- newborn screen - Hb electrophoresis - sickledex

iron deficiency blood test results: - Hb - Hct - MCV - ferritin - serum iron - TIBC - WBC? - platelets?

- low Hb - low Hct - low MCV - low ferritin - low serum iron - HIGH TIBC - low WBC - low or high platelets

Sickle cell blood test results: - Hb - RBC indeces - MCV - retics - leukocytes - thrombocytes - ESR - haptoglobin - LDH - bilirubin - peripheral smear

- low Hb - RBC indices normal - MCV not normal (decreased) - reticulocytosis LOW - leukocytosis LOW - thrombocytosis LOW - low ESR - very low or absent haptoglobin - high LDH - high bilirubin - smear shows sickle RBC and howel-jolly bodies

Common Hematologic Presentations Flashcards by Art F

most common blood disorder seen in family med?

anemia

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patients at risk for anemia:

rheumatoid arthritis or other autoimmune disease
kidney disease
cancer
liver disease
thyroid disease
inflammatory bowel disease

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common types of anemias:

-iron def (B12 and folate)
-anemia of pregnancy
aplastic anemia
hemolytic
sickle cell

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Random presenting symptoms for anemias:

-picophagia (eating ice or clay)
-pale or having yellow (sallow) skin
-generalized weakness
-brittle nails or hair loss
-sore or smooth tongue
-headache, especially with activity
-pounding or whooshing in the ears
rapid HR
-shrotness of breath or chest pain especially with activity
-unexplained fatigue or lack of energy

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***most common cause of anemia in the US?

iron deficiency - blood loss or poor absorption of iron

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**iron deficiency:
1) predominant age?
2) predominant sex?

1) ALL especially toddlers (fussy eaters) and menstruating women -poor and under-immunized children
2) female > male

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At risk people for iron deficiency anemia:

menstruation, heavy periods, pregnant, breast feeding, recent childbirth
surgery
trauma
GI disease (inflammatory bowel disease)
vegetarians, vegans, and other diets
blood loss (hemorrhoids!)
children who drink 16-24 ounces a day of cows milk

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Less common reasons for iron deficiency anemia:

intravasclar hemolysis
chronic nose bleeds
frequent blood donations
kidney and bladder

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Treatment of iron deficient anemias?

treat the cause
diet
iron replacement (cause constipation and poop will be black)
blood transfusions in severe cases

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most common form of inherited blood disorder?

sickle cell anemia

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Sickle cell disease symptoms:

anemia/pale
dark urine
yellow eyes
painful swelling hands/feet
stunted growth
frequent pain episodes
stroke

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Sickle cell trait symptoms:

asymptomatic
carrier
hematuria
rare sickle event

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Sickle cell testing?

newborn screen
Hb electrophoresis
sickledex

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iron deficiency blood test results:

Hb
Hct
MCV
ferritin
serum iron
TIBC
WBC?
platelets?

low Hb
low Hct
low MCV
low ferritin
low serum iron
HIGH TIBC
low WBC
low or high platelets

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Sickle cell blood test results:

Hb
RBC indeces
MCV
retics
leukocytes
thrombocytes
ESR
haptoglobin
LDH
bilirubin
peripheral smear

low Hb
RBC indices normal
MCV not normal (decreased)
reticulocytosis LOW
leukocytosis LOW
thrombocytosis LOW
low ESR
very low or absent haptoglobin
high LDH
high bilirubin
smear shows sickle RBC and howel-jolly bodies

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Treatment of sickle cell?

Prevention: fluids, rest, oxygen

- Crisis: Pain- narcotics and steroids

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Athlete with sickle cell- what do you tell them?

make sure that they:

rest before and after - try not to warm up too much
drink plenty of fluids

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deep vein thrombosis - presentation:

leg pain on dorsiflexion of the foot
palpable tender cords (blood vessel inflamed)
edema
discoloration
pain on compression

Lab testing to do for DVT?

D-Dimer
CBC
PTT
PT
INR
Venous doppler/Compression ultrasound
contrast venography - gold standard technically difficult and small risk morbidity

mean age for venous throbosis?

60 yo

Who is at risk?

long plane rides of drives
trauma
surgery
pregnancy
immobility
hormone replacement therapy (HRT)
obesity
smoking…

venous thrombosis

-treatment:

avoid prolonged immobilization
position changes
frequent rest stops
antcoagulants
clot busters
thrombectomy

superficial:

anti-inflammatories
compression stockings
moist heat

teen presents with mild fatigue and delayed puberty: youre thinkings….

thalessemias!

alpha thalessemia - presentation:

silent carriers, asymptomatic

alpha and beta thalessema trait - presentation?

asymptomatic or mild anemia

beta thalessemia intermedia - presentation:

- mild to moderate anemia * **-slow growth and delayed puberty*** - brittle and easy to fracture bones - enlarged spleen

hemoglobin H disease or beta thalessemia major - presentation?

* **-occurs in first two years of life*** - pale/listless - poor appetite - dark urine - slowed growth and delayed puberty - jaundice - enlarged liver, spleen, heart - Bone problems: fractures, maxillary hyperplasia and dental malocculusion

testing for thalessemias?

CBC peripheral smear -Hb electrophoresis -bone marrow aspiration

test results for thalessemia trait?

- Hb = 10-12 - Hct=28-40% (MAJOR may go down to <10%) - peripheral blood: microcytosis, hypochromia, TARGET cells - inc reticulocytes

Target cells, think what disease?

thalessemia

At risk for thalessemias?

- people with FMHx - Mediterranean, middle eastern, southeast asian, or african - male=female

Thalessemia mild case Tx?

-none

Thalessemia intermedia Tx?

None - unless symptomatic

Thalessemia major Tx:

- iron chelation - transfusions - folate supplementation - treat bacterial infections - avoid strenuous activities - life long monitoring - avoid iron rich foods - tea drinking may reduce intestinal iron absorption

Pateint presents: Alcohol induced pain, F, C, NS, persistent itch without rash and enlargement of side of neck

- 36min - listen? whatis disease? lymphoma?

Results of lymphoma testing?

- anemia - thrombocytopenia - leukopenia - hypercalcemia - elevated LDH - serum protein electrophoresis - monoclonal immunoglobin (M-Protein)

at risk for lymphoma?

- all age groups - non-hodgkin more than hodgkin - males > females - immunodef - autoimmune - HIV - FMHx - first degree relative - diet high in fat and meats - exposure to certain pesticides

weakness fatigue fever chills, NS, other flu like symtpoms, headaches, enlarged liver and spleen, swollen tonsils, bone pain, paleness, pin sized red spots on skin, WL .. think what disease?

leukemia

leukemia labs and imaging?

``` CBC ESR liver/renal Fx coagulation profile spinal tap ``` ultrasound CT abdomen diagnostic BM

Lab result leukemia

- differential platelets: subnormal RBCs, neutrophils and platelets - high ESR - high LDH - high uric acid - coagulation profile - may be prolonged spinal tap - leukemic cells

At risk for leukemia?

- male> female - radiation - chemical or drugs - immunodef disorders - cigarettes - chemo - Downs and or other family conditions esp if more leukemia

4 types of leukemia:

ALL AML CLL CML

Leukemia treatment?

chemo | BM transplant