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Hemo, lymph, and immune > Clinical Care of the Hematologic System > Flashcards

Clinical Care of the Hematologic System Flashcards

1
Q

What is usually the cause of iron deficiency in adults?

A

bleeding

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2
Q

how is anemia defined in regards to hematocrit levels with adult males and females?

A

less than 41% (Hemoglobin 13.5g/dL) in Males

less than 37% (hemoglobin 12g/dL in Females

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3
Q

what are the symptoms/PE findings of of anemia?

A

lymphadenopathy, hepatosplenomegaly, or bone tenderness.

Mucosal changes such as smooth tongue suggests megaloblastic anemia

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4
Q

What labs would you do for anemia?

A

CBC with diff
Iron with total iron biding capacity (TIBC)
Microscopic analysis
Hemoglobin electrophoresis

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5
Q

what will be your findings on TIBC for anemia?

A

Ferritin value <12 mcg/L indicates iron (Fe) deficiency anemia

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6
Q

what is the treatment if the cause of anemia is not identified?

A

referral to internal medicine

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7
Q

What are some of the specific anemias?

A

Iron Deficiency Anemia

Vitamin B12 Deficiency

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8
Q

Physical exam findings of Iron deficiency anemia?

A

fatigue, tachycardia, palpitations, tachypnea on exertion.

smooth tongue, brittle nails, cheilosis. dysphagia, and pica (craving foods not rich in iron, like ice chips).

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9
Q

What is the most important treatment with anemia?

A

identification of blood loss….

after Oral Iron (ferrous sulfate, 325 mg, 3x day, 3-6 months)
or parenteral iron (dosage derived by hematologist)

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10
Q

What are the essentials of diagnosis for Vitamin B12 Deficiency?

A

hype segmented neutrophils on peripheral blood smear.
Serum B 12 < 100pg/ml

Hallmark is megaloblastic anemia (large RBCs)

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11
Q

vitamin b12 deficiency normally develops more than how many years after vitamin b 12 ceases?

A

3 years.

because the body has 2000-5000 mcg of b12 stored.

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12
Q

what population is most likely to see B12 deficiency?

A

vegans

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13
Q

what are some rare causes of b12 deficiency?

A

fish tapeworm
pancreatic insufficiency
Severe Crohn disease that destroyed much of the ileum

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14
Q

physical findings of B12 deficiency?

A

glossitis
anorexia
diarrhea
late stages will be pale, w paresthesia and difficulty w balance

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15
Q

what is the hallmark of Vitamin B 12 deficiency?

A

megaloblastic anemia on CBC with diff.

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16
Q

What is the treatment of Vitamin B12 deficiency?

A

IM injection of B12. Daily for a week, Weekly for a month, monthly for life.

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17
Q

three stages of blood clotting?

A

Formation of prothrombinase
prothrombin into thrombin
thrombin converts soluble fibrinogen into insoluble fibrin threads

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18
Q

Hemophilia A is a congenital deficiency of which coagulation factor?

A

VIII

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19
Q

Hemophilia B is a congenital deficiency of which coagulation factor?

A

IX

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20
Q

what is a condition where the process of coagulation and fibrinolysis become abnormally activated within the vasculature, leading to ongoing coagulation and fibrinolysis?

A

Disseminated intravascular coagulation (DIC)

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21
Q

what are some manifestations of DIC?

A

petechia, ecchymoses, blood oozing from wounds.

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22
Q

causes of DIC?

A

sepsis
malignancy
obstetrical complications
intravascular hemolysis

less common, but seen in heat stroke, crush injuries and rattlesnake and viper bites.

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23
Q

what medications would you give for DIC?

A

heparin

coumadin

24
Q

symptoms of DIC

A

bruising
epistaxis
bleeding from eyes
heavy vaginal bleeding

25
Q

what drugs could cause a episodic hemolytic anemia in patients with g6pd?

A

Primaquine, aspirin, ciprofloxacin

26
Q

what do you call the “bite” cells that appear in patients with g6pd under oxidative stress?

A

Heinz bodies.

27
Q

how do you see heinz bodies on a blood smear?

A

stain with Cresyl Violet or they will not be visible.

28
Q

Symptoms/Physical Exam findings of Sickle Cell:

A

jaundice, pigment, gallstones, hepatosplenomegaly, and poor healing ulcers over the lower tibia

non healing ulcers in the lower ley.
cardiomegaly
painful episodes in the bones (especially long bones and chest)
low grade fever

29
Q

if you have Sickle Cell Trait, you are clinically normal, but what can cause acute painful episodes?

A

extreme conditions such as vigorous exertion at high altitudes (or in unpressurized aircrat)

30
Q

what percentage of blasts will be in the bone marrow with acute leukemia?

A

20%

31
Q

two classifications of acute leukemia?

A

Acute myeloid leukemia (AML) is an adult disease with median age of 60 years old.
Acute Lymphoblastic leukemia (ALL) 80% in childhood and 20% of adults.

32
Q

You will have blasts in what percentage of acute leukemia patients?

A

90%

33
Q

vast majority of AML patients are diagnosed at what age?

A

20

34
Q

symptoms of acute leukemia

A

fatigue
bleeding on mucosal surfaces, gingival bleeding, epistaxis, menorrhagia
infection
gum hypertrophy and bone and joint pain

patients may appear peale and have petechia.
enlarged liver, spleen, and lymph nodes
sternum, tibia, and femur tenderness

35
Q

DDX of acute leukemia

A

mono
pertussis
anemia
hypothyroid

36
Q

what is the hallmark of acute leukemia with labs/studies/EKG?

A

pancytopenia with circulating blasts

patients with ALL may have mediastinal mass visible with x ray

37
Q

what percentage of blasts is required to make a diagnosis of acute leukemia?

A

20%

38
Q

How many achieve remission with AML diagnosed under 60 years old?

A

70-80%

39
Q

what is a high white cell count called?

A

leukocytosis

40
Q

what is a low white cell count called?

A

leukopenia

41
Q

what are some etiologies of neutrophils leukocytosis?

A

bacterial infection
inflammation
metabolic disease
stress

42
Q

what are some etiologies of lymphocyte leukocytosis?

A

viral infection
immune disease
stress
leukemia

43
Q

what are some etiologies of eosinophil leukocytosis?

A

skin disease
drug reaction
parasite infection
asthma

44
Q

what are some etiologies of basophil leukocytosis?

A

chronic myeloid leukemia

45
Q

signs and symptoms of leukocytosis or leukopenia are varied and depend on underlying cause. name some

A 
Infectious symptoms: 
fever
skin erythema, ulcerations, fissure, 
gingivitis, swelling, oral ulceration dental pain
abnormal respiratory exam

Other findings:
jaundice
joint pain

46
Q

how do you determine the cell being affected with either leukocytosis or leukopenia?

A

CBC with diff

47
Q

what is the disease with abnormally low amount of circulating platelets?

A

thrombocytopenia

48
Q

the risk of spontaneous bleeding with thrombocytopenia does not increase until the platelets fall below what range?

A

10,000 to 20,000 /mcl

49
Q

potential causes of thrombocytopenia?

A 
bone marrow failure
DIC 
chemo
nutritional deficiencies 
bone malignancy 
meds
50
Q

symptoms of thrombocytopenia

A

Petechia***

mucocutaneous bleeding

51
Q

treatment for thrombocytopenia?

A

stop offending medications
evaluate for cause
refer to internal medicine or hematologist
MEDEVAC

52
Q

What is thrombocytosis?

A

abnormally high amount of circulating thrombocytes n(450,000)

53
Q

what are the two different categories of thrombocytosis?

A

Reactive- anemia, blood loss, infection, inflammation, post splenectomy

Autonomous- primarily cancers of bone marrow

54
Q

symptoms of thrombocytosis?

A 
50-60 years of age
elevated platelets 
increased risk of thrombosis 
erythromelagia-  painful burning of hands with erythema 
splenomegaly in 25% of patients
55
Q

Treatment for thrombocytosis?

A

refer to hematology if there is no infectious cause and does not resolve in 2-4 weeks

Hemo, lymph, and immune (5 decks)

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