Hematology Flashcards
What is a shift to the left with an increase overall WBC count?
Bandemia
What is pain profile of cluster headaches?
severe, unilateral periorbital pain occurring daily for several weeks around the eye
What are the complications of Enteral Nutritional Support aka Refeeding syndrome?
Hypo:
phosphatemia
kalemia
magnesemia
calcemia
thiamine deficiency
What are the causes of HYPOKALEMIA?
- Chronic use of diuretics
- GI loss
- Excess renal loss
- Alkalosis from DKA: increase in pH: decrease in K+ bc H+ leaves the cell & K+ enters the cell
What is the common reason for Hyponatremia (low Na) but increase serum osmolality?
Hyperglycemia usually from HHNK
What are NL Ca++ levels?
Total Ca++: 2.2 - 2.6 mmol/L
8.5 - 10.5 mg/dl
Ionized Ca++: 1.1 -1.4
How does pH affect Ca++?
Acidosis = increase ion Ca++
Alkalosis = decrease ion Ca++
How much CA++ is bound to albumin?
50%; therefore, NL Ca++ in low albumin levels suggest pt is HYPERcalcemic.
What are the causes of HYPER-kalemia?
drugs: i.e., NSAIDS
Excess intake
renal failure
hypoaldosteronism
cell death (apoptosis)
How much does K+ increase with each drop of pH?
K increases by 0.7 mEq/L with each 0.1 drop in potential hydrogen (pH)
What happens to K+ when acidosis occurs?
Shifts of intracellular K+ to the extracellular space occur with acidosis.
What are the EKG classic sign of HYPER-kalemia?
tall peaked T waves
What is the emergent tx for HYPER-K+? >6.5 mEq/L or cardiac toxicity or muscle paralysis?
Regular Insulin 10 U + one amp of D50 (pushes K+ into the cell)
What is the classic symptom of Respiratory Acidosis?
Myoclonus with asterixis
What are the s/sx of respiratory ALKALOSIS?
- Stocking/glove tingling
- Paresthesia
- light-headedness
- anxiety
- TETANY - if very severe
Causes of metabolic ACIDOSIS with INCREASED anion gap
- DKA
- Alcoholic ketoacidosis
- Lactic acidosis - trauma patients
Causes of metabolic ACIDOSIS with NORMAL anion gap
- Diarrhea - losing HCO3
- Ileostomy
- Renal tubular acidosis - RTA intra renal
- Recovery from DKA
What do you use if 0.9% Saline is contraindicated for tx of Metabolic ACIDOSIS?
Acetazolamide 250 - 500 mg IV every 4 -6 hours.
What are the 5 common infections affecting the adult from Streptococcus Pneumonia (S. Pneumoniae)?
- Sinusitis
- Meningitis
- Acute otitis media
- Bronchitis
- CAP
What are the s/s of acute organ rejection?
- Immediate organ failure
- Flu-like sx (i.e. fever, chills, malaise, etc.)
Tx: Immediate bx of the transplanted organ ASAP
What is the immediate action when herpes zoster is found in the ocular (eye)?
STAT referral to ophthalmologist - medical emergency bc can cause blindness
What are the most effective anti-rejection regiments for tranplant?
Triple therapy: 3 immunosuppressants from different classes:
- CORTICOSTEROIDS: steroids
Ex: Methylprednisolone or
Prednisone (Deltasone, Orasone, Meticorten)
AND
- ANTIMETABOLITE: antiproliferative agents
maintenance immunosuppressantsEx: Azathioprine (Imuran),
Mycophenolate mofetil (Cellcept), or
Mycophenolate sodium (Myfortic), or
Cyclophosphamide (Cytoxan).AND
- Mammalian Target of Rapamycin (mTOR) inhibitorEx: Sirolimus (Rapamune), t
Temsirolimus (Torisel),
Everolimus (Afinitor).OR
- Calcineurin inhibitors:Ex: Tacrolimus (Prograf) or
Cyclosporine (Sandimmune, Neoral, Gengraf).
What is the drug of choice for post-herpetic neuralgia?
Gapapentin (Neurotin) or Pregabalin (Lyrica)
What is the recommended Shingrix vaccine?
All adults > 50 y.o., regardless of previous shingles vaccine - 2 doses
2nd dose given 2 - 6 months after the initial dose
Name the End-Of-Life terminal extubation considerations.
- Family: prepartation, education, support
- MSO4 or another opioid: tx tachypnea and respiratory distress
- Scopolamine patches behind the ear or SL atropine otic drops under the tongue to reduce excessive secretions
What is anemia of chronic disease?
normo - cytic,
normo - chromic
from inflammation, infection, renal failure, and malignancy, DM
Tx: underlying cause
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
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.
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
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
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
What is the tx for pernicious anemia?
B12 - cyanocobalamin 100 mcg IM daily x 1 week
Monthly administration for maintenance
S/sx of pernicious anemia
weakness
glossitis
palpitations
dizziness
anorexia
paresthesia
loss of vibratory sense
loss of fine motor control
+ romberg
+ babinski
What is folic acid deficiency?
Inadequate intake/malabsorption of folic acid ( needed for RBC production)
s/sx of folic acid deficiency
fatigue
DOE
pallor
HA
tachycardia
anorexia
glossitis
NO NEUROLOGICAL signs
lab values for folic deficiency
MACRO cytic
NL MCHC normo chromic
decrease serum folate
RBC folate < 100 ng/m
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
ETOH abusers will present with folic acid deficiency. What is the tx?
Administer thiamine (B1), folic acid and banana bag
What is Von Willebrand factor?
Genetic disorder: mutation of deficiency in von Willebrand factor/clotting factor VIII
s/sx of Von Willebrand factor?
frequent prolonged or severe episode of bleeding
easy bruising
Tx for Von Willebrand factor
desmopressin, recombinant van Willebrand Factor (vWF)/ factor VIII concentrate
What are leukemias?
Neoplasms arising from hematopoietic cells in the bone marrow
Hallmark of Acute Myelogenous Leukemia (AML)
80% OF acute leukemias in adults
remission rates from 50% to 85%
long term survival rates appx 40%
Hallmark of Acute Lymphocytic Leukemia (ALL)
90% remission in children
PANCYTOPENIA with circulation blasts
Gold standard or diagnostic test for abnormal Hgb, i.e.,:
1. Alpha or Beta Thalassemia
2. sickle cell
Hgb electrophoresis
Gold standard or diagnostic tool for Temporal arteritis
Biopsy of the temporal artery & refer to ophthalmologist for management
NL Hgb males
14 - 17.4 g/dL
NL Hgb females
12 - 16 g/dL
NL Hct males
42 - 52 %
NL Hct females
36 % - 48%
NL MCV
80 - 100 fL
NL RDW (red cell distribution width)
> 14.5%
elevated RDW is indicative of IDA
Plt count at risk for bleeding
<14, 000 (ITP)
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
NL WBC
4,500 - 11,000 (increase bacterial infections)
What causes an increase in neutrophils or segs?
> 50% (increase bacterial infections)
What is the % increase of Band forms (immature WBCs) in bandemia?
> 6% (increase severe bacterial infections)
aka shift to the left
What causes an increase in eosinophils?
> 3% (increase allergies, intestinal parasites)
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
Hallmark of Chronic lymphocytic leukemia (CLL)
Lymphocytosis
Hallmark of Chronic Myelogenous leukemia (CML)
occurs in > 40 y.o.
survival rate: 65% alive in 5 years
Philadelphia chromosome.
What is the management for leukemias?
Chemotherapy
- Initiate allopurinol to reduce tumor lysis syndrome in high risk patients
Bone marrow transplant
Control symptoms
What confirms dx of leukemia?
Bone marrow aspiration
What lab values are found in tumor lysis syndrome?
hyperuricemia - causes renal failure
hyper K+
hyper PO4
hypo Ca++
What is stage I lymphoma?
dz localized to single lymph node or group
What is stage II lymphoma?
More than one lymph node group
confined to one side of the diaphragm
What is stage III lymphoma?
Both side of diaphragm
spleen involvement
What is stage IV lymphoma?
Liver or bone marrow involvement.
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
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
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
What is the management of Non/Hodgkin’s dz?
Radiation
Chemotherapy
Bone marrow transplantation
What is NL range for plateletes?
150,000 - 450, 000
How to differentiate ITP from SLE?
Bone marrow analysis
What two drugs are used to reverse HIT?
Argatroban
Lepirudin
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
What is the reason for cryoprecipitate transfusion?
to maintain FIBRINOGEN levels
What is the reason for FFP transfusion?
to replace clotting factors
What is the reason for platelet transfusion?
for thrombocytopenia
