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HEME/ONC > flex case (anemia & thrombocytopenia) > Flashcards

flex case (anemia & thrombocytopenia) Flashcards

1
Q

causes of anemia

A

RBC loss
impaired production (hypoproliferative)
increased destruction

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2
Q

what is the issue with secondary hemostasis?

A

clotting factors

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3
Q

what lab to get for primary hemostasis

A

CBC

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4
Q

what lab to get for secondary hemostasis

A

PT/INR
aPTT

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5
Q

what type of bleeding do you see with primary hemostasis

A

petechiae, mucosal

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6
Q

what type of bleeding do you see with secondary hemostasis?

A

hemarthrosis, hematomas, ICH, GI bleeds

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7
Q

which type of hemostasis is epistaxis and menorrhagia common?

A

primary hemostasis

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8
Q

which 4 factors are involved in the intrinsic pathway

A

8, 9, 11, 12

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9
Q

extrinsic pathway factors (1)

A

7

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10
Q

which factors/proteins are vitamin K dependent? (6)

A

2,7,9,10
protein C & S

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11
Q

what is the most common bleeding disorder? (hint: autosomal dominant d/o)

A

vWD

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12
Q

what kind of bleed do you see with vWD?

A

primary hemostasis

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13
Q

why might you see hemarthroses with vWD?

A

bc factor 8 is involved

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14
Q

2 things you need to diagnose vWD?

A

vWF antibodies
factor VIII activity

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15
Q

with vWB you have prolonged bleeding time but normal platelet count, why?

A

bc the issue isn’t the platelets itself, the issue is with the factor

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16
Q

3 sx of hemophilia

A

hemarthoses
hematomas
ICH

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17
Q

two labs you need to diagnose hemophilias

A

aPTT
factor levels

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18
Q

hemophilia A is a deficiency of which factor?

A

factor 8

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19
Q

hemophilia B is a deficiency of which factor?

A

factor 9

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20
Q

how do you treat hemophilia?

A

replace the missing factor

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21
Q

how do you treat vWD?

A

DDAVP if its type 1 or 2
Humate P or alphate if unsure (replacement therapy)

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22
Q

how does DDAVP work?

A

causes release of immobilized vWF; its an analog of ADH

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23
Q

4 microcytic anemias (TICS)

A

thalassemia
iron deficiency
chronic (30%)
sideroblastic

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24
Q

3 sx of iron deficiency anemia

A

pica
heavy menses/blood loss
melena

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25
Q

3 things to diagnose iron deficiency anemia

A

low iron
low ferritin
HIGH TIBC

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26
Q

sx of thalassemia (A vs B)

A

A– variable sx (mild to fetal death)
B– sx start at 4-6 mo old

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27
Q

5 things to diagnose thalessemia

A

LOW MCV
Dx w/ Hg
normal iron stores
splenomegaly
electrophoresis

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28
Q

how is thalessemia treated?

A

iron chelation transfusions
bone marrow bx is curative

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29
Q

what is thalessemia

A

diminished or absent synthesis of globin chains

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30
Q

3 lab values for anemia of chronic dz diagnosis

A

Low iron & TIBC
high ferritin
high ESR/CRP

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31
Q

what do you give to someone in renal failure with anemia of chronic dz?

A

EPO

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32
Q

how is sideroblastic anemia diagnosed (3)

A

sideroblasts
basophilic stippling
lead level

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33
Q

how is sideroblastic anemia treated?

A

chelate lead

34
Q

in all anemias, what do you do when Hg is <7?

A

TRANSFUSION!!!

35
Q

what is anemia of chronic dz

A

RBC survival reduction and increased hepcidin bc of inflammation which blocks iron release and mobilization

36
Q

what is ferritin

A

it is an acute phase reactant often elevated in response to inflammation
iron storage

37
Q

why is iron low in anemia of chronic dz?

A

not being used by bone marrow or marrow isn’t responding to erythropoietin

38
Q

name the two macrocytic anemias

A

vitamin B12 deficiency
folate deficiency

39
Q

which tends to have a lower MCV– iron deficiency or thalessemia

A

thalessemia (60s)

40
Q

which anemia tends to be seen in vegans, ppl who drink, malabsorption and has neurologic sx?

A

vitamin B12 deficiency

41
Q

MMA & homocysteine differences in B12 and folate deficiencies

A

B12– HIGH MMA & homocysteine
folate– normal MMA & HIGH homocysteine

42
Q

why is folate deficiency not seen much with absorption issues?

A

it is absorbed throughout the entire GI tract

43
Q

pernicious anemia is a subset of what anemia?

A

vit B12 deficiency anemia

44
Q

which anemia is caused by lack of intrinsic factor or anti-intrinsic factor antibodies?

A

pernicious anemia– common in older age

45
Q

if a patient has classic anemic sx + jaundice or splenomegaly, what type of anemia should you suspect?

A

hemolytic anemia

46
Q

level of retics in all hemolytic anemias

A

high (>2%)

47
Q

LDH and bilirubin levels in all hemolytic anemias

A

HIGH (markers of hemolysis)

48
Q

name the 3 hereditary hemolytic anemias

A

sickle cell
hereditary spherocytosis
G6PD deficiency

49
Q

what is sickle cell anemia

A

splenomegaly– sequestration and destruction of abnormally shaped cells

50
Q

how is sickle cell diagnosed?

A

Hg-S on electrophoresis

51
Q

how is hereditary spherocytosis diagnosed?

A

spherocytes on blood smear

52
Q

how is hereditary spherocytosis treated?

A

based on severity, supportive to splenectomy (the definitive treatment)

53
Q

what is G6PD deficiency?

A

an x-linked recessive (males) enzyme deficiency

54
Q

how is G6PD diagnosed

A

heinz bodies on blood smear

55
Q

how is G6PD treated?

A

avoid oxidative drugs and fava beans

56
Q

what is aplastic anemia?

A

bone marrow damage causing pancytopenia

57
Q

what would a bone marrow bx show in aplastic anemia?

A

fat cells!

58
Q

causes of aplastic anemia

A

meds
chemo/radiation
benzene

59
Q

which two meds did we say causes aplastic anemia

A

sulfa
chloramphenicol

60
Q

how is aplastic anemia treated?

A

based on severity- transfusion, transplant

61
Q

two conditions that have pancytopenia that we talked about

A

MDS/cancer
aplastic anemia

62
Q

5 conditions with increased risk of thrombosis (prothrombotic) & familial

A

Factor V Leiden
Prothrombin Gene Mutation
Protein C,S Deficiencies
Antithrombin III Deficiency
Antiphospholipid syndrome (APS)

63
Q

name 4 thrombocytopenias

A

ITP
TTP
HUS
DIC

64
Q

what is the most common thrombocytopenia

A

ITP

65
Q

which thrombocytopenia is post viral and no systemic illness?

A

ITP

66
Q

does ITP have spont. hemarthroses?

A

Nope

67
Q

3 sx of ITP

A

mucosal or skin purpura
epistaxis
oral bleeding

68
Q

expected labs with ITP

A

low platelets with other labs normal

69
Q

how is ITP treated?

A

its self limited
use steroids if platelets <50k
IVIG

70
Q

which thrombocytopenia would show schistocytes?

A

TTP

71
Q

sx of TTP

A

sick, fever
hemolytic anemia/thrombocytopenia/renal insuf
mental status changes

72
Q

expected labs with TTP

A

high LDH
low haptoglobin; normal coags
coombs negative

73
Q

how is TTP tx? (2)

A

plasma exchange
steroids (+/-)
its fatal if not treated

74
Q

causes of DIC

A

sepsis
trauma/burn
pregnancy complication
cancer liver dz

75
Q

which thrombocytopenia involves overactivating clotting system that depletes factors?

A

DIC

76
Q

3 things you need for DIC diagnosis

A

prolonged PT, PTT (coag factors impaired)
low fibrinogen
elevated D-dimer

77
Q

how is DIC tx?

A

underlying cause, replace consumed factors, blood products

78
Q

typical patient with HUS

A

kid who ate raw meat and likely has an ecoli shigatoxin infection

79
Q

2 sx of HUS

A

diarrhea
neuro involvement in some

80
Q

how is HUS diagnosed? (3)

A

renal failure (high creatinine)
hemolytic anemia
normal coagulation

81
Q

how is HUS tx? (2)

A

steroids
FFP

HEME/ONC (5 decks)

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