hematology Flashcards
what might a serum ferritin level lower than 100-120 ng/ml in a pt with inflammatory disease suggest?
iron deficiency concomitant with anemia of chronic disease
changes in iron studies seen in anemia of chronic disease
decreased transferrin and TIBC level
increased serum ferritin
changes in iron studies seen in iron deficiency anemia
increased transferrin and TIBC levels
decreased ferritin levels
characteristic finding on BM biopsy in aplastic anemia
hypoplastic BM (<20% cellularity) with normal maturation of all cell lines
initial management in pts with aplastic anemia (after BM biopsy)…
withdrawl of any causative agents
CT scan of chest to R/O thymoma
in a question stem, what should you look for to dx. aplastic anemia?
look at all 3 cell lines - all will be decreased
reticulocytes will be decreased
should have hypocellular BM biopsy
how do you supplement iron in iron deficiency anemia?
oral ferrous sulfate, 325 mg three times daily
who should receive parenteral iron therapy?
those pts with iron deficiency anemia who have problems with malabsorption ex. celiac dz, Crohn’s dz, small bowel dz
what are “bite” cells in G6PD deficiency caused by?
produced when accumulated oxidized Hb remains adherent to the RBC mb with an adjacent mb bound clear zone; spleen takes a “bite” out of these RBCs
how can you tell a pt apart with hereditary spherocytosis and warm-AIHA?
direct Coomb’s test is positive in warm AIHA and negative in spherocytosis
characteristic findings in a pt with thalassemia
1 low MCV
- target cells on PBS
- normal results on iron studies
common lab findings in hemolytic anemia
elevated LDH
decreased haptoglobin
reticulocytosis
schistocytes are associated with ? (4)
mechanical/prosthetic heart valves
TTP
HUS
DIC
peripheral blood smear findings in iron deficiency anemia
microcytosis
hypochromia
anisocytosis - diff. sizes
poikilocytosis - diff shapes
what types of cell characterize warm-AIHA on peripheral blood smear?
spherocytes
what does it mean when a “mixing corrects to normal”
pt likely has a factor deficiency
- it will remain abnormal if a factor inhibitor is present
how can you make the dx. of DIC?
prolonged PT, aPTT and thrombin time positive D-dimers decreased fibrinogen decreased platelet count microangiopathic hemolytic anemia
what disease do you suspect in a pt who has a personal/family history of bleeding tendency, prolonged bleeding time, elevated aPTT and a low factor VIII level?
von willebrand disease
in someone with a low factor VIII level, how can you distinguish vWD from hemophilia A?
vWD causes prolonged bleeding time, while hemophilia A does not
best screening test for bleeding disorder
clinical history
what risk factors of bleeding require further screening (PT, aPTT, plt count) pre-operatively?
personal/family history of bleeding liver disease significant alcohol use malabsorption anticoagulation therapy
a pt with sickle cell dz presents with transient aplastic crises – what should you consider?
acute infection with parvovirus B19
- dx. with serum IgM abs
- recovery is usually spontaneous
management of acute chest syndrome
exchange transfusion
best test to diagnose osteonecrosis (avascular necrosis) in pt with sickle cell dz?
MRI of the hip
where is pain typically located in avascular necrosis?
groin
reflex sympathetic dystrophy
complex regional pain syndrome
- localized osteoporosis
- pain in extremities with swelling, limited ROM, vasomotor instability and skin changes
therapy of pt with sickle cell dz who developed stroke
chronic blood transfusion therapy to maintain peripheral blood HbS level < 50%
what should you consider in any pt with an otherwise unexplained decrease in platelet count and/or new thrombotic event 5-10 days after initiation of heparin therapy? how should you tx. them?
- heparin induced thrombocytopenia
2. stop heparin and administer argatroban
gold standard dx. test for HIT
C14-serotonin release assay
- but negative assay does not exclude HIT
TTP is due to deficiency of what?
ADAMST13
pentad of TTP
neurological symptoms fever renal failure thrombocytopenia micropathic hemolytic anemia
Tx. of TTP
plasma exchange
Evans syndrome
combination of warm AIHA and ITP
condition in which platelets clump together and cannot be counted properly
pseudothrombocytopenia
how can you dx. pseudothrombocytopenia
finding clumps of platelets (can occasionally adhere to neutrophils) on stained blood film
what do you do if you find pseudothrombocytopenia?
redraw pts blood using alternative anticoagulant to EDTA, such as heparin or sodium citrate
gestational thrombocytopenia
usually have platelet levels around 70 000
first line tx. for pts with ITP
steroids
indications for steroid tx. in ITP
symptomatic bleeding and plt count < 50 000 OR plt counts < 15 000
Tx of pt diagnosed with antiphospholipid syndrome
indefinite anticoagulation
how do you confirm the diagnosis of antiphospholipid syndrome?
2 positive lab tests (anticardiolipid ab or lupus inhibitor assay) ATLEAST 12 weeks apart - this is to ensure the findings were not transient
what are the antiphospholipid ab?
IgG anti-cardiolipin
B2-glycoprotein I abs
how can you diagnose antiphospholipid syndrome?
history of a thrombotic event (ex. recurrent pregnancy loss) in association w/ persistent lupus anticoagulant or persistently elevated ab
who is antiphospholipid syndrome common in?
SLE pts
- can also be been in cancer, infections (HIV) or drugs
decreased AG in the presence of anemia, proteinuria, hypercalcemia and renal failure suggests…
multiple myeloma
what is MGUS characterized by?
monoclonal spike < 3 g/dL
< 10% plasma cells in BM
absence of lytic bone lesions, anemia, hypercalcemia or renal failure
