Hematology Flashcards
Define anemia.
Low Hgb, Hct, or RBC
What is the role of evaluating reticulocytes in evaluating anemia?
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).
What are common S/S associated with anemia?
Weakness, fatigue, palpitations, tachycardia, dyspnea, positional dizziness, syncope, hemorrhage, pallor.
What type of anemia is indicated by “spoon nails” on physical exam?
Iron deficiency
What types of anemia should be suspected in nutritional disorders or malabsorption?
B12, Folate, iron deficiency
What physical exam finding indicates B12 deficiency?
Neuro symptoms –> dec vibratory and position sense.
Define pica and state the type of anemia it is associated with.
Eating things not usually considered food –> iron deficiency
What type of anemia is most commonly associated with alcohol use disorder?
Folate (vitamin B9) deficiency
List 4 types of anemia that are most commonly microcytic.
Thalassemia, iron deficiency, chronic inflammation, sideroblastic (lead excess)
Define thalassemia.
Under production of alpha or beta globin chains leading to decreased Hgb synthesis and increased RBC hemolysis.
State the number of alpha chains present on Hgb and describe the thalassemia associated with deficiency in the varied number of alpha chains.
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
Differentiate beta thalassemia major from minor.
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.
Describe the two subtypes of beta thalassemia minor.
Minima: few or no symptoms
Intermedia: moderate to severe anemia
How is beta thalassemia differentiated clinically from iron deficiency anemia?
Beta: serum iron and ferritin usually normal or elevated, Hgb between 3 and 6, microcytosis is more severe than in iron deficiency.
What is the most common cause of anemia worldwide?
Iron deficiency
What is the most common cause of ion deficiency and what are other causes?
Blood loss –> PUD/NSAIDs, CA, heavy menstruation.
Other - decreased intake or absorption
What serum lab findings are indicative of iron deficiency anemia?
Hgb and Hct decreased
Hypochromic and microcytic
Ferritin < 20, transferrin < 15%, TIBC elevated
What is the treatment for iron deficiency?
Find source of bleeding
Ferrous sulfate in slowly escalating doses taken on empty stomach and with vitamin C (iron likes acid)
T/F: Anemia of chronic disease is most often a microcytic anemia.
False: about 70% normocytic, 30% microcytic
List some common diseases that may produce anemia of chronic disease.
infection, neoplasm, autoimmune (SLE, RA)
List common causes of sideroblastic anemia.
Lead poisoning, AUD, myelodysplasia
What serum lab findings are indicative of sideroblastic anemia?
Low Hct, hypochromic
What finding will be evident on peripheral smear on a patient with lead poisoning?
Basophilic stippling
What is the treatment for sideroblastic anemia?
Chelation if lead toxicity, transfusion if symptomatic
What are the most common causes of normocytic anemia?
Acute blood loss, chronic disease, organ failure, impaired marrow function.
List some conditions that may cause impaired marrow function.
Infection, medications, chemo/radiation, aplastic anemia
What are the two most common causes of macrocytic anemia?
Folate deficiency, B12 deficiency
List the causes of folic acid deficiency and state which is most common.
MC = poor dietary intake (anorexia is ex). Others = pregnancy, AUD, chronic hemolytic anemia, malabsorption (rare)
What are the most important clinical features of folate deficiency anemia?
Sore toungue, vague GI S/S, absence of neuro S/S (differentiates from B12 deficiency)
What lab finding is pathognomonic for folate deficiency?
hypersegmented polymorphonuclear cells
What is the treatment for folic acid deficiency?
1st line = PO replacement with 1mg per day
Other: Decrease ETOH, avoid meds that hinder folic acid metabolism (Bactrim, seizure meds)
Name and describe the most common cause of B12 deficiency.
Pernicious anemia - lack of intrinsic factor which is necessary for B12 absorption.
Other than the most common, what are some causes of vitamin B12 deficiency?
Strict vegan diet, gastric surgery, pancreatic insufficiency, metformin, crohn’s
What clinical feature differentiates B12 deficiency from folate deficiency and other causes of anemia?
Neurological symptoms
How is B12 deficiency anemia treated?
B12 supplementation, PO cobalamin
List three broad causes of hemolytic anemia and give examples of each.
Hereditary: Thalassemia, SCD, G6PD
Immune: TTP, HUS, DIC
Trauma: Burns
What lab findings are consistent with hemolytic anemia?
Reticulocyte count > 2, dec Hgb, elevated indirect bilirubin (jaundice), elevated LDH
What testing is done to detect antibodies for RBCs that may be a cause of hemolytic anemia?
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
Describe S/S associated with polycythemia.
HA, dizziness, pruritis after showering, splenomegaly
What is the most common cause of polycythemia?
Mutation of JAK2 gene
What are the treatment options for polycythemia?
phlebotomy, hydroxyurea, aspirin
Describe the type of pateint that will most commonly present with idiopathic thrombocytopenic purpura (ITP).
Child 2-6 years old with history of recent viral infection.
What S/S are most commonly associated with ITP?
Easy bleeding/bruising, petechiae, purpura, and gingival bleeding
What lab finding is most consistent with ITP?
Platelets < 50,000
What is the treatment for ITP?
observation, steroids, IVIG
