Fatigue Flashcards
What are common malignant causes of fatigue?
Leukemia, lymphoma, plasma cell disorders, metastatic solid tumors, paraneoplastic disorders, secondary hematologic causes
What are some history q’s to ask for a possible hematology pt w fatigue?
Fever or night sweats? Bleeding (GI, GU, etc) LN swelling? Early satiety or weight loss Prior hx of tx for cancer?
What are some possible causes of SOB in hematologic fatigue pt?
Pleural effusion, pericardial effusion, anemia, constrictive pericardial sx, LAD
What should you look for on PE for evidence of hematologic dz?
petechiae, purpura, ecchymoses, hematoma, hemarthrosis, telangiectasis
What is the ONE TEST you should always order if suspecting anemia?
The reticulocyte count!
Labs and clinical features of iron deficiency
microcytic hypochromic anemia presenting w constitutional symptoms
Have decreased serum iron and ferritin, but increased TBIC
What is one way to know if a pt has anemia of chronic disease?
doesn’t respond to iron supplementation
What is factitious anemia?
Anemia due to autophlebotomy - could have underlying psychiatric disease
Mechanical anemia
feet striking ground repeatedly causes damaged of RBCs in capillaries on plantar surface of feet.
common in marathon runners. tx w padded footwear
Cardiac anemia
usually mild but found in pt w severe aortic stenosis and pt w prosthetic valves and ongoing lysis of RBCs
Enzyme deficiency
Has heinz bodies, collections of denatured Hb.
found early in G6PD pt. also have bite cells once Hb is removed by macrophages.
normocytic normochromic anemia
Lead anemia
hemolytic anemia interfering w cation pump and shortening RBC tine line
slows production of RBCs in marrow
Malaria
MC cause of hemolytic anemia in the world
can have severe hemolysis w dark urine bc of hemoglobinuria
Tx of warm ab hemolytic anemia
most aren’t in danger but transfusions can be helpful - watch for cross matching hemolysis
steroids in high doses can cause long-lasting remission
Immunosuppressives can also be of benefit
sometimes need splenectomy if pt requires chronic steroid use
clinical signs of polycythemia vera
facial rubor, pruritis w hot water, and signs of hyper viscosity.
Splenomegaly in 70%
DDx of PV
hemoconcentration, COPD, EPO producing tumors (RCC and neuroendocrine), hemoglobinpathy w high affinity Hb
Evaluation of PV
PE, CBC, CMP, dehydrated? EPO and US of kidneys maybe.
Want to evaluated lungs w PFT
what is a common mutation in PV?
JAK, esp w normal EPO levels
Tx of PV?
Phelbotomy
What is the typical definition of fatigue?
Difficulty initiating or maintaining voluntary mental or physical activity
If a patient complains of fatigue and is then also noted to have muscle weakness, what should be your next step?
Localize to CNS, PNS, NMJ, or muscle
What disease has fatiguability of muscle power as a presenting sx?
Myasthenia Gravis - diminution of force that muscle generates on repeat contraction
Episodic fatigue can be a premonitory sx of _____
migraine
Fatigue combined w true muscle weakness, hair loss, dry skin, weight gain, cold intolerance, constipation is likely to be ______
Hypothyroidism
If a person is fatigued, and has heat intolerance, sweating, and palpitations they probably have _______
hyperthyroidism
Adrenal insufficiency can manifest w fatigue and ?
Anorexia, weight loss, nausea, myalgia, and arthralgia
Mild hypercalcemia v severe hypercalcemia
Mild –> a lil fatigue
Severe –> lethargy, stupor, coma
Which two chronic organ specific diseases can cause fatigue?
Liver failure and chronic kidney disease
Which two cardiopulm diseases often have fatigue as a sx negatively affecting QOL?
Congestive heart failure and COPD
Which symptoms associated w fatigue should raise the alarm for malignancy or occult infection?
fever, chills, night sweats, weight loss
What should be given special attention in the SHx?
Life stressors, work hours, social support, domestic affairs
Fatiguable weakness does not have ______ like patients with fatigue normally do
Breakaway weakness
If at pt has widespread MSK pain w tender points what should you be considering?
Fibromyalgia
What is a reasonable lab workup in pt presenting w faitgue?
CBC w diff Electrolytes Glucose Renal fxn Liver fxn Thyroid fxn
Which cytokines in early aggressive leukemia or lymphomas are responsible for causing fatigue?
IL-1, IL-6, IL-8
Which drugs could reduce fatigue sx?
Psychostimulants like amphetamines, modafinil, and armodafinil
