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Primary > Diagnosis and Management of Hematologic and Oncologic Disorders > Flashcards

Diagnosis and Management of Hematologic and Oncologic Disorders Flashcards

1
Q

Reduction below normal of erythrocytes, hemoglobin, or volume of red blood cells (RBCs) caused by a variety of factors, including blood loss, bone marrow failure/impaired production, or hemolysis/destruction of RBCs

A

Anemias

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2
Q

The main component of RBCs and the essential protein that combines with and transports 02 to the body

A

Hgb:

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3
Q

Measures tile % of a given volume of whole blood that is occupied by erythrocytes; the amount of plasma to total RBC mass (RBC concentration)

A

Hct

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4
Q

Total iron-binding capacity

A

TIBC:

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5
Q

Expression of the average volume and size of individual erythrocytes

A

Mean Corpuscular Volume (MCV)

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6
Q

Normal: 14 to 18g/100 ml (males)

12 to 16g/100 ml (females)

A

Hgb

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7
Q

Normal: 250 to 450 ug/dl

A

TIBC

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8
Q

Normal: 50 to 150 gg/dl

A

Serum Iron

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9
Q

Normal: 40 to 54% (males)

37 to 47% (females)

A

Hct

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10
Q

Normal: 80 to 100 u3

A

Mean Corpuscular Volume (MCV)

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11
Q

microcytic =

A

< 80

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12
Q

Expression of the average amount and weight of Hgb contained in a single erythrocyte

A

Mean Corpuscular Hemoglobin (MCH):

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13
Q

normocytic =

A

80-100

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14
Q

Expression of the average Hgb concentration or proportion of each RBC occupied by Hgb as a percentage: more accurate measure than MCH

A

Mean Corpuscular Hemoglobin Concentration (MCHC):

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15
Q

macrocytic =

A

> 100

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16
Q

Normal: 32 to 36%

A

Mean Corpuscular Hemoglobin Concentration (MCHC):

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17
Q

Hypochromic %?

A

<32%

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18
Q

Normochromic %?

A

32%-36%

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19
Q

Hyperchromic ____%

A

> 36%

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20
Q

Iron deficiency anemia and thalassemia

A

Low MCV:

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21
Q

B 12 or folate deficiency, alcoholism, liver failure, and drug effects

A

High MCV:

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22
Q

Anemia of chronic disease, sickle cell disease, renal failure, blood loss, and hemolysis

A

Normocytic:

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23
Q

Microcytic, hypochromic anemia due to an overall deficiency of iron

A

Iron Deficiency Anemia

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24
Q
  1. The most common cause of anemia
A

Iron Deficiency Anemia

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25
Q
  1. ____ loss exceeds intake so that storage is depleted

- -> decrease in iron available for RBC formation

A

Iron

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26
Q
  1. Caused by: Blood loss, inadequate iron intake, impaired absorption of ____
A

iron

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27
Q

Signs/Symptoms

  1. Usually slow in onset, few symptoms with Hct > 30
  2. As the Hct falls, see:
    a. Pica: Unusual food cravings such as ice, clay, etc.
    b. Dyspnea and mild fatigue with exercise
    c. Headache
    d. Palpitations
    e. Weakness
    f. Tachycardia
    g. Postural hypotension
    h. Pallor
A

Iron deficiency anemia

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28
Q

Laboratory/Diagnostics: Iron deficiency anemia

  1. ____ Hgb
  2. ___ Hct
  3. _____ MCV (microcytic)
  4. _____ MCHC (hypochromic)
  5. _____ RBC
  6. ____ serum iron
  7. _____ serum ferritin
  8. _____ TIBC
  9. _____ RDW (red cell distribution width)
A
  1. Low Hgb
  2. Low Hct
  3. Low MCV (microcytic)
  4. Low MCHC (hypochromic)
  5. Low RBC
  6. Low serum iron
  7. Low serum ferritin
  8. High TIBC
  9. High RDW (red cell distribution width)
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29
Q

Management

1. Oral ferrous sulfate _______ mg one to two hours after meals

A

300-325 mg

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30
Q

Iron should not be taken with ______, as they interfere with absorption.

A

antacids

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31
Q

Taking iron with juice that has _____ ___increases absorption

A

vitamin C

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32
Q

Foods high in iron: Raisins, green leafy vegetables, ____ ___, citrus products, and iron-fortified bread and cereals

A

red meats

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33
Q

_________

Genetically inherited disorders resulting in abnormal Hgb production and microcytic, hypochromic anemia

A

Thalassemia

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34
Q

Incidence

1. Found mainly in the Mediterranean, _____, Middle Eastern, Indian, and Asian populations

A

African

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35
Q

Signs/Symptoms

1. General physical findings are unremarkable unless the form of ______ is severe

A

thalassemia

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36
Q

Laboratory/Diagnostics: Thalassemia

  1. _____ Hgb
  2. ___ MCV (microcytic)
  3. ____ MCHC (hypochromic)
  4. ____ TIBC
  5. _____ ferritin
  6. ________ a or B Hgb chains
A
  1. Decreased Hgb
  2. Low MCV (microcytic)
  3. Low MCHC (hypochromic)
  4. Normal TIBC
  5. Normal ferritin
  6. Decreased a or B Hgb chains
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37
Q

Management: Thalassemia

  1. No _____ for mild to moderate forms
  2. RBC transfusion/splenectomy for more severe forms
  3. Iron is contraindicated as iron overload can result
A

treatment

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38
Q

Macrocytic, normochromic anemia due to folic acid deficiency

A

Folic Acid Deficiency

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39
Q

Cause: Folic Acid Deficiency

Inadequate intake/malabsorption of ___ ____ (needed for RBC production)

A

folic acid

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40
Q

Signs/Symptoms: _____ _____ _____

  1. Fatigue
  2. Dyspnea on exertion
  3. Pallor
  4. Headache
  5. Tachycardia
  6. Anorexia
  7. Glossitis
  8. Aphthous ulcers
A

Folic Acid Deficiency

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41
Q

____ neurological signs are seendifferentiates B12 from folic acid deficiency*

A

No

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42
Q

Laboratory/Diagnostics: Folic Acid Deficiency

  1. Hct and RBC ______
  2. MCV _______ (macrocytic)
  3. MCHC ______ (normochromic)
  4. Serum folate ______
  5. Red blood cell folate ____ ng/mL
A
  1. Hct and RBC decreased
  2. MCV elevated (macrocytic)
  3. MCHC normal (normochromic)
  4. Serum folate decreased
  5. Red blood cell folate < I00 ng/mL
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43
Q

Management: Folic Acid Deficiency

  1. Folate ___ mg orally every day
  2. Foods high in folic acid: ______, peanut butter, fish, green leafy vegetables’ iron-fortified bread and cereals
A
  1. Folate 1 mg orally every day

2. Foods high in folic acid: Bananas, peanut butter, fish, green leafy vegetables’ iron-fortified bread and cereals

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44
Q

____ ______

Macrocytic, normochromic anemia due to deficiency of intrinsic factor, which results in malabsorption of B 12

A

Pernicious Anemia

45
Q

Signs/Symptoms:

  1. Weakness
  2. Glossitis
  3. Palpitations
  4. Dizziness
  5. Anorexia
  6. Paresthesia
  7. Loss of vibratory sense
  8. Loss off’me motor control
  9. Positive Romberg
  10. Positive Babinski
A

Pernicious Anemia

46
Q

Laboratory/Diagnostics: Pernicious Anemia
1. Hgb, Hct, and RBCs _______
2. MCV ______ (macrocytic)
3. Serum B12 _______ (< 0.1 ug/ml)
4. Anti-IF (intrinsic factor) and anti parietal cell antibody
tests affirm a ________.
5. Schilling test may help to determine the cause.

A
  1. Hgb, Hct, and RBCs decreased
  2. MCV increased (macrocytic)
  3. Serum B12 decreased (< 0.1 ug/ml)
  4. Anti-IF (intrinsic factor) and anti parietal cell antibody
    tests affirm a deficiency.
  5. Schilling test may help to determine the cause.
47
Q

Management: Pernicious Anemia

  1. B12 (cyanocobalamin) ____ ug IM daily x 1 week
  2. Maintenance treatment requires continuous lifelong monthly administration.
A

100 ug

48
Q

Chronic normocytic, normochromic anemia associated with chronic inflammation, infection, renal failure, and malignancy

A

Anemia of Chronic Disease

49
Q

Cause: Anemia of Chronic Disease
1. Etiology unclear: Involves decreased erythrocyte life
span
2. The ______ most common cause of anemia

A

second

50
Q

Signs/ Symptoms: Anemia of Chronic Disease

  1. Fatigue
  2. Weakness
  3. ______ on exertion
  4. Anorexia
A
  1. Dyspnea
51
Q

Laboratory/Diagnostics: Anemia of Chronic Disease

  1. Hgb and Hct ___
  2. MCV ______
  3. MCHC _____
  4. Serum iron and TIBC ____
  5. Serum ferritin is _____ (> 100 ng/mL)
A
  1. Hgb and Hct low
  2. MCV normal (normocytic)
  3. MCHC normal (normochromic)
  4. Serum iron and TIBC low
  5. Serum ferritin is high (> 100 ng/mL)
52
Q

Management: Anemia of Chronic Disease

  1. Treat associated ______
  2. Provide nutritional support
  3. Dyspnea on exertion
  4. Anorexia
A

disease

53
Q

Chronic hemolytic anemia that is genetically transmitted characterized by sickle-shaped RBC

A

Sickle Cell Anemia

54
Q

Signs/Symptoms: Sickle Cell Anemia
1. Signs of the disease develop in infancy or childhood
2. Delayed growth and development, increased
susceptibility to infections is common
3. In a crisis, patients experience:
a. Sudden onset of severe ____ in extremities, back,
chest, and abdomen
b. Aching joint pain
c. Weakness
d. Dyspnea

A

pain

55
Q

General Concepts: Sickle Cell Anemia
1. An acute, periodic exacerbation in which RBCs become
____-shaped and cause vessel obstruction
2. Cellular hypoxia results in acidosis and tissue ischemia.
3. Pain occurs from tissue ischemia and blood hyperviscosity.
4. Factors which precipitate sickling include hypoxia,
infections, high altitudes, dehydration, physical or
emotional stress, surgery, blood loss, acidosis

A

sickle

56
Q

Laboratory/Diagnostics: Sickle Cell Anemia
1. Hgb ______
2. Peripheral smear shows classic distorted sickle-shaped
RBCs
3. Cellulose acetate and citrate agar gel electrophoresis
to confirm Hgb genotype

A
  1. Hgb decreased
  2. Peripheral smear shows classic distorted sickle-shaped
    RBCs
  3. Cellulose acetate and citrate agar gel electrophoresis to
    confirm Hgb genotype
57
Q

Management: Sickle Cell Anemia
1. Treat both acute and chronic complications of the
disease
2. Acute:____ for dehydration, analgesics for pain, and
___ for hypoxemia

A
  1. Fluids

oxygen

58
Q

____________-

Idiopathic and chronic marrow disorder, due to genetic mutation, resulting in increased RBCs and increased hematocrit

A

Polycythemia

59
Q

Signs/Symptoms: Polycythemia

  1. Fatigue
  2. Weakness
  3. _____ disturbances
  4. Headache
A

Visual

60
Q

Laboratory/Diagnostics: Polycythemia

  1. Hemoglobin > 18.5 g/dL in men; > 16.5 g/dL in women
  2. Presence of _______ or similar genetic mutation
A

JAK2617V F

61
Q

Management: Polycythemia

  1. Phlebotomy
  2. _______
  3. Referral
A

Aspirin

62
Q

The disorder that results in excessive levels of iron; untreated iron overload increases the risk of a variety of conditions

A

Hemochromatosis

63
Q 
Signs/Symptoms: Hemochromatosis
1. Fatigue
2. \_\_\_\_ pain
3. Pain in knuckles of the pointer and middle
    fingers
A

Joint

64
Q

Laboratory/Diagnostics: Hemochromatosis

1.____ panel test

A

Iron

65
Q

Management: Hemochromatosis

  1. ___ chelation
  2. Surgery, if needed
  3. Do not consume foods that contain large amounts of iron (i.e., red meat)
A

Iron

66
Q

A genetic disorder that results in results in reduced ability to create blood clots; caused by mutation or deficiency in ____ ______ factor and clotting factor VIII

A

von Willebrand disease

67
Q

Signs/Symptoms: von Willebrand disease

  1. Frequent, prolonged, or severe episodes of bleeding
  2. Easy _____
A

bruising

68
Q

Management: von Willebrand disease

1. _________, recombinant vWF, vWf/factor VIII concentrate

A

Desmopressin

69
Q

Neoplasms arising from hemat0Poietic cells in the bone marrow

A

Leukemias

70
Q

Cause/Incidence: Leukemias

  1. Often, ____ ___ cause can be found.
  2. More frequent in males
A

no direct

71
Q

________ Leukemia:

a. Constitutes 80% of acute leukemia in adults
b. Remission rates from 50 to 85%
c. Long term survival: ruffly 40%

A

Acute Nonlymphocvtic Leukemia (ANL)/Acute Myelogenous Leukemia (AML)

72
Q

______ Leukemia:

a. More difficult to cure in adults than children (90% remission rate in children)
b. Pancytopenia with circulating blasts (the hallmark of the disease)

A

Acute Lymphocytic Leukemia (ALL)

73
Q

______ _____ leukemia:

a. Most common leukemia in adults
b. This occurs in both middle and old age
c. Median survival is 10 years
d. Lymphocytosis (the hallmark of the disease)

A

Chronic Lymphocytic Leukemia (CLL)

74
Q

___ _____

a. Occurs most often in persons aged 40 and older
b. Median survival is three to four years
c. Philadelphia chromosome seen in leukemic cells (the hallmark of the disease)

A

Chronic Myelogenous (CML)

75
Q

Simas/Symptoms: Leukemia

  1. May be asymptomatic
  2. Fatigue
  3. Weakness
  4. Anorexia
  5. Generalized __________
  6. Weight loss
A

lymphadenopathy

76
Q

Management: Leukemia

  1. __________
  2. Bone marrow transplantation
  3. Control of symptoms
A

Chemotherapy

77
Q

Lymphomas: Lymphocytic Malignancy
Diagnosis/Staging
1. Diagnosed by biopsy of enlarged ____ ___

A

lymph nodes

78
Q

Stage ___: Liver or bone marrow involvement

A

4

79
Q

Stage ___: Lymph nodes or the spleen involved; occurs on both sides of the diaphragm

A

3

80
Q

Stage ___: Disease localized to a single lymph node or group

A

1

81
Q

Stage __: More than one lymph node group involved; confined to one side of the diaphragm

A

2

82
Q

Stage __: More than one lymph node group involved; confined to one side of the diaphragm

A

2

83
Q

Non-Hodgkin’s Lymphoma

e. In the _____stage, the disease is usually apparent.

A

advanced

84
Q

Non-Hodgkin’s Lymphoma

b. Often presents with ________

A

lymphadenopathy

85
Q

Non-Hodgkin’s Lymphoma
d. A ____ predictable pattern of a spread than Hodgkin’s
disease

A

less

86
Q

Non-Hodgkin’s Lymphoma

a. The cause is ____; may have viral etiology

A

unknown

87
Q

Non-Hodgkin’s Lymphoma
c. Most common neoplasm between ages ____ and ___
years

A

20 and 40 years

88
Q

Non-Hodgkin’s Lymphoma:

In the ______ stage, the disease is usually apparent

A

advanced

89
Q

Hodgkin’s Disease:

b. More common in males; the average age is ____ years.

A

32

90
Q

Hodgkin’s Disease:
c. Usually presents with cervical _____ and spreads
in a predictable fashion along with lymph node groups

A

adenopathy

91
Q

Hodgkin’s Disease:
d. Characteristic ____ ___ cells differentiate from
non-Hodgkin’s disease

A

Reed-Sternberg

92
Q

Hodgkin’s Disease:

The cause is _______.

A

unknown

93
Q

Laboratory/Diagnostics: Lymphomas: Lymphocytic Malignancy

1. CT, x-rays, ultrasonography, and/or MRI used to locate and ____ disease

A

stage

94
Q

Are Non- Hodgkins Lymphoma and Hodgkin’s Disease both Lymphomas: Lymphocytic Malignancy?

A

Yes

95
Q

Laboratory/Diagnostics: Lymphomas: Lymphocytic Malignancy

2. ______ and histopathologic examination confirm the diagnosis.

A

Biopsy

96
Q

Management: Lymphomas: Lymphocytic Malignancy
1. _______
2. Chemotherapy
a. Initiate allopurinol to reduce tumor lysis syndrome in
high-risk patients
3. Bone marrow transplantation

A

Radiation

97
Q

Cancer staging system developed and maintained by the Union for International Cancer Control (UICC); not all tumors have TNM classifications (e.g., brain tumors)

A

TNM Classification of Malignant Tumors (TNM)

98
Q

TNM Classification of Malignant Tumors (TNM)
Mandatory Parameters (‘T’, ‘N’, and ‘M’)
T (a, is, 0, 1 to 4): Size or direct extent of the ____
tumor

A

primary

99
Q

TNM Classification of Malignant Tumors (TNM)

M (0/1): ____ metastasis

A

Distant

100
Q

TNM Classification of Malignant Tumors (TNM)

N (0 to 3): Spread to ___ lymph nodes

A

regional

101
Q

The use of an “X” instead of a number or other suffix means that the parameter was ____ _____.

A

not assessed

102
Q

TNM Classification of Malignant Tumors (TNM)

M (0/1): ______ metastasis

A

Distant

103
Q

The immune system’s diminished function with age leads to a decline in the response to infection.

A

“Immunosenescence”:

104
Q

Innate immunity functions (_______, natural killer cells, neutrophils) decline

A

macrophages

105
Q

Adaptive immune responses ______ with geriatric patients.

A

diminishes

106
Q

In geriatrics decreased thymic hormone production resulting in a decreased number of functioning ______ in geriatrics

A

T-cells

107
Q

In geriatrics, there is a decreased ______ production and response

A

antibody

108
Q

In geriatrics, there is a ______ response to antigens

A

diminished

109
Q

Possible findings/results: Geriatrics

a. Overall increased susceptibility to ______
b. Poor wound healing
c. Exacerbation of chronic diseases
d. Waning vaccine-induced antibody response

A

infection

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