FNP-Hematology

Question 1

What is Reticulocytosis?

Answer 1

immature RBCs, slightly larger than a RBC

Question 2

Lab value for neutropenia

Answer 2

ANC <1,500/mm^3

Question 3

Vitamin B12 Deficiency

[know the lab results, s/sx, common causes)

Answer 3

Peripheral smear: shows macroovalocytes, some megaloblasts & multisegmented neutrophils (>5-6 lobes)

Neurological signs (numbness, ataxia with positive Romberg test, loss of vibration, possible sense, impaired memory, dementia in severe cases).

Common cases: malabsorption (d/t pernicicious anemia, gastric disease/infection or medications).

Question 4

Multiple Myeloma

Definition & symptoms

Answer 4

Cancer of plasma cells
Symptoms-fatigue, weakness & bone pain
Causes proteinuria w/ Bence-Jones proteins, hypercalcemia, normocytic anemia

Question 5

Normal MCV value

Answer 5

80-100 (Size of RBC’s)
<80: microcytic
>100: macrocytic

Question 6

Normal value of Mean Corpuscular Hgb Concentration (MCHC)

Answer 6

31.0-37.0g/dL

Measure color of RBCs

Question 7

Which anemia(s) has decrease MCHC?

Answer 7

iron-deficiency anemia & thalassemia (hypochromic)

Question 8

Is total iron-binding capacity (TIBC) increased or decreased in iron-deficiency anemia?

Answer 8

TIBC is a measure of available transferrin that is left unbound (to iron) & it is ELEVATED when there is not enough iron to transport

Question 9

What lab test is most sensitive for iron-deficiency anemia?

Answer 9

Serum ferritin (not serum iron b/c it is not as sensitive as ferritin & can be affected by recent blood transfusions)

Question 10

What is poikilocytosis?

Answer 10

Abnormal RBCs w/ variable shapes seen on peripheral smear. Seen w/ severe deficiency anemia

Question 11

What is Anisocytosis?

Answer 11

Variable sizes of RBCs

Question 12

What is the gold-standard test to diagnose hemoglobinopathies such as sickle cell anemia & thalassemia?

Answer 12

Hemoglobin electrophoresis

Question 13

Iron-deficiency Anemia (know symptoms & lab results)

Answer 13

Pallor of skin, conjunctiva & nail beds, daily fatigue, exertional dyspnea, may have glossitis (sore & shiny red tongue, angular cheilitis, pica, konilonychia (in severe cases), systolic murmurs, tachycardia, or heart failure.

Microcytic & hypochromic (small & pale RBCs)

Question 14

Name some macrocytic anemias

Answer 14

Pernicious anemia, folate deficiency, Vitamin B12 deficiency

Question 15

What are the RBC changes in thalassemia minor?

Answer 15

Abnormal in Beta-thalassemia (microcytic, hypochromic), Normal if alpha-thalassemia

Question 16

What should you avoid taking iron pill with?

Answer 16

Antacid-wait about 4 hours (b/c it minimize binding)

Tetracycline antibiotics, levothyroxine & bisphosphonates (iron decreases its effectiveness)

Question 17

What are food sources of Vitamin b12?

Answer 17

all foods of animal origin (meat, poultry, eggs, milk & cheese)

Question 18

What do you always check both vitamin B12 & folate level together?

Answer 18

A pt can be deficient in both B12 & folate. H/H will go up with folate supplementation only (even if still deficient in B12).

Question 19

What is the treatment for pernicious anemia?

Answer 19

B12 injections 1000mcg (1mg) per week x4 weeks, then monthly injections OR high oral doses (1,000-2,000mcg) daily

Question 20

What lab results should cause you to suspect pernicious anemia?

Answer 20

ELEVATED Parietal antibody test (antiparietal antibody) and/ or intrinsic factor antibody tests (anti-IF)