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NPLEX II TIA > Hematology > Flashcards

Hematology Flashcards

1
Q

what is the final/main diagnostic test for most hematologic disorders?

A

bone marrow biopsy

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2
Q

What 3 nutritional cofactors are important in making heme and are often in iron supplements?

A

B6
glycine
succinate

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3
Q

what is normal TIBC? what would an increased or decreased value mean?

A

normal: 255-450 mcg/dL
increased: iron def anemia, PG, hormonal birth control
decreased: anemia of chronic disease, sideroblastic anemia, hemochromatosis

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4
Q

How is % iron saturation calculated

A

serom iron / TIBC

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5
Q

what are normal ferritin levels? when is ferritin often elevated or low?

A

normal: 20-300 (ideal 50-100)
elevates during inflammation/cancer
low during iron def/anemia

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6
Q

What pathologies could lead to an increased RBC count?

A

polycythemia vera
erythrocytosis

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7
Q

What pathologies could lead to an increased hematocrit (RBC mass)?

A

polycythemia vera
erythrocytosis
dehydration
shock

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8
Q

What pathologies could lead to an increased hemoglobin (blood concentration)?

A

polycythemia vera
severe burns
COPD
CHF

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9
Q

What pathologies could lead to an increased MCV?

A

macrocytic anemia

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10
Q

What pathologies could lead to an increased MCHC?

A

spherocytosis

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11
Q

What pathologies could lead to an increased MCH?

A

macrocytic anemia

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12
Q

What pathologies could lead to a decreased RBC count?

A

anemia
blood loss
lymphoma
myeloproliferative disorder
leukemia

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13
Q

What pathologies could lead to a decreased hematocrit?

A

anemia
leukemia
acute blood loss

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14
Q

What pathologies could lead to a decreased hemoglobin?

A

anemia
hemolytic rxns
hemorrhage
system disease

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15
Q

What pathologies could lead to a decreased MCV?

A

microcytic anemia

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16
Q

What pathologies could lead to a decreased MCHC?

A

iron def
macrocytic anemia
thalassemia

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17
Q

What pathologies could lead to a decreased MCH?

A

microcytic anemia

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18
Q

factors that can interfere with testing RBC count

A

dehydration
age
altitude
pregnancy

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19
Q

factors that can interfere with testing hematocrit

A

dehydration
age
altitude
pregnancy

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20
Q

factors that can interfere with testing hemoglobin

A

altitude
excess fluid
pregnancy
drugs

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21
Q

factors that can interfere with testing MCV

A

can be normal in normocytic anemia

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22
Q

factors that can interfere with testing MCHC

A

presence of cold agglutins, lipemia, high amounts of heparin

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23
Q

factors that can interfere with testing MCH

A

hyperlipidemia

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24
Q

normal hematocrit

A

F: 36-48
M: 42-52

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25
Q

normal hemoglobin

A

F: 12-16
M: 14-17

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26
Q

normal MCV

A

82-98

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27
Q

normal MCHC

A

31-37

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28
Q

normal MCH

A

26-34

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29
Q

normal RBC count

A

F: 3.6-5 x 10^6
M: 4.2-5.4 x 10^6

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30
Q

What pathologies could lead to an increased RDW?

A

iron def
vitamin B12/folate def
thalassemia

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31
Q

What pathologies could lead to an increased platelet count?

A

malignancy
myelogenous leukemia
polycythemia vera

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32
Q

What pathologies could lead to an increased WBC count?

A

infxn
leukemia
malignant neoplasms

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33
Q

What pathologies could lead to an increased neutrophil count?

A

bacterial infxns
inflammation
leukemia

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34
Q

What pathologies could lead to increased lymphocytes?

A

leukemia
lymphoma
mononucleosis
viral dz

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35
Q

What pathologies could lead to increased monocytes?

A

TB
subacute bacterial endocarditis
leprosy
lipid storage dz
some leukemias

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36
Q

What pathologies could lead to increased eosinophils?

A

allergies
parasite infxn
skin dz
infxn

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37
Q

What pathologies could lead to increased basophils?

A

granulocytic and basophilic leukemia
myeloid metaplasia
hodgkins lymphoma

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38
Q

What pathologies could lead to decreased RDW?

A

posthemorrhagic anemia

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39
Q

What pathologies could lead to decreased platelets?

A

idiopathic thrombocytopenia
purpura
exposure to DDT
chemo

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40
Q

What pathologies could lead to decreased WBC?

A

viral infxn
bone marrow depression/disorders

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41
Q

What pathologies could lead to decreased neutrophils?

A

drugs
chemicals/radiation
blood dz
acute relentless bacterial ifxn with poor prognosis

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42
Q

What pathologies could lead to decreased lymphocytes?

A

chemo
steroid administration
tumor
malignancy

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43
Q

What pathologies could lead to decreased monocytes?

A

prednisone use
hairy cell leukemia
RA
HIV

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44
Q

What pathologies could lead to decreased eosinophils?

A

cushings syndrome
medications

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45
Q

What pathologies could lead to decreased basophils?

A

acute infxn
stress
steroid therapy

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46
Q

factors that can interfere with testing RDW

A

result isnt useful if anemia is not present

47
Q

factors that can interfere with testing platelet count

A

count inc after exercise, in winter, and at high altitudes

48
Q

factors that can interfere with testing WBC count

A

age, time of day

49
Q

factors that can interfere with testing neutrophils

A

steroid administration
extreme heat or cold
age

50
Q

factors that can interfere with testing eosinophils

A

stress
time of day

51
Q

normal values RDW

A

11.5-14-5%

52
Q

normal values platelets

A

140-400 x 10 ^3

53
Q

normal values WBC

A

5-10^3

54
Q

normal ratio of WBC

A

“never let me eat blood”

N: 50-60
L: 20-40
M: 2-6
E: 1-4
B: 0.5-1

55
Q

what is meant by “left shift”

A

over 6% immature band neutrophils
indicates bacterial infxn

56
Q

what is meant by “right shift”

A

hypersegmentation of neutrophils
indicates B12/folate deficiency

57
Q

What hemotologic disorders would you be most suspicious of if a patient was reporting pain?

A

macrocytic anemias
leukemias
sickle cell anemia
multiple myeloma

58
Q

What hemotologic disorders would you be most suspicious of if a patient was reporting fatigue

A

microcytic and macrocytic anemias
leukemias
mono
lymphomas

59
Q

What hemotologic disorders would you be most suspicious of if a patient was reporting purpura

A

senile purpura
ITP/TTP
true clotting disorders: VWF, hemoA&B

60
Q

What hemotologic disorders would you be most suspicious of if a patient was reporting GI complaints

A

pernicious anemia

61
Q

What hemotologic disorders would you be most suspicious of if a patient was reporting lymphadenopathy

A

lymphomas
mono

62
Q

What hemotologic disorders would you be most suspicious of if a patient was exhibiting hepatomegaly or splenomegaly

A

both: leukemias
spleen only: mono

63
Q

basic labs for heme

A

CBC w differential and PLT
reticulocyte count
ferritin, TIBC

64
Q

aside from initial work up, what additional testing would you consider for suspected macrocytosis?

A

MMA
neutrophil segmentation
B12 and folate levels

65
Q

aside from initial work up, what additional testing would you consider for suspected microcytosis?

A

iron studies
RBC morphology
reticulocyte counts
erythropoetin levels

66
Q

aside from initial work up, what additional testing would you consider for lymphadenopathy?

A

WBC morphology
EBV and CMV viral studies
bone marrow studies

67
Q

aside from initial work up, what additional testing would you consider for hemolysis

A

indirect and direct bilirubin
RBC morphology and membrane studies
reticulocyte count

68
Q

aside from initial work up, what additional testing/considerations would you have for pain

A

consider B12 anemias
urine electrophoresis (bence jones protein)
R/O hemolytic anemias

69
Q

aside from initial work up, what additional testing/considerations would you have for neuro sx

A

macrocytic anemia work up

70
Q

anemia is defined how?

A

low HCT and Hb

71
Q

name the microcytic anemias (low MCV)

A

iron def
thalassemia
sideroblastic
lead poisoning

72
Q

name the normocytic anemias (normal MCV)

A

acute blood loss
hemolysis
anemia of chronic disease
anemia of renal failure
myelodysplastic syndromes

73
Q

name the macrocytic anemias (high MCV)

A

folate def
b12 def
drug toxicity (e.g. zidovudine)
alcoholism/chronic liver dz

74
Q

typical values of the following for iron def anemia:

  • smear
  • SI
  • TIBC
  • % sat
  • ferritin
A
  • smear: microcytic/hypochromic
  • SI: <30
  • TIBC: >360
  • % sat: <10
  • ferritin: <15
75
Q

typical values of the following for thalassemia:

  • smear
  • SI
  • TIBC
  • % sat
  • ferritin
A
  • smear: microcytic/hypochromic with targeting
  • SI: normal to high
  • TIBC: normal
  • % sat: 30-80
  • ferritin: 50-300
76
Q

typical values of the following for sideroblastic anemia:

  • smear
  • SI
  • TIBC
  • % sat
  • ferritin
A
  • smear: variable
  • SI: normal to high
  • TIBC: normal
  • % sat: 30-80
  • ferritin: 50-300
77
Q

typical values of the following for inflammation:

  • smear
  • SI
  • TIBC
  • % sat
  • ferritin
A
  • smear: normal microcytic/hypochromic
  • SI: <50
  • TIBC: <300
  • % sat: 10-20
  • ferritin: 30-200
78
Q

microcytic hypochromic anemias

A

iron def
thalassemia
chronic infxn
severe protein def

79
Q

what pathologies would you consider in a normocytic, normochromic anemia with high reticulocytes?

A

lost blood cells
- acute blood loss
- hemolytic anemia

80
Q

what pathologies would you consider in a normocytic, normochromic anemia with low reticulocytes?

A

underproduction
- red cell aplasia
- drugs, leukemia, aplasitic anemia
- chronic dz, liver or kidney dz

81
Q

macrocytic anemia etiology and diagnostic testing

A

vitamin B12 def; may be folic acid responsive

dx:
- elevated MCV, low reticulocyte count
- hyper segmented (>5) neutrophils
- low b12 levels
- low MMA (serum)

82
Q

what is the most common hemolytic anemia? what would you see on a peripheral smear of someone with this diagnosis?

A

G6P deficiency
bite cells or heinz bodies on peripheral smear

83
Q

would a G6PD patient appear anemic?

A

not unless exposed to oxidant drugs; which is why its important to check RBC G6PD prior to high dose vit C IVs

84
Q

why does G6PD offer a selective advantage against malaria?

A

malaria infests the RBC

85
Q

etiology sickle cell disease

A

replacement of glutamic acid by valine at position 6 of the B chain leading to hemoglobin S

86
Q

signs/sx sickle cell

A

occlusion of precapillary arterioles
anemia and splenomegaly
attacks of pain in chest, abdomen, skeleton
multiple infarctions in bone marrow

87
Q

hemochromatosis etiology and clinical picture

A

inherited disorder that results from excessive iron absorption from food; cant get rid of iron and it oxidizes and deposits in skin/other tissues

manifests typically at 40-60, more commonly in men
liver failure (cirrhosis)
pancreatic failure (“bronze diabetes”)

88
Q

epoetin alfa indications / use

A

anemia related to:
- chronic renal failure
- zidovudine therapy in HIV pts
- chemotherapy in pts with metastatic nonmyeloid malignancies

reduction of allogenic blood transfusions in surgery pts

unlabeled uses: anemia for chronically ill pts, CHF, chronic dz, postpartum anemia, sickle cell, thalassemia, jehovahs witnesses

89
Q

what dx of are dx of exlusion when you have ruled out all other causes for purpura?

A

purpura simplex
senile purpura

90
Q

henoch schonlein purpura etiology and clinical picture

A

inflammatory disorder of unknown cause with IgA complexes in capillary beds/joints

acute respiratory infxn usually precedes the purpura

purpuric rash on LEs
abdominal pain or renal involvement
arthritis
hematuria

91
Q

ITP etiology and clinical picture

A

Ab form against platelets; frequently preceded by URI/viral infxn

presents as petechiae and other bleeding such as CNS bleeding or bleeding gums

92
Q

TTP etiology and clinical picture

A

fatal; usually die at 30-40 with tx
due to inhibitor of vWF-cleaving protease and unchecked platlet aggregation

dx criteria:
microangiopathic hemolytic anemia (shistocytes, helmet cells on smear)
elevated LDH
mental status changes or fluctuating focal neuro deficits

93
Q

hemolytic uremic syndrome etiology and clinical picture

A

hemolytic anemia from toxin > hemolytic cells plug up kidney > kidney failure

etiology:
bacterial: diarrheal illness from ecoli, shigella, staph
drugs: chemo, tacrolimus, ticlopidine, oral contraceptives

94
Q

VWD etiology and clinical picture

A

hereditary abnormal synthesis of vWF > dec platelet adhesion and dec serum levels of factor VIII:C

hx heavy menses
epistaxis
easy bruising
GI bleeding

other testing normal; do clotting studies/vW profile

95
Q

disseminated intravascular coagulation (DIC) etiology and clinical picture

A
  • complication of obstetrics (abruptio placentae, saline aborrtion, retained products of conception, amniotic fluid embolism, eclampsia)
  • infxn (esp gram neg with endotoxin release)
  • malignancy (esp adenocarcinoma of pancreas and prostate, acute leukemia)
96
Q

hemophilia A etiology, dx, tx

A

X linked recessive def of factor VIII
dx by factor VIII assay; PTT normal or elevated, PT and thrombin clot time normal.

tx:
factor VIII supplementation

97
Q

hemophilia B (christmas disease) etiology, dx, tx

A

X-linked recessive def of factor IX
dx by factor IX assay, tx def

98
Q

what condition most commonly causes relative/reactive polycythemia?

A

emphysema/COPD (rxn to inc erythropoietin)

NOT A CANCER

99
Q

polycythemia vera pathophys/sx

A

absolute increase in red cell mass (similar to a leukemia of RBC)

fatigue, weakness, dizziness, HA, visual problems
itching after warm bath
easy bruising or bleeding with little or no injury

100
Q

multiple myeloma etiology and sx

A

neoplastic proliferation of a single clone of plasma cell producing monoclonal IgG or IgA

bone and back pain, unexplained fractures
bleeding problems
aggravation of arrythmias

101
Q

multiple myeloma diagnostic

A

bone marrow biopsy
bone x ray (shows fractures, “punched out” bone lesions)
hypercalcemia
bence jones proteniuria

102
Q

waldenstroms macroglobulinemia presentation and etiology

A

malignant disease of b lymphocytes with overproduction of IgM > hyper viscous blood and peripheral vascular compromise

similar multiple myeloma presentation but less common

103
Q

what is the most common leukemia in children?

A

acute lymphocytic leukemia (ALL)

104
Q

ALL etiology, sx, prognosis

A

fever, bone pain, hepatosplenomegaly

associated with down syndrome, radiation, viral infxns

90% remission with tx, 3-6 mo surivial without tx

105
Q

what is the most common leukemia in adults 15-39?

A

acute myeloblastic leukemia (acute nonlymphocytic leukemia)

106
Q

acute myleoblastic/nonlymphocytic leukemia presentation and prognosis

A

splenomegaly
auer rods in cytoplasm
may present with bleeding disorders or high WBC

cure rate 10-15%, 1 year survivial with chemo

107
Q

what age is a typical pt with chronic myleogenous leukemia?

A

45

108
Q

chronic myleogenous leukemia etiology, clinical presentation, and prognosis

A

well differentiated granulocytic leukemia (may include any cell line); slow for 3 years then “blast crisis”
90% of pts have the philadelphia (Ph) chromosome

hepatosplenomegaly, fatigue, generalized LA, weakness, anorexia/wt loss

4-6 year survival

109
Q

chronic lymphocytic leukemia typically affects individuals around what age?

A

over 55

110
Q

chronic lymphocytic leukemia sx

A

none
enlarged lymph nodes, liver, spleen
fatigue
abn bruising (late in dz)
night sweats
loss of appetite
wt loss
VERY inc WBC (50-250k) - often found incidentally

111
Q

hodgkins lymphoma etiology and sx

A

20 or 60 yo
curable, familial

single asx swollen node (unexplained lymphadenopathy)
unexplained recurrent fevers
night sweats
wt loss
lymphocytopenia
reed sternberg cell with hodgkins disease

112
Q

what is the most common lymphoma?

A

non-hodgkins lymphoma

113
Q

non hodgkins lymphoma etiology and presentation

A

malignant growth of B or T cells
similar presentation to hodgkins
associated with burkitts and immunoblastic lymphomas

114
Q

burkitts lymphoma etiology and presentation

A

B lymphocyte tumor
lymphadenopathy in the maxilla or mandible

associated with EBV in US, malaria in africa
may predispose pt to NHL

NPLEX II TIA (12 decks)

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