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Heme Exam 3 > Common Hematologic Presentations > Flashcards

Common Hematologic Presentations Flashcards

1
Q

most common blood disorder seen in family med?

A

anemia

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2
Q

patients at risk for anemia:

A
  • rheumatoid arthritis or other autoimmune disease
  • kidney disease
  • cancer
  • liver disease
  • thyroid disease
  • inflammatory bowel disease
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3
Q

common types of anemias:

A
  • -iron def (B12 and folate)
  • -anemia of pregnancy
  • aplastic anemia
  • hemolytic
  • sickle cell
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4
Q

Random presenting symptoms for anemias:

A

-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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5
Q

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

A

iron deficiency - blood loss or poor absorption of iron

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6
Q
  • **iron deficiency:
    1) predominant age?
    2) predominant sex?
A

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

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7
Q

At risk people for iron deficiency anemia:

A
  • 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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8
Q

Less common reasons for iron deficiency anemia:

A
  • intravasclar hemolysis
  • chronic nose bleeds
  • frequent blood donations
  • kidney and bladder
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9
Q

Treatment of iron deficient anemias?

A
  • treat the cause
  • diet
  • iron replacement (cause constipation and poop will be black)
  • blood transfusions in severe cases
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10
Q

most common form of inherited blood disorder?

A

sickle cell anemia

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11
Q

Sickle cell disease symptoms:

A
  • anemia/pale
  • dark urine
  • yellow eyes
  • painful swelling hands/feet
  • stunted growth
  • frequent pain episodes
  • stroke
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12
Q

Sickle cell trait symptoms:

A
  • asymptomatic
  • carrier
  • hematuria
  • rare sickle event
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13
Q

Sickle cell testing?

A
  • newborn screen
  • Hb electrophoresis
  • sickledex
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14
Q

iron deficiency blood test results:

  • Hb
  • Hct
  • MCV
  • ferritin
  • serum iron
  • TIBC
  • WBC?
  • platelets?
A
  • low Hb
  • low Hct
  • low MCV
  • low ferritin
  • low serum iron
  • HIGH TIBC
  • low WBC
  • low or high platelets
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15
Q

Sickle cell blood test results:

  • Hb
  • RBC indeces
  • MCV
  • retics
  • leukocytes
  • thrombocytes
  • ESR
  • haptoglobin
  • LDH
  • bilirubin
  • peripheral smear
A
  • 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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16
Q

Treatment of sickle cell?

A
  • Prevention: fluids, rest, oxygen

- Crisis: Pain- narcotics and steroids

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17
Q

Athlete with sickle cell- what do you tell them?

A

make sure that they:

  • rest before and after - try not to warm up too much
  • drink plenty of fluids
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18
Q

deep vein thrombosis - presentation:

A
  • leg pain on dorsiflexion of the foot
  • palpable tender cords (blood vessel inflamed)
  • edema
  • discoloration
  • pain on compression
19
Q

Lab testing to do for DVT?

A
  • D-Dimer
  • CBC
  • PTT
  • PT
  • INR
  • Venous doppler/Compression ultrasound
  • contrast venography - gold standard technically difficult and small risk morbidity
20
Q

mean age for venous throbosis?

A

60 yo

21
Q

Who is at risk?

A
  • long plane rides of drives
  • trauma
  • surgery
  • pregnancy
  • immobility
  • hormone replacement therapy (HRT)
  • obesity
  • smoking…
22
Q

venous thrombosis

-treatment:

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

superficial:

  • anti-inflammatories
  • compression stockings
  • moist heat
23
Q

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

A

thalessemias!

24
Q

alpha thalessemia - presentation:

A

silent carriers, asymptomatic

25
Q

alpha and beta thalessema trait - presentation?

A

asymptomatic or mild anemia

26
Q

beta thalessemia intermedia - presentation:

A
  • mild to moderate anemia
  • -slow growth and delayed puberty*
  • brittle and easy to fracture bones
  • enlarged spleen
27
Q

hemoglobin H disease or beta thalessemia major - presentation?

A
  • -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
28
Q

testing for thalessemias?

A

CBC
peripheral smear
-Hb electrophoresis
-bone marrow aspiration

29
Q

test results for thalessemia trait?

A
  • Hb = 10-12
  • Hct=28-40% (MAJOR may go down to <10%)
  • peripheral blood: microcytosis, hypochromia, TARGET cells
  • inc reticulocytes
30
Q

Target cells, think what disease?

A

thalessemia

31
Q

At risk for thalessemias?

A
  • people with FMHx
  • Mediterranean, middle eastern, southeast asian, or african
  • male=female
32
Q

Thalessemia mild case Tx?

A

-none

33
Q

Thalessemia intermedia Tx?

A

None - unless symptomatic

34
Q

Thalessemia major Tx:

A
  • 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
35
Q

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

A
  • 36min - listen? whatis disease?

lymphoma?

36
Q

Results of lymphoma testing?

A
  • anemia
  • thrombocytopenia
  • leukopenia
  • hypercalcemia
  • elevated LDH
  • serum protein electrophoresis - monoclonal immunoglobin (M-Protein)
37
Q

at risk for lymphoma?

A
  • 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
38
Q

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?

A

leukemia

39
Q

leukemia labs and imaging?

A 
CBC
ESR
liver/renal Fx
coagulation profile
spinal tap

ultrasound
CT abdomen

diagnostic BM

40
Q

Lab result leukemia

A
  • differential platelets: subnormal RBCs, neutrophils and platelets
  • high ESR
  • high LDH
  • high uric acid
  • coagulation profile - may be prolonged

spinal tap - leukemic cells

41
Q

At risk for leukemia?

A
  • male> female
  • radiation
  • chemical or drugs
  • immunodef disorders
  • cigarettes
  • chemo
  • Downs and or other family conditions esp if more leukemia
42
Q

4 types of leukemia:

A

ALL
AML
CLL
CML

43
Q

Leukemia treatment?

A

chemo

BM transplant

Heme Exam 3 (8 decks)

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