Hematology Flashcards
anemic patients with reticulocyte count > 2 indicates
working marrow, RBC loss is either from bleeding or hemolysis
anemic patients with reticulocyte count > 2 indicates
working marrow, RBC loss is either from bleeding or hemolysis
anemic with retic cound
bone marrow failure from lack of epo or nutrients
why does renal failure cause anemia
lack of EPO production
what does high indirect bilirubin mean?
hemolysis or glibert syndrome
high indirect bilirubin, high LDH, and high corrected retic count all point to?
hemolysis
everyone has a least _____types of hemoglobin
3
a decrease is what 2 type of hemoglobin leads to thalassemia?
alpha and beta
normal white blood cell count
4.5 -11
normal platelet count
150-400
normal recticulocyte count
25-85
Burr cells =
uremia (too much urea in the blood) kidney’s are not doing well
Spur cells=
postsplenectomy
Schistocytes =
DIC, vasulitis, and thrombotic thrombocytopenia
Tear drop
iron deficiency
target cells
thalassemias
basophilic stippling
lead toxicity
bite cells
G6PD deficiency
rouleaux formation
Multiple myeloma
increased recticulocyte count =
hemolysis or hemorrhage
type of cells found in sideroblastic lead
dimorphic stippling
who gets alpha thalassemia and who gets beta
Alpha; asian and Beta is meds and africans
life long anemia and positive iron stores think….
thalassemia
what determines the severity of alpha thalassemia
how much chains are deleted
another name for beta thalassemia?
Cooley’s anemia
tx for thalassemia?
transfusions, but must be careful not to overload
iron overloading may result in
hemosiderosis, heart failure, cirrhosis.
what medication can be given to postpone hemosiderosis
deferoxamine or oral deferasirox
what are iron store and hemoglobin levels like in thalassemia?
hemoglobin is low 3-6 and iron is normal
definitive tx for thalassemia
bone marrow transplant or spenectomy
what is the hallmark of Fe deficiency?
Pica
what is plummer vinson syndrome
formation of esophageal webs due to severe iron deficiency
what plasma ferritin level indicates iron insufficiency
what if serum iron is decreased to
dx = iron deficiency
what can be taken with iron to help with absorption
vitamin c
treatment for iron defiency
325mg of ferrous sulfate, therapy should be continued for 6 months
anemia can be caused by chronic inflammation, what labs should you get
CRP and ESR
what type of screening is used for sideroblastic anemia and what are the causes
prussian blue stain show rings. lead, etoh
treatment for lead poisoning
chelation therapy
anemia of chronic disease have what size cells
normocytic
anemia due to renal failure can be tx with?
Recombinant epo
name a couple of folate acid antagonist
phenytoin, trimethoprim-sulfamethoxazole and sulfasalazine
lacking folic acid will you have neurologic symptoms?
no. but you may have a sore tongue
Macro-ovalocytes and hyper segmented polymorphonuclear cells are path gnomonic for ?
Folic acid deficiency (macrocytic anemia), keep in mind that B12 deficiency can also have this
Howell jolly bodies =
folic acid deficiency
name the buzz words for b12 deficiency of pernicious anemia
smooth tongue, stocking-glove paresthesia, dementia (neurologic problems)
tx pernicious anemia
lifelong b12 injections
tx pernicious anemia
lifelong b12 injections
anemic with retic cound
bone marrow failure from lack of epo or nutrients
why does renal failure cause anemia
lack of EPO production
what does high indirect bilirubin mean?
hemolysis or glibert syndrome
high indirect bilirubin, high LDH, and high corrected retic count all point to?
hemolysis
everyone has a least _____types of hemoglobin
3
a decrease is what 2 type of hemoglobin leads to thalassemia?
alpha and beta
normal white blood cell count
4.5 -11
a what age do sickle cell problems start
6 months when Hgb F starts to fall
normal recticulocyte count
25-85
Burr cells =
uremia (too much urea in the blood) kidney’s are not doing well
Spur cells=
postsplenectomy
Schistocytes =
DIC, vasulitis, and thrombotic thrombocytopenia
Tear drop
iron deficiency
target cells
thalassemias
basophilic stippling
lead toxicity
bite cells
G6PD deficiency
rouleaux formation
Multiple myeloma
increased recticulocyte count =
hemolysis or hemorrhage
type of cells found in sideroblastic lead
dimorphic stippling
who gets alpha thalassemia and who gets beta
Alpha; asian and Beta is meds and africans
life long anemia and positive iron stores think….
thalassemia
what determines the severity of alpha thalassemia
how much chains are deleted
another name for beta thalassemia?
Cooley’s anemia
tx for thalassemia?
transfusions, but must be careful not to overload
iron overloading may result in
hemosiderosis, heart failure, cirrhosis.
what medication can be given to postpone hemosiderosis
deferoxamine or oral deferasirox
what are iron store and hemoglobin levels like in thalassemia?
hemoglobin is low 3-6 and iron is normal
definitive tx for thalassemia
bone marrow transplant or spenectomy
what is the hallmark of Fe deficiency?
Pica
what is plummer vinson syndrome
formation of esophageal webs due to severe iron deficiency
what plasma ferritin level indicates iron insufficiency
less than 20
what if serum iron is decreased to
dx = iron deficiency
what can be taken with iron to help with absorption
vitamin c
treatment for iron defiency
325mg of ferrous sulfate, therapy should be continued for 6 months
anemia can be caused by chronic inflammation, what labs should you get
CRP and ESR
what type of screening is used for sideroblastic anemia and what are the causes
prussian blue stain show rings. lead, etoh
treatment for lead poisoning
chelation therapy
anemia of chronic disease have what size cells
normocytic
anemia due to renal failure can be tx with?
Recombinant epo
name a couple of folate acid antagonist
phenytoin, trimethoprim-sulfamethoxazole and sulfasalazine
lacking folic acid will you have neurologic symptoms?
no. but you may have a sore tongue
Macro-ovalocytes and hyper segmented polymorphonuclear cells are path gnomonic for ?
Folic acid deficiency (macrocytic anemia), keep in mind that B12 deficiency can also have this
Howell jolly bodies =
folic acid deficiency
name the buzz words for b12 deficiency of pernicious anemia
smooth tongue, stocking-glove paresthesia, dementia (neurologic problems)
are MMA and homocystenine levels increased in anemia due to vitamin b12?
YES
tx pernicious anemia
lifelong b12 injections
Acronym for hemolytic anemia
HIT
what does HIT stand for
hereditary, immune attack and trauma
Hereditary causes of hemolytic anemai
G6PD, thalassemia, sickle cell
Immune attack causes of hemolytic anemia
TTP, HUS, DIC
The direct coombs test id antibodies on______
the RBC
the indirect test id antibodies in the______
patient’s serum
Test for G6DP hemolysis
Heinz body test
who does sickle cell affect in the US
blacks
a what age do sickle cell problems start
6 months when Hgb F starts to fall
what causes a sickle cell crisis
dehydration, altitude, acidosis, hypoxemia, stress, menses
sickle cell patients are at an increased risk for
strep pneumo infection, ulcer, spleen and gallbladder issues
what ortho issue is more common in sickle cell patients
AVN of the femoral and humeral head
that method demonstrates the level of different hemoglobin in the red cells
electrophoresis
findings of sickle cells on peripheral smear
Howell jolly bodies
preventative tx for sickle cell
low dose penicillin daily from birth to 6 years old, pneumo vaccines and screening to prevent stroke. daily hydroxyurea should also be considered.
what type of a genetic disorder is G6PD
X-linked (black males)
what causes episodic hemolysis in G6PD
Fava beans and oxidative drugs like aspirin
Coomb’s test results: Warm IgG positive = what causes?
CLL, NHL, Hodgkin, SLE
Coomb’s test results: Cold IgM positive/ positive complement C3d =
infection, EBV, CMV, mono
polycythemia vera is known to have what mutation
JAK2
Poly..Vera might convert to…
myelofibrosis or chronic myeloid leukemia
Upper GI issue associated with poly, vera
PUD
what is the most commen complication of poly. vera
thrombosis
signs of primary poly, vera
HTN, splenomegaly, thrombosis
who is affected by AML
all mature lions (ADULTS) over 60 years old
who is affected by ALL
all little lions 3-7 years old
CBC for leukemia
pancytopenia, circulating blasts >20%
Auer rods are seen in what type of leukemia
AML
Terminal deoxynucleotidyl transferase is diagnostic for
ALL
what are 3 stages of CML
chronic, accelerated and acute (blast crisis >30% blasts)
tx for ALL
chemo (50% of children will be cured
what should be contained on a hyper coagulation panal
protein S and C, antithrombin III, factor V leiden, HIT essay
what test is used to defect lupus anticoagulant
russell’s viper venom
treatment for lupus anti autoimmune causes
prednisone
hallmark leukocytosis number > 20,000
CLL
hallmark is leukocytosis with a WBC of 150,000
CML
what replaced the search for the philly gene in CML
BCR-ABL
a smudge cell are pathognomics for
CLL
Reed strenberg cells found, associated with epstein barr virus and incident peaks in 20s and 50s
Hodgkins lymphoma
B lymphocytes associated with HIV and occurs in 20-40 year olds
NON-hodgkins lymphoma
treat for NON- hodgkins lymphoma if only 1-2 nodes involved
radiation
treatment for NON-hodgkins lymphoma involves more than 1 node?
chemo
treatment for hodgkins
chemo or chemo + radiation
What are rouleaux formations
spike on serum protein electrophoresis, positive multiple myeloma
bence jones, lytic lesions, replacement of bone marrow?
MM
monoclonal paraprotein
MM
most common bleeding disorder
vWD
what clotting factor is missing in vWD
8
PET vs PITT
extrinsic vs intrinsic
next step if either PT or PTT is long?
Thrombin time (TT)
what does thrombin time measure
conversion of fibrinogen to fibrin
thrombocytopenia, post viral infection, autoimmune IgG disorder
ACUTE immune thrombocytopenia purpura (ITP)
thrombocytopenia more common in females, associated with HIV, autoimmune and hep C
CHRONIC immune thrombocytopenia purpura
Rare but fatal thrombocytopenia associated with HIV, pregnancy, and anti-clotting drugs
TTP
thrombocytopenia that causes hemorrhage in pt w/ severe illness, sepsis, burns, and cancer
DIC
thrombocytopenia similar to TTP, but found in children with toxicgenic e.coli
HUS
if platelet count is below 50,000 symptoms include?
petecitea, purpura, bleeding gums
Will PT/PTT be normal or abnormal in TTP, HUS, DIC and HIT
abnormal in DIC and HIT
tx for HIT
stop heparin
tx for TTP
FFP and plasma exchange, no platelets
tx for HUS
support, no platelets
tx for DIC
FFP cryo platelets
dx study for TTP
autoantibodies against ADAMTS 13 lead to excessive platelet aggregation
dx for HIT
ELISA is positive, PF4 heparin antibody enzyme
tx for ITP
support, steroids or take out spleen
what is more common acquired or congenital platelet dysfunction
acquired, due to aspirin and NSAIDS
test for platelet function
platelet function testing (PFT) problems even though the platelet number is normal
dx test for vWD
PT is normal and PTT may be prolonged & PFA prolonged, factor VIII is low, vWD is low
abnormal pt and ptt
got to think DIC
tx for vWD
desmopressin (DDAVP) nasal spray for prevention before procedures and Factor VIII concentrates
is PTT or PT increased with hemophilia A
PTT, everything else is normal
what is more common hemophila A or B
A
most common acquired cause of inability to clot?
Vitamin K deficiency
what studies are prolonged in Vit K deficiency?
PT and PTT, vita K level and factors II, VII, IX, and X (2.7,9,10)
is Hyperhomocysteinemia venous of arterial
arterial
What is the best treatment for hemophilia A?
Factor 8
Which of the following thrombophilias may result from B 6 , B 12 , or folate deficiency?
Homocysteine is broken down in the body by Vit B 6 , B 12 , and folate. Thus, hyperhomocysteinemia may result from a deficiency in any of these compounds.
A 65 year old female presents to your office with an acute onset of gingival bleeding, frequent epistaxis, and fatigue. She denies having night sweats. Physical exam reveals a slight fever, without lymphadenopathy. Complete Blood Count demonstrates WBC 50,000; hemoglobin 8.9; platelets 20,000; and peripheral smear shows myeloblasts. Which of the following findings is consistent with the likely diagnosis?
This patient is presenting with acute myeloid leukemia (AML). A CBC will show leukocytosis with anemia/thrombocytopenia. Bone marrow biopsy is the definitive test, which will reveal Auer rods, which is pathognomic for AML.
Which of the following signs of metastatic disease is characterized by palpable pelvic nodes on pelvic or rectal exam?
Palpable pelvic nodes on pelvic or rectal exam are termed Blumer’s shelf, and may be a sign of metastatic cancer.
Which of the following venous thrombophilias may lead to heparin resistance?
Can lead to heparin resistance since heparin activates on Antithrombin III.
Which of the following is the most common cause of B 12 deficiency?
Atrophic gastritis, the autoimmune destruction of gastric parietal cells leads to a lack of intrinsic factor. Vitamin B 12 absorption is dependent on adequate levels of intrinsic factor.
what two coag-pathies are people really sick?
TTP and DIC
Do not give platelets in what 3 coag-pathies
TTP, HUS, and HIT
the only coag-pathy with true venous and arterial clots?
HIT
two coag-pathy with hemolytic anemia
TTP & HUS
what is more serious ITP or TTP
TTP (may be CNS findings)
what type of leukemia has the exam finding of Spenomegaly
CML
Antithrombin III deficiency causes clots and is complicated by its possible resistance to _____
heparin
