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EOR Exam - Family Medicine > Hematology > Flashcards

Hematology Flashcards

1
Q

Define anemia.

A

Low Hgb, Hct, or RBC

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2
Q

What is the role of evaluating reticulocytes in evaluating anemia?

A

Normal reticulocyte count (> 2) indicates healthy marrow and bleedign is most likely cause of anemia. Low reticulocyte count indicates marrow failure or lack of eryhtropoietin (EPO).

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3
Q

What are common S/S associated with anemia?

A

Weakness, fatigue, palpitations, tachycardia, dyspnea, positional dizziness, syncope, hemorrhage, pallor.

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4
Q

What type of anemia is indicated by “spoon nails” on physical exam?

A

Iron deficiency

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5
Q

What types of anemia should be suspected in nutritional disorders or malabsorption?

A

B12, Folate, iron deficiency

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6
Q

What physical exam finding indicates B12 deficiency?

A

Neuro symptoms –> dec vibratory and position sense.

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7
Q

Define pica and state the type of anemia it is associated with.

A

Eating things not usually considered food –> iron deficiency

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8
Q

What type of anemia is most commonly associated with alcohol use disorder?

A

Folate (vitamin B9) deficiency

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9
Q

List 4 types of anemia that are most commonly microcytic.

A

Thalassemia, iron deficiency, chronic inflammation, sideroblastic (lead excess)

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10
Q

Define thalassemia.

A

Under production of alpha or beta globin chains leading to decreased Hgb synthesis and increased RBC hemolysis.

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11
Q

State the number of alpha chains present on Hgb and describe the thalassemia associated with deficiency in the varied number of alpha chains.

A

4: normal number of Hgb alpha globins
3: silent (asymptomatic) carrier
2: mild anemia
1: severe anemia that worsens with fever or exposure to certain meds –> requires transfusions
0: causes hydrops fetalis and usually stillbirth

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12
Q

Differentiate beta thalassemia major from minor.

A

Major: AKA Cooley anemia. S/S begin at 4-6 months (switch from maternal to fetal Hgb) –> severe anemia requiring transfusions. Many die before age 30.
Minor: Only one gene is damaged producing no or minor symptoms.

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13
Q

Describe the two subtypes of beta thalassemia minor.

A

Minima: few or no symptoms
Intermedia: moderate to severe anemia

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14
Q

How is beta thalassemia differentiated clinically from iron deficiency anemia?

A

Beta: serum iron and ferritin usually normal or elevated, Hgb between 3 and 6, microcytosis is more severe than in iron deficiency.

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15
Q

What is the most common cause of anemia worldwide?

A

Iron deficiency

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16
Q

What is the most common cause of ion deficiency and what are other causes?

A

Blood loss –> PUD/NSAIDs, CA, heavy menstruation.

Other - decreased intake or absorption

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17
Q

What serum lab findings are indicative of iron deficiency anemia?

A

Hgb and Hct decreased
Hypochromic and microcytic
Ferritin < 20, transferrin < 15%, TIBC elevated

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18
Q

What is the treatment for iron deficiency?

A

Find source of bleeding

Ferrous sulfate in slowly escalating doses taken on empty stomach and with vitamin C (iron likes acid)

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19
Q

T/F: Anemia of chronic disease is most often a microcytic anemia.

A

False: about 70% normocytic, 30% microcytic

20
Q

List some common diseases that may produce anemia of chronic disease.

A

infection, neoplasm, autoimmune (SLE, RA)

21
Q

List common causes of sideroblastic anemia.

A

Lead poisoning, AUD, myelodysplasia

22
Q

What serum lab findings are indicative of sideroblastic anemia?

A

Low Hct, hypochromic

23
Q

What finding will be evident on peripheral smear on a patient with lead poisoning?

A

Basophilic stippling

24
Q

What is the treatment for sideroblastic anemia?

A

Chelation if lead toxicity, transfusion if symptomatic

25
Q

What are the most common causes of normocytic anemia?

A

Acute blood loss, chronic disease, organ failure, impaired marrow function.

26
Q

List some conditions that may cause impaired marrow function.

A

Infection, medications, chemo/radiation, aplastic anemia

27
Q

What are the two most common causes of macrocytic anemia?

A

Folate deficiency, B12 deficiency

28
Q

List the causes of folic acid deficiency and state which is most common.

A

MC = poor dietary intake (anorexia is ex). Others = pregnancy, AUD, chronic hemolytic anemia, malabsorption (rare)

29
Q

What are the most important clinical features of folate deficiency anemia?

A

Sore toungue, vague GI S/S, absence of neuro S/S (differentiates from B12 deficiency)

30
Q

What lab finding is pathognomonic for folate deficiency?

A

hypersegmented polymorphonuclear cells

31
Q

What is the treatment for folic acid deficiency?

A

1st line = PO replacement with 1mg per day

Other: Decrease ETOH, avoid meds that hinder folic acid metabolism (Bactrim, seizure meds)

32
Q

Name and describe the most common cause of B12 deficiency.

A

Pernicious anemia - lack of intrinsic factor which is necessary for B12 absorption.

33
Q

Other than the most common, what are some causes of vitamin B12 deficiency?

A

Strict vegan diet, gastric surgery, pancreatic insufficiency, metformin, crohn’s

34
Q

What clinical feature differentiates B12 deficiency from folate deficiency and other causes of anemia?

A

Neurological symptoms

35
Q

How is B12 deficiency anemia treated?

A

B12 supplementation, PO cobalamin

36
Q

List three broad causes of hemolytic anemia and give examples of each.

A

Hereditary: Thalassemia, SCD, G6PD
Immune: TTP, HUS, DIC
Trauma: Burns

37
Q

What lab findings are consistent with hemolytic anemia?

A

Reticulocyte count > 2, dec Hgb, elevated indirect bilirubin (jaundice), elevated LDH

38
Q

What testing is done to detect antibodies for RBCs that may be a cause of hemolytic anemia?

A

Indirect Coombs Test: Looks for antibodies floating in blood –> done before blood transfusion or in pregnancy to determine sensitization to Rh
Direct Coombs Test: Looks for antibodies on RBCs –> presence of clumping of RBCs (agglutination) is positive

39
Q

Describe S/S associated with polycythemia.

A

HA, dizziness, pruritis after showering, splenomegaly

40
Q

What is the most common cause of polycythemia?

A

Mutation of JAK2 gene

41
Q

What are the treatment options for polycythemia?

A

phlebotomy, hydroxyurea, aspirin

42
Q

Describe the type of pateint that will most commonly present with idiopathic thrombocytopenic purpura (ITP).

A

Child 2-6 years old with history of recent viral infection.

43
Q

What S/S are most commonly associated with ITP?

A

Easy bleeding/bruising, petechiae, purpura, and gingival bleeding

44
Q

What lab finding is most consistent with ITP?

A

Platelets < 50,000

45
Q

What is the treatment for ITP?

A

observation, steroids, IVIG

EOR Exam - Family Medicine (15 decks)

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