Hematalogic Disorders Flashcards
Most common type of anemia?
Iron deficiency anemia (IDA)
Medications that prevent micronutrient absorption & contribute to anemia
Chronic (>8 wks) PPI use (vitamin B12 & Iron malabsorption), Metformin (Vitamin B12 malabsorption)
Normal RBC lifespan?
90-120 days
Hemoglobin to hematocrit (H&H) ratio?
1:3 (*may be altered in dehydration)
Microcytic cell size?
MCV <80 fL
Normocytic cell size?
MCV 80-96 fL
Macrocytic cell size?
MCV >96 fL
Small RBCs are always ____ RBCs? (hint: color)
Pale
What is a normal RDW (RBC distribution width)?
11.5-15%
– >15% = new cells differ in size (larger or smaller) when compared with older cells
– likely earliest lab indicator of evolving micro/macrocytic anemia
What are reticulocytes?
Young RBCs (Normal = 1-2%)
Most common etiologies for normocytic anemia in primary care (rank order)?
- Anemia of chronic disease
- Chronic kidney disease
- Acute blood loss
Most common etiologies for microcytic anemia with elevated RDW in primary care?
- Iron deficiency
- Plumbism (lead toxicity)
What is ferritin testing used to identify?
Estimate of iron stores
*Tip: always order ferritin over iron studies (those are done in specialty areas)
Most common etiology for microcytic anemia with normal RDW in primary care?
Alpha or beta thalassemia minor
At-risk ethnic groups for alpha thalassemia minor? (hint: AAA)
Asian, African ancestry
At-risk ethnic groups for beta thalassemia minor? (hint: BAMME) *more common in North America
African, Mediterranean, Middle Eastern ancestry
Most common etiology for macrocytic anemia with elevated RDW in primary care?
- Vitamin B12 deficiency (especially pernicious anemia)
- Folate deficiency anemia
*Vit B12 deficiency will give most macrocytic in size
Types of drug-induced macrocytosis usually without anemia?
- Alcohol excess (men >5/day, women >3/day) *RBCs are “swollen”
- Antiepileptic drugs –> carbamazepine (Tegretol), phenytoin (Dilantin), methotrexate
**Medical treatment typically not needed; counsel about ETOH use
How to differentiate IDA vs thalassemia trait anemia (both microcytic)?
Increased RDW in IDA vs. normal RDW in thalassemia trait
What micronutrient may be deficient in someone who follows a vegan diet?
Vitamin B12 (common in animal foods –> meat, poultry, eggs, milk, cheese)
Most common types of anemia in the elderly (rank order)?
- Anemia of chronic disease (ACD)
- IDA
- Pernicious anemia (distant 3rd)
How is oral iron therapy best absorbed?
On an empty stomach
**Avoid taking with antacids or milk (med will bind to substances & may cause to be less effective). May cause GI upset (nausea, constipation)
**Vit C is marginally effective in increasing absorption
Pale conjunctiva on physical exam is a(n) (earlier/later) sign of anemia?
Later sign (usually present in hgb < 9 g/dL)
A hemic murmur may be caused from?
Profound dehydration, febrile, hyperthyroid toxicosis
Profound anemia (ex: hgb=6 g/dL) may increase the risk for? (hint: cardiac)
Myocardial ischemia
Glossitis (smooth, red tongue) may be present in what type of anemia?
Vit B 12 deficiency (ex: pernicious anemia)
What nutritional supplements can increase the bleeding risk?
Ginseng, gingko, garlic, fish oil
**should be discontinued at least 7-10 days prior to surgical procedure & use in caution with ASA, DOACs, warfarin
What is the average lifespan of a platelet?
7-10 days
**Platelet life is permanently altered by med for life span (ex: aspirin)
Normal hgb?
Female: 12-16 g/dL
Male: 14-18 g/dL
Normal hct?
Female: 36-47%
Male: 42-52%
Normal RBC for female?
4.2-5.4 million/mm3
Normal MCV?
80-96 fL
Normal MCH?
25-35 pg/cell
Normal MCHC?
31-37 g/dL
Total iron-binding capacity (TIBC) is (elevated/decreased) in IDA?
Elevated (not enough iron to transport)
*TIBC normal in thalassemia, vit B12 deficiency, folate-deficiency anemia (iron levels are normal)
What is total iron-binding capacity (TIBC)?
Measure of available transferrin left unbound to iron
*Normal= 250-410
*Elevated if not enough iron to transport (ex: IDA)
What is the most sensitive test for IDA?
Serum ferritin
*Decreased in IDA; normal to high in thalassemia minor/trait
*Normal: 20-40 ng/mL
What is serum ferritin?
Stored form of iron
What is anisocytosis?
RBCs with variable sizes
What is poikilocytosis?
RBCs with variable shapes (seen with severe IDA)
Normal RDW?
11.5-15%
Normal total WBC?
6,000-10,000
Neutrophils (poly/segs) are associated with?
Bacteria
**Normal % in differential = ~60%
Lymphocytes are associated with?
Virus
**Normal % in differential = ~30%
Monocytes are associate with?
Debris
**“Monos tidy up debris”. May have increase in % a few days after illness, surgery, etc.
**Normal % in differential= ~6%
Eosinophils are associated with?
Allergens, parasites (“worms, wheezes, weird diseases”)
**Normal % in differential= ~3%
Basophils are associated with?
Anaphylaxis
**Normal % in differential= ~1%
Mnemonic to help recall WBC cell lines & order of reporting?
Nobody (neutrophil; 60%)
Likes (lymphocyte; 30%)
My (monocyte; 6%)
Educational (eosinophil; 3%)
Background (basophil; 1%)
What occurs in a “left shift?”
Leukocytosis (elevated WBC >10,000), neutrophilia (neutrophils >60%), bandemia (bands >4%)
Neutropenia defined by ANC of?
<1,500/mm3
Medication causes of neutropenia?
psychotropics, antivirals, antibiotics, NSAIDs, antithyroids, ACEIs, propranolol
Clinical presentation of vitamin B12 deficiency?
Gradual onset of symmetric peripheral neuropathy (starting in feet and/or arms)
Other: numbness, ataxia (+ Romberg test), impaired memory, loss of vibration & position sense
Hodgkins Lymphoma clinical presentation? (cancer of beta lymphocytes/B cells)
Night sweats, fevers, pain with ingestion of alcoholic drinks
Other: generalized pruritis with painless enlarged lymph nodes (neck), anorexia, weight loss. (“B” symptoms)
*Presence of Reed-Sternberg cells
Non-Hodgkin’s Lymphoma clinical presentation? (cancer of lymphocytes/B cells and killer cells
Night sweats, fever, weight loss, generalized lymphadenopathy (painless)
*Poor prognosis
Multiple myeloma clinical presentation? (cancer of plasma cells)
Fatigue, weakness, bone pain (back or chest)
*CRAB (hypercalcemia, renal failure (Bence-Jones proteinuria), anemia, bone disease
Hemophila A (X-linked recessive disease) is caused by Factor ___ deficiency?
VIII
Total iron-binding capacity (TIBC) is (elevated/decreased) in IDA?
Elevated (not enough iron to transport)
*TIBC normal in thalassemia, vit B12 deficiency, folate-deficiency anemia (iron levels are normal)
What is anisocytosis?
RBCs with variable sizes
Gold-standard test to diagnose hemoglobinopathies (ex: sickle cell anemia, thalassemias)
Hemoglobin electrophoresis (only need to do once)
Examples of iron-rich foods?
Red meat, some beans (ex: black beans), green leafy vegetables
Types of antibiotics to avoid taking with iron supplement?
Quinolones, tetracyclines (iron binds to substances and becomes inactivated)
Homocysteine levels are increased in _____ & _____ deficiency anemia?
Folate (primarily) & Vit B 12
Antiparietal antibodies are elevated in ____ anemia?
Pernicious anemia
Average life span of RBC in sickle-cell anemia?
10-20 days
*Howell-Jolly bodies and target cells present on peripheral smear
Best absorbed and cheapest iron supplementation available OTC?
Ferrous sulfate
Aplastic anemia lab presentation?
Pancytopenia (leukopenia, anemia, thrombocytopenia)
*May be related to radiation, drug ADRs, viral infection)
*Bone marrow biopsy is gold standard diagnostic test
Ferritin, serum iron, TIBC, and MCHC are all normal/abnormal in thalassemia trait compared to IDA
Normal
