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Block 3: Hem/Onc > Clin Med: Hematology > Flashcards

Clin Med: Hematology Flashcards

1
Q

What % of total body weight is blood?

A

8%

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2
Q

What % of total body weight is other fluids & tissues?

A

92%

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3
Q

Breakdown percentages of whole blood?

A
  • 55% plasma
  • 45% formed elements
  • 1% buffy coat
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4
Q

What PROs are found in the plasma of blood?

A
  • Albumin 57 - 60%
  • Globulins 38%
  • Fibrinogen 4%
  • Prothrombin 1%
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5
Q

Broad breakdown of plasma percentages.

A
  • 7% PROs
  • 92% H2O
  • 1% solutes
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6
Q

What other solutes are found in the plasma of blood?

A
  • Iron
  • Nutrients
  • Waste products
  • Gases
  • Regulatory substances
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7
Q

Formed elements include___ & give values.

A
  • Platelets (140,000 - 340,000)
  • Leukocytes (5,000 - 10,000)
  • Erythrocytes (4.2 - 6.2 million)
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8
Q

Describe RBC production

A
  1. Kidney detect reduced O2 carrying capacity in blood
  2. Kidney secrete erythropoietin (EPO) into blood stream
  3. EPO stimulates erythropoiesis by bone marrow
  4. Addition of circulating erythrocytes incr O2 carry capacity in blood
  5. Increase O2 carrying capacity relieves the initial stimulus that triggered EPO secretion
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9
Q

Anemia: incr rate of destruction pathophys:

A
  • Autoimmune
  • Structural changes (sickle cell, spherocytes, ovalocytes)
  • Enzyme deficiencies (G6PD, pyruvate kinase)
  • Mechanical (prosthetic valves, microthrombi)
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10
Q

Breakdown of Leukocytes & values

A
  • Neutrophils (40 - 60%)
  • Lymphocytes (20 - 40%)
  • Monocytes (2 - 8%)
  • Eosinophils (2 - 4%)
  • Basophils (0.5 - 1%)
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11
Q

How is anemia measured?

A

Hgb & hematocrit

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12
Q

Anemia decr production pathophys:

A
  • Lack of critical factor
    –>Erythropoietin (kidney disease)
    –>Hemoglobin formation – hemoglobin A&B, heme, iron
    –>Cell division factors – vitamin B12, folate
    –>Bone marrow suppression (radiation, drugs, alcohol, hormones, infection)
    –>Bone marrow failure (aplastic anemia, dyscrasias, leukemias/lymphomas)
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13
Q

Anemia: loss of the vessels pathophys:

A
  • Bleeding (hemorrhage, menorrhagia, GI bleed)
  • Frequent blood draws/donations
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14
Q

CBC includes:

A
  • RBC
  • Hgb
  • Mean RBC volume (MCV)
  • Mean cell hemoglobin (MCH)
  • Red cell distribution width (RDW)
  • WBC
  • Platelet count (Plt)
  • Mean platelet volume (MPV)
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15
Q

What is RBC count?

A

total # of RBCs in blood

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16
Q

What is Hb?
(hemoglobin)

A

Concentration of hgb in the blood

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17
Q

What is Hct?
(hematocrit)

A

Volume of “packed” red cells

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18
Q

What is MCV?
(mean REC volume)

A

average size of RBCs

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19
Q

What is MCH?
(mean cell hgb)

A

weight of Hgb in the average RBC

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20
Q

What is RDW?
(red cell distribution width)

A

standard deviation of the MCV

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21
Q

What is WBC?
(WBC count)

A
  • # of leukocytes
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22
Q

What is Plt?
(platelet count)

A
  • # of platelets
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23
Q

What is MPV?
(mean platelet volume)

A

average size of platelets

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24
Q

What does Anisocytosis means & give examples?

A

variation in size

  • Macrocytes
  • Microcytes
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25
Q

What does Poikilocytosis means & give examples?

A
  • Schistocytes
  • Spherocytes
  • Sickle cells
  • Teardrop cells
  • Target cells
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26
Q

Ways to analyze anemia

A

Morphology
- MCV
- MCH (correlates w/ MCV)

  • Specific shapes in specific dz
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27
Q

What is microcytic MCV value & examples?

A

< 80

  • deficiency, lead poisoning, thalassemia
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28
Q

What is the normocytic MCV value & examples?

A

80 - 100

  • hemorrhage, hemolytic
29
Q

What is the macrocytic MCV value & examples?

A

> 100

  • B12, Folate, alcohol abuse, liver dz
30
Q

S/S for severe anemia

A
  • Dyspnea
  • Fatigue
  • Pallor
31
Q

What is the most common cause of anemia worldwide?

A

iron deficiency

32
Q

S/S for mild/mod anemia

A
  • often asymptomatic
  • may have breathlessness and/or fatigue when exercising
33
Q

What are the types of Microcytic anemias?

A
  • Iron deficiency anemia
  • Anemia of chronic disease
  • Thalassemias
  • Sideroblastic
34
Q

RFs for iron deficiency anemia

A
  • females
  • infants & young children
  • adolescents
  • elderly persons
  • persons living in developing countries
  • obese persons
  • vegetarians & vegans
  • frequent blood donors
  • ppl who have GI disorders or have had GI surg
35
Q

Meds that can cause iron deficiency anemia

A
  • Chronic NSAIDs
  • H2blockers
  • Antacids
  • Proton pump inhibitors
  • Chronicaspirin use
  • Zinc supplement
36
Q

CDC Iron Deficiency Anemia screening

A
  • start at ~1yo for children at high risk of IDA
  • encourage females to eat iron-rich foods
  • nonpreg women of childbearing age should be screening every 5-10 yrs starting in adolescence
  • women at high risk for IDA should be screen annually (extensive menstrual blood loss, low iron intake, previous dx of IDA
  • screen for anemia should begin at 1st prenatal visit for preg women
37
Q

What enhances absorption of iron?

A

Vit C

38
Q

What inhibits the absorption of Iron?

A

Ca++

39
Q

Alpha thalassemia trait (2 abnormal): presentation

A

mild - mod microcytosis & hypochromia

40
Q

Silent carrier ( 1 abnormal copy): presentation

A

Usually asymptomatic
May have mild microcytosis and hypochromia

41
Q

Hydrops fetalis (HF) (4 abnormal): presentation

A

usually die in utero (80%)

42
Q

Hemoglobin H disease (HgH) (3 abnormal): presentation

A
  • microcytic, hypochromic, hemolytic anemia
  • mild jaundice
  • moderate hepatosplenomegaly
  • growth retardation (in children)
43
Q

Alpha Thalassemia: Outcomes & Px

A
  • Excellent outcomes for carriers and trait
  • hgb H (HbH) dz, complications:
    –>cholelithiasis, infx, leg ulcers,FA deficiency

Hb Bart hydrops fetalis syndrome
–> maternal complications in 50% of cases
preeclampsia, antepartum hemorrhage, sepsis

44
Q

Thalassemia minor (AKA trait): Presentation

A

Asymptomatic, but may have mild anemia

45
Q

Thalassemia intermedia: Presentation

A
  • Variable symptom onset/severity
  • symptoms may begin in children 2-6yo & include diminished growth & development including failure of sexual maturation
    OR
    pts may be asymptomatic into adult life & present w/ mild anemia
46
Q

Thalassemia major (AKA Cooley’s anemia): Presentation

A
  • growth retardation
  • jaundice, skin pallor
  • poor musculature
  • genu valgum (knock knees)
  • craniofacial changes
47
Q

Types of Macrocytic anemia & examples.

A
  • Megaloblastic
    –> Vitamin B12 and folate deficiencies
  • Non-megaloblastic
    –> Liver dz; Alcohol; Myelodysplastic disorders; Aplastic anemia; Chemotherapy
48
Q

Beta Thalassemias: Outcomes & Px

A

Px in beta-thalassemia major:
–> if no tx, early death (abt 5 years old) often due to infxs & wasting

In treated pts:
–> pts used to die by age 30yo; newer tx has incr avg lifespan to 40+ yrs.
–> regular transfusion therapy & iron chelation therapy may prolong survival into 40s & 50s
–> Complications:
HF, attributed to cardiac iron accumulation due to transfusions, (most common cause of death in thalassemia)
Iron accumulation in endocrine glands, causes low hormone levels

49
Q

Pts at incr risk for Vit B12 def?

A
  • older ppl >65yo
  • vegetarians
  • conditions/procedures that decr vitB12 absorp
  • on meds known to interfere w/ absorp (metformin & PPI)
50
Q

Neurologic symptoms seen in Vit B12 def?

A
  • altered taste & smell
  • erectile dysfunction
  • fatigue/sleepiness
  • hearing loss tinnitus
  • walking worsens
51
Q

Neuropsychiatric symptoms seen in Vit B12 def?

A
  • cognitive impair
  • delusions
  • dementia
  • depression
  • lability
  • mania
  • memory loss
  • psychosis
  • word finding disturbances
52
Q

SSA: RFs

A

ancestry from:
- sub-Saharan Africa
- Caribbean
- Central & South America
- India
- Mediterranean basin
- Middle East

53
Q

What guides RBC transfusions?

A

HEMOGLOBIN

Also look at
- Intravascular volume status
- evidence of shock
- Duration & severity of anemia

54
Q

RBC Transfusions Indications:

A
  • Hgb <7
  • Hgb <8 if (recent surg, or coronary artery syndrome)
55
Q

What is the expected incr in RBC after transfusion in adults

A

1 g/dL (10 g/L) (Hct by 3%)

56
Q

What are plasma components?

A

noncellular portion of blood that is separated & frozen after collection

57
Q

Uses of plasma components?

A

treat & prevent bleeding in pts w/ coagulopathy & to replete plasma PROs that are low

58
Q

Indications for plasma transfusions:

A

Pts w/ active bleeding or risk of bleeding
- Pts bleeding or req prophylaxis for bleeding to due isolated deficiency of coagulation factor
- congenital or acquired thrombotic thrombocytopenia purpura (TTP)

59
Q

What is the typical rate of infusion for plasma transfusions?

A

10 - 20 mL/kg

incr coagulation by 20% after

60
Q

Acute intravascular hemolysis transfusion rxn

A

More than 85% of adverse hemolytic rxns involving the transfusion of RBC result from clerical error.
- Usually caused by ABO-incompatible transfusion. Can result in organ failure.

TX: FLUIDS

61
Q

Nonhemolytic febrile transfusion rxn

A

Usually mild, fever, chills, rigors, mild dyspnea. Due to a rxn to donor white cells (HLA) & more common in pts who have received multiple transfusions or delivered several children.

TX: TYLENOL

62
Q

Mild allergic transfusion rxns

A

Urticaria or pruritus can be caused by sensitization to plasma proteins in transfusion product.

TX: BENADRYL

63
Q

Anaphylactic reaction - Transfusion Rxns

A
  • Acute hypoTN, hives, abdominal pain & resp distress; seen mostly in IgA-deficient recipients.

TX: FLUIDS & EPI

64
Q

Infx - Transfusion Rxn

A

Can transfer bacteria, viruses, parasites, prions. Newer infectious organisms more likely to be transferred

  • TX: DEPENDS ON MICROBE
65
Q

Sepsis - Transfusion Rxn

A

Usually caused by transfusion of a bacterially infx transfusion product, w/ platelet transfusions having the greatest risk.E. coli, Pseudomonas, Serratia, Salmonella,&Yersinia most common

TX: SEEN MORE IN PLATELETS B/C THEY ARE @ ROOM TEMP

66
Q

Volume overload - Transfusion-associated circulatory overload (TACO)

A

Usually due to excess volume infusion; can exacerbate CHF.

TX: DIURETICS

67
Q

Lung injury - Transfusion-related acute lung injury (TRALI)

A

Acute pulm edema due to antibodies in the donor blood reacting w/ the recipient

TX: INTUBATION

68
Q

Delayed Hemolytic Rxn

A

occurs 1-30 days after transfusion

  • similar to acute hemolytic rxn, but usually less severe symptoms & rarely fatal.
  • May go unrecognized.
  • Often due to mismatch of minor blood group antigens
69
Q

Transfusion-associated graft-versus-host dz

A
  • donor lymphocytes attack immunocompromised recipient’s bone marrow.
  • Rare but high rate of mortality

Block 3: Hem/Onc (6 decks)

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