Hematology Flashcards
7 bleeding disorders to know
HIT
ITP
TTP
hemolytic uremic syndrome
hemohilia
DIC
VWD
meds that cause easy bruising (5)
nsaids - mc
steroids
antidepressants
abx
obviously anticoagulants/antiplatelets
3 nutrition related causes of easy bruising
protein malnutrition
vit c defic
vit k defic
X-linked bleeding disorders only affecting males (2)
factor VIII defic
factor IX defic
autosomal bleeding d.o affecting males and females equally
VWD
mc congenital d.o of hemostasis
VWD
what are the smallest bleeding lesions that suggest problems w. PLT number for fxn
petechiae
what do purpura make you think of (2)
thrombocytopenia
coagulation cascade d.o
palpable purpura make you think of
IgA vasculitis (henoch schoenline purpura)
purpura plus hypermobile joints
ehlers danlos
6 causes of post op bleeding
surgical bleeding
meds
inherited d.o
liver dz
renal dz
DIC
what do you think of when a pt has a hx of excessive bleeding after minor procedures or heavy menses
VWD
mc presentation of hemophilia
in childhood w. spontaneous hemarthrosis
why does renal failure cause easy bleeding
uremia inhibits PLT fxn
3 causes of DIC
severe sepsis
malignancy
childbirth complications
presentation of DIC (6)
bleeding and microthrombi
diffuse bleeding from wounds/surgical sites
hematemesis
digital cyanosis
renal insufficiency
stroke
young woman w. malar rash, arthritis, photosensitivity, renal/cardiac sx, fevers, malaise, and recurrent pregnancy loss, and elevated PTT
antiphospholipid syndrome (SLE)
young woman w. bleeding after mild surgical procedure or hx of excessive menses
VWD
mc anemia in the US
IDA
3 hallmarks of IDA
nail spooning
pica
glossitis
lab indicator that iron supplementation is working in a pt w. IDA
increasing reticulocytes means iron is working
basophilic stippling
lead poisoning
tx for lead poisoning
EDTA
dx for anemia of chronic dz requires
pesence of chronic infxn, inflammation, or ca
lab findings of anemia of chronic dz
low EPO
increased serum ferritin
tx for anemia of chronic dz
EPO
tx underlying cause
AI destruction of gastric parietal cells -> lack of intrinsic factor
vit B12 deficiency
sx of B12 deficiency
loss of vibratory/fine touch
how does B12 affect homocysteine levels
increased homocysteine
hypersegmented neutrophils
B12 deficiency
6 rf for B12 deficiency
etoh
vegetarian/vegan
celiac
ibd
surgery
parasites
what is the role of folate in anemia
it is a cofactor for DNA synthesis -> deficiency = anemia
6 causes of folate deficiency
malnutrition
etoh/drugs
pregnant
SSA
thalassemia
crohn’s/tropical sprue
how does folate deficiency presentation differ from B12 defic
no neuro sx w. folate defic
how does folate defic affect homocysteine
increased homocysteine
“macro ovalocytes and hypersegmented PMNs” is pathognomonic for
folate deficiency
4 hemolytic anemias to know
g6pd
hereditary spherocytosis
ssa
thalassemia
hallmark lab finding of hemolytic anemia
increased reticulocytes
3 sx of hemolytic anemia
dark urine
back pain
jaundice
what type of bilirubin is increased w. hemolytic anemia
indirect
what happens to haptoglobin w. hemolytic anemia
decreased
peripheral smear findings of hemolytic anemia
microcytic, normochromic
spherocytes
2 causes of g6pd deficiency
oxidative stress: infxn vs meds
malaria
3 triggers for g6pd
fava beans
antimalarials
sulfonamides
3 sx of g6pd deficiency
jaundice
LUQ pain
splenomegaly
2 peripheral smear findings of g6pd defic
bite cells
heinz bodies
inherited dysfxn or deficiency in one or both of the erythrocyte membrane proteins -> spherocytic erythrocytes are destroyed in the spleen -> hemolytic anemia
hereditary spherocytosis
tx for hereditary spherocytosis
splenectomy
complication of hereditary spherocytosis
hypoplastic crises following aute viral infxn
5 sx of hypoplastic crisis
profound anemia
HA
nausea
pancytopenia
pigmented gallstones
SSA is caused by a mutation in the _ gene
beta globlin -> changes 6th aa from glutamic acid to valine
6 triggers for SSA
infxn/fever
excess exercise
anxiety
abrupt temp change
hypoxia
hypertonic dyes
4 complications of SSA
pulmonary htn
ESRD
hand/foot/mouth
priaprism -> impotence
increased reticuloycites PLUS severe pain in a male AA
SSA
electrophoresis finding of SSA
Hgb S
howell jolly bodies on peripheral smear is pathognomonic for
SSA
tx for severe SSA sx
hydroxyurea
indicatons for hydroxyurea w. SSA
3+ crises/year
health maintenance for SSA (4)
-regular slit lamp exams
-abx if splenectomy/prophylactic prior to procedures
-vaccines early in life
-vigorous hydration prior to exercise/temp changes/stress/infxn
abs bind to the patient’s erythrocytes -> hemolysis
AI hemolytic anemia
2 types of AI hemolytic anemia
warm - mc
cold
lab findings of AI hemolytic anemia
(+) direct coombs
increased: reticulocytes, LDH, indirect bili
decreased: haptoglobin
tx for AI hemolytic anemia (5)
rituximab
steroids
cyclophospamide
cyclosporine
IVIG
only two beta globin genes, but four alpha globin genes -> changes stability of Hgb -> hemolysis
thalassemia
tx for thalassemia
transfuse PRN
iron/folate supplementation
bone marrow transplant
splenectomy