Clinical Care of Hematologic, Immune and Lymphatic system

Question 1

What level anemia is defined by a hematocrit levels of male and female adults?

Answer 1

Male: less than 47%
Females: less than 37%

Question 2

What should be ordered for every patient coming in for a blood disorder/condition

Answer 2

CBC (Complete blood count) with differential

Question 3

What is the most common cause of anemia world wide

Answer 3

Iron deficiency

Question 4

What increases the chances of anemia

Answer 4

Menstruation, pregnancy, and frequent blood donors

Question 5

What are hall mark signs and symptoms for anemia

Answer 5

• Skin and mucosal changes
• Smooth tongue
• brittle nails
• cheilosis (cracks on the corners of the mouth)
• Develop Pica, craving for specific foods (Ice chips) often not rich with iron

Question 6

Treatment for Anemia

Answer 6

Ferrous sulfate (iron supplement) 325 mg three times a day for 3-6 months

Question 7

What will be the serum be for someone with vitamin B12 deficiency

Answer 7

Serum vitamin B12 level <100 pg/mL

Question 8

Which people are most common who have vitamin B12 deficiency

Answer 8

Vegans (strict vegetarians who avoid all dairy products as well as meat and fish)

Question 9

When doing a CBC w/ Diff, what is a hallmark for Vitamin B12 deficiency?

Answer 9

Megaloblastic anemia (LARGE RBC) characteristic find is macro-ovalocyte with hyper-segmented neutrophils

Question 10

What are the lab results for Overt deficiency and symptomatic deficiency for vitamin B12

Answer 10

Overt: <170 pg/mL
Symptomatic: <100 pg/mL

Question 11

What is the treatment for vitamin B12 deficiency

Answer 11

IM injection of vitamin B12. Daily for the first week, weekly for the first month, then monthly for life

Question 12

What deficiency is a hereditary enzyme defect that causes episodic hemolytic anemia because of the decreased ability of red blood cells to deal with oxidative stresses

Answer 12

Glucose 6 phosphate dehydrogenase (G6PD)

Question 13

Oxidized hemoglobin denatures and forms precipitants called what and what do they do to the cell?

Answer 13

• Heinz bodies

- Cause membrane damage, which leads to removal of these cells by the spleen

Question 14

Hemolysis occurs as a results of oxidative stress on the red blood cells, generated by drugs to include

Answer 14

Primaquine (malaria medication

Dapsone 
Quinidine 
Quinine 
Sulfonamides 
Nitrofurantoin 
Aspirin 
Ciprofloxacin

Question 15

What are the shape of cells you would see in a red blood cell smear in G6PD patients

Answer 15

reveal a small number of (bite) cells

Question 16

What anemia is an autosomal recessive disorder in which an abnormal hemoglobin (hemoglobin S) leads to chronic hemolytic anemia with numerous clinical consequences

Answer 16

Sickle Cell

Question 17

What symptoms do people with sickle cell anemia usually complain about

Answer 17

Acute painful episodes including bone (back and long bones) and the chest. Episodes last hours to days and may produce low-grade fever

Question 18

What are the hallmarks when drawing labs on someone with sickle cell anemia

Answer 18

Nucleated red blood cells.

Hypersplenism such as Howell-Jolly Bodies and target cells

Question 19

What should patients with the sickle cell trait should avoid

Answer 19

Acute painful episodes only under extreme conditions such as vigorous exertion at high altitudes (in unpressurized aircraft)

Question 20

What is a malignancy of the hematopoietic progenitor cell. These cells proliferate in an uncontrolled fashion and replace normal bone marrow elements

Answer 20

Leukemia

Question 21

What is ALL, who does it it affect

Answer 21

Acute Lymphoblastic Leukemia

Comprised 80% in childhood and 20% in adults

Question 22

What is AML and who is affected

Answer 22

Acute Myeloid leukemia

Primarily Adult diseases with a median age presentation of 60 years and increasing incidence with advanced age

Question 23

For people with Leukemia, where would bone tenderness may be presented?

Answer 23

Long bones such as the sternum, tibia and femur

Question 24

What is the hallmark in lab for someone with leukemia under a microscope

Answer 24

Combination of pancytopenia with circulating blasts

Question 25

What is the treatment for leukemia

Answer 25

• Referral to hematologist
• MEDEVAC
• Combination chemo and radiation therapy will be the mainstay of therapy

Question 26

What is leukocytosis and Leukopenia

Answer 26

Leukocytosis: High white cell count
Leukopenia: Low total white cell count (<4400 cells/microL)

Question 27

What is thrombocytopenia

Answer 27

Abnormally low amount of circulating platelets

Question 28

What are the symptoms and signs of thrombocytopenia

Answer 28

• Petechia (red bruising)/ red spots

- Mucocutaneous bleeding

Question 29

What is thrombocytosis

Answer 29

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

Question 30

What is the treatment of thrombocytosis

Answer 30

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

Question 31

Two classifications of lymphadenopathy

Answer 31

Localized - Only in one region

Generalized - More than one region

Question 32

Common causes of lymphadenopathy

Answer 32

HIV
TB
Lupus
Infectious Mono