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FNP4 Review > Hematology > Flashcards

Hematology Flashcards

1
Q

Def of anemia…

A
  • Reduction in one or more RBC measurements:
    1. RBC count
    2. Hemoglobin
    3. Hematocrit
    Anemia is never normal!
    Always suspect that something is going on with your patient!
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2
Q

Size vs color of RBCs

A

Size= MCV (_cytic)
Color= MCH (_chromic)

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3
Q

indicates degree of variation in RBC size (<15% is normal)

A

RDW
(how uniform RBCs are in size)

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4
Q

Why would the bone marrow make small RBCs?

A

If it didn’t have enough iron

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5
Q

Serum iron vs Serum Ferritin

A

Serum iron: measure of iron in circulation
Serum ferritin: measure of iron in storage (ferritin is a protein that stores iron)

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6
Q

TIBC?

A

total iron-binding capacity – reciprocal relationship!

Ex. Egg count is high, Capacity is low= TIBC is low

Egg count is low
Capacity is high
Iron count is low
TIBC is high

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7
Q

a visual description of the red blood cells; appears on CBC report
* Example: “microcytic hypochromic RBCs”
***Should always be considered when a patient presents with anemia

A

Peripheral blood smear

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8
Q

Immature RBC

A

Reticulocytes
a visual description of the red blood cells; appears on CBC report
* Example: “microcytic hypochromic RBCs”
***Should always be considered when a patient presents with anemia

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9
Q

Microcytic Anemias

A
  • Common causes:
     Iron deficiency anemia (IDA)
     Thalassemia
  • Less common causes:
     Anemia of chronic disease (<20%)
     Sideroblastic anemia
     Lead toxicity
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10
Q
  • _What: Microcytic, hypochromic anemia
  • _Why: Blood loss
  • _Where: GI, Gyn
A

Iron Deficiency Anemia

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11
Q

Common symptoms in young adult with IDA

A

Fatigue, weakness, exercise intolerance

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12
Q

Young adult- middle-aged adult = Fatigue, weakness, headache, irritability, exercise intolerance

Older adult = Exacerbation of comorbidities (angina, heart failure, dementia)

A

IDA

Most people are asymptomatic (until 30/10)

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13
Q

RBC 3.5 4.2-4.9 million/microL
HGB 9.5 g/dL 12-15 g/dL
HCT 28.6% 37-51%
MCV 72 80-96
MCH 21.6 23.7-28.4
RDW 18.6 12-17
PLT 265 150-375
Serum Fe Decreased
Serum ferritin Decreased
TIBC Elevated

A

IDA

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14
Q

How to treat IDA?

A

Iron supplementation
+ foods like spinach

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15
Q

Sx of iron supplementation intolerance?
Is all iron the same? How long do pts need to supplement for IDA?

A

Heart burn and constipation are common (esp with Fumrate)
Ferrous Sulfate is best tolerated
All Iron is Not Created Equally!
Replacement: usually 4-6 months with 150-200 mg elemental iron daily!

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16
Q

Which normal lab result indicates that iron supplementation could be stopped?

A

Serum ferritin iron
(stored iron)

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17
Q

RBC 3.5 4.2-4.9 million/microL
HGB 9.5 g/dL 12-15 g/dL
HCT 28.6% 37-51%
MCV 72 80-96
MCH 21.6 23.7-28.4
RDW 18.6 12-17
PLT 265 150-375
MPV 7.1 6.5-12
Serum Fe Normal
Serum ferritin Normal
TIBC Normal

A

Thalassemia

18
Q

Microcytic/ hypochromic RBCs
Possible nucleated RBCs
Uneven Hgb distribution, producing “target cells”

A

Thalassemia

19
Q

*What: microcytic, hypochromic
*Why: inherited
*Types: alpha, beta, others
*Diagnostic test: Hgb electrophoresis
*Treatment: consider reproductive counseling

A

Thalassemia

20
Q

Do pts with thalassemia need iron replacement?

A

NO! – if body doesn’t need iron it will store in the liver = hepatotoxicity

21
Q

What: normocytic, normochromic anemia; microcytic, hypochromic (not common)
* _Why: red blood cell life span is shortened from the normal 100-120 days to 60-90 days
* _Treatment: better control of underlying chronic disease, treatment of malignancy, or treatment of underlying cause

A

Anemia of Chronic disease

22
Q
  • Vast differential diagnosis:
  • Anemia of chronic disease (infection, inflammation, malignancy)
  • Acute blood loss
  • Early IDA
  • Malignancy
  • Chronic renal insufficiency
  • Poorly managed chronic disease
  • Other less common diseases
A

Normocytic, Normochromic Anemia

23
Q

What might be most helpful in determining etiology of normocytic, normochromic anemia?
1. RDW
2. Patient history
3. Reticulocyte count
4. Stool for occult blood

A

Patient history

24
Q

A 72-year-old man has normocytic, normochromic anemia. His stool for occult blood is positive. What is the likely etiology of this anemia?

  1. Iron deficiency anemia
  2. Anemia secondary to GI bleed
  3. Anemia secondary to malignancy
  4. B12 deficiency anemia
A
  1. Anemia secondary to malignancy
    - malignancy can cause normocytic/ normochromic changes
25
Q

Is this pt anemic? How to describe?

RBC 3.8 4.2-4.9 million/microL
HGB 9.8 g/dL 12-15 g/dL
HCT 27.8% 37-51%
MCV 103 80-96
MCH 26.5 23.7-28.4

A

Yes, Macrocytic/ normochromic

26
Q

Common macrocytic anemias

A

B12 deficiency
Folate deficiency

27
Q

What: macrocytic anemia
Presentation: asymptomatic patient OR unexplained neuro symptoms, cognitive changes, “burning tongue”

A

B12 deficiency
Folate deficiency

28
Q

Who does B12/ Folate deficiency usually affect?
How to treat?

A

Who: older adults, alcoholics, malnourished, bariatric/gastric surgery patients, strict vegans/vegetarians
Treatment: B12 and/or folate supplementation

29
Q

Causes of b12 deficiency

A

Pernicious anemia
Inadequate dietary intake of B1 (not found in plant sources)
Gastrectomy, bariatric surgery (absorption)
PPIs, metformin, colchicine, impaired metabolism, methotrexate
H. Pylori

30
Q

PA is an autoimmune condition that prevents formation of the vitamin B12-intrinsic factor complex = increases risk of GI cancer

A

Pernicious Anemia

31
Q

Causes of folate deficiency

A

Inadequate dietary intake
Increased requirements (pregnancy)
Intestinal malabsorption

32
Q

How to manage pt with Vit B12 or folate deficiencies?
Symptomatic vs asymptomatic

A

If patient is asymptomatic: can treat both orally:
- B12 (1,000-2,000 mcg daily)
- Folate 1mg daily
* IF patient is symptomatic: consider treating both IV.
- B12: lifelong treatment needed if cause is not reversible (like PA)
- Folate: 1-4 months or until hematologic recovery

33
Q

Expected outcomes of neuro deficits after Tx b12 deficiency

A

Expected outcomes of neuro deficits after Tx b12 deficiency

Usually reversible. Sx improvement within 5-10 days
*Reticulocyte count rapidly increases and peaks 7-10 days after treatment initiated

34
Q

Why are older adults at more risk of B12/ Folate deficiency?

A

pH in stomach rises = less acidic and thus they absorb less B12 and folate

35
Q

How do PPIs affect folate and B12 ?

A

Pts on PPPT have less acidity in stomach = absorb less

36
Q

Decrease in platelet count (< 150,000)
* Rest of CBC is usually normal
- Petechiae and purpura (does not itch and usually feels well otherwise)

A

Thrombocytopenia

37
Q

Reasons for thrombocytopenia

A
  • Recent infection (viral, bacterial)
  • Idiopathic
  • Drug-induced
  • SLE
  • Antiphospholipid syndrome
  • Leukemia
  • Others
38
Q

How to manage thrombocytopenia?

A
  • Referral to hematologist
  • Prednisone for 4-6 weeks; may need daily course for chronic ITP
  • Minimal activity to prevent injury or bruising (e.g., no contact sports)
  • Avoidance of aspirin
39
Q

________ are the same as “segs” = polys

A

Neutrophils

40
Q

Patient Norms
WBC 3.2 4-15
RBC 4.01 (L) 4.5-5.60
HGB 11.4 (L) 13.7-17.3
HCT 34.8 (L) 37.5-51.0
MCV 103.7 (H) 83.4-96.0
MCH 28.1 27.8-32.5
MCHC 34.0 32.5-35.4
RDW 18 (H) 12-17
PLT 316 150-375
MPV 8.1 6.5-12
POLY% 47.5 (L) 55-75
LYMPHS% 42.1 (H) 30-40
MONO% 9.8 (H) 0-9
EOS% 0.3 0-6
BASO% 0.3 0-6
What labs to run next?

A

Viral infection > 24 hours with macrocytic, normochromic anemia
- Polys and lymps are 1st responders
- If low poly and elevated lymph think Viral (numerically close )
- Monos- don’t come to help fight infections for at least 24 hours

Run B12/ Folate labs next

41
Q

WBC 14.9 (H) 4-11
RBC 4.08 4.2-4.9
HGB 10.0 (L) 12-15
HCT 30.0 (L) 37-51
MCV 70.4 (L) 73-85
MCH 21.2 (L) 23.7-28.4
MCHC 29.4 (L) 31.3-35.7
RDW 19.6 (H) 12-17
PLT 315 150-375
MPV 7.1 6.5-12
POLY% 76 (H) 55-75
LYMPHS% 10 (L) 30-40
MONO% 11.9 (H) 0-11
EOS% 0.1 0-6
Bands 2.0

Anemia? Differentials ?
Anemia recent onset?

A

Microcytic, hyperchromic

Differentials: IDA, thalassemia, lead toxicity

Yes Anemia is recent because the high iron RDW tells us that the cells vary largely in size. If anemia had been going on (>120 days) the big/ normal size cells would have died off leaving uniformly small cells and a normal RDW

  • Bands shows immature white blood cells … should be worried if seen in central circulation
42
Q

WBC 16.9 4-11
RBC 4.08 4.2-4.9
HGB 11.0 (L) 12-15
HCT 33.0 (L) 37-51
MCV 70.4 (L) 73-85
MCH 21.2 (L) 23.7-28.4
MCHC 33.4 31.3-35.7
RDW 19.6 (H) 12-17
PLT 155 (L) 150-375
MPV 7.1 6.5-12
POLY% 51 (L) 55-75
LYMPHS% 12 (L) 30-40
MONO% 16.9 (H) 0-12
EOS% 0.1 0-6
Blasts 20
Interpretation?

A

Microcytic, hypochromic

Bone marrow problem..
- Presence of Blasts shows VERY immature RBCs in circulation = refer to hematology ASAP
- High mono=going on > 24 hours

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