Hematology Flashcards
1
Q
high reticulocyte count suggests (2)
A
hemolysis
acute blood loss
2
Q
for the dx of anemia __ must be low
A
RBC
3
Q
in males, anemia is defined as H/H
A
<13.5 / <41%
4
Q
in adult females, anemia is defined as H/H
A
>12 / <37%
5
Q
lab Hgb is defined as
A
grams of Hgb per 100 mL of whole blood
6
Q
lab hematocrit is defined as
A
% of a sample of whole blood occupied by intact RBC
7
Q
MCV is defined as
A
average size of the RBC
8
Q
MCV is categorized into
A
macrocytic
normocytic
microcytic
9
Q
macrocytic anemia is defined as MCV
A
>100 fl
10
Q
microcytic anemia is defined as MCV
A
<80 fl
11
Q
reticulocyte count is defined as the
A
number of immature RBCs
12
Q
what are the 3 causes of anemia
A
- RBC loss
- decreased RBC production
- increased RBC destruction
13
Q
what are the 6 main symptoms of anemia
A
- fatigue
- tachycardia
- HSM
- DOE
- pallor
- bone tenderness
14
Q
anemia is described first based on __
and second based on__
A
- MCV (RBC size)
- Hgb concentration (MCH and MCHC)
15
Q
microcytic anemias include (4)
A
- IDA (involve)
- thalassemia (tiny)
- anemia of chronic dz (anemias)
- sideroblastic (super)
involve super tiny anemias
16
Q
normocytic anemias include (3)
A
- anemia of chronic dz
- aplastic
- hemolytic
17
Q
macrocytic anemias include (2)
A
- vitamin B12 deficiency
- folate deficiency
18
Q
the average american diet consists of __ g of iron/day
A
10-15
19
Q
only __ % of dietary iron is absorbed
A
10
20
Q
once absorbed, iron is transferred via
A
transferrin
21
Q
iron is stored as
A
ferritin
22
Q
what is the leading cause of anemia worldwide
A
IDA
23
Q
IDA is classified as __, but
may be __ early on
A
microcytic
normocytic
24
Q
what are the 3 causes of IDA
A
- insufficient dietary intake
- poor absorption
- chronic blood loss
25
when you see tachycardia, brittle nails, angular cheilitis, pruritis, pica, anxiety, tingling, and numbness, think
IDA
26
list the 4 iron tests in order of sensitivity
1. ferritin → first lab to become low
2. TIBC
3. transferrin saturation
4. serum iron
27
in IDA, TIBC will be
elevated
28
in IDA, transferrin saturation will be
low
29
the first lab to become low in IDA is
ferritin
30
in IDA, serum iron may be
low or normal
31
serum iron is a __ indicator of iron
poor
32
what is the first test in evaluation of IDA
DRE (digital rectal exam)
33
after DRE, what is the next step in IDA evaluation
iron tests if no blood in stool
34
what are the 3 steps in tx of IDA
1. diet
2. iron supplementation
3. parenteral
35
what type of iron supplementation should be used in IDA (if dietary approaches are not an option/unsuccessful)
ferrous sulfate 325 mg TID → 10 mg is absorbed
36
w. iron supplementation, H/H should be halfway normal in __ weeks
and totally normal by __ months
3
2
37
what are 3 symptoms of severe thalassemia
growth failure
bone deformities
jaundice (lysis of cells)
38
what are the 3 classifications of thalassemia
1. carriers → trait
2. minor → few to no symptoms
3. major → symptomatic
39
thalassemia is classified as mild to moderate\_\_,
\_\_
microcytic
hypochromic
40
in thalassemia, iron studies will be
normal
41
in thalassemia, reticulocyte count will be
nl - elevated
42
what will you see on a blood smear for thalassemia
target cells
43
what is the definitive dx for thalassemia
hemoglobin electrophoresis
44
when you see hereditary impaired Hgb synthesis, think
thalassemia
45
what is the tx for mild thalassemia
folate supplementation
46
what 2 tx should be avoided in thalassemia
iron supplements → iron deficiency is not the problem
sulfonamides → can cause hemolytic crisis
47
what are 3 tx for severe thalassemia
blood transfusions
splenectomy
bone marrow transplant
48
what is the only cure for thalassemia
allogenic stem cell transplant
49
what are 3 complications of thalassemia
1. hemochromatosis
2. increased infxn → splenectomy
3. bone deformities
50
sideroblastic anemia is classified as \_\_
w, __ iron studies
microcytic
normal
51
what is the dx test for sideroblastic anemia
bone marrow showing ringed sideroblasts
52
what does basophilic stippling make you think of
sideroblastic anemia related to lead poisoning
53
sideroblastic anemia is usually an __ dz
acquired
54
what are some acquired causes of sideroblastic anemia
etoh
lead/copper/zinc poisoning
copper or B6 deficiency
55
tx for sideroblastic anemia is \_\_
rarely needed
56
when you see parasthesias, weakness, loss of vibratory sense, and loss of balance, think
vitamin B12 deficiency anemia
57
what is the most common cause of vitamin B12 deficiency
pernicious anemia
58
pernicious anemia causes loss of __ cells
that help absorb \_\_
gastric
B12
59
consider B12 deficiency in what 2 pt populations
vegans
massive gastric surgery
60
in B12 deficiency, MCV is
elevated
61
what is the cure for B12 deficiency
injected or PO B12
62
folic acid is needed for \_\_
and \_\_
DNA synthesis and repair
63
consider folic acid deficiency in what 2 pt populations
etohism
eating disorders
64
what is the cure for folic acid deficiency
folic acid supplementation
65
if reticulocyte count is high in normocytic anemias, think __ anemia
hemolytic
66
in normocytic anemias, if reticulocyte count is low, think what type of anemia
anemia of chronic dz
67
anemia of chronic dz has __ symptoms
mild
68
name 5 RF for anemia of chronic dz
1. chronic infxn/inflammation
2. ca
3. liver dz
4. renal dz
5. \>85 yo → 20%
69
in anemia of chronic dz, MCV is \_\_
or \_\_
normal
mildly microcytic
70
what drug may be used in anemia of chronic dz
Epogen → erythropoietin
71
when you see frequent infxns, easy bleeding, purpura, petechiae think
aplastic anemia
72
lab values for aplastic anemia will show
pancytopenia → all blood lines will be low
73
aplastic anemia is caused by __ failure dt
\_\_ or
\_\_
bone marrow
injury
abnormal expression of stem cells
74
aplastic anemia can be caused by (3 things)
1. trauma (XRT/chemo)
2. drugs (esp antisz)
3. AI
75
in aplastic anemia, reticulocytes will be \_\_
and smear will be \_\_
low
normal (normocytic)
76
bone marrow aspiration in aplastic anemia will show
hypocellular
77
what are 2 tx for mild aplastic anemia
1. blood transfusions
2. platelet transfusions
78
what are 2 tx for severe aplastic anemia
bone marrow transplant
immunosuppression
79
severe aplastic anemia has a __ prognosis
and most pt die of \_\_
poor
infections
80
what are 2 defining characteristics of hemolytic anemias
1. jaundice
2. more likely to have HSM
81
what are the 2 types of hemolytic anemia
1. intrinsic → hereditary
2. extrinsic
82
in hemolytic anemias, bone marrow production of erythrocytes \_\_
increases
83
what 3 lab values will be high in hemolytic anemias
1. reticulocytes
2. bilirubin
3. LDH
84
what is the cure for hemolytic anemia
transfusions
85
G6PD deficiency is characterized as
episodic
86
when you see, decreased ability of RBC to deal w. oxidative stress, think
G6PD deficiency
87
\_\_ mark cells for destruction in spleen,
and are produced in \_\_
Heinz bodies
G6PD deficiency
88
in G6PD deficiency, smear will show
Heinz bodies
89
what 2 lab values will be elevated in G6PD deficiency
bilirubin
reticulocytes
90
what is the tx for G6PD deficiency
avoid known oxidative drugs
91
what are 5 characteristics of sickle cell anemia
1. chronically ill appearance
2. jaundice
3. splenomegaly
4. systolic murmur
5. non-healing ulcers
stupid cells just sickle nonstop
92
what dz is characterized by valine substitution for glutamine in the globin chain
sickle cell anemia
93
what do you think of when you see Howell-Jolly bodies and target cells
sickle cell anemia
94
reticulocyte count in sickle cell anemia will be
elevated
95
sickle cell anemia dx is confirmed using what test
Hgb electrophoresis → Hgb S is 85-90% of Hgb
96
what drug is used to stimulate erythropoiesis in sickle cell anemia
hydroxyurea
97
what nutrient is supplemented in sickle cell anemia
folic acid
98
what is a major complication of sickle cell anemia
osteonecrosis
99
what is defined as, the process by which blood clots
coagulation
100
disorders of clotting can be \_\_
or \_\_
bleeding
obstructive → thrombosis
101
hemostasis is categorized into \_\_
and \_\_
primary
secondary
102
primary hemostasis includes (3)
platelet adhesion, activation, aggregation
103
primary hemostasis creates a
hemostatic plug
104
secondary hemostasis involves (2)
clotting factors
fibrin complex
105
secondary hemostasis \_\_
the \_\_
stabilizes
platelet plug
106
coagulation panel includes what 5 values
1. bleeding time (bleeding)
2. activated partial thromboplastin time (aPTT) (activates)
3. prothrombin time (platelet)
4. fibrinogen (factors)
5. D-dimer (directly)
107
what test evaluates how well platelets are working
bleeding time
108
what test on the coagulation panel evaluates the intrinsic pathway
activated partial thromboplastin time (aPTT)
109
what test on the coagulation panel evaluates the extrinsic pathway
prothrombin time (PTT)
110
what lab value in the coagulation panel is prolonged in warfarin use, liver dysfxn, and vit K deficiency
PTT (prothrombin time) -\> extrinsic factors
111
which value in the coagulation panel indicates greater bleeding risk of decreased
fibrinogen
112
what lab value in the coagulation panel measures the products of clot breakdown
D-dimer
113
what are the 5 bleeding disorders
1. thrombocytopenia
2. hemophilia
3. von wildebrand
4. coagulopathy of liver dz
5. vitamin K deficiency
114
when you see petechiae, purpura, ecchymosis, and long bleeding time after trauma, think
thrombocytopenia
115
you should be concerned when thrombocytes are \<
and spontaneous bleeding occurs when thrombocytes are
50,000
20,000
116
name 3 causes of thrombocytopenia
1. decreased platelet production → drugs
2. increased platelet destruction
3. other → sepsis, blood loss
117
thrombocytopenia is usually diagnosed \_\_
after a __ is obtained
incidentally
CBC
118
what is the only test that will be abnormal in thrombocytopenia (excluding diagnostic CBC)
bleeding test time
119
what are the 3 tx steps in thrombocytopenia
1. address underlying cause
2. remove offending meds
3. evaluate bone marrow failure/destruction → CA eval, bone marrow aspiration
120
what are the 6 types of thrombocytopenia related to increased platelet destruction
DIC
TTP
HELLP
ITTP
HIT
HUS
121
when you see a well appearing pt w. rash, mucosal bleeding, and easy bruising, think
ITTP (Idiopathic Thrombocytopenic Purpura)
122
ITTP is common in kids post
viral infxn
123
ITTP is an __ dz
autoimmune
124
in ITTP, __ are tagged for destruction
platelets
125
diagnosis of ITTP is a platelet count \<
10,000 mcL
126
diagnosis of ITTP includes __ of ddx
exclusion
127
in ITTP, all labs will be normal except for (2)
thrombocytopenia
prolonged bleeding time
128
in kids, ITTP is
self limiting
129
in ITTP, you do not need to treat adults who have platelets \> \_\_
without \_\_
20,000
bleeding
130
in ITTP, you need treat adults with ITTP \< \_\_
with \_\_
20,000
bleeding
131
what are 4 tx for ITTP
1. prednisone
2. IVIG
3. platelet transfusion
4. splenectomy
132
in ITTP, platelet transfusion should only be used in the case of
active bleeding
133
in ITTP, splenectomy is indicated if
chronic or refractory
134
what is the pentad of TTP (thrombotic thrombocytopenic purpura)
1. fever
2. thrombocytopenia purpura
3. hemolytic anemia
4. neurological symptoms (sz, TIA, AMS)
5. renal failure
135
in TTP, pt's appear
seriously ill
136
TTP is an __ dz
AI
137
triggers for TTP include
1. meds
2. bacterial infxn
3. pregnancy
4. other AI
5. bone marrow transplant
138
TTP pt's may. have underlying
enzyme defect
ADAMTS13
139
tx for TTP is
emergent
140
what are 6 tx for TTP
1. admit!
2. corticosteroids
3. pRBCs
4. plasmaphoresis
5. ASA
6. splenectomy
141
in TTP, platelet transfusion should be avoided unless there is
catastrophic bleeding
142
when you see kid + renal failure + hemolytic anemia, think
HUS (hemolytic uremic syndrome)
143
what is the triad of HUS
thrombocytopenia
renal failure
hemolytic anemia
144
in HUS, toxins preferentially attack the
kidneys
145
HUS usually occurs after
GI illness → e.coli, shigella, salmonella
146
in hemolytic anemias, labs will show __ bilirubin
unconjugated
147
in hemolytic anemias, LDH will be
elevated
148
urinalysis in HUS will show
hematuria
proteinuria
149
in kids, HUS is
self limiting
150
tx for HUS in kids is
obs
IVF
monitor renal fxn
151
in adults, tx for HUS is
the same as for TTP
admit
corticosteroids
pRBCs
plasmahoresis
ASA
splenectomy
152
in the tx of HUS, you should avoid
abx → increase bacterial lysis by releasing more toxins
153
what does HELLP stand for
Hemolysis
Elevated
Liver Enzymes
Low
Platelet Count
154
what is the cardinal symptom of HELLP
RUQ abd pain
also n/v, blurry vision, HA, epistaxis
155
HELLP usually occurs in what pt population
pregnant women in the last trimester
156
HELLP usually occurs in combo w.
eclampsia
pre eclampsia
157
diagnostic lab values for HELLP are (3)
1. thrombocytopenia
2. hemolytic anemia (low H/H, hyperbilirubinemia, elevated LDH)
3. elevated LFTs
158
what is the tx for HELLP
delivery of baby → halts process completely
159
there his a highly favorable outcome for HELLP if the baby is delivered after __ weeks
34
160
what is considered too low for hemoglobin
\< 12 g/dl
161
what is considered too low for hematocrit
\< 35%
162
what is nl for WBC
4,500-10,000
163
which type of thrombocytopenia involves a bleeding event that accompanies a dz process like infxn, sepsis, trauma, ca, pregnancy
DIC (Disseminated Intravascular Coagulation)
164
what do you think when you see a very sick patient that has oozing/frank bleeding from multiple sites, and clotting at the same time
DIC (Disseminated Intravascular Coagulation)
165
what will the coag panel show in DIC
lit up!
everything is abnormal
166
what are the 3 tx steps for DIC
1. ABC management AND cardiopulmonary support
2. tx underlying d.o → ex deliery baby, abx for sepsis
3. transfuse blood products as needed → try to save this step
*Heparin is debatable and per specialist*
167
a thrombus is more likely than bleeding in which thrombocytopenia
Heparin Induced Thrombocytopenia (HIT)
168
the vast majority of HIT pt are what population
hospitalized
169
HIT occurs __ days after Heparin administration
~5
170
HIT involves abnormal \_\_
that activate \_\_
abs
platelets
171
the dx for HIT is a platelet count that drops __ or more after Heparin administration
50% or more
172
what are the 3 tx steps for HIT
1. replace Heparin w. any DOC *besides Warfarin*
2. eval for thrombosis w. imaging → US, CT, PE
3. avoid Heparin indefinitely
*rarely need platelet transfusion*
173
what are the 5 bleeding disorders
1. haemophilia
2. von Wildebrand's Dz
3. liver dz coagulopathy
4. vitamin K deficiency
5. thrombocytopenia
## Footnote
*have very low vitamin K totals*
174
haemophilia is classified into
mild, moderate, severe
175
Haemophilia A is __ common than Haemophilia B and involves
factor __ deficiency
more
factor VIII
176
Haemophilia B is also called \_\_
and involves factor __ deficiency
christmas disease
IX
177
what are the 3 most common sites of bleeding in haemophilia
`1. joints (hemearthrosis)
2. soft tissue (muscle)
3. brain
178
haemophilia involves greatly prolonged \_\_
coagulation time
179
how do you dx haemophilia
clotting factors (usually incidentally after bleeding event)
180
in haemophilia labs, __ and
\_\_ will be normal and
\_\_ will be prolonged
normal: CBC and bleeding time (platelets are not defective)
aPTT (intrinsic factor)
181
besides clotting factors, what is another useful test in haemophilia dx
factor VIII or IX assays will be low
182
what is this condition, and what disease is it always associated with
hemearthrosis → massive bleeding into the joint
haemophilia
183
what is the main tx for haemophilia
prevention!
avoid drugs that interfere w. clotting (ASA, NSAIDS etc)
prophylaxis prior to surgery w. deficient factor
lifestyle modification
184
what is the most common congenital coagulopathy
von Wildebrand's Dz
185
von Wildebrand's dz is often diagnosed \_\_
post \_\_
incidentally
dental surgery
186
von Wildebrand's (and other coagulopathies) will never involve which PE finding
hemearthrosis
187
von Wildebrand symptoms are generally
mild
188
what are 3 labs in the dx of von Wildebrand's
1. ASA challenge → ASA will cause prolonged bleeding time; OR prolonged bleeding time at baseline
2. vWF plasma level → will be low
3. factor VIII → will be low (doesn't need to be checked for every pt)
189
name 3 tx for von Wildebrand's, if tx is needed
1. avoid ASA
2. DDAVP → releases stored vWF
3. factor VIII → contains vWF
190
what 2 drugs are used in von Wildebrand's
1. DDAVP
2. Factor VIII
191
what coagulopathy would you consider in pt w. liver dz/etohism
coagulopathy of liver dz
192
pt w. coagulopathy of liver dz may have what PE finding
massive ascites
193
where are all coagulation factors produced, with the exception of VIII
liver
194
the liver produces all coagulation factors except for
VIII
195
what is the best/most specific test to evaluate current coagulation status
PT/INR
196
what lab must be checked prior to paracentesis in pt w. caogulopathy of liver dz who has ascites
PT/INR
197
what drug should you give a pt w. coagulopathy of liver dz prior to procedure if a bleeding event has occurred
FFP (fresh frozen plasma)
198
vitamin K is necessary to make which 4 clotting factors
II
VII
IX
X
199
what are 2 main causes of vitamin K deficiency
1. malnutrition
2. abx → kill gut bacteria
200
what two lab values will be prolonged in vitamin K deficiency
1. PT
2. aPTT
201
\_\_ will be prolonged more than
\_\_ in vitamin K deficiency
PT prolonged longer than aPTT -\> extrinsic factor
202
what are the 5 clotting disorders that have an underlying cause
1. protein C deficiency
2. factor V Leiden
3. protein S deficiency
4. polycythemia vera
5. antiphosphlipid antibody syndrome (APS)
CVS PA
203
what are some acquired hypercoagulable states
hormone/OCP use
surgery
immobility
ca
pregnancy
obesity
204
all clotting disorders (regardless of underlying cause) place pt at risk for
venous thromboembolism → DVT, PE, CVA, MI, miscarriage
205
what are the 4 tx for clotting disorders
1. **acute:** Heparin; +/- thromboectomy or thrombolysis
2. **preventative:** Coumadin or Plavix
3. Avoid OCPs
4. minimize risk factors → no smoking, comorbidities etc
206
it pt comes in w. unprovoked DVT or PE, what are the evaluation steps
1. suspect underlying coagulopathy: APS, Protein C/S deficiency, Facfor V Leiden
2. do a panel of all 4 tests to figure out cause
207
APS is more common in \_\_
and patients with \_\_
women
lupus
208
which clotting disorder is responsible for 20% of DVTs, ⅓ of ischemic strokes, and a significant # of miscarriages
APS
209
in APS, at least __ of the 3 diagnostic tests must be positive to confirm dx
2
210
what is the most common inherited form of coagulopathy
Factor V Leiden
211
Factor V affects \_\_
to \_\_% of
\_\_
3-8%
Caucasians
212
Factor V Leiden is the underlying cause in \_\_
to \_\_% of clots
25-50%
213
what are the 2 possible diagnostic tests for Factor V Leiden
1. PCR
2. activated Protein C (APC)
214
proteins C and S inhibit which 2 clotting factors
V, VIII
215
what are the diagnostic tests for protein C and protein S deficiencies
protein C/protein S assay
216
what is the cardinal symptom of polycythemia vera
pruritis
*esp after taking a hot shower*
217
APS is an __ dz
AI
218
Factor V Leiden is a __ dz
inherited
219
Protein C and S Deficiency are a type of __ dz
genetic
220
polycythemia is an __ dz
acquired
221
besides pruritis, polycythemia vera also includes what 3 symptoms
1. HA
2. fatigue
3. splenomegaly
222
how is polycythemia vera the opposite of aplastic anemia
CBC shows elevation in all bloodlines
*bone marrow is hypercellular*
223
what is the hallmark lab of polycythemia vera
hematocrit \> 60%
224
if hematocrit is \>60%, you know that the pt has
polycythemia vera
225
what is the tx for polycythemia vera
phlebotomy PRN until hematocrit \< 60%
