Hematology

Question 1

Iron Deficiency Anemia

Answer 1

-nutritional deficiency
-women, children, elderly +65, vegans, GI disorders, pregnancy
-inadequate oxygenation, pica, glossitis, cheilosis, koilonychia
-LOW RBC, LOW H&H, LOW SERUM IRON, HIGH TIBC, HIGH TRANSFERRIN
-Iron rich foods: red organ meats, dark greens, beats
-PO ferrous sulfate. 1 hr before meals, w/ orange juice, liquid iron w straw, IM iron z-track
-AVOID COFFEE AND TEA
-black stool with PO iron

Question 2

B12/ Pernicious Anemia

Answer 2

-nutritional deficiency
-aging b/c less intrinsic factor, stomach resection, GI diseases, chronic alcoholics, long term antacids, vegans
-inadequate oxygenation, neuro symptoms (paresthesia, proprioception, ams, confusion, depression, mimic dementia)
-LOW RBC, LOW H&H, LOW B12, HIGH MMA
-SCHILLING TEST tests for intrinsic factor
-B12 rich foods: meats, seafood, eggs, dairy
-PO B12 dont take w/alcohol
-B12 IM if pernicious, monthly for life
-NEEDS TO BE TREATED IN 6 MONTHS, SPINAL CORD DAMAGE

Question 3

Folic Acid Anemia

Answer 3

-nutritional deficiency
-undernourished, chronic substance abusers, hemodialysis, children, pregnancy, lactation
-inadequate oxygenation, glossitis, diarrhea
-LOW H&H, LOW SERUM FOLATE, HIGH HOMOCYSTEINE
-folic acid rich foods: green leafy vegetables, nuts, dried beans, yeast
-methotrexate, birth control, metformin will affect absorption
-folic acid 1 mg QD (folvite), IM, SUBQ, IV also available
-PREGNANCY NEEDS 400 MCG DAILY

Question 4

Aplastic Anemia

Answer 4

-failure of the bone marrow causing pancytopenia
-acquired by exposure to toxins: arsenic and meds: dilantin, chemo, radiation, hep c, hiv
-inadequate oxygenation, sore throat, swelling of lymph nodes, fever, infections, excessive bruising, petechial, infection risk
-LOW CBC, ALL CELL LEVELS DEPRESSED, needs bone marrow biopsy
-immunosuppresive therapy: corticosteroids, cyclosporin, npugen, leukine, procrit (to stimulate bone marrow)
-Avoid unwashed fruits and vegetables and raw foods due to high risk of infection
-could become blood transfusion dependent, possibly need bone marrow transplant

Question 5

Thalassemia Anemia

Answer 5

-hemolytic anemia, affects hemoglobin
-mediterranean descent
-minor: sign is bronze skin coloring
-major: sign is severe anemia, fractures, organ enlargement, jaundice
-minor treatment: none needed
-major treatment: blood transfusions
-can become blood transfusion dependent
-excess iron can become toxic
-alpha major and beta major are fatal

Question 6

Sickle Cell

Answer 6

-hemolytic anemia, abnormal hemoglobin synthesis
-passed on to children
-african descent
-inadequate oxygenation, pain, jaundice, enlarged spleen, tissue death
-DIAGNOSED DURING NEWBORN SCREEN, HIGH BILI B/C RBC’S ARE BREAKING DOWN AND RELEASING BILI
-avoid triggers: hypoxemia, low temp, excessive exercise, dehydration
-meds: hydroxyurea(prevents formation of sickle shaped RBC), Apheresis to filter out the blood
-can lead to sickle cell crisis symptoms are pain and edema from vasoocclusion, low oxygen, crisis takes 4-6 days to resolve, repeated crisis can cause organ damage and stroke

Question 7

Acquired hemolytic

Answer 7

-hemolytic anemia, hemolysis due to factors outside of RBC: mechanical trauma, immune system mediated responses etc
-risks are patients on hemodialysis or radiation for cancer or autoimmune disorders
-inadequate oxygenation, enlarged spleen, jaundice, hypoxemia
-remove cause if possible, supportive care, corticosteroids if autoimmune response is the cause
-complications is bone marrow starts to expand, developing fractures

Question 8

Acute blood loss

Answer 8

-no issue with production or formation of RBC’s, RBC loss is due to excessive bleeding
-trauma, surgery, childbirth, hemorrhage
-inadequate oxygen, circulatory collapse, hypotension, decreased LOC, shock, death
-stop bleeding
-replace lost fluid or transfusion