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Hematology Flashcards

1
Q

What is a shift to the left with an increase overall WBC count?

A

Bandemia

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2
Q

What is pain profile of cluster headaches?

A

severe, unilateral periorbital pain occurring daily for several weeks around the eye

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3
Q

What are the complications of Enteral Nutritional Support aka Refeeding syndrome?

A

Hypo:
phosphatemia
kalemia
magnesemia
calcemia
thiamine deficiency

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4
Q

What are the causes of HYPOKALEMIA?

A
  1. Chronic use of diuretics
  2. GI loss
  3. Excess renal loss
  4. Alkalosis from DKA: increase in pH: decrease in K+ bc H+ leaves the cell & K+ enters the cell
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5
Q

What is the common reason for Hyponatremia (low Na) but increase serum osmolality?

A

Hyperglycemia usually from HHNK

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6
Q

What are NL Ca++ levels?

A

Total Ca++: 2.2 - 2.6 mmol/L
8.5 - 10.5 mg/dl
Ionized Ca++: 1.1 -1.4

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7
Q

How does pH affect Ca++?

A

Acidosis = increase ion Ca++
Alkalosis = decrease ion Ca++

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8
Q

How much CA++ is bound to albumin?

A

50%; therefore, NL Ca++ in low albumin levels suggest pt is HYPERcalcemic.

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9
Q

What are the causes of HYPER-kalemia?

A

drugs: i.e., NSAIDS
Excess intake
renal failure
hypoaldosteronism
cell death (apoptosis)

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10
Q

How much does K+ increase with each drop of pH?

A

K increases by 0.7 mEq/L with each 0.1 drop in potential hydrogen (pH)

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11
Q

What happens to K+ when acidosis occurs?

A

Shifts of intracellular K+ to the extracellular space occur with acidosis.

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12
Q

What are the EKG classic sign of HYPER-kalemia?

A

tall peaked T waves

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13
Q

What is the emergent tx for HYPER-K+? >6.5 mEq/L or cardiac toxicity or muscle paralysis?

A

Regular Insulin 10 U + one amp of D50 (pushes K+ into the cell)

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14
Q

What is the classic symptom of Respiratory Acidosis?

A

Myoclonus with asterixis

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15
Q

What are the s/sx of respiratory ALKALOSIS?

A
  1. Stocking/glove tingling
  2. Paresthesia
  3. light-headedness
  4. anxiety
  5. TETANY - if very severe
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16
Q

Causes of metabolic ACIDOSIS with INCREASED anion gap

A
  1. DKA
  2. Alcoholic ketoacidosis
  3. Lactic acidosis - trauma patients
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17
Q

Causes of metabolic ACIDOSIS with NORMAL anion gap

A
  1. Diarrhea - losing HCO3
  2. Ileostomy
  3. Renal tubular acidosis - RTA intra renal
  4. Recovery from DKA
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18
Q

What do you use if 0.9% Saline is contraindicated for tx of Metabolic ACIDOSIS?

A

Acetazolamide 250 - 500 mg IV every 4 -6 hours.

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19
Q

What are the 5 common infections affecting the adult from Streptococcus Pneumonia (S. Pneumoniae)?

A
  1. Sinusitis
  2. Meningitis
  3. Acute otitis media
  4. Bronchitis
  5. CAP
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20
Q

What are the s/s of acute organ rejection?

A
  1. Immediate organ failure
  2. Flu-like sx (i.e. fever, chills, malaise, etc.)

Tx: Immediate bx of the transplanted organ ASAP

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21
Q

What is the immediate action when herpes zoster is found in the ocular (eye)?

A

STAT referral to ophthalmologist - medical emergency bc can cause blindness

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22
Q

What are the most effective anti-rejection regiments for tranplant?

A

Triple therapy: 3 immunosuppressants from different classes:

  1. CORTICOSTEROIDS: steroids

Ex: Methylprednisolone or
Prednisone (Deltasone, Orasone, Meticorten)

                                      AND
  1. ANTIMETABOLITE: antiproliferative agents
    maintenance immunosuppressantsEx: Azathioprine (Imuran),
    Mycophenolate mofetil (Cellcept), or
    Mycophenolate sodium (Myfortic), or
    Cyclophosphamide (Cytoxan).
                                            AND
  2. Mammalian Target of Rapamycin (mTOR) inhibitorEx: Sirolimus (Rapamune), t
    Temsirolimus (Torisel),
    Everolimus (Afinitor).
                                     OR
  3. Calcineurin inhibitors:Ex: Tacrolimus (Prograf) or
    Cyclosporine (Sandimmune, Neoral, Gengraf).
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23
Q

What is the drug of choice for post-herpetic neuralgia?

A

Gapapentin (Neurotin) or Pregabalin (Lyrica)

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24
Q

What is the recommended Shingrix vaccine?

A

All adults > 50 y.o., regardless of previous shingles vaccine - 2 doses
2nd dose given 2 - 6 months after the initial dose

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25
Name the End-Of-Life terminal extubation considerations.
1. Family: prepartation, education, support 2. MSO4 or another opioid: tx tachypnea and respiratory distress 3. Scopolamine patches behind the ear or SL atropine otic drops under the tongue to reduce excessive secretions
26
What is anemia of chronic disease?
normo - cytic, normo - chromic from inflammation, infection, renal failure, and malignancy, DM Tx: underlying cause
27
What are the lab values for anemia of chronic disease?
Normo - cytic [MCV NL] normo - chromic [MCHC NL] LOW serum iron/TIBC serum ferritin HI > 100 ng/mL
28
What is Thalassemia major (Cooley's anemia)?
2 genes for beta-thalassemia and NO normal beta-chain gene: a. HOMOZYGOUS for beta thalassemia b. causes striking deficiency in beta chain production and production of Hb A Normal presentation at birth bc protective effects of fetal Hgb Anemia develops w/in first few months of life and becomes progressively worse/severe.
29
What are the lab findings for Cooley's anemia?
low Hgb low MCV: microcytic low MCHC: microchromic NL TIBC NL Ferritin low alpha/beta Hgb chains
30
Tx for Cooley's anemia?
No tx for mild or moderate forms RBC transfusion/splenectomy for severe forms Iron is CONTRAINDICATED as iron overload can result Prenatal genetic testing of parents - if desired
31
Which anemia has neurological signs?
Pernicious Anemia - malabsorption of B12 Serum B12 < 200 pg/mL Anti-IF (intrinsic factor) and anti-parietal cell antibody test MCV increased Hgb/Hct/RBC's low/decrease
32
What is the tx for pernicious anemia?
B12 - cyanocobalamin 100 mcg IM daily x 1 week Monthly administration for maintenance
33
S/sx of pernicious anemia
weakness glossitis palpitations dizziness anorexia paresthesia loss of vibratory sense loss of fine motor control + romberg + babinski
34
What is folic acid deficiency?
Inadequate intake/malabsorption of folic acid ( needed for RBC production)
35
s/sx of folic acid deficiency
fatigue DOE pallor HA tachycardia anorexia glossitis NO NEUROLOGICAL signs
36
lab values for folic deficiency
MACRO cytic NL MCHC normo chromic decrease serum folate RBC folate < 100 ng/m
37
Tx for folic acid deficiency
Folate 1 mg orally every day Eat foods HI in folate: banana peanut butter fish green leafy veggies iron-fortified breads/cereals
38
ETOH abusers will present with folic acid deficiency. What is the tx?
Administer thiamine (B1), folic acid and banana bag
39
What is Von Willebrand factor?
Genetic disorder: mutation of deficiency in von Willebrand factor/clotting factor VIII
40
s/sx of Von Willebrand factor?
frequent prolonged or severe episode of bleeding easy bruising
41
Tx for Von Willebrand factor
desmopressin, recombinant van Willebrand Factor (vWF)/ factor VIII concentrate
42
What are leukemias?
Neoplasms arising from hematopoietic cells in the bone marrow
43
Hallmark of Acute Myelogenous Leukemia (AML)
80% OF acute leukemias in adults remission rates from 50% to 85% long term survival rates appx 40%
44
Hallmark of Acute Lymphocytic Leukemia (ALL)
90% remission in children PANCYTOPENIA with circulation blasts
45
Gold standard or diagnostic test for abnormal Hgb, i.e.,: 1. Alpha or Beta Thalassemia 2. sickle cell
Hgb electrophoresis
46
Gold standard or diagnostic tool for Temporal arteritis
Biopsy of the temporal artery & refer to ophthalmologist for management
47
NL Hgb males
14 - 17.4 g/dL
48
NL Hgb females
12 - 16 g/dL
49
NL Hct males
42 - 52 %
50
NL Hct females
36 % - 48%
51
NL MCV
80 - 100 fL
52
NL RDW (red cell distribution width)
>14.5% elevated RDW is indicative of IDA
53
Plt count at risk for bleeding
<14, 000 (ITP)
54
What is the NL values for recticulocytes?
0.5% - 1.5% of red cells (Increase acute bleeds), starting tx for Vitamin deficiencies ( iron, B12, folate) acute hemolytic episodes
55
NL WBC
4,500 - 11,000 (increase bacterial infections)
56
What causes an increase in neutrophils or segs?
>50% (increase bacterial infections)
57
What is the % increase of Band forms (immature WBCs) in bandemia?
>6% (increase severe bacterial infections) aka shift to the left
58
What causes an increase in eosinophils?
>3% (increase allergies, intestinal parasites)
59
What are the s/sx of Thalasemia major (Cooley's anemia)?
a. Failure to thrive b. Feeding difficulties (d/t easy fatigue and lack of O2) c. bouts of fever d. diarrhea e. hepatosplenomegaly and jaundice f. maxillary enlargement
60
Hallmark of Chronic lymphocytic leukemia (CLL)
Lymphocytosis
61
Hallmark of Chronic Myelogenous leukemia (CML)
occurs in > 40 y.o. survival rate: 65% alive in 5 years Philadelphia chromosome.
62
What is the management for leukemias?
Chemotherapy - Initiate allopurinol to reduce tumor lysis syndrome in high risk patients Bone marrow transplant Control symptoms
63
What confirms dx of leukemia?
Bone marrow aspiration
64
What lab values are found in tumor lysis syndrome?
hyperuricemia - causes renal failure hyper K+ hyper PO4 hypo Ca++
65
What is stage I lymphoma?
dz localized to single lymph node or group
66
What is stage II lymphoma?
More than one lymph node group confined to one side of the diaphragm
67
What is stage III lymphoma?
Both side of diaphragm spleen involvement
68
What is stage IV lymphoma?
Liver or bone marrow involvement.
69
What are the characteristics of Non-Hodgkin's Lymphoma?
Cause is unknown, possible VIRAL etiology. less predictable pattern of spread than Hodgkin's disease Most common neoplasm in young adult: 20 & 40 yrs Spike of incidence in age 57 Advanced stage dz is usually apparent
70
What is the characteristic of Hodgkin's dz?
Cause unknown Reed Sternberg cells More common in males age: 32 Presents with cervical adenopathy and spreads in a predictable fashion along lymph node groups
71
What laboratory/dx to test for Hodgkin's dz?
CT Xrays US MRI used to locate and stage the dz Bx and histopathologic examination confirm dx
72
What is the management of Non/Hodgkin's dz?
Radiation Chemotherapy Bone marrow transplantation
73
What is NL range for plateletes?
150,000 - 450, 000
74
How to differentiate ITP from SLE?
Bone marrow analysis
75
What two drugs are used to reverse HIT?
Argatroban Lepirudin
76
What is DIC?
An acquired coagulation disorder which results from the intravascular activation of both the coagulation and fibrinolytic systems, causing simultaneous thrombosis and hemorrhage; mortality rate is 50% - 80%. Lab: - Thrombocytopenia - HI PT/PTT - HI FDP Seen in: - severe cases of septic shock
77
What is the reason for cryoprecipitate transfusion?
to maintain FIBRINOGEN levels
78
What is the reason for FFP transfusion?
to replace clotting factors
79
What is the reason for platelet transfusion?
for thrombocytopenia

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