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Hematology and Oncology > EXAM #3: COMMON HEMATOLOGIC PRESENTATIONS > Flashcards

EXAM #3: COMMON HEMATOLOGIC PRESENTATIONS Flashcards

1
Q

Why is angina a common symptom of anemia in patients with pre-existing CAD?

A

Decreased oxygen delivery to the heart b/c of decreased oxygen in the blood

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2
Q

What is the definition of anemia in males and feamles?

A
  • Males= Hb less than 13.5

- Females= Hb less than 12.5

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3
Q

What are the common causes of a microcytic anemia?

A

1) Fe++ deficiency
2) ACD
3) Sideroblastic anemia
4) Thalassemia

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4
Q

How does iron deficiency lead to microcytic anemia?

A

Hb= heme + globin

  • Decreased iron
  • Decreased heme
  • Decreased Hb
  • ->Microcytic anemia
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5
Q

What is the most common cause of Fe++ deficiency in infants?

A

Breast-feeding

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6
Q

What is the most common cause of Fe++ deficiency in children?

A

Poor diet

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7
Q

What is the most common cause of Fe++ deficiency in Adults?

A

PUD vs. hookworm

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8
Q

What is the most common cause of Fe++ deficiency in Elderly?

A

Colon polyps/carcinoma

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9
Q

What lab values are characteristic of Fe++ deficiency anemia?

A
  • Decreased ferritin
  • Increased TBIC
  • Decreased serum Fe++
  • Decreased %saturation
  • Increased FEP
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10
Q

How does increased Hepcidin production in ACD lead to microcytic anemia?

A

1) Hepcidin sequesters Fe++ in storage sites
2) Decreased available Fe++
3) Decreased heme
4) Decreased Hb

–>Microcytic anemia

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11
Q

What are the lab findings in ACD?

A
  • Increased Ferretin
  • Decreased TIBC
  • Decreased serum Fe++
  • Decreased %saturation
  • Increased FEP
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12
Q

Explain the etiology of sideroblastic anemia leading to microcytic anemia.

A

Sideroblastic anemia= congenital defect in ALA Synthease, the rate limiting step of heme synthesis

1) Decreased protoporphyrin
2) Decreased heme
3) Decreased Hb

–>Microcytic anemia

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13
Q

When protoporphyrin is deficient, where is Fe++ trapped? What does this lead to?

A

Mitochondria –> “Ringer sideroblasts”

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14
Q

What are the acquired causes of sideroblastic anemia?

A

Alcoholism
Pb poisoning
Vitamin B6 deficiency

B6 is the cofactor for ALA synthase

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15
Q

What are the lab findings in sideroblastic anemia?

A
  • Increased ferretin
  • Decreased TBIC
  • Increased serum Fe++
  • Increased %saturation
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16
Q

Outline the etiology of microcytic anemia in Thalassemia.

A

Decreased synthesis of globin chains=
- Decreased Hb

–>Microcytic anemia

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17
Q

What is the hallmark PBS finding of Beta-Thalassemia?

A

Target cells

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18
Q

What is the approach to treating stable Fe++ deficiency anemia in the elderly?

A

Oral Fe++ therapy with 325 mg of Ferrous Sulfate and 500 units Vitamin C

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19
Q

What are the most common causes of macrocytic anemia?

A

Folate/ B12 deficiency

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20
Q

How do Folate and B12 deficiency lead to macrocytic anemia?

A

Both are necessary for DNA precursors; leads to cell enlargement without division

21
Q

What type of neutrophil is associated with Folate and B12 deficiency?

A

Hypersegmented i.e. greater than 5 lobes

22
Q

Folate deficiency picmonic.

A

See picmonic.

23
Q

B12 deficiency picmonic.

A

See picmonic.

24
Q

What are the lab findings associated with folate deficiency?

A

1) Decreased folate
2) Increased homocysteine
3) Normal MMA

25
Q

What does increased homocysteine increase the risk for?

A

Thrombosis

26
Q

What are the lab findings associated with B12 deficiency?

A

1) Decreased B12
2) Increased serum homocystine
3) Increased MMA

27
Q

How is B12 deficiency treated?

A

1) Parenteranl injection

2) Oral supplementation

28
Q

How do you correct a RC count?

A

RC x Hct/45

29
Q

What does a corrected RC count greater than 3 represent?

A

Good marrow response

30
Q

What does a corrected RC count less than 3 represent?

A

Poor marrow response

31
Q

What are the clinical findings associated with extravascular hemolysis?

A

1) Splenomegaly
2) Jaundice
3) Bilirubin gallstones

32
Q

What are the clinical findings associated with intravascular hemolysis?

A

1) Hemoglobinuria
2) Hemoglobinemia
3) Hemosidinuria

33
Q

What is the inheritance pattern of G6PD?

A

X-linked recessive

34
Q

Outline the etiology of G6PD.

A
  • Decreased G6PD
  • Decreased NADPH
  • Decreased reduced glutathione
  • Oxidative injury
35
Q

What are the PBS findings associated with G6PD?

A

Heinz bodies

Bite cells

36
Q

What type of anemia is seen with G6PD?

A

Normocytic

37
Q

What type of hemolysis is associated with G6PD?

A

Predominantly intravascular

Note that this is different from the case presentation from class

38
Q

What is the most common source of a PE?

A

DVT

39
Q

What is a “D-dimer?”

A

Fibrin solubility product

40
Q

Aside from DVTs, what else can cause a PE?

A

1) Amniotic fluid embolus
2) Fat embolus
3) Hypercoaguable state
4) Cancer

41
Q

What is the etiology of PV?

A

Polycythemia Vera= neoplastic proliferation of myeloid cells, esp. RBC

42
Q

What mutation is associated with PV?

A

JAK2

43
Q

What are the symptoms of PV?

A

Hyperviscosity Syndrome:

1) Itching with bathing
2) Headache
3) Blurred vision

44
Q

What is a serious complication of PV?

A

Budd Chiari Syndrome

45
Q

What is treatment for PV?

A

1) Phlebotomy
2) ASA
3) Hydroxyurea

46
Q

How is PV distinguished from reactive polycythemia?

A
  • PV= decreased EPO, SaO2 normal

- Reactive= low SaO2, increased EPO

47
Q

What are the SaO2 and EPO findings associated with RCC?

A

Normal SaO2 and high EPO

48
Q

What are the lab findings in PV?

A

1) High WBC

2) ALL myeloid cells are increased, more so of the 1 lineage affected

49
Q

What is the full differential for a patient with macrocytic anemia not attributable to folate or B12 deficiency?

A

1) Hypothyroidism
2) Liver Disease
3) Alcoholism
4) Myelodysplastic Syndrome

Hematology and Oncology (38 decks)

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