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AGNP Board Exam > Hematalogic Disorders > Flashcards

Hematalogic Disorders Flashcards

1
Q

Most common type of anemia?

A

Iron deficiency anemia (IDA)

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2
Q

Medications that prevent micronutrient absorption & contribute to anemia

A

Chronic (>8 wks) PPI use (vitamin B12 & Iron malabsorption), Metformin (Vitamin B12 malabsorption)

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3
Q

Normal RBC lifespan?

A

90-120 days

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4
Q

Hemoglobin to hematocrit (H&H) ratio?

A

1:3 (*may be altered in dehydration)

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5
Q

Microcytic cell size?

A

MCV <80 fL

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6
Q

Normocytic cell size?

A

MCV 80-96 fL

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7
Q

Macrocytic cell size?

A

MCV >96 fL

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8
Q

Small RBCs are always ____ RBCs? (hint: color)

A

Pale

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9
Q

What is a normal RDW (RBC distribution width)?

A

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

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10
Q

What are reticulocytes?

A

Young RBCs (Normal = 1-2%)

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11
Q

Most common etiologies for normocytic anemia in primary care (rank order)?

A
  1. Anemia of chronic disease
  2. Chronic kidney disease
  3. Acute blood loss
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12
Q

Most common etiologies for microcytic anemia with elevated RDW in primary care?

A
  1. Iron deficiency
  2. Plumbism (lead toxicity)
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13
Q

What is ferritin testing used to identify?

A

Estimate of iron stores
*Tip: always order ferritin over iron studies (those are done in specialty areas)

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14
Q

Most common etiology for microcytic anemia with normal RDW in primary care?

A

Alpha or beta thalassemia minor

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15
Q

At-risk ethnic groups for alpha thalassemia minor? (hint: AAA)

A

Asian, African ancestry

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16
Q

At-risk ethnic groups for beta thalassemia minor? (hint: BAMME) *more common in North America

A

African, Mediterranean, Middle Eastern ancestry

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17
Q

Most common etiology for macrocytic anemia with elevated RDW in primary care?

A
  1. Vitamin B12 deficiency (especially pernicious anemia)
  2. Folate deficiency anemia

*Vit B12 deficiency will give most macrocytic in size

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18
Q

Types of drug-induced macrocytosis usually without anemia?

A
  1. Alcohol excess (men >5/day, women >3/day) *RBCs are “swollen”
  2. Antiepileptic drugs –> carbamazepine (Tegretol), phenytoin (Dilantin), methotrexate

**Medical treatment typically not needed; counsel about ETOH use

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19
Q

How to differentiate IDA vs thalassemia trait anemia (both microcytic)?

A

Increased RDW in IDA vs. normal RDW in thalassemia trait

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20
Q

What micronutrient may be deficient in someone who follows a vegan diet?

A

Vitamin B12 (common in animal foods –> meat, poultry, eggs, milk, cheese)

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21
Q

Most common types of anemia in the elderly (rank order)?

A
  1. Anemia of chronic disease (ACD)
  2. IDA
  3. Pernicious anemia (distant 3rd)
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22
Q

How is oral iron therapy best absorbed?

A

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

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23
Q

Pale conjunctiva on physical exam is a(n) (earlier/later) sign of anemia?

A

Later sign (usually present in hgb < 9 g/dL)

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24
Q

A hemic murmur may be caused from?

A

Profound dehydration, febrile, hyperthyroid toxicosis

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25
Q

Profound anemia (ex: hgb=6 g/dL) may increase the risk for? (hint: cardiac)

A

Myocardial ischemia

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26
Q

Glossitis (smooth, red tongue) may be present in what type of anemia?

A

Vit B 12 deficiency (ex: pernicious anemia)

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27
Q

What nutritional supplements can increase the bleeding risk?

A

Ginseng, gingko, garlic, fish oil

**should be discontinued at least 7-10 days prior to surgical procedure & use in caution with ASA, DOACs, warfarin

28
Q

What is the average lifespan of a platelet?

A

7-10 days

**Platelet life is permanently altered by med for life span (ex: aspirin)

29
Q

Normal hgb?

A

Female: 12-16 g/dL
Male: 14-18 g/dL

30
Q

Normal hct?

A

Female: 36-47%
Male: 42-52%

31
Q

Normal RBC for female?

A

4.2-5.4 million/mm3

32
Q

Normal MCV?

A

80-96 fL

33
Q

Normal MCH?

A

25-35 pg/cell

34
Q

Normal MCHC?

A

31-37 g/dL

35
Q

Total iron-binding capacity (TIBC) is (elevated/decreased) in IDA?

A

Elevated (not enough iron to transport)

*TIBC normal in thalassemia, vit B12 deficiency, folate-deficiency anemia (iron levels are normal)

36
Q

What is total iron-binding capacity (TIBC)?

A

Measure of available transferrin left unbound to iron
*Normal= 250-410
*Elevated if not enough iron to transport (ex: IDA)

37
Q

What is the most sensitive test for IDA?

A

Serum ferritin

*Decreased in IDA; normal to high in thalassemia minor/trait
*Normal: 20-40 ng/mL

38
Q

What is serum ferritin?

A

Stored form of iron

39
Q

What is anisocytosis?

A

RBCs with variable sizes

40
Q

What is poikilocytosis?

A

RBCs with variable shapes (seen with severe IDA)

41
Q

Normal RDW?

A

11.5-15%

42
Q

Normal total WBC?

A

6,000-10,000

43
Q

Neutrophils (poly/segs) are associated with?

A

Bacteria

**Normal % in differential = ~60%

44
Q

Lymphocytes are associated with?

A

Virus

**Normal % in differential = ~30%

45
Q

Monocytes are associate with?

A

Debris

**“Monos tidy up debris”. May have increase in % a few days after illness, surgery, etc.
**Normal % in differential= ~6%

46
Q

Eosinophils are associated with?

A

Allergens, parasites (“worms, wheezes, weird diseases”)

**Normal % in differential= ~3%

47
Q

Basophils are associated with?

A

Anaphylaxis

**Normal % in differential= ~1%

48
Q

Mnemonic to help recall WBC cell lines & order of reporting?

A

Nobody (neutrophil; 60%)
Likes (lymphocyte; 30%)
My (monocyte; 6%)
Educational (eosinophil; 3%)
Background (basophil; 1%)

49
Q

What occurs in a “left shift?”

A

Leukocytosis (elevated WBC >10,000), neutrophilia (neutrophils >60%), bandemia (bands >4%)

50
Q

Neutropenia defined by ANC of?

A

<1,500/mm3

51
Q

Medication causes of neutropenia?

A

psychotropics, antivirals, antibiotics, NSAIDs, antithyroids, ACEIs, propranolol

52
Q

Clinical presentation of vitamin B12 deficiency?

A

Gradual onset of symmetric peripheral neuropathy (starting in feet and/or arms)
Other: numbness, ataxia (+ Romberg test), impaired memory, loss of vibration & position sense

53
Q

Hodgkins Lymphoma clinical presentation? (cancer of beta lymphocytes/B cells)

A

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

54
Q

Non-Hodgkin’s Lymphoma clinical presentation? (cancer of lymphocytes/B cells and killer cells

A

Night sweats, fever, weight loss, generalized lymphadenopathy (painless)

*Poor prognosis

55
Q

Multiple myeloma clinical presentation? (cancer of plasma cells)

A

Fatigue, weakness, bone pain (back or chest)

*CRAB (hypercalcemia, renal failure (Bence-Jones proteinuria), anemia, bone disease

56
Q

Hemophila A (X-linked recessive disease) is caused by Factor ___ deficiency?

A

VIII

57
Q

Total iron-binding capacity (TIBC) is (elevated/decreased) in IDA?

A

Elevated (not enough iron to transport)

*TIBC normal in thalassemia, vit B12 deficiency, folate-deficiency anemia (iron levels are normal)

58
Q

What is anisocytosis?

A

RBCs with variable sizes

59
Q

Gold-standard test to diagnose hemoglobinopathies (ex: sickle cell anemia, thalassemias)

A

Hemoglobin electrophoresis (only need to do once)

60
Q

Examples of iron-rich foods?

A

Red meat, some beans (ex: black beans), green leafy vegetables

61
Q

Types of antibiotics to avoid taking with iron supplement?

A

Quinolones, tetracyclines (iron binds to substances and becomes inactivated)

62
Q

Homocysteine levels are increased in _____ & _____ deficiency anemia?

A

Folate (primarily) & Vit B 12

63
Q

Antiparietal antibodies are elevated in ____ anemia?

A

Pernicious anemia

64
Q

Average life span of RBC in sickle-cell anemia?

A

10-20 days

*Howell-Jolly bodies and target cells present on peripheral smear

65
Q

Best absorbed and cheapest iron supplementation available OTC?

A

Ferrous sulfate

66
Q

Aplastic anemia lab presentation?

A

Pancytopenia (leukopenia, anemia, thrombocytopenia)

*May be related to radiation, drug ADRs, viral infection)
*Bone marrow biopsy is gold standard diagnostic test

67
Q

Ferritin, serum iron, TIBC, and MCHC are all normal/abnormal in thalassemia trait compared to IDA

A

Normal

AGNP Board Exam (2 decks)

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