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FNP boards > Hematological and select immunological disorders > Flashcards

Hematological and select immunological disorders Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

True/false: Symptoms of anemia seldom occur unless hemoglobin levels decrease to less than 10 g/dL

A

True

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2
Q

Anemia diagnostic testing

A

First line test → CBC

  • Note hemoglobin, hematocrit, and RBC values
  • What is the RBC size (MCV)
    • Microcytic (low MCV) → impaired hemoglobin synthesis
      • Ex: IDA, thalassemia
      • Will also have low MCH and MCHC
    • Macrocytic (high MCV) → impaired RNA and DNA synthesis
      • Ex: folic acid and vitamin b12
      • Normochromic (MCH) and normal MCHC
    • Normocytic
      • Ex: acute blood loss, anemia of chronic disease
      • What is the hemoglobin content (color) of the cell (MCH or MCHC)
    • What is the RDW (RBC distribution width)
      • Degree of variation in RBC size
    • What is the % of reticulocytes
      • Body attempts to create new cells (reticulocytes) in anemia
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3
Q

What is the RBC size?

  • Microcytic vs normocytic vs macrocytic
A

Microcytic → MCV less than 80

Normocytic → MCV 80-96

Macrocytic → MCV greater than 96

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4
Q

What is the RBCs hemoglobin content (MCH and MCHC)?

  • Normochromic vs hypochromic
A

Normochromic → MCHC 31-37

Hypochromic → MCHC less than 31 (pale)

  • Microcytic and hypo chromic go together
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5
Q

Common causes of iron deficiency anemia (IDA)

A

Chronic blood loss

  • Occult GI blood loss (oozing gastritis or malignancy) in males
  • Heavy menstrual flow in women
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6
Q

Iron deficiency anemia (IDA) diagnostic testing

A
  • Low to normal hemoglobin, hematocrit, RBC count
    • RDW >15% (increasing variation)
  • Low serum iron level
  • Elevated TIBC
    • if more transferrin is available for binding, TIBC increases reflecting iron deficiency
  • Iron saturation <15%
  • Low serum ferritin level
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7
Q

IDA treatment

A
  • Iron supplementation (ferrous gluconate or sulfate), 50-60 mg
    • Avoid enteric coated supplements
    • Twice daily, no sooner than ever 6 hours, for 3-6 months
    • Taken on empty stomach
  • Ascorbic acid (vitamin C) enhances iron absorption
    • Taken at same time as iron supplement
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8
Q

What medications decrease iron absorption?

A
  • Antacids - separate use by 2+ hours
  • Caffeine - separate use by 2+ hours
  • Levodopa - separate meds by as much time as possible
  • Histamine-2 receptor antagonist
  • PPI
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9
Q

Iron supplementation will effect absorption of which medication classes?

A
  • Fluoroquinolones - separate by 6+ hours
  • Levodopa
  • ACE inhibitors - separate use by 2+ hours
  • Tetracyclines - separate by 3-4+ hours
  • Levothyroxine - take levothyroxine 2+ hours before or 4 hours after iron dose
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10
Q

Lab evaluation during IDA resolution

A
  • Reticulocytes at 1-2 weeks to ensure marrow response
  • Hemoglobin at 6 weeks to 2 months to ensure recovery
  • Ferritin at 2 months after measure of normal hemoglobin (or 4 months after initiation of iron therapy)
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11
Q

Normocytic (MCV 80-96), normochromic anemia with normal RDW

  • Most common etiology?
A

Acute blood loss, anemia of chronic disease

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12
Q

Microcytic (MCV <80), hypo chromic anemia with elevated RDW

  • Most common etiology
A

IDA

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13
Q

Microcytic (MCV <80), hypo chromic anemia with normal RDW

  • Most common etiology
A

Alpha or beta thalassemia

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14
Q

Macrocytic (MCV >96), normochromic anemia with elevated RDW

  • Most common etiology
A
  • Vitamin b12 deficiency
  • Pernicious anemia
  • Folate deficiency
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15
Q

What is thalassemia?

A

Genetically based blood condition wherein the body makes an abnormal hemoglobin form (alpha and beta)

  • Consider genetic testing if thal minor or thal trait
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16
Q

What are the two forms of macrocytic anemia?

A
  • Vitamin b12 deficiency
  • Folic acid deficiency
17
Q

Folic acid deficiency anemia diagnostic testing

A

Macrocytic, normochromic anemia with elevated RDW

  • Serum folic acid and vitamin b12
  • Can follow up with serum homocysteine (elevated for both) and MMA (elevated in vitamin b12 deficiency only)
18
Q

Folic acid deficiency anemia treatment and management

A
  • Folate rich diet
  • Supplementation (1 mg/day)
    • If planning to become pregnant, 0.4 mg/day for 3 months before conception
    • If history of previous neural tube defect, increase to 4 mg/day for 3 months and continue through first 12 weeks of pregnancy
19
Q

True/false: The term ‘pernicious anemia’ is usually given to vitamin b12 deficiency secondary to lack of intrinsic factor

A

True - When vitamin b12 is ingested orally, it binds with intrinsic factor (glycoprotein produced by gastric parietal cells)

20
Q

What two medications can limit dietary vitamin b12 absorption?

A

PPIs and metformin

21
Q

Pernicious anemia clinical presentation

A

Slowly progressive with vague signs and symptoms

  • Weakness
  • Sore tongue with absent papillae
  • Anorexia with unintended weight loss
  • GI disturbance
22
Q

Vitamin b12 anemia clinical presentation

A

Neuropathy

  • Paresthesia
  • Weakness
  • Clumsiness
  • Unsteady gait
  • New onset MS change (forgetfulness)
  • Hypoactive DTR
  • Tachycardia
23
Q

Vitamin b12 anemia diagnostic testing

A

Macrocytic, normochromic anemia with elevated RDW

  • Low serum cobalamin (b12)
  • Folic acid deficiency
24
Q

Vitamin b12 anemia treatment and management

A
  • Parenteral vitamin b12 preferred over oral
    • Will be needed for the rest of the patient’s life
    • Monitor for drug interactions
    • Can start empiric supplementation with either b12 or folic acid if unsure which is cause
25
Q

What medications can effect vitamin b12 absorption?

A
  • Colchicine
  • Potassium supplements
  • Ascorbic acid (vitamin C)
  • PPI
26
Q

Anemia of chronic disease diagnostic testing

A

Diagnosis of exclusion

  • Serum iron, transferrin, reticulocyte count, ferritin (for IDA)
27
Q

Anemia of chronic disease treatment and management

A
  • Treatment of underlying inflammatory disease
  • In chronic kidney disease (eGFR <45), erythropoietin production is reduced
    • Epoetin alfa SQ or IV
    • Iron therapy
28
Q

Anaphylaxis clinical presentation

A
  • Acute onset of reaction with involvement of skin, mucosal tissue, or both and at least one of the following:
    • Respiratory compromise
    • Reduced BP
    • Symptoms of end organ dysfunction
  • 2+ of the following occur rapidly after exposure to a likely allergen:
    • Involvement of skin/mucosal tissue
    • Respiratory compromise
    • Reduced BP or associated symptoms
    • Persistent GI symptoms
  • Reduced BP after exposure to a known allergen

FNP boards (20 decks)

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