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Hematology > Chapter 3 Hematologic MDT > Flashcards

Chapter 3 Hematologic MDT Flashcards

1
Q

Hematocrit in adult males less than 41% (hmg < 13.5g/dL)

Hematocrit in adult females less than 37% (hmg <12 g/dL)

A

Anema

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2
Q

Commonly the cause of iron deficiency in adults

A

Bleeding

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3
Q

Two anemia classifications

A

Pathophysiologic basis (increase or decrease production of RBCs)

Cell size

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4
Q

Signs and symptoms:

Lymphadenopathy, hepatosplenomegaly, or bone tenderness

Mucosal changes such as a smooth tongue

A

Anemia (megaloblastic)

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5
Q

Anemia labs:

Iron with total iron binding capacity (TIBC)
-Less than what ferritin value indicates Fe deficiency anemia?

A

12 mcg/L

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6
Q

Anemia labs:

Why would you get hemoglobin electrophoresis?

A

To evaluate for alpha or beta thalassemia

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7
Q

Treatment for:

Anemia

A

Identification of blood loss

Treatment specific to the specific cause of anemia

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8
Q

Most common cause of anemia

A

Iron deficiency

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9
Q

Increases the chances of iron deficiency anemia

A

Menstruation

Pregnancy

Frequent blood donors

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10
Q

Most important cause of iron deficiency anemia

A

Blood loss, especially GI blood loss

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11
Q

Physical findings:

Fatigability, tachycardia, palpitations, and tachypnea on exertion

Severe: Skin/mucosa changes. Smooth tongue, brittle nails, cheilosis

A

Iron deficient anemia

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12
Q

Cause of dysphagic in iron deficient anemia patients

A

Formation of esophageal webs (Plummer-Vinson syndrome)

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13
Q

Many iron-deficient patients develop this, crave specific foods often not rich in iron

A

Pica

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14
Q

Labs for iron deficient anemia

A

CBC - decreased mean corpuscular volume (MCV)

Iron - Ferritin value <12 mcg/L

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15
Q

Treatment for iron deficient anemic patients

A

Ferrous sulfate 325mg TID for 3-6 months

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16
Q

Vitamin B12 deficiency can cause

A

Macrocytic anemia

-B12 level <100 pg/ml

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17
Q

All vitamin B12 comes from:

A

Diet, all foods of animal origin

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18
Q

The daily absorption of vitamin B12

A

5 mcg

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19
Q

Liver contains ____-____ mcg of stored vitamin B12.

Daily losses are ___ mcg/dL.

The body has enough B12 stores for __ years.

A

2000-5000mcg

3-5 mcg/dL

3 years

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20
Q

Surgical resection of the ileum will eliminate the site of:

A

B12 absorption

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21
Q

Rare causes of B12 deficiency

A

Fish tapeworm infection

Pancreatic insufficiency

Severe Crohn’s disease (destroys the ileum)

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22
Q

Physical findings:

  • Glossitis
  • Anorexia
  • Diarrhea
  • Late stages: Pale skin, paresthesia and difficulty with balance
A

B12 deficiency

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23
Q

Hallmark lab findings in B12 deficiency

A

CBC w/ Diff: Megaloblastic Anemia (Large RBCs)

-Macro-ovalocyte with hyper-segmented neutrophils

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24
Q

B12 deficiency:

Mean corpuscular volume (MCV) will be:

A

Strikingly elevated (MCV = RBC volume from CBC)

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25
Q

Treatment for B12 deficiency

A

IM Injection of B12

  • Daily first week
  • Weekly first month
  • Monthly for life
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26
Q

Three mechanisms that reduce loss of blood from blood vessels

A

Vascular spasm

Platelet plug formation

Blood clotting

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27
Q

Vascular spasm is caused by damage to smooth muscle and reflexes initiated by _____ receptors

A

Pain

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28
Q

Three stages of blood clotting

A

Formation of prothrombinase

Conversion of prothrombin into thrombin

Thrombin converts soluble fibrinogen into insoluble fibrin threads

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29
Q

Factors that are vitamin K dependent

A

II

VII

IX

X

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30
Q

Laboratory measurement of the function of intrinsic and extrinsic coagulation pathways

A

PTT (intrinsic)

PT (extrinsic)

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31
Q

Congenital deficiency of coagulation factor VIII

A

Hemophilia A

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32
Q

Congenital deficiency of coagulation factor IX

A

Hemophilia B

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33
Q

In many older patients, what viruses from receipt of contaminated blood products can cause coagulopathy?

A

HIV

Hep C

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34
Q

Life threatening emergency.

Causes thrombosis and hemorrhage.

Coagulation and fibrinolysis become abnormally activated, leading to ongoing coagulation and fibrinolysis.

A

Disseminated intravascular coagulation (DIC)

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35
Q

Common bleeding manifestations of DIC

A

Petechiae

Ecchymoses

Blood oozing from wound sites, IV lines, catheters, mucosal surfaces

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36
Q

Common thromboembolic manfestations of DIC

A

Venous thromboembolism (VTE) and arterial thrombosis with tissue or organ ischemia

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37
Q

Common causes of DIC

A

Sepsis

Malignancy

Trauma

OB complications

Hemolysis (malaria or ABO incompatible transfusion)

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38
Q

Less common causes of DIC

A

Heat stroke

Crush injuries

Rattlesnake/Viper Bite

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39
Q

Treatment for DIC

A

Treat the underlying cause

40
Q

Symptoms/physical findings:

  • Bruising without trauma
  • Bleeding into joint spaces
  • Epistaxis
  • Bleeding from eyes
  • Very heavy vaginal bleeding for prolong times in females
A

DIC

41
Q

Labs:

DIC

A

PT, PTT

42
Q

X-linked recessive disorder commonly seen in American black men, affecting 10-15%

Episodic hemolysis in response to oxidant drugs or infection

A

G6PD

43
Q

G6PD

A

Glucose-6-phosphate dehydrogenase

44
Q

G6PD:

Oxidized hemoglobin denatures and forms precipitants called:

A

Heinz bodies

45
Q

G6PD patients to avoid oxidant drugs like:

A

Dapsone

Primaquine
Quinidine
Quinine

Sulfonamides

Nitrofurantoin

Aspirin

Ciprofloxacin

46
Q

Labs for G6PD:

Red blood cell smear is not diagnostic but may reveal a small number of “____” cells

A

“bite”

47
Q

G6PD:

Support by monitoring with what lab test?

A

CBC

48
Q

Autosomal recessive disorder in which an abnormal hemoglobin leads to chronic hemolytic anemia with numerous clinical consequences

A

Sickle Cell

49
Q

The rate of sickling is influenced by the concentration of _______ and by the presence of other hemoglobin within the cell

A

Hemoglobin S

50
Q

Hemoglobin S gene is carried in __% of American black people

A

8%

51
Q

_ of 400 American black children will be born with sickle cell anemia

A

1 out of 400

52
Q

Symptoms/Physical findings:

Chronically produces jaundice, pigment gallstones, hepatosplenomegaly, poorly healing ulcers over the lower tibia.

Life-threatening anemia can occur during hemolytic/aplastic crises, usually associated with viral or other infection or by folate deficiency

Acute painful episodes include the bones and chest, last hours to days and may produce a fever

Cardiomegaly

Chronic pain

A

Sickle Cell Anemia

53
Q

Lab studies:

Sickle Cell

A

CBC w/ Diff

-Hematocrit is usually 20-30%

54
Q

Sickel Cell:

Blood smear will show what percentage of irreversibly sickled cells

A

5-50%

55
Q

SCA:

Hallmarks of hypersplenism

A

Howell-Jolly bodies and target cells

56
Q

Sickle cell hemoglobin is confirmed by hemoglobin electrophoresis with hemoglobin S accounting for __% of hemoglobin.

A

86-98%

57
Q

Disease where no hemoglobin A is present

A

Homozygous S disease

58
Q

Allogeneic hematopoietic stem cell transplantation before end organ damage, it can cure __% of children with SCA.

A

80%

59
Q

Treatment for SCA:

A

Folic acid supplements (1mg PO daily)

Transfusions for aplastic/hemolytic crises

Keep hydrated

Search for underlying infection

60
Q

Average life expectancy for SCA is:

A

40-50 years old

61
Q

Sickle cell trait

A

Heterozygous genotype (AS)

62
Q

Sickle cell trait:

Screening for sickle hemoglobin will be positive.

What percentage will be hemoglobin S?

A

40%

63
Q

Malignancy of the hematopoietic progenitor cell. These cells proliferate in an uncontrolled fashion and replace normal bone marrow.

A

Leukemia

64
Q

Leukemia is linked to:

A

Radiation and some toxins (benzene)

65
Q

Compromised 80% if the acute leukemias of childhood. It is seen in adults, causing approximately 20% of adult acute leukemias.

A

Acute lymphoblastic leukemia (ALL)

66
Q

Primarily an adult disease with a median age at 60 years and an increasing incidence with advanced age.

A

Acute myeloid leukemia (AML)

67
Q

Leukemia:

Blasts in peripheral blood in __% of patients

A

90%

68
Q

Symptoms/Physical findings:

  • Fatigue
  • Bleeding (gums, mucosa, skin)
  • Infection
  • Gum hypertrophy, bone and joint pain
  • Pale skin and have purpura and petechiae
  • Enlargement of liver, spleen, and lymph nodes
  • Bone tenderness, particularly in the sternum, tibia, and femur
A

Leukemia

69
Q

Hallmark of acute leukemia is:

A

Combination of pancytopenia with circulating blasts

70
Q

Aleukemic leukemia

A

No presence of blasts (10% of cases)

71
Q

What percentage of blasts require to make a diagnosis of acute leukemia??

A

20%

72
Q

Patients with Acute Lymphoblastic Leukemia may show what on chest radiograph?

A

Mediastinal mass

73
Q

Treatment for leukemia

A

Referral to hematologist

MEDEVAC

Chemo and radiation therapy is the mainstay

74
Q

Approximately ___% of adults with AML under age 60 y/o achieve complete remission

A

70-80%

75
Q

Chemotherapy leads to the cure in __% of patients

A

35-40%

76
Q

Bone marrow transplants is curative in ___% of cases

A

50-60%

77
Q

High WBC count

A

Leukocytosis

78
Q

Low WBCs (<4400 cells/mL)

A

Leukopenia

79
Q

WBC:

  • Bacterial infection
  • Inflammation
  • Metabolic disease
  • Stress
A

Neutrophils

80
Q

WBC:

  • Viral infection
  • Immune disease
  • Stress
  • Leukemia
A

Lymphocytes

81
Q

WBC:

  • Skin diseases
  • Drug reaction
  • Parasite infection
  • Asthma
A

Eosinophils

82
Q

WBC:

-Chronic myeloid leukemia

A

Basophils

83
Q

WBC:

  • Infection
  • Autoimmune disease
A

Monocytes

84
Q

Benign ethnic neutropenia

Infections (Hepatitis, HIV, Epstein-Barr, Parasitic, rickettsia infections)

Medications

Nutrition: vitamin deficiencies (B12, folate, copper)

Hematologic malignancies (leukemia, lymphoproliferative disorders, myelodysplastic syndromes)

Rheumatic disorders (RA, SLE)

A

Etiologies of leukopenia

85
Q

Signs and symptoms of leukopenia or leukocytosis

A

Fever

Skin erythema, ulcerations, fissures, or tenderness

Gingivitis, swelling, oral ulceration, dental pain

Abnormal respiratory exam

86
Q

Neuro or psychiatric abnormalities may suggest what?

A

Nutritional deficiency (B12, copper)

87
Q

Abnormally low amount of circulating platelets

A

Thrombocytopenia

88
Q

The risk of spontaneous bleeding does not typically increase until the platelet count falls below ____/mcL

A

10,000-20,000

89
Q

Potential causes of thrombocytopenia:

A

Bone marrow failure or malignancy

Disseminated intravascular coagulation (DIC)

Chemo or radiation therapy

Nutritional deficiencies (folate or iron)

Medications

90
Q

Potential causes of thrombocytopenia:

A

Bone marrow failure or malignancy

Disseminated intravascular coagulation (DIC)

Chemo or radiation therapy

Nutritional deficiencies (folate or iron)

Medications

91
Q

Signs and symptoms of thrombocytopenia

A

PETECHIA (coagulopathy would cause bruising)

Mucocutaneous bleeding (gingival, nosebleeds)

92
Q

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

A

Thrombocytosis

93
Q

Two different categories of thrombocytosis

A

Reactive

  • Anemia/blood loss
  • Infection
  • Non-infectious inflammation
  • Post splenectomy

Autonomous
-Primarily cancer of bone marrow

94
Q

Signs/Physical findings:

  • First sign is elevated platelets
  • 50-60 y/o
  • Erythromelalgia - painful burning of the hands w/ erythema
  • Splenomegaly in 25%
A

Thrombocytosis

95
Q

Labs/Studies:

Thrombocytosis

A

CBC w/ diff

Blood smear

Iron studies

Inflammatory markers (based on history)

96
Q

Treatment:

Thrombocytosis

A

Refer to hematology if there is no infectious cause or it does not resolve on its own in 2-4 weeks

Hematology (5 decks)

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