • RDW WNL

you suspect….

A

drug-induced macrocytosis, most commonly from excess alcohol intake. otherwise can be from anticonvulsants or methotrexate

56
Q

CBC returns:

  • RBCs low
  • Hgb low
  • Hct low
  • MCV elevated
  • MCHC WNL
  • RDW elevated

you suspect…..

A

macrocytic anemia, most commonly folate or B12 deficiency. ca also be caused by alcohol excess. other causes include pregnancy, hypothyroid, reticulocytosis, and cirrhosis or chronic liver disease

FAT RBC:
Fetus
Alcochol
Thyroid
Reticulocytosis
B12 and folate
Cirrhosis
57
Q

CBC returns:

  • RBCs elevated
  • Hgb low
  • Hct low
  • MCV low
  • MCHC low
  • RDW WNL

you suspect….

A

thalassemia minor / thalassemia trait (alpha or beta)

58
Q

CBC returns:

  • RBCs low
  • Hgb low
  • Hct low
  • MCV low
  • MCHC low
  • RDW elevated

you suspect….

A

microcytic anemia, most commonly from iron deficiency. in children, may be caused by lead toxicity

59
Q

CBC returns:

  • RBCs low
  • Hgb low
  • Hct low
  • MCV WNL
  • MCHC WNL
  • RDW WNL

you suspect…

A

normocytic anemia, most commonly anemia of chronic disease. may also be caused by a host of other conditions:

MR B CALM

  • marrow failure
  • renal failure
  • blood loss (acute)
  • chronic disease
  • aplastic anemia
  • leukemia
  • metastasis (cancer)
60
Q

_____ requirements increase in reticulocytosis

A

micronutrient

e.g., if they have a B12 deficiency anemia. you will supplement the deficient B12, but they will still need other micronutrients to replenish their blood supply including extra iron and folate for a bit. So an MVI with all of these might be a good choice

61
Q

what is epoetin alfa (Epo)

A

biologically identical to endogenous erythropoietin from the kidney, induces erythropoiesis

62
Q

uncommon to use Epo in primary care. what are some indications where this might be used?

A

helpful for severe anemias, particularly in the presence of advancing renal failure.

EPO supply is diminished in CKD, usually beginning when the eGFR reaches <49

63
Q

normal eGFR

A

90-120 mL/min

64
Q

EPO supplementation may be most useful in severe anemias of chronic disease when the eGFR reaches….

A

<49 mL/min

65
Q

90% of your EPO is produced by the ….. and 10% by the…..

A

90% by kidneys

10% by the livers

66
Q

vegans need to supplement with….

A

B12

67
Q

most common anemia in childhood

A

iron deficiency

68
Q

most common anemia during pregnancy

A

iron deficiency

69
Q

most common anemia during women’s reproductive years

A

iron deficiency

70
Q

most common anemia in the elderly

A
  1. anemia of chronic disease
  2. iron deficiency
  3. pernicious anemia (especially older WOMEN, as this is autoimmune process)
71
Q

if the MCHC is normal, they do not have a problem with….

A

iron

72
Q

conjunctival pallor indicates a Hgb of less than…

A

<9 g/dL

73
Q

____ anemias present like an acute bleed with painless jaundice

A

hemolytic

74
Q

type of murmur you hear in someone with profound anemia, third trimester of pregnancy, or severely ill

A

hemic murmur

75
Q

next test:

MCV low, MCHC low, RDW normal

A

hemoglobin electrophoresis (concern for thalassemia minor)

76
Q

next test:

low MCV, low MCHC,RDW elevated

A

ferritin (sounds like IDA)

77
Q

next test:

MCV high, MCHC normal, RDW elevated

A

B12 and folate (two most common macrocytic anemias)

78
Q

a normal RDW means that new cells being created are the same size as the old cells. you have thus ruled out…..

A

3 nutritional deficiencies (iron, folate, B12)

79
Q

which nutritional supplements increase bleeding risk and need to be d/c 7-10 days before elective surgeries and used in caution with other anticoagulants (3)

A
  • ginseng
  • gingko
  • fish oil
80
Q

Cooley’s anemia, aka….

A

beta thalassemia MAJOR (would be discovered in childhood because it is so severe)

81
Q

sickle cell anemia is autosomal [dominant vs. recessive]

A

recessive

both parents need sickle cell TRAIT and the child needs to inherit two copies of the affected gene

82
Q

what is the Hct on CBC telling you

A

% of whole blood that is red blood cells

83
Q

Normal Hgb for women

A

12-16 g/dL

84
Q

Normal Hct for women

A

37-47%

85
Q

Normal Hgb for men

A

14-18%

86
Q

Normal Hct for men

A

42-54%

87
Q

next step in your work-up when CBC demonstrates a normocytic anemia

A

look for endocrine, liver, and renal disease

  • TSH
  • LFTs
  • BUN/creatinine

if normal, look for an iron-deficiency anemia (serum iron, TIBC, % saturation, ferritin)

if still normal, refer for bone marrow biopsy with a hematological specialist

88
Q

the normocytic anemia of chronic disease will progress to a _____ anemia if left untreated

A

microcytic anemia

89
Q

next best test when you have a normocytic anemia

A

reticulocyte count

90
Q

what do you expect for TIBC in iron deficiency anemia

A

high

91
Q

microcytic anemia in men and post-menopausal females should be considered a sign of ______ until proven otherwise

A

GI bleeding

consider colonoscopy and endoscopy

92
Q

good dietary sources of iron for those with iron deficiency anemia (3)

A
  • red meat
  • beans/legumes
  • green, leafy vegetables
93
Q

oral iron supplementation regimen for iron deficiency anemia

A

ferrous sulfate 300mg PO TID on an empty stomach x1 month, come back for lab work and should see an increasing reticulocyte count. Track CBC until it is back to normal range.

94
Q

(2) primary side effects of oral iron supplementation

A
  • stomach upset (ok to take with a meal to increase compliance if they cannot tolerate on empty stomach)
  • constipation
95
Q

hypersegmented polymorphonuclear leukocytes (HPL) present on peripheral smear indicates a ______ anemia

A

megaloblastic (folate or B12)

96
Q

NO hypersegmented polymorphonuclear leukocytes (HPLs) found on peripheral smear indicates a _______ anemia

A

non-megaloblastic

97
Q

(2) types of macrocytic, megaloblastic anemias

A

folate and B12 deficiency

98
Q

(3) types of macrocytic, non-megaloblastic anemias

A
  • alcoholism (70%)
  • hypothyroidism
  • cytotoxic drugs
99
Q

what is the role of the Schilling test in low B12 anemias

A

a 24-hr urine test that determines whether or not intrinsic factor is being produced

100
Q

folate and B12 deficiencies can both interfere with absorption of ______

A

iron

101
Q

differential causes for folate deficiency anemias

A
  • alcoholism
  • malabsorption condition
  • celiac disease
  • chronic hemolytic disease
  • excessive intake of fava beans
  • hyperthyroidism
  • inadequate intake of fresh vegetables
  • medications
  • pregnancy/lactation
  • renal hemodialysis
  • sprue
  • TPN
102
Q

dietary sources high in folic acid

A
  • liver
  • wheat bran/grains fortified
  • green, leafy vegetables
  • beans
103
Q

folic acid supplementation regimen for deficiency

A

folic acid 1-5mg PO QD until their Hct is normal. should see reticulocyte count increasing first

have them come back in 7-10 days, then 3 months

104
Q

(2) lab tests to consider when CBC demonstrates a macrocytic anemia

A

serum B12 level, schilling test (24 hour urine)

105
Q

sore tongue from atrophic glossitis, think of this type of anemia…

A

B12 deficiency

106
Q

neurologic involvement (e.g., neuropathy in feet), think of this type of anemia….

A

B12 deficiency (s/t decrease in myelin integrity)

107
Q

one type of B12 deficiency anemia is an autoimmune condition

A

pernicious anemia, s/t decreased production of intrinsic factor from destruction of the gastric parietal cells

108
Q

underlying causes for B12 deficiency anemia

A
  • lack of protein intake (vegan)
  • pernicious anemia (autoimmune)
  • malabsorption syndromes (e.g., after bariatric surgery)
  • bacterial or parasitic infections of the bowel
  • chronic pancreatic insufficiency
  • crohn’s disease
  • gastrectomy, ileal resection
  • hyperthyroidism
  • medications
  • sprue
  • pregnancy/lactation
109
Q

treatment for diagnosed pernicious anemia

A

IM injections of B12 Q1 month for the rest of life

110
Q

hemolytic and sickle cell anemias are both ___cytic

A

normocytic

AGPCNP Board Prep (21 decks)

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