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Peds Patho Exam 3 > Hematology > Flashcards

Hematology Flashcards

1
Q

Anemia symptoms (15)

A
  1. Pale skin, lips, hands or conjunctiva
  2. Tachycardia
  3. Dyspnea
  4. Fatigue
  5. Dizziness/Vertigo, especially upon standing
  6. Headache
  7. Irritability
  8. Irregular menstruation cycles
  9. Amenorrhea
  10. Glossitis
  11. Jaundice; Because RBC are rapidly breaking down (hemolysis)
  12. Splenomegaly/Hepatomegaly
  13. Delayed growth and development; Due to less perfusion and oxygenation
  14. Impaired wound and tissue healing
  15. People who are very anemic their mouths hurt
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2
Q

Anemia causes (7)

A
  1. Nutritional deficiencies; Iron, Folate, Vitamin B12
  2. Inherited diseases
  3. Autoimmune diseases
  4. Bleeding
  5. Malignancies
  6. Medications
  7. Infections
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3
Q

Anemia work-up (10)

A
  1. Complete Blood Count (CBC)
  2. Hemoglobin
  3. Mean Corpuscular Volume (MCV)
    * Looking at size/volume of RBC
  4. Ferritin
    * Order feritin, cbc and iron binding capacity and serum iron (never feritin alone, but feritin is more imp than serum iron)
  5. Iron Binding Capacity (TIBC)
  6. Vitamin B12
  7. Folate
  8. Hemoglobin Electrophoresis
    * Hgb electrophoresis – do it for sickle cell patients; tells you shape of the Hgb
  9. Bone Marrow Aspirate
  10. Bone Marrow Biopsy
    * Bone marrow aspiration/biopsy – suspected cancer; checking for malignancy
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4
Q

Anemia with 80-100 MCV (3)

A

80 – 100 is Normal

  1. Iron Deficiency Anemia
  2. Chronic Disease
  3. B12 with Fe Deficiency
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5
Q

Anemia with >100 MCV (3)

A

> 100 = Elevated MCV or Large RBC

a. B12 Deficiency – Most Common
b. Folate Deficiency – Less Common
c. Myelodysplastic Syndrome – Rare

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6
Q

Anemia with <80 MCV (2)

A

< 80 = Reduced MCV

a. Iron Deficiency
b. Inherited Deficiency (i.e. Thalassemia)

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7
Q

Folate: causes for deficiency and treatment (8)

A
  1. Body stores for 2-3 months
  2. Causes: Dietary – RARE IN US
  3. Disease based: Celiac, small bowel resection, Chron’s
  4. Medications: antibiotics, diuretics, anticonvulsants
  5. Increased Utilization: alcoholism, pregnancy
  6. Lab values: Decreased serum folate, increased LDH
  7. Work up: GI referral if normal diet
  8. Treatment: Folic Acid 1 mg daily
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8
Q

B12 Deficiency: lab values, causes, work-up, treatment (5)

A
  1. Deficiency takes 5-10 years

2. Lab value: B12 under

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9
Q

Iron deficiency anemia (6)

A
  1. Test: look at MCV (under 80)
    a. Ferritin typically is under 15 but iron deficiency when under 40
  2. TIBC elevated
  3. Elevated platelet count (corrects when anemia improves) – NOT ALL CASES
  4. Once Hgb normalizes and they get more iron, the symptoms go away
  5. Look for occult blood to make sure they aren’t bleeding (ex: menstrual issues)
  6. Work up: fecal occult blood, menses hx, referral to GI, gastric bypass etc., LEAD LEVEL
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10
Q

iron deficiency anemia symptoms (6)

A
  1. conjunctival pallor
  2. brittle nails
  3. crusting sides of the mouth
  4. PICA is associated with iron deficiency anemia – want to eat ice, woodchips, dried pasta, etc. (unique to iron deficiency) – once they get iron they stop
  5. Will get sores in mouth if very anemic
  6. Restless leg syndrome
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11
Q

Sickle cell anemia and bone marrow

A

Bone marrow tries to catch up with problems going on (ex: stress, infection) and the more cells released, the more viscous and misshapen the cells get

a. Will be in severe, severe pain
b. Need to give narcotics
c. Eventually they become resistant to the drugs

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12
Q

sickle cell anemia types (3)

A
  1. HGB SS(HGB 9 and under)
  2. HGB SC(hgb 10-14)
  3. HGB S Beta thal (HGB 8-11)
    * The types vary on how mis-shapen the RBC cells are
    * The lower the Hgb, the more severe the symptoms
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13
Q

Complications of sickling/crisis (11)

A

a. Veno-occlusive Crisis (VOC)
b. AVN
c. Renal failure
d. Priapism
e. Acute chest syndrome
f. Foot and Leg Ulcers
g. Heart failure
h. Infection Risk (asplenic)
i. Stroke
j. Thrombosis
k. Retinopathy

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14
Q

Thalassemia: General info (2)

A
  1. Normal Red Blood Cells
    a. One pair of alpha globin chains
    b. One pair of beta globin chains
  2. Reduction or absence of production of one of globin chains
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15
Q

Alpha or beta thalassemia minor (4)

A

a. Asymptomatic
b. Borderline anemia
c. Diagnosis b/c microcytic anemia, hypochromic red cells, may have reduced HGB.
d. Not clinically significant

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16
Q

Beta thalassemia major (3)

A

a. Requires chronic transfusion
b. Hemochromatosis
c. Beta is more complicated and life-threatening

17
Q

Aplasatic anemia (3)

A
  1. Deficiency of Blood Cells
    a. White
    b. Red
    c. Platelets
  2. Bone Marrow Failure
    a. Complications
    b. Infection
    c. Bleeding
    d. Profound Anemia
  3. Should be a deficiency of at least two lines of cells
    a. It is because the bone marrow is not working properly
18
Q

Aplastic anemia causes (13)

A
  1. Idiopathic
    a. Most common

Inherited Disorders

  1. Fanconi anemia
  2. Dyskeratosis congenita
  3. Shwachman-Diamond syndrome
  4. Reticular dysgenesis
  5. Amegakaryocytic thrombocytopenia
  6. Familial aplastic anemias

Infections

  1. EBV
  2. CMV
  3. HIV
  4. Medications

Toxin Exposure

  1. Benzine
  2. Radiation Exposure
19
Q

Myelodysplastic Syndrome (3)

A
  1. MDS develops in the bone marrow – all blood cells produced by stem cells in marrow
    a. MDS is very similar to aplastic anemia, but it has more to do with the stem cells
    b. Small amount of stem cells in marrow and they are responsible for producing all of your blood cells
    * Begins producing unhealthy cells or too many blasts and become myelodysplastic
    c. Will progress to leukemia – ALL or AML, usually AML which is more life-threatening
  2. Most common is primary MDS, idiopathic
  3. Secondary MDS could be due to chemo or radiation or other factors
20
Q

MDS Pathology (5)

A
  1. Decreased Production of all types of Healthy Blood Cells
  2. Blood cells are unable mature and function properly
  3. RBC and WBC may mature but not normally or in sufficient numbers
  4. Increased blasts, increases and the number of mature cells decrease
  5. POD - blasts continue to increase and invade the bone marrow – normal function lost
21
Q

Symptoms of MDS (3)

A

a. Infections
b. Bleeding
c. Anemia

22
Q

Diagnosis of MDS (5)

A
  1. CBC
  2. Comprehensive Metabolic Panel
  3. LDH
  4. Bone Marrow Aspirate and Biopsy
  5. Cytogenetics
    - Cytogenetics looks at cells to see if there are any mutations in the DNA or translocations in chromosomes
23
Q

Hemophilia: Two main types

A
  1. Hemophilia A is caused by absent or low level of factor VIII (8)
  2. Hemophilia B is caused by absent or low level of factor IX (9)
24
Q

Hemophilia symptoms (5)

A
  1. Easy Bruising
  2. Epistaxis - difficult to control
  3. Hematuria
  4. Hematochezia or Melena
  5. Muscle and/or Joint bleeds
    - Pain
    - Edema
    - Immobility
  6. Internal bleeding
    - Cranial bleeds (potentially life-threatening)
25
Q

Diagnostic labs for hemophilia (5)

A
  1. CBC
  2. PT
  3. PTT/INR
    - Look at coag times with PTT/INR
  4. Clotting Factor Levels
  5. Genetic Testing
26
Q

ITP (4)

A
  1. Curable
  2. Clinically significant when platelet count under 30,000
  3. Often Idiopathic
  4. Acute thrombocytopenia is the most common form of ITP – most common in children
    a. 90 percent of cases—and occurring between the ages of 2 and 6 years
    b. Acute symptoms
    c. Resolves usually in weeks but by 6 months
    d. Recurrence is unusual once resolved
27
Q

ITP Physical exam (2)

A

a. Petechiae

b. Purpura

28
Q

ITP: When to seek urgent care (2)

A
  1. Unless platelet count under 10-15k
    a. Generally start on steroids
    b. Refer to hematology
  2. ER For life threatening bleeding or platelets <10,000
29
Q

Thrombosis: PE Symptoms (4)

A
  1. Chest pain
  2. shortness of breath
  3. increased heart rate
  4. decreased oxygen saturation
30
Q

Thrombosis: DVT (4)

A
  1. left leg more common, typically deep vein above the knee
  2. Symptoms: swelling, pain, tenderness
  3. Compression stockings +/- to prevent post thrombotic syndrome
  4. Need to know if provoked or unprovoked
31
Q

Provoked thrombosis (6)

A
  1. Treat for 3-6 months
  2. Recent surgery (risk of recurrence 1% within 1 year)
  3. Estrogen therapy
  4. Pregnancy
  5. Leg injury
  6. Long flight (risk of recurrence 5% within 1 year)
32
Q

Unprovoked thrombosis (4)

A
  1. Typically treated for 6 months to indefinite
  2. High risk of recurrence 10% within 1 year
  3. Cancer may be as 20% risk of recurrence (lower risk if in remission)
  4. Unprovoked recurrent thrombosis should be treated lifelong
33
Q

thrombocytosis definition

A

Elevated platelet count greater than 450,000

34
Q

Thrombocytosis causes (6)

A

THINK REACTIVE

  1. Infection — 31 percent
  2. Infection plus postsurgical status — 27 percent
  3. Postsurgical status — 16 percent
  4. Malignancy — 9 percent
  5. Postsplenectomy state — 9 percent
  6. Acute blood loss or iron deficiency — 8 percent

Peds Patho Exam 3 (7 decks)

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