Fatigue DSA + Reading Flashcards
What hemotologic causes of fatigue are specific to dyspnea?
anemia
lymphadenopathy
malignancy
What do telangiectasias suggest?
connective tissue dz or hereditary hemorrhagic telangiectasia
What is the best test to run to work-up anemia?
reticulocyte count
What are the five general defects causing decreased reticulocyte count and anemia?
defects of stem cells (aplastic anemia)
proliferation/distribution defects of erythroid progenitor cells (chronic kidney dz)
disturbances of DNA synthesis (megaloblastic anemia)
disturbance of hemoglobin synthesis
unknown or multiple mechanisms (chronic dz, marrow infiltration)
What labs will you see in iron deficiency anemia?
mucrocytic hypochromic anemia
low iron and ferritin
increased TIBC
How do you treat anemia of chronic dz?
(iron supplementation is NOT effective)
supportive care if anemia is mild (Hb 10-12)
if severe, transfusions may be helpful
What is factitious anemia
autophlebotomy
underlying psych issue
What is march hemoglobinuria?
feet striking ground repeatedly damages RBCs in capillaries on soles of feet –> pee blood the next morning
What is cardiac anemia?
pts w/ severe aortic stenosis and pts w/ prosthetic valves –> get lysis of RBCs –> mild anemia
What do you see on smear of G6PD deficiency?
heinz bodies - denature hb
Bite cells - denatured hb removed by spleen
anemia - normochromic
How does lead cause anemia?
interferes w/ cation pump - shortened RBC survival time
inhibits ferochelatase –> buildup of protoporphorin and decr heme synthesis
inhibits ALAD –> buildup of ALA
What is the most common cause of hemolytic anemia worldwide?
malaria
What types of Immunoglobulins cause cold and warm immune-mediated hemolytic anemia?
(its always warm in Georgia, its cold in minnesota)
IgG –> warm
IgM –> cold
What is the main tx for Immune-mediated hemolytic anemia?
high-dose steroids
can use transfusions if needed
cyclophosphamide and azathioprine if refractory
splenectomy if chronic
What are the sx of polycythemia vera?
facial rubor
hyperviscosity signs - HA, dizziness, blurred vision, heaviness in arms or legs
pruritis w/ hot shower/bath
splenomegaly (frequently involved in extramedullary hematopoiesis in spent phase)
What are the risks of polycythemia vera?
w/out tx –> thrombotic complications (budd-chiary syndrome)
usual cause of death in treated pts is progressive marrow fibrosis w/ pancytopenia (spent phase)
What do you have to rule out when evaluating someone with polycythemia vera?
abnormal lung function (smokers often have elevated carboxyhemoglobin)
interstitial lung dz - would see decreased DLCO
What mutation is associated w/ polycythemia vera?
JAK-2
w/ normal serum EPO, ID’s 98% of P. vera pts
How do you tx p. vera?
phlebotomy of 250-500 cc every 1-2 weeks as long as Hct > 50%
usually keep doing this every 6-12 weeks
can use hydroxyurea
What is the risk of using alkylating agents to tx P. vera?
therapy-related leukemia
What sleep disorder should be considered w/ cc of fatigue?
obstructive sleep apnea
What drugs are commonly associated with fatigue?
antidepressants
antipsychotics
anxiolytics
opiates
antispasticity and antiseizure agents
beta blockers
What is chronic multisymptom illness?
gulf-war syndrome
prominent fatigue is noted in presentation
Why should you do a formal neuro exam when working up fatigue?
to rule out objective muscle weakness
