Common Hematologic Presentations Flashcards
most common blood disorder seen in family med?
anemia
patients at risk for anemia:
- rheumatoid arthritis or other autoimmune disease
- kidney disease
- cancer
- liver disease
- thyroid disease
- inflammatory bowel disease
common types of anemias:
- -iron def (B12 and folate)
- -anemia of pregnancy
- aplastic anemia
- hemolytic
- sickle cell
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
***most common cause of anemia in the US?
iron deficiency - blood loss or poor absorption of iron
- **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
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
Less common reasons for iron deficiency anemia:
- intravasclar hemolysis
- chronic nose bleeds
- frequent blood donations
- kidney and bladder
Treatment of iron deficient anemias?
- treat the cause
- diet
- iron replacement (cause constipation and poop will be black)
- blood transfusions in severe cases
most common form of inherited blood disorder?
sickle cell anemia
Sickle cell disease symptoms:
- anemia/pale
- dark urine
- yellow eyes
- painful swelling hands/feet
- stunted growth
- frequent pain episodes
- stroke
Sickle cell trait symptoms:
- asymptomatic
- carrier
- hematuria
- rare sickle event
Sickle cell testing?
- 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
Treatment of sickle cell?
- Prevention: fluids, rest, oxygen
- Crisis: Pain- narcotics and steroids
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
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
