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Hematology Flashcards

1
Q

RBC Indices
-2-: -1-; expression of the average volume and -2- of individual -3-
> Important classification: -4-: -5-

A
  1. Mean corpuscular volume (MCV)
  2. Size
  3. erythrocytes
  4. Microcytic
  5. < 80 fl
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2
Q

RBC Indices - Size
> -1-: -2-
> -3-: -4-

A
  1. Normocytic
  2. 80-100 fL
  3. macrocytic
  4. > 100 fL
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3
Q 
RBC Indices
-1-: expression of the proportion of each RBC occupied by Hgb as a percentage; -2- of the cell; more reliable for measureing RBC pathologies than MCH
> -3-: 32-36% (32-33% for newborns)
> -4-: <32%
> -5-: >36% (>33% for newborns)
A
  1. Mean corpuscular hemoglobin concentration (MCHC)
  2. “color”
  3. Normochromic
  4. Hypochromic (pale, increased central clearing)
  5. Hyperchromic
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4
Q

RBC Indices
-1-: -2- -3-; experssion of the average amount and -1- of hgb contained in a single erythrocyte; not as useful
> Physiologic: -3-

A
  1. Weight
  2. Mean corpuscular (MCH)
  3. hemoglobin
  4. 27 - 33 pg
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5
Q 
RBC Indices
-1-
> IDA: -2-
> -3-: -4- or slightly decreased
> -5-: physiologic -1-
A
  1. Red cell Distribution Width (RDW)
  2. increased
  3. Thalassemia
  4. physiologic
  5. ACD
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6
Q

RBC Indices
-1-
> No. of -2- RBCs in circulation
> Expressed as a -3-

A
  1. Ret count
  2. new/young (i.e., immature)
  3. percentage (physiologic is 0.5-1.5%)
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7
Q

RBC Indices - Ret Count
Index of -1- and -2-
> Also -3-

A
  1. bone marrow health
  2. response to anemia
  3. response to therapy (sign of improving anemia as RBCs are released from the marrow)
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8
Q

Anemias
> Def: Anemia is not a disease itself, but rather a -1- that results in a low number of RBCs
> Classification: Anemias are classified according to RBC -2- and hgb -3-

A
  1. sign of an underlying condition
  2. size (MCV)
  3. concentration (MCHC)
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9
Q

Anemias - Classification

-1-: -2-, -3-, & thalassemia

A
  1. Microcytic/hypochromic
  2. IDA
  3. lead poisoning
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10
Q

Anemias - Classification

Microcytic/hypochromic: -2-, -3-, & -4-

A
  1. IDA
  2. thalassemia
  3. lead poisoning
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11
Q

Anemias - Classification

Normocytic/normochromic: -1-, acute -2-, -3-, -4-, -5-

A
  1. ACD
  2. blood loss
  3. early IDA
  4. infection
  5. medication
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12
Q

Anemias - Classification

-1-: -2-, -3-, early IDA, acute -4-, -5-

A
  1. Normocytic/normochromic
  2. infection
  3. ACD
  4. blood loss
  5. medication
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13
Q

Anemias - Classification

-1-: vitamin -2- deficiency, -3- deficiency, -4- anemia

A
  1. Macrocytic/normochromic
  2. B12
  3. folate
  4. pernicious
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14
Q

IDA
> Caused by -1-, increased needs, or -2-
> In -3-, iron deficiency is due to a(n) -1- (e.g., -4-, -5-) or microhemorrhage from the gut due to an early intake of cow’s milk (<12 months old)

A
  1. decreased iron intake
  2. slow GI blood loss
  3. infancy
  4. low-iron formula
  5. exclusive breast-feeding w/o iron supplementation
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15
Q

IDA
> In -1-, ID is often due to a(n) -2- the expense of iron-rich solid foods
> In -3-, -4- contribute to an inadequate -5-, specifically in girls after menarche

A
  1. toddlers
  2. increased reliance on dairy milk at
  3. Adolescents
  4. dieting practices
  5. intake of iron (green, leafy vegetables for one)
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16
Q

IDA - S/S
Severity depends on -1-
> Easy -2- and -3-
> -4- (-5-)

A
  1. degree of anemia
  2. fatigability
  3. lethargy
  4. Pica
  5. mostly ice
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17
Q

IDA - S/S
> Postural -1- in -2-
> -3-
> Flat, brittle or -4-

A
  1. hypotension
  2. severe anemia
  3. brittle hair
  4. spoon-shaped nails
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18
Q

IDA - Lab/Dx
> Low -1-
> low -2-
> Increased -3-

A
  1. MCV
  2. MCHC
  3. RDW
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19
Q

IDA - Lab/Dx
> Serum -1- < 12 mcg/L (indicates depleted -2-)
> -3-: low incases of inadequate iron intake; elevated in cases of blood loss & resolving anemia

A
  1. ferritin
  2. iron stores
  3. Ret count
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20
Q

IDA - Mgmt
A(n) -1- is required while the cause is being managed and should be contineud until the resolution of the underlying process
> Treat with -2- once daily until -3-, then
> Replace -4-

A
  1. medicinal iron supplement
  2. elemental iron 3-6 mg/kg/day
  3. Hgb returns to physiologic levels
  4. iron stores: 2-3 mg/kg/day for 4 months
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21
Q

IDA - Mgmt
> Take iron supplement with -1-; take at least 1 hour before or 2 hours after eating (empty stomach)
> Consider -2- to prevent -3- iron therapy
> Discuss the importance of -4-

A
  1. Vitamin C to improve absorption
  2. miralax
  3. constipation caused by
  4. adherence to iron regimen
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22
Q

Thalassemia
Def: a group of -1- disorders characterized by a(n) -2- and -3- chains
> -4- of each gene -5-

A
  1. hereditary
  2. abnormal synthesis of alpha (4 genes)
  3. beta (two genes) globin
  4. One or more
  5. can be missing
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23
Q

Thalassemia
> Type is determined by -1-
> Severity depends on -2- affected
> Usually found in individuals -3-

A
  1. which genes are missing (alpha vs. beta thalassemia)
  2. number of genes
  3. of Mediterranean descent
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24
Q

Thalassemia - Causes/Incidence
> Second most common cause of -1-
> Often identifed during perinatal period or -2-
> -3- genetic disorder

A
  1. microcytic anemia
  2. newborn screening
  3. Autosomal Recessive
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25
Thalassemia - S/S -1- to -2- of anemia > -3- color to -4-
1. varies from asymptomatic 2. severe s/s 3. **Pale or bronze** 4. skin
26
``` Thalassemia - S/S > -1- > -2- > -3- > Frontal -4- ```
1. tachypnea 2. tachycardia 3. hepatosplenomegaly 4. bossing
27
``` Thalassemia - PE Findings > -1- >> -2- >> -3- >> -4-/severe anemia ```
1. Infancy 2. FTT 3. irritability 4. pallor
28
``` Thalassemia - PE Findings > -1- >> -2- >> -3- >> -4- due to -5- ```
1. Older child 2. bony changes (erythropoiesis) 3. splenomegaly 4. iron overload 5. multiple transfusions
29
``` Thalassemia - Lab/Dx > CBC shows >> -2- >> -3- >> -4- ```
2. low hgb 3. low MCV (microcytic anemia) 4. hypochromic RBCs
30
Thalassemia - Lab/Dx > -1- > -2- > -3-
1. high ret count 2. **hgb electrophoresis** 3. high ferritin
31
Thalassemia - Mgmt > referral to -1- > obtain a -2- (-3-) of affected relatives for AG
1. hematology 2. genogram/family history 3. 3-generations
32
Sickle Cell Anemia | Def: A -1- in which abnormal hgb leads to the dev of -2-, which have a -3-
1. chronic hemolytic anemia 2. sickle-shaped RBCs 3. shorter life-span
33
Sickle Cell Anemia - Causes/Incidence > -1- disorder in which HgbS develops instead of HgbA; the pt is -2- > Most prevalent in -3-; Hgb S gene is carried in 8% of -3-: incidence of sickle cell trait is -4-; incidence of sickle cell disease in -3- is 1 in 365
1. autosomal disorder 2. homozygous for Hgb S (Hgb SS) 3. persons of African/-American ancestry 4. 1 in 13
34
Sickle Cell Anemia - Causes/Incidence > Patients who have -1- are generally -2- but are -3- > The peak incidence of infection is -4- of age
1. heterozygous Hgb genotype (AS) 2. clinically asymptomatic (unless hypoxic) 3. carriers 4. 5 months
35
Sickle Cell Anemia - S/S > Sickle cell -1- >> pts usually have -2- >> May experience acute painful symptoms under extreme conditions such as -3- at -4- and -5-
1. Trait (Hgb AS) 2. no clinical symptoms 3. extreme exertion 4. high altitudes 5. severe dehydration
36
Sickle Cell Anemia - S/S > Sickle cell -1- >> -2- due to a -3- (Sickled cells -4-; -5-) usually in the back, chest, abdomen, and long bones
1. anemia (Hgb SS) 2. sudden, excrutiating pain 3. vaso-occlusive crisis 4. adhere to vascular lining 5. ED visit
37
``` Sickle Cell Anemia - S/S > Sickle cell anemia >> -1- >> -2- >> Tendency toward -3- ```
1. Low grade fever 2. delayed puberty 3. more frequent infections (which also aggravate crisis)
38
Sickle Cell - PE Findings > -1- >> This sub-population is -2- with -3- findings
1. SCT 2. clinically physiologic 3. no pathologic exam
39
``` Sickle Cell Anemia - PE Findings > SCA >> Chronically ill in appearance >> -1- >> -2- (vision changes) >> -3- >> -4- with hyperdynamic precordium >> Systolic murmur ```
1. jaundice 2. retinopathy 3. hepatosplenomegaly 4. enlarged heart
40
``` Sickle Cell Anemia - PE Findings > SCA >> -1- in appearance >> jaundice >> retinopathy (-2-) >> hepatosplenomegaly >> enlarged heart with hyperdynamic precordium >> Systolic -3- ```
1. Chronically ill 2. vision changes 3. murmur
41
Sickle Cell Anemia - Lab/Dx > -1- > Labs show a complex -2- indicative of -3-: >> Pathologic -4-: sickle-shaped RBCs which have a shorter lifespan >> -5-
1. **Hemoglobin electrophoresis** 2. constellation of findings 3. SCA 4. hemoglobin (SS) 5. chronic hemolytic anemia
42
Sickle Cell Anemia - Lab/Dx | > Children with SCT may have episodes of -1- and inability to concentrate their -2- due to -3-
1. gross hematura 2. urine 3. renal tubular damage
43
Sickle Cell Anemia - Mgmt > -1- > Hematopoietic -2- > -3- chronically on -4- supplementation
1. Collaboration with hematologist 2. stem-cell transplant 3. Maintained 4. folic acid
44
Sickle Cell Anemia - Mgmt > -1- is to prevent episodes and to provide support during the crisis episode >> Keep client adequately **hydrated** >> Ensure -2- >> analgesics for pain control >> -3- for assoc. -4- >> Transfusions and/or exchange transfusions for intractable crisi and as a preventative measure for clients undergoing anesthesia
1. Cornerstone of therapy 2. adequate oxygenation 3. antibiotics 4. infection
45
Sickle Cell Anemia - Mgmt > Cornerstone of therapy is to prevent episodes and to provide support during the crisis episode >> Keep client adequately -1- >> Ensure adequate oxygenation >> -2- control >> antibiotics for assoc. infection >> -3- and/or exchange transfusions for intractable crisises and as a preventative measure for clients undergoing anesthesia
1. **hydrated** 2. analgesics for pain 3. Supplemental
46
Sickle Cell Anemia - Mgmt | > -1- to -2- production of -3-, which -4-
1. hydroxyurea, 15-35 mg/kg/day 2. stimulate 3. fetal hemoglobin (hgb F) 4. does not sickle
47
Sickle Cell Anemia - Mgmt > Immunize with -1- and confirm -2- > Provide or refer for -3-
1. pneumovax (PS23) 2. hep B immunity 3. genetic counseling
48
Idiopathic/Immune Thrombocytopenic Purpura (ITP) - Gen Concepts/Incidence > -1- > Thrombocytopenia: decrased (-2-) number of platelets in the blood > -3- of the skin, including bruising > Incidence peaks between -4-
1. idopathic: unknown (could be immune) 2. < 150k platelets/mcL 3. Purpura: purple discoloring 4. 1 & 6 yo
49
``` Idiopathic/Immune Thrombocytopenic Purpura (ITP) - S/S > -1- (petechiae or purpura) > -2- > -3- > -4- minor cuts ```
1. easy bruising 2. bleeding from gums 3. nose bleeds 4. prolonged bleeding from
50
Idiopathic/Immune Thrombocytopenic Purpura (ITP) - Lab/Dx > -1- > additional blood and urine tests to measure -2- and detect possible infections > Review of the child's -3- > -4- may be needed (if -5-)
1. CBC 2. bleeding time 3. medications 4. bone marrow aspiration 5. ITP is chronic
51
Idiopathic/Immune Thrombocytopenic Purpura (ITP) - Mgmt > -1- > Children usually -2- > A variety of mgmt strategies may be used, including -3- the platelet count, -4-, among others
1. refer to hematology 2. improve w/o treatment 3. medications to increase 4. surgery (splenectomy)
52
Hemophilia A (X-linked recessive) > Occurs in -1- > Deficiency of -2-
1. 1:5000 males | 2. Factor VIII
53
``` Hemophilia A (X-linked recessive) > Female carriers (Mendelian distribution) have, with each pregnancy, a 25% chance of having a(n): >> -3- >> -4- >> healthy son >> -6- ```
3. affected son 4. carrier daughter 6. non-carrier daughter
54
``` Hemophilia A (X-linked recessive) > -1- have--with each pregnancy--a -2- having a(n): >> affected son >> carrier daughter >> -5- >> non-carrier daughter ```
1. Female carriers (Mendelian distribution) 2. 25% chance of 5. healthy son
55
``` Hemophilia A (X-linked recessive) > frequency of carrier females is -1- > Typical findings >> -2- at birth >> -3-: ranges from spontaneous bleeding to bleeding after trauma (usually -4-) ```
1. 1:2500 2. Phenotypically physiologic 3. Bleeding tendency 4. discovered with circumcision
56
Hemophilia A (X-linked recessive) - Mgmt > Infusions of recombinant -1- or only when -2- > Possible -3- to surgical procedures > -4-
1. factor VIII prophylactically 2. a bleed occurs 3. desmopressin IV/SQ/nasally prior 4. NSAID avoidance
57
Lead Poisoning Def: The CDC definition of lead poisoning is -1-; can occur via ingestion or inhalation > Common Sources >> Paint and paint dust (houses -2-; mandated laws require -3-!) >> -4-
1. a level over 3.5 mcg/dL 2. prior to 1978 3. lead free paint 4. contaminated soil
58
``` Lead Poisoning - S/S > -1- > Severe: -2-, difficult walking, neuropathies > -3- discoloration -4- > -5- ```
1. Vague GI symptoms 2. lethargy 3. Buronian lines: bluish 4. of gingival border (another reason oral exam is important in these patients)
59
Lead Poisoning - S/S >> -1- >> -2- in more -3- >> May have a -4-
1. papilledema 2. cognitive delays 3. severe cases 4. history of pica
60
Lead Poisoning - General assessment > Medical -1- > -2- >> Family members' behaviors, -3-
1. and developmental history (mouthing and pica history) 2. Environmental history 3. occupations
61
Lead Poisoning - General assessment > Detailed -1- > Physical exam >> Pay particular attention to the -2- the child's -3- development
1. nutritional history 2. neuro exam 3. psychosocial & language
62
Lead Poisoning - Lab/Dx/Tx > -1- blood level concentrations >> level < 3.5 mcg/dL (-3- testing) >> level 3.5-10 mcg/dL (-5-)
1. **Venous** (after capillary levels are high) 3. non-toxic; follow-up lead 5. Class I: 6-mo f/u + AG
63
Lead Poisoning - Lab/Dx/Tx > lead: 10-14 mcg/dL (Class -2-) > Lead: 15-19 mcg/dL (Class -4- assessment -5-)
2. IIA - F/u lead level in 3 months, & assess iron levels 4. IIB - confirm lead level in 20 days and 3 months - environmental/playmate 5. after confirmation level is high
64
Lead Poisoning - Lab/Dx | > ... iron status
Ferritin to assess
65
Lead Poisoning - Distal Mgmt > Observe for -1-, impaired renal function, or vit D deficiencies > -2- for prevention of sources -3-
1. hgb-opathies 2. AG needed 3. of lead ingestion
66
Leukemias Def: A group of -1- in which physiologic bone marrow elements are replaced by pathologic, poorly differentiated lymphocytes known as blast cells > -2- accounts for about -3-, with a peak -4- years of age; it occurs more frequently in boys than girls, and is more common among caucasian children
1. malignant hematological diseases 2. acute lymphocytic leukemia (ALL) 3. 75% of cases 4. incidence around 4
67
Leukemias | > -1- accounts for up to 20% of childhood leukemia cases; occurs primarily in -2- children
1. AML | 2. infants and older
68
``` Leukemias - S/S > -1- > -2- > -3- > Chronically -4- ```
1. pale 2. listless 3. Irritable 4. tired
69
Leukemias - S/S > Hx of -1- > -2- such as epistaxis, -3-, and hematomas > -4- and hepatosplenomegaly
1. repeated infections 2. bleeding 3. petechia 4. lymphadenopathy
70
Leukemias - Lab/Dx > -1- , platelet, and ret counts > -2- may demonstrate -3- > -4- will show the poorly differentiated -5- that have been replacing the healthy bone marrow tissue
1. CBC w/ differentiated WBCs - (thrombocytopenia is common and anemia is usally present) 2. **Peripheral Smear** 3. malignant cells (blasts) 4. bone marrow 5. blast cells
71
Leukemias - Mgmt > referral -1- > -2-
1. to hem/onc | 2. familial support
72
Lead Poisoning - Lab/Dx/Tx | > Lead 20-44 mcg/dL: Class -1-, repeat in -2- to confirm; -3- if confirmed; f/u -4- until hazard -5-; refer to -6-
1. III 2. 5 days 3. environmental/playmate eval 4. monthly 5. abates, then quarterly 5. CPS
73
Lead Poisoning - Lab/Dx/Tx | > Lead 45-69 mcg/dL: Class -1-, repeat in -2-; -3-; f/u -4-; refer to -5-
1. IV 2. 3 days to confirm 3. environmental, playmate evaluation if confirmed 4. at least monthly until hazard abates, then quarterly 5. CMS and psych eval
74
Lead Poisoning - Lab/Dx/Tx | > Lead >69 mcg/dL: Class -1-, repeat in -2-; -3-; f/u -4-; refer to -5-
1. V 2. Immediately to confirm 3. environmental, playmate evaluation if confirmed 4. at 1-2 week intervals until hazard abates, then provider discretion 5. CMS and psych eval
75
``` Henoch-Schönlein purpura (HSP) > most common -1- found in young children > appears more commonly in the -2- > most frequently seen in -3- > -4- is a common trigger ```
1. small vessel vasculitis 2. spring and fall 3. males ages 2-7 4. Group A streptococcus
76
``` Henoch-Schönlein purpura (HSP) S/S > skin: -1- > GI (-2-) >> Mild: -3- >> Severe: -4- > MS: -5- ```
1. non-thrombocytopenic/non-blanchable palpable purpura 2. usually follows rash 3. colicky abdominal pain 4. profuse bleeding/perforations 5. arthritis
77
Iron deficiency anemia is a common nutritional disorder and frequently affects children -1- of age who are given -2- and insufficient intake of high-iron foods. Persistent iron deficiency anemia can negatively affect -3-. Severe anemia can contribute to fatigue, -4-, and a change in the -5-.
1. 12-36 months 2. excessive dairy products 3. cognitive function/learning 4. irritability 5. oxygen dissociation curve
78
The AAP recommends that a child’s hemoglobin level be checked at -1- of age. A low -2- indicate that the child has iron deficiency anemia likely related to an insufficient -3- of iron. The -4- of iron deficiency anemia is reduced iron stores, which is reflected in the -5-, a protein that estimates the stores of iron.
1. 12 months 2. H&H and MCV 3. dietary intake 4. first laboratory indication 5. ferritin value
79
As stores of iron decrease, the -1- more increases, which is evaluated through total -2-. With reduced availability of hemoglobin, the -3- and the MCV decreases. Administration of -4- will increase the hemoglobin by one to two g/dL -5-.
1. capacity to absorb 2. iron binding capacity 3. RDW increases 4. *iron supplementation* 5. within *one month*
80
Supplemental iron is continued for -1- normalization of the hemoglobin to develop -2-. With severe anemia, a -3- can be obtained shortly after iron therapy has begun to -4- of iron deficiency anemia.
1. 2-3 months after 2. adequate iron reserves 3. reticulocyte count 4. confirm the diagnosis
81
Serum iron, ferritin, and total iron binding capacity are -1- to make the diagnosis of iron deficiency anemia and are usually obtained when the -2- are not improving as expected with -3-. Serum ferritin levels may be tested -4- iron supplements are stopped to assure adequate iron stores.
1. not required 2. hemoglobin and hematocrit 3. iron supplementation 4. 6 months after
82
Anemia of chronic disease is categorized as a -1-. Iron deficiency anemia, thalassemia, and lead poisoning are all -2-.
1. normocytic/normochormic anemia | 2. microcytic and hypochromic

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