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Clin Med II - Exam 1 > Hematology > Flashcards

Hematology Flashcards

1
Q

high reticulocyte count suggests (2)

A

hemolysis

acute blood loss

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2
Q

for the dx of anemia __ must be low

A

RBC

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3
Q

in males, anemia is defined as H/H

A

<13.5 / <41%

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4
Q

in adult females, anemia is defined as H/H

A

>12 / <37%

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5
Q

lab Hgb is defined as

A

grams of Hgb per 100 mL of whole blood

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6
Q

lab hematocrit is defined as

A

% of a sample of whole blood occupied by intact RBC

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7
Q

MCV is defined as

A

average size of the RBC

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8
Q

MCV is categorized into

A

macrocytic

normocytic

microcytic

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9
Q

macrocytic anemia is defined as MCV

A

>100 fl

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10
Q

microcytic anemia is defined as MCV

A

<80 fl

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11
Q

reticulocyte count is defined as the

A

number of immature RBCs

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12
Q

what are the 3 causes of anemia

A
  1. RBC loss
  2. decreased RBC production
  3. increased RBC destruction
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13
Q

what are the 6 main symptoms of anemia

A
  1. fatigue
  2. tachycardia
  3. HSM
  4. DOE
  5. pallor
  6. bone tenderness
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14
Q

anemia is described first based on __

and second based on__

A
  1. MCV (RBC size)
  2. Hgb concentration (MCH and MCHC)
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15
Q

microcytic anemias include (4)

A
  1. IDA (involve)
  2. thalassemia (tiny)
  3. anemia of chronic dz (anemias)
  4. sideroblastic (super)

involve super tiny anemias

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16
Q

normocytic anemias include (3)

A
  1. anemia of chronic dz
  2. aplastic
  3. hemolytic
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17
Q

macrocytic anemias include (2)

A
  1. vitamin B12 deficiency
  2. folate deficiency
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18
Q

the average american diet consists of __ g of iron/day

A

10-15

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19
Q

only __ % of dietary iron is absorbed

A

10

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20
Q

once absorbed, iron is transferred via

A

transferrin

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21
Q

iron is stored as

A

ferritin

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22
Q

what is the leading cause of anemia worldwide

A

IDA

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23
Q

IDA is classified as __, but

may be __ early on

A

microcytic

normocytic

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24
Q

what are the 3 causes of IDA

A
  1. insufficient dietary intake
  2. poor absorption
  3. chronic blood loss
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25
Q

when you see tachycardia, brittle nails, angular cheilitis, pruritis, pica, anxiety, tingling, and numbness, think

A

IDA

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26
Q

list the 4 iron tests in order of sensitivity

A
  1. ferritin → first lab to become low
  2. TIBC
  3. transferrin saturation
  4. serum iron
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27
Q

in IDA, TIBC will be

A

elevated

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28
Q

in IDA, transferrin saturation will be

A

low

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29
Q

the first lab to become low in IDA is

A

ferritin

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30
Q

in IDA, serum iron may be

A

low or normal

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31
Q

serum iron is a __ indicator of iron

A

poor

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32
Q

what is the first test in evaluation of IDA

A

DRE (digital rectal exam)

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33
Q

after DRE, what is the next step in IDA evaluation

A

iron tests if no blood in stool

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34
Q

what are the 3 steps in tx of IDA

A
  1. diet
  2. iron supplementation
  3. parenteral
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35
Q

what type of iron supplementation should be used in IDA (if dietary approaches are not an option/unsuccessful)

A

ferrous sulfate 325 mg TID → 10 mg is absorbed

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36
Q

w. iron supplementation, H/H should be halfway normal in __ weeks

and totally normal by __ months

A

3

2

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37
Q

what are 3 symptoms of severe thalassemia

A

growth failure

bone deformities

jaundice (lysis of cells)

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38
Q

what are the 3 classifications of thalassemia

A
  1. carriers → trait
  2. minor → few to no symptoms
  3. major → symptomatic
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39
Q

thalassemia is classified as mild to moderate__,

__

A

microcytic

hypochromic

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40
Q

in thalassemia, iron studies will be

A

normal

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41
Q

in thalassemia, reticulocyte count will be

A

nl - elevated

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42
Q

what will you see on a blood smear for thalassemia

A

target cells

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43
Q

what is the definitive dx for thalassemia

A

hemoglobin electrophoresis

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44
Q

when you see hereditary impaired Hgb synthesis, think

A

thalassemia

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45
Q

what is the tx for mild thalassemia

A

folate supplementation

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46
Q

what 2 tx should be avoided in thalassemia

A

iron supplements → iron deficiency is not the problem

sulfonamides → can cause hemolytic crisis

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47
Q

what are 3 tx for severe thalassemia

A

blood transfusions

splenectomy

bone marrow transplant

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48
Q

what is the only cure for thalassemia

A

allogenic stem cell transplant

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49
Q

what are 3 complications of thalassemia

A
  1. hemochromatosis
  2. increased infxn → splenectomy
  3. bone deformities
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50
Q

sideroblastic anemia is classified as __

w, __ iron studies

A

microcytic

normal

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51
Q

what is the dx test for sideroblastic anemia

A

bone marrow showing ringed sideroblasts

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52
Q

what does basophilic stippling make you think of

A

sideroblastic anemia related to lead poisoning

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53
Q

sideroblastic anemia is usually an __ dz

A

acquired

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54
Q

what are some acquired causes of sideroblastic anemia

A

etoh

lead/copper/zinc poisoning

copper or B6 deficiency

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55
Q

tx for sideroblastic anemia is __

A

rarely needed

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56
Q

when you see parasthesias, weakness, loss of vibratory sense, and loss of balance, think

A

vitamin B12 deficiency anemia

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57
Q

what is the most common cause of vitamin B12 deficiency

A

pernicious anemia

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58
Q

pernicious anemia causes loss of __ cells

that help absorb __

A

gastric

B12

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59
Q

consider B12 deficiency in what 2 pt populations

A

vegans

massive gastric surgery

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60
Q

in B12 deficiency, MCV is

A

elevated

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61
Q

what is the cure for B12 deficiency

A

injected or PO B12

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62
Q

folic acid is needed for __

and __

A

DNA synthesis and repair

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63
Q

consider folic acid deficiency in what 2 pt populations

A

etohism

eating disorders

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64
Q

what is the cure for folic acid deficiency

A

folic acid supplementation

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65
Q

if reticulocyte count is high in normocytic anemias, think __ anemia

A

hemolytic

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66
Q

in normocytic anemias, if reticulocyte count is low, think what type of anemia

A

anemia of chronic dz

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67
Q

anemia of chronic dz has __ symptoms

A

mild

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68
Q

name 5 RF for anemia of chronic dz

A
  1. chronic infxn/inflammation
  2. ca
  3. liver dz
  4. renal dz
  5. >85 yo → 20%
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69
Q

in anemia of chronic dz, MCV is __

or __

A

normal

mildly microcytic

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70
Q

what drug may be used in anemia of chronic dz

A

Epogen → erythropoietin

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71
Q

when you see frequent infxns, easy bleeding, purpura, petechiae think

A

aplastic anemia

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72
Q

lab values for aplastic anemia will show

A

pancytopenia → all blood lines will be low

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73
Q

aplastic anemia is caused by __ failure dt

__ or

__

A

bone marrow

injury

abnormal expression of stem cells

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74
Q

aplastic anemia can be caused by (3 things)

A
  1. trauma (XRT/chemo)
  2. drugs (esp antisz)
  3. AI
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75
Q

in aplastic anemia, reticulocytes will be __

and smear will be __

A

low

normal (normocytic)

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76
Q

bone marrow aspiration in aplastic anemia will show

A

hypocellular

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77
Q

what are 2 tx for mild aplastic anemia

A
  1. blood transfusions
  2. platelet transfusions
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78
Q

what are 2 tx for severe aplastic anemia

A

bone marrow transplant

immunosuppression

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79
Q

severe aplastic anemia has a __ prognosis

and most pt die of __

A

poor

infections

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80
Q

what are 2 defining characteristics of hemolytic anemias

A
  1. jaundice
  2. more likely to have HSM
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81
Q

what are the 2 types of hemolytic anemia

A
  1. intrinsic → hereditary
  2. extrinsic
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82
Q

in hemolytic anemias, bone marrow production of erythrocytes __

A

increases

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83
Q

what 3 lab values will be high in hemolytic anemias

A
  1. reticulocytes
  2. bilirubin
  3. LDH
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84
Q

what is the cure for hemolytic anemia

A

transfusions

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85
Q

G6PD deficiency is characterized as

A

episodic

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86
Q

when you see, decreased ability of RBC to deal w. oxidative stress, think

A

G6PD deficiency

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87
Q

__ mark cells for destruction in spleen,

and are produced in __

A

Heinz bodies

G6PD deficiency

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88
Q

in G6PD deficiency, smear will show

A

Heinz bodies

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89
Q

what 2 lab values will be elevated in G6PD deficiency

A

bilirubin

reticulocytes

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90
Q

what is the tx for G6PD deficiency

A

avoid known oxidative drugs

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91
Q

what are 5 characteristics of sickle cell anemia

A
  1. chronically ill appearance
  2. jaundice
  3. splenomegaly
  4. systolic murmur
  5. non-healing ulcers

stupid cells just sickle nonstop

92
Q

what dz is characterized by valine substitution for glutamine in the globin chain

A

sickle cell anemia

93
Q

what do you think of when you see Howell-Jolly bodies and target cells

A

sickle cell anemia

94
Q

reticulocyte count in sickle cell anemia will be

A

elevated

95
Q

sickle cell anemia dx is confirmed using what test

A

Hgb electrophoresis → Hgb S is 85-90% of Hgb

96
Q

what drug is used to stimulate erythropoiesis in sickle cell anemia

A

hydroxyurea

97
Q

what nutrient is supplemented in sickle cell anemia

A

folic acid

98
Q

what is a major complication of sickle cell anemia

A

osteonecrosis

99
Q

what is defined as, the process by which blood clots

A

coagulation

100
Q

disorders of clotting can be __

or __

A

bleeding

obstructive → thrombosis

101
Q

hemostasis is categorized into __

and __

A

primary

secondary

102
Q

primary hemostasis includes (3)

A

platelet adhesion, activation, aggregation

103
Q

primary hemostasis creates a

A

hemostatic plug

104
Q

secondary hemostasis involves (2)

A

clotting factors

fibrin complex

105
Q

secondary hemostasis __

the __

A

stabilizes

platelet plug

106
Q

coagulation panel includes what 5 values

A
  1. bleeding time (bleeding)
  2. activated partial thromboplastin time (aPTT) (activates)
  3. prothrombin time (platelet)
  4. fibrinogen (factors)
  5. D-dimer (directly)
107
Q

what test evaluates how well platelets are working

A

bleeding time

108
Q

what test on the coagulation panel evaluates the intrinsic pathway

A

activated partial thromboplastin time (aPTT)

109
Q

what test on the coagulation panel evaluates the extrinsic pathway

A

prothrombin time (PTT)

110
Q

what lab value in the coagulation panel is prolonged in warfarin use, liver dysfxn, and vit K deficiency

A

PTT (prothrombin time) -> extrinsic factors

111
Q

which value in the coagulation panel indicates greater bleeding risk of decreased

A

fibrinogen

112
Q

what lab value in the coagulation panel measures the products of clot breakdown

A

D-dimer

113
Q

what are the 5 bleeding disorders

A
  1. thrombocytopenia
  2. hemophilia
  3. von wildebrand
  4. coagulopathy of liver dz
  5. vitamin K deficiency
114
Q

when you see petechiae, purpura, ecchymosis, and long bleeding time after trauma, think

A

thrombocytopenia

115
Q

you should be concerned when thrombocytes are <

and spontaneous bleeding occurs when thrombocytes are

A

50,000

20,000

116
Q

name 3 causes of thrombocytopenia

A
  1. decreased platelet production → drugs
  2. increased platelet destruction
  3. other → sepsis, blood loss
117
Q

thrombocytopenia is usually diagnosed __

after a __ is obtained

A

incidentally

CBC

118
Q

what is the only test that will be abnormal in thrombocytopenia (excluding diagnostic CBC)

A

bleeding test time

119
Q

what are the 3 tx steps in thrombocytopenia

A
  1. address underlying cause
  2. remove offending meds
  3. evaluate bone marrow failure/destruction → CA eval, bone marrow aspiration
120
Q

what are the 6 types of thrombocytopenia related to increased platelet destruction

A

DIC

TTP

HELLP

ITTP

HIT

HUS

121
Q

when you see a well appearing pt w. rash, mucosal bleeding, and easy bruising, think

A

ITTP (Idiopathic Thrombocytopenic Purpura)

122
Q

ITTP is common in kids post

A

viral infxn

123
Q

ITTP is an __ dz

A

autoimmune

124
Q

in ITTP, __ are tagged for destruction

A

platelets

125
Q

diagnosis of ITTP is a platelet count <

A

10,000 mcL

126
Q

diagnosis of ITTP includes __ of ddx

A

exclusion

127
Q

in ITTP, all labs will be normal except for (2)

A

thrombocytopenia

prolonged bleeding time

128
Q

in kids, ITTP is

A

self limiting

129
Q

in ITTP, you do not need to treat adults who have platelets > __

without __

A

20,000

bleeding

130
Q

in ITTP, you need treat adults with ITTP < __

with __

A

20,000

bleeding

131
Q

what are 4 tx for ITTP

A
  1. prednisone
  2. IVIG
  3. platelet transfusion
  4. splenectomy
132
Q

in ITTP, platelet transfusion should only be used in the case of

A

active bleeding

133
Q

in ITTP, splenectomy is indicated if

A

chronic or refractory

134
Q

what is the pentad of TTP (thrombotic thrombocytopenic purpura)

A
  1. fever
  2. thrombocytopenia purpura
  3. hemolytic anemia
  4. neurological symptoms (sz, TIA, AMS)
  5. renal failure
135
Q

in TTP, pt’s appear

A

seriously ill

136
Q

TTP is an __ dz

A

AI

137
Q

triggers for TTP include

A
  1. meds
  2. bacterial infxn
  3. pregnancy
  4. other AI
  5. bone marrow transplant
138
Q

TTP pt’s may. have underlying

A

enzyme defect

ADAMTS13

139
Q

tx for TTP is

A

emergent

140
Q

what are 6 tx for TTP

A
  1. admit!
  2. corticosteroids
  3. pRBCs
  4. plasmaphoresis
  5. ASA
  6. splenectomy
141
Q

in TTP, platelet transfusion should be avoided unless there is

A

catastrophic bleeding

142
Q

when you see kid + renal failure + hemolytic anemia, think

A

HUS (hemolytic uremic syndrome)

143
Q

what is the triad of HUS

A

thrombocytopenia

renal failure

hemolytic anemia

144
Q

in HUS, toxins preferentially attack the

A

kidneys

145
Q

HUS usually occurs after

A

GI illness → e.coli, shigella, salmonella

146
Q

in hemolytic anemias, labs will show __ bilirubin

A

unconjugated

147
Q

in hemolytic anemias, LDH will be

A

elevated

148
Q

urinalysis in HUS will show

A

hematuria

proteinuria

149
Q

in kids, HUS is

A

self limiting

150
Q

tx for HUS in kids is

A

obs

IVF

monitor renal fxn

151
Q

in adults, tx for HUS is

A

the same as for TTP

admit

corticosteroids

pRBCs

plasmahoresis

ASA

splenectomy

152
Q

in the tx of HUS, you should avoid

A

abx → increase bacterial lysis by releasing more toxins

153
Q

what does HELLP stand for

A

Hemolysis

Elevated

Liver Enzymes

Low

Platelet Count

154
Q

what is the cardinal symptom of HELLP

A

RUQ abd pain

also n/v, blurry vision, HA, epistaxis

155
Q

HELLP usually occurs in what pt population

A

pregnant women in the last trimester

156
Q

HELLP usually occurs in combo w.

A

eclampsia

pre eclampsia

157
Q

diagnostic lab values for HELLP are (3)

A
  1. thrombocytopenia
  2. hemolytic anemia (low H/H, hyperbilirubinemia, elevated LDH)
  3. elevated LFTs
158
Q

what is the tx for HELLP

A

delivery of baby → halts process completely

159
Q

there his a highly favorable outcome for HELLP if the baby is delivered after __ weeks

A

34

160
Q

what is considered too low for hemoglobin

A

< 12 g/dl

161
Q

what is considered too low for hematocrit

A

< 35%

162
Q

what is nl for WBC

A

4,500-10,000

163
Q

which type of thrombocytopenia involves a bleeding event that accompanies a dz process like infxn, sepsis, trauma, ca, pregnancy

A

DIC (Disseminated Intravascular Coagulation)

164
Q

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

A

DIC (Disseminated Intravascular Coagulation)

165
Q

what will the coag panel show in DIC

A

lit up!

everything is abnormal

166
Q

what are the 3 tx steps for DIC

A
  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
Q

a thrombus is more likely than bleeding in which thrombocytopenia

A

Heparin Induced Thrombocytopenia (HIT)

168
Q

the vast majority of HIT pt are what population

A

hospitalized

169
Q

HIT occurs __ days after Heparin administration

A

~5

170
Q

HIT involves abnormal __

that activate __

A

abs

platelets

171
Q

the dx for HIT is a platelet count that drops __ or more after Heparin administration

A

50% or more

172
Q

what are the 3 tx steps for HIT

A
  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
Q

what are the 5 bleeding disorders

A
  1. haemophilia
  2. von Wildebrand’s Dz
  3. liver dz coagulopathy
  4. vitamin K deficiency
  5. thrombocytopenia

have very low vitamin K totals

174
Q

haemophilia is classified into

A

mild, moderate, severe

175
Q

Haemophilia A is __ common than Haemophilia B and involves

factor __ deficiency

A

more

factor VIII

176
Q

Haemophilia B is also called __

and involves factor __ deficiency

A

christmas disease

IX

177
Q

what are the 3 most common sites of bleeding in haemophilia

A

`1. joints (hemearthrosis)

  1. soft tissue (muscle)
  2. brain
178
Q

haemophilia involves greatly prolonged __

A

coagulation time

179
Q

how do you dx haemophilia

A

clotting factors (usually incidentally after bleeding event)

180
Q

in haemophilia labs, __ and

__ will be normal and

__ will be prolonged

A

normal: CBC and bleeding time (platelets are not defective)

aPTT (intrinsic factor)

181
Q

besides clotting factors, what is another useful test in haemophilia dx

A

factor VIII or IX assays will be low

182
Q

what is this condition, and what disease is it always associated with

A

hemearthrosis → massive bleeding into the joint

haemophilia

183
Q

what is the main tx for haemophilia

A

prevention!

avoid drugs that interfere w. clotting (ASA, NSAIDS etc)

prophylaxis prior to surgery w. deficient factor

lifestyle modification

184
Q

what is the most common congenital coagulopathy

A

von Wildebrand’s Dz

185
Q

von Wildebrand’s dz is often diagnosed __

post __

A

incidentally

dental surgery

186
Q

von Wildebrand’s (and other coagulopathies) will never involve which PE finding

A

hemearthrosis

187
Q

von Wildebrand symptoms are generally

A

mild

188
Q

what are 3 labs in the dx of von Wildebrand’s

A
  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
Q

name 3 tx for von Wildebrand’s, if tx is needed

A
  1. avoid ASA
  2. DDAVP → releases stored vWF
  3. factor VIII → contains vWF
190
Q

what 2 drugs are used in von Wildebrand’s

A
  1. DDAVP
  2. Factor VIII
191
Q

what coagulopathy would you consider in pt w. liver dz/etohism

A

coagulopathy of liver dz

192
Q

pt w. coagulopathy of liver dz may have what PE finding

A

massive ascites

193
Q

where are all coagulation factors produced, with the exception of VIII

A

liver

194
Q

the liver produces all coagulation factors except for

A

VIII

195
Q

what is the best/most specific test to evaluate current coagulation status

A

PT/INR

196
Q

what lab must be checked prior to paracentesis in pt w. caogulopathy of liver dz who has ascites

A

PT/INR

197
Q

what drug should you give a pt w. coagulopathy of liver dz prior to procedure if a bleeding event has occurred

A

FFP (fresh frozen plasma)

198
Q

vitamin K is necessary to make which 4 clotting factors

A

II

VII

IX

X

199
Q

what are 2 main causes of vitamin K deficiency

A
  1. malnutrition
  2. abx → kill gut bacteria
200
Q

what two lab values will be prolonged in vitamin K deficiency

A
  1. PT
  2. aPTT
201
Q

__ will be prolonged more than

__ in vitamin K deficiency

A

PT prolonged longer than aPTT -> extrinsic factor

202
Q

what are the 5 clotting disorders that have an underlying cause

A
  1. protein C deficiency
  2. factor V Leiden
  3. protein S deficiency
  4. polycythemia vera
  5. antiphosphlipid antibody syndrome (APS)

CVS PA

203
Q

what are some acquired hypercoagulable states

A

hormone/OCP use

surgery

immobility

ca

pregnancy

obesity

204
Q

all clotting disorders (regardless of underlying cause) place pt at risk for

A

venous thromboembolism → DVT, PE, CVA, MI, miscarriage

205
Q

what are the 4 tx for clotting disorders

A
  1. acute: Heparin; +/- thromboectomy or thrombolysis
  2. preventative: Coumadin or Plavix
  3. Avoid OCPs
  4. minimize risk factors → no smoking, comorbidities etc
206
Q

it pt comes in w. unprovoked DVT or PE, what are the evaluation steps

A
  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
Q

APS is more common in __

and patients with __

A

women

lupus

208
Q

which clotting disorder is responsible for 20% of DVTs, ⅓ of ischemic strokes, and a significant # of miscarriages

A

APS

209
Q

in APS, at least __ of the 3 diagnostic tests must be positive to confirm dx

A

2

210
Q

what is the most common inherited form of coagulopathy

A

Factor V Leiden

211
Q

Factor V affects __

to __% of

__

A

3-8%

Caucasians

212
Q

Factor V Leiden is the underlying cause in __

to __% of clots

A

25-50%

213
Q

what are the 2 possible diagnostic tests for Factor V Leiden

A
  1. PCR
  2. activated Protein C (APC)
214
Q

proteins C and S inhibit which 2 clotting factors

A

V, VIII

215
Q

what are the diagnostic tests for protein C and protein S deficiencies

A

protein C/protein S assay

216
Q

what is the cardinal symptom of polycythemia vera

A

pruritis

esp after taking a hot shower

217
Q

APS is an __ dz

A

AI

218
Q

Factor V Leiden is a __ dz

A

inherited

219
Q

Protein C and S Deficiency are a type of __ dz

A

genetic

220
Q

polycythemia is an __ dz

A

acquired

221
Q

besides pruritis, polycythemia vera also includes what 3 symptoms

A
  1. HA
  2. fatigue
  3. splenomegaly
222
Q

how is polycythemia vera the opposite of aplastic anemia

A

CBC shows elevation in all bloodlines

bone marrow is hypercellular

223
Q

what is the hallmark lab of polycythemia vera

A

hematocrit > 60%

224
Q

if hematocrit is >60%, you know that the pt has

A

polycythemia vera

225
Q

what is the tx for polycythemia vera

A

phlebotomy PRN until hematocrit < 60%

Clin Med II - Exam 1 (7 decks)

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