Common presentation of hematological malignancies Flashcards
What are the microcytic anemias?
Fe deficiency Thalassemia Anemia of chronic disease Hemoglobinopathies Sideroblastic anemia
What does ferritin measure?
Body Fe stores
What does TIBC measure?
Number of open spots on transferritin
What does retic count measure? What is normal?
Reticulocyte count (immature RBCs)
0.5-1.5%
What does urea breath test check for?
H.pylori infection
What are the three common causes of Fe deficiency anemia?
Inadequate absorption
Inadequate utilization
Excessive loss
What is the treatment for a gastric ulcer?
PPIs
What vitamin increases the absorption of Fe?
Vitamin C
What mineral suppresses the absorption of Vitamin C?
Ca
How long does it take for the retic count to rise in response to Fe therapy? Hb?
Fe = 1 week Hb = 2 weeks
How long should you continue fe therapy?
Until serum Fe normal
What drug interferes with vit b12 absorption?
PPIs
What are the causes of megaloblastic macrocytic anemia?
Vit B12 deficiency
Folate deficiency
What are the causes of non-megaloblastic macrocytic anemia? (4)
myelodysplastic syndrome
Liver disease
Hypothyroidism
Alcoholism
What condition are multilobed neutrophils found in? What are these called?
Macrocytic anemia
Hypersegmented neutrophils
What happens to the reticulocyte count in pernicious anemia?
Goes down
What disease has high methylmalonic acid and total homocysteine levels? Which has just high homocysteine levels?
Both high = B12
Just homocysteine = folate
How long does it take retic count to increase with B12 administration?
End of first week
How long does the megaloblastic anemia take to correct with B12 supplementation?
6-8 weeks
What is the general ddx for normocytic anemia?
Hemolytic anemia
What are the causes of intrinsic hemolytic anemia? (3)
Membrane defects Enzyme deficiencies (G6PD) Hemoglobinopathies
What are the causes of extrinsic hemolytic anemia? (3)
Autoimmune
Alloimmune
Non-immune (trauma, infx)
What is the test used to identify immune mediated hemolytic anemia?
Coombs test
What is the reticulocyte count like in hemolytic anemia?
high
What type of anemia is LDH high in?
extrinsic hemolytic anemia
What does an elevated indirect bilirubin indicate? Direct?
Indirect = liver problem Direct = obstruction
BIte cells on PBS = ?
G6PD deficiency
What are the triggers for G6PD deficiency?
Fava beans
Infections
Drugs (antimalarials and sulfa)
What are the two types of drugs that pts with G6PD deficiency should avoid?
Sulfa drugs
Antimalarials
What happens to BUN with GI bleeds?
Can increase, but not incredibly sensitive
Itchy after showering = what disease?
Polycythemia vera
What hematological diseases should you be concerned about with skin changes?
Hemochromatosis (gray)
Polycythemia vera
PCT
What are the secondary causes of polycythemia vera? How can you differentiate this from primary polycythemia vera?
COPD, pulmonary HTN, CHF (lung issues where you need more oxygen carrying capacity)
EPO will be low in primary polycythemia vera
What is the treatment for polycythemia vera?
Phlebotomy
ASA to prevent clots
