CLINICAL CARE OF THE HEMATOLOGIC SYSTEM Flashcards
True/false
Congenital anemia is suggested by the patient’s personal and family history.
True
Poor _____ may result in folic acid deficiency and contribute to iron deficiency, but bleeding is much more commonly the cause of iron deficiency in adults.
diet
Anemia is defined by a hematocrit in adults less than ______ in males or less than _____ in females.
41% (hemoglobin 13.5 g/dL) in males
37% (hemoglobin less than 12 g/dL) in females.
Anemias are classified according to either:
-Pathophysiologic basis, i.e., whether related to increased or decreased production of red blood cells
-Cell Size
Mucosal changes such as a smooth tongue suggest ________
Megaloblastic anemia
S/s for Anemia
Attention to signs of primary hematologic diseases such as
lymphadenopathy,
hepatosplenomegaly, or bone tenderness
Labs to run for suspected anemia
(1) CBC with differential
(2) Iron with total iron binding capacity (TIBC)
a) Ferritin value <12 mcg/L indicates Fe deficiency anemia
(3) Microscopic analysis
(4) Hemoglobin electrophoresis (to evaluate for alpha or beta thalassemia)
TX for anemia
(1) Most important treatment is identification of the cause of blood loss, especially a
source of occult blood loss.
(2) Other treatment specific once cause of anemia is identified
_____ is the most common cause of anemia worldwide.
Iron deficiency
True/False
Menstruation, pregnancy, and frequent blood donors increase chances for iron deficiency anemia.
True
Prolonged aspirin use, or the use of other anti-inflammatory drugs, may cause _____ even without a documented structural lesion.
GI bleeding
All vitamin B12 comes from the diet and is present in all foods of animal origin. The daily absorption of vitamin B12 is ___
5 mcg
vitamin B12 deficiency develops more than ____ after vitamin B12 absorption ceases
3 years
-What Dx/ TX
1) Glossitis
2) Anorexia
3) Diarrhea
4) Late stages patient will appear pale, with paresthesia and difficulty with balance.
-Lab/Image Findings
1) CBC with diff: Hallmark is megaloblastic anemia (large RBC’s), characteristic find is macro-ovalocyte with hypersegmented neutrophils.
2) Mean corpuscular volume (MCV) strikingly elevated. MCV= RBC volume as part of CBC w/diff
3) Abnormally low B12 serum level. Overt deficiency <170 pg/mL, Symptomatic <100 pg/mL
4) Elevated LDH and bilirubin
Vitamin B12 Deficiency Anemia
-Tx
IM injection of vitamin B12. Daily for first week, weekly for first month,
then monthly for life.
True/False
B-12 deficiency is a Lifelong disease, deficiency will recur if injections discontinued
True
What Dx/Tx
1) Fatigability, tachycardia, palpitations and tachypnea on exertion.
2) Severe deficiency causes skin and mucosal changes, including a smooth tongue, brittle nails, and cheilosis.
3) Dysphagia because of the formation of esophageal webs (Plummer- Vinson syndrome) also occurs.
4) Many iron-deficient patients develop pica, craving for specific foods (ice chips, etc) often not rich in iron.
-Lab/Image Findings
1) CBC with differential
a) Decreased mean corpuscular volume (MCV).
2) Iron with total iron binding capacity (TIBC)
3) Ferritin value <12 mcg/L
Iron Deficiency Anemia
1) Most important treatment is identification of the cause of blood loss, especially a source of occult blood loss.
2) Oral Iron
Coag Intrinsic pathway, with key factors
XII, XI, VIII, IX.
Coag Extrinsic pathway with the key factor
VII
_________ is a systemic process with the potential
for causing thrombosis and hemorrhage. It can present as an acute, life-threatening
emergency.
Disseminated intravascular coagulation (DIC)
Laboratory measurement of the function of:
1) Intrinsic pathway is by measuring _____,
2) extrinsic is measured by ____.
1) PTT
2) PT
What issue
Common bleeding manifestations include petechiae; ecchymoses; and blood oozing from wound sites, intravenous lines, catheters, mucosal surfaces while Common thromboembolic manifestations of
DIC include venous thromboembolism (VTE) and arterial thrombosis with tissue or organ ischemia.
DIC
What dx/ TX
(1) Bruising (ecchymosis) without any known incident/trauma
(2) Bleeding into joint spaces.
(3) Epistaxis
(4) Bleeding from eyes
(5) Very heavy vaginal bleeding for prolonged periods of times in females.
DIC
-The major principle in the management of DIC is treatment of the underlying cause in order to eliminate the stimulus for ongoing coagulation and thrombosis.
-This is true medical emergency and requires immediate MEDEVAC
Meds to consider for DIC
(a) Heparin
(b) Coumadin
(c) Rivaroxaban
(d) Apixaban
(e) Pradaxa
Labs to run for DIC
(1) PT, PTT, INR
(2) CBC
______ is a hereditary enzyme defect that causes episodic hemolytic anemia because of the decreased ability of red blood cells to deal with oxidative stresses.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
_____ is the process of RBCs rupturing
Hemolysis
