Hematology Flashcards
Blood loss of 15% or higher results in
Orthostatic hypotension
Systolic drop more than 20mm ahh
What is defined as an absolute neutrophil count of less than 1500 mm
Neutropenia
What condition is consistent with a gradual onset of symmetrical peripheral neuropathy starting in the feet and or arms
Vitamin B 12 deficiency
Neurological signs such as numbness, ataxia “positive Romberg test”, loss of vibration and positive sense, impaired memory, And dementia “severe cases”
Vitamin B 12 deficiency
What type of cancer affects the beta lymphocytes “B cells”
Hodgkin’s lymphoma
Night sweats, fevers, pain with ingestion of alcoholic drinks, generalized Pruritus with painless enlarged lymph nodes (neck), anorexia, and weight loss are all symptoms of
Hodgkin’s lymphoma
What type of cancer affects the lymphocytes “usually B cells” and killer cells
Non-Hodgkin’s lymphoma
What type of cancer affects older adults greater than 65 years of age, with night sweats, fever, weight loss, generalized lymphadenopathy “painless”.
Non-Hodgkin’s lymphoma
What type of cancer affects the plasma cells. Symptoms include fatigue, weakness, and bone pain that is usually located in the back or chest. Proteinuria with Bence-Jones proteins, hypercalcemia, normocytic anemia. More common in older adults
Multiple myeloma
What is defined as a platelet count of less than 150,000
Thrombocytopenia
When a patient presents with thrombocytopenia, you have to look for
Bleeds
Easy bruising, bleeding gums, nosebleeds, hematuria
Bruising on the distal lower and upper extremities is usually related to
Physical activity
Aspirin, NSAIDs, heparin, Washington, SSRI, steroids can all cause
Bruising
If a patient presents with bruising what should they be evaluated for
Von Willebrand’s disease, vitamin C deficiency, or scurvy. Possible coagulation disorder
What is the proportion of red blood cells in 1 mL of plasma
Hematocrit
What is the measure of the average size of red blood cells
MCV
What is the measure of the average color of red blood cells
MCH
What is a measure of available transferrin that is left unbound to iron
Total iron binding capacity
If the iron count is high, the total iron binding capacity he is
Low
If The iron count is low, the total iron binding capacity is
High
What is the storage form of iron
Serum ferritin
What is the most sensitive test for iron deficiency anemia
Serum ferritin
In iron deficiency anemia, serum ferritin is
Decreased
In thalassemia trait, serum ferritin is
Normal to high
What is decreased in iron deficiency anemia
Serum iron
Serum iron is normal to high in
Thalassemia and macrocytic anemia’s
When testing Serum levels
The patient needs to avoid iron supplements 24 hours before testing the serum ferritin level
A measure of the variability of the size of red blood cells in a given sample
RDW
Immature red blood cells
Reticulocytes
What is the cause of an elevation of reticulocytes or reticulocytosis
It is elevated with supplementation of iron, folate, or B 12 after just deficiency, after acute bleeding episodes, hemolysis, leukemia, and with erythropoietin treatment. Chronic bleeding does not cause elevation of the reticulocytes due to compensation
If there is no reticulocytosis after in acute bleeding episode (after 3-4 days), Hemolysis, or after appropriate supplementation of deficient mineral “iron, folate, or B 12” rule out
Bone marrow failure i.e. aplastic anemia. Which is diagnosed by bone marrow biopsy
What is poikilocytosis
Peripheral smear
Poikilocytosis or peripheral smear is seen with
Severe iron deficiency anemia. Red blood cells abnormal with variable shapes seen in the peripheral smear
If there is a deficiency in folate or B 12 what type of anemia would this be
Macrocytic anemia
What test is the gold standard for sickle cell anemia and the thalassemias
Hemoglobin electrophoresis
What types of patients have secondary polycythemia
Chronic smoker, long time COPD, long-term residents at high-altitude’s, or EPO treatment
What is and elevated immaculate and hemoglobin
Polycythemia
What is a decrease in the hemoglobin and hematocrit value below the norm for the patient’s age and gender
AnemiA
What is a microcytic hypochromic anemia
Iron deficiency anemia
What is the term for spoon shaped nails often found in Iron deficiencyanemia
Koilonychia
What is the most common cause of iron deficiency anemia
Blood loss (overt or occult) heavy menses, pregnancy, Poor diet, G.I. blood loss, post gastrectomy, and increased physiological requirement
Giving an infant cows milk before 12 months of age can cause
G.I. bleeding
What do these labs indicate:
Decreased hemoglobin and hematocrit, decreased MCV, decreased MCH, Decreased Ferritin and iron level, increased total iron binding capacity , increased RDW
Iron deficiency anemia
What type of anemia would cause an increase in antiparietal anti-bodies, MCV also increased, MCH within normal limits
Pernicious anemia
B 12 deficiency anemia
What type of anemia would cause an increase in the MCV, MCH in normal limits, and a decrease in folate level
Folate deficiency
What type of anemia would have an MCV within normal limits, MCH within normal limits.
Normocytic anemia or anemia of chronic disease such as rheumatoid arthritis or inflammatory diseases
What type of anemia would produce Howell jolly bodies and target cells on the peripheral smear with a normocytic normochromic anemia
Sickle cell anemia
What is the norm value for a red blood cell count
4.2 to 4.9
What is the normal value for hemoglobin
12 to 15
What is the norm value for hematocrit
37 to 51%
Does COPD increase or decrease hemoglobin and hematocrit
Increase
Measure of iron in circulation
Serum iron
Indicates ability of bone marrow to produce red blood cells usually immature red blood cells
Reticulocyte count
What labs should you always order with a patient that presents with anemia
Peripheral smear
If a patient is found to have I am deficiency anemia and B 12 anemia what term is used to describe two concurrent anemias
Mixed anemia
What test is very useful with mixed anemias
Peripheral smear
Hey macrocytic normochromic anemia would be consistent with
Folate or B 12 anemia
What is two distinct populations of red blood cells
Dimorphic smear
If the iron count is high, The total iron binding capacity is
Love
If the iron count is low the total iron binding capacity is
High
What is the average lifespan of a normal red blood cell
Three month or 100 to 120 days
What is the average lifespan of a platelet
Three days
What are two common causes of microcytic anemia
Iron deficiency anemia and thalassemia
What is the mostcommon reason for Iron deficiency anemia
Blood loss
What is another cause of microcytic anemia that may not be as common
lead toxicity
Most people with microcytic anemia’s are a symptomatic until their H&H reach
30/10
Weakness, headache, irritability, fatigue, exercise intolerance are all classic presentation of
Microcytic anemia’s
Older adults may present with exacerbation of co-morbids such as angina, worsening dementia in
Microcytic anemia’s
In Iron deficiency anemia the RDW count is greater or less than 15%
Greater than 15%
What is the average lifespan of red blood cells
100 to 120 days
In long-standing iron deficiency anemia RDW is greater or less than 15%
Less than 15%
What types of foods can help with iron deficiency anemia
Organ meats “liver”, red meat, dried peas and beans, dark green leafy vegetables, whole grains.
How much elemental iron is needed to correct iron deficiency anemia
150 to 200 mg per day of elemental iron
How long do you replace and treat Iron deficiency anemia with elemental iron
4 to 6 months of oral replacement. If hemoglobin is not increased after one month of iron replacement therapy, trouble
What are common side effects of iron supplementation
G.I. upset and constipation
What is the most common form of iron replacement
Ferrous sulfate
After four weeks of iron supplementation the hematocrit and hemoglobin should go up how many points in the first month
Hematocrit will go up three points, hemoglobin will go up one point
What must be rolled out with iron ore deficiency anemia
G.I. malignancy
How should supplemental iron be taken for better absorption
It should be taken between meals with vitamin C or orange juice for better absorption
What are some drug interactions with supplemental iron
Antacids, dairy products, quinolones, or tetracycline
A genetic disorder in which the bone marrow produces abnormal hemoglobin and results in a microcytic hypochromic anemia
Thalassemia
What ethnic groups are more destined for Thalassemia
Mediterranean, north African, Middle Eastern and South Asians
Alpha thalassemia is most common in what ethnic group
South east Asians such as Chinese, Cambodian, Filipinos and Thai
What is the gold standard diagnostic test for thalassemia
Hemoglobin electrophoresis
what is recommended for patients with thalassemia
Genetic counseling
Does thalassemia minor trait need treatment
No
What is the screening test for all anemias
CBC “hemoglobin/hematocrit”
What is a diagnostic test for thalassemia and sickle cell anemia
Hemoglobin electrophoresis
If the ferritin level is low, the patient has
Iron deficiency anemia
If the ferritin level is high, the patient has
Thalassemia minor/trait
Patients with chronic illness and or auto immune disease have a higher risk of what type of anemia
Normocytic
If a patient up and an acid, they must wait how many hours before taking their iron pill
Four hours
Failure to respond to iron supplementation may be a sign of
Continuing blood loss, misdiagnosis “have thalassemia instead of iron deficiency anemia”, malabsorption i.e. celiac disease
Iron poisoning in children less than the age of six may cause
DEAth
In beta thalassemia types, what must be avoided
Excessive consumption of iron
What type of anemia is caused by the destruction of the pluripotent stem cells in side the bone marrow
APlastic anemia
Radiation, adverse effect of a drug, and viral infection can cause what kind of anemia
Aplastic anemia
What is the gold standard diagnostic test for aplastic anemia
Bone marrow biopsy
How do you treat aplastic anemia
Refer to hematologist as soon as possible if septic refer to ED
Mild to moderate normocytic normal chronic anemia is what type of anemia
Anemia of chronic disease or chronic inflammation
How do you treat anemia of chronic disease
Treatment is aimed at control of underlying disease
What are the types of macrocytic anemia’s
B 12 or pernicious anemia and folate deficiency
What vitamin is necessary for the health of the neurons and the brain, and from normal DNA production of the red blood cells
B 12
Chronic B 12 deficiency causes
Severe nerve damage and brain damage i.e. dementia. Neurologic damage may not be reversible
And auto immune disorder caused by the distraction of parietal cells in the fun death resulting in cessation of intrinsic factor production.
Pernicious anemia
What is necessaryin order to absorb B12 from the small intestine
Intrinsic factor
What are some other causes of B 12 deficiency
Gastrectomy, strict vegan, alcoholics, small bowel disease
What foods are B12 sources
All foods of animal origin such as meat, poultry, eggs, milk, cheese
Tingling/numbness of hands and feet, neuropathy starts in peripheral nerves and migrates centrally, difficulty walking and difficulty in performing fine motor skills is example of what type of deficiency
B 12
What value represents a normal reflex
+2
What value represents a sluggish reflex
+1
Abnormal Rhomberg test is consistent with what type of anemia
Pernicious anemia or 12 deficiency
B12 is also known as
Cobolamin
When you check a B 12 level what other level needs to be checked. These two levels must always be checked together
Folate
Alcohol and substance abuse consumption is a cause of
Macrocytosis
What deficiency is characterized by neurological changes
B 12 deficiency
If a patient has a normal MMA level and an elevated homocysteine level this is consistent with
Folate deficiency
If a patient has an elevated MMA level and an elevated homocysteine level this is consistent with
B12 deficiency
How is B 12 deficiency managed
Vitamin B 12 (cobalamin) IM administered every day for one week, then weekly for one month, then monthly for life.
How is folic acid deficiency treated
Folic acid given PO
Neurologic deficit of B12 deficiency is usually reversible an improvement should be seen and how many days
5 to 10 days
How long does a patient need to be treated for B 12 deficiency
Lifelong
How long do you treat folate deficiency
1 to 4 months or until hematologic recovery
What value represents a decreased B 12 level
Less than 200
What are antibody tests for B 12 deficiency
Anti-parietal and anti-intrinsic factor antibody
Homocysteine level is elevated or decreased in B12 and folate deficiency
Elevated
MMA is elevated or decreased in B12 deficiency
Elevated
B12 deficiency anemia, macrocytic anemia, neurologic symptoms are all associated with
Pernicious anemia
A cheap screening test for sickle cell anemia is
Sickledex
If the parietal antibody test and or the intrinsic factor antibody test are elevated the patient has
Pernicious anemia
Any patient complaining of neuropathy or dementia should have what levels checked
B 12
If there is a decrease in platelet count but the rest of the CBC is normal the patient has
Thrombocytopenia
What is the platelet count in thrombocytopenia
Less than 150,000
White blood cells usually within normal limits
What are some causes of thrombocytopenia
Recent infection either viral or bacterial, idiopathic, drug induced, SLE, leukemia
How should thrombocytopenia be managed
Refer to hematologist
Prednisones for 4 to 6 weeks, may need daily course of chronic ITP, minimal activity to prevent injury or bruising no contact sports and avoidance of aspirin
What is the most common cause of folic acid deficiency anemia
In adequate dietary intake
What drugs interfere with folate absorption
Phenytoin, trimethoprim-sulfa, methotrexate, zidovidine
What constitutes as the most white blood cells in the body at greatest quantity
Neutrophils
When poly and lymphs are close together think
Viral
When poly And lymphs are far apart think
Bacterial
When mono is high on a CBC it is most likely that
The person has been inspected for greater than 24 hours
If you see bands on a CBC it means
Immature red blood cells. Really bad infection
Patients with sickle cell have an increased resistance to what type of infection
Malaria
Patients with what type of anemia are at higher risk of death from infection with encapsulated bacteria i.e. streptococcus pneumonia and haemophilus influenza due to hyposplenia
Sickle cell anemia
Ischemic necrosis of bones or skin, renal and or liver dysfunction, priapism, hemolytic episodes, hyposplenism, and frequent infections are all symptoms of
Sickle cell anemia
What isThe screening test for sickle cell anemia
CBC
What is the gold standard diagnostic tool for sickle cell anemia
Hemoglobin electrophoresis
How do you treat sickle cell anemia
Refer patients with disease to hematologist
Only what type of anemia has neurologic symptoms i.e. tingling and numbness
B 12 deficiency anemia
With mixed in the me as such as iron deficiency and B12 the MCV is usually
Within normal limits
What is the most common type of thrombocytopenia found in children between the ages of two and four
Idiopathic thrombocytopenia purpura
ITP
How is iron better absorbed
On an empty stomach
What is an expected finding if a laboratory identifies metamyelocytes in a patient
Splenomegaly
What type of medication for arthritis contributes to iron deficiency anemia
Nonsteroidal anti-inflammatory drugs (NSAIDS)
in a patient with recent onset iron deficiency anemia i.e. the last 3 to 4 months how would the RDW look would it be increased or decreased
Increased
A measure of the degree of variation in red blood cell size is indicated by
RDW
If a patient has leukocytosis this means
They have an infection of unknown origin
Patients with pernicious anemia may be observed to have
Glossitis
What disease is characterized By Low platelet count and other red or white cell abnormality’s
Acute lymphocytic leukemia
The nurse practitioner differentiates physiologic jaundice from pathologic jaundice by assessment of the
Timing of the onset of the jaundice
If a newborn develops a cephalomatoma the newborn is at an increased risk for
Jaundice
A child with sickle cell anemia presents with a history of sudden onset of rapid breathing with left upper quadrant tenderness upon palpation. The child is most likely experiencing
Sequestration crisis
What symptom is associated with B 12 deficiency anemia
Tingling and numbness of both feet
Today the patient is diagnosed with iron deficiency anemia and started on a daily iron supplement. In order to best assess the adequacy of supplementation the nurse practitioner would appropriately order a follow up
Hemoglobin level in one month
A 23-year-old female patient of Italian descent has been diagnosed with anemia secondary to glucose-6-phosphate dehydrogenase deficiency. It is important to teach this patient to avoid
Fava beans, ASA, anti-malarials
The most appropriate therapy for an elderly patient with pernicious anemia is
Intramuscular injections of vitamin B 12
Is shakiness or jitteriness associated with anemia
No
A 17-year-old has mononucleosis. His CBC is best categorized by
Increased lymphocytes and decreased total white count
The INR for a patient taking Coumadin for a fib is expected to be increased or decreased
Increased
Ecchymotic lesions greater than how many centimeters without a history of significant trauma is most likely to indicate an underlying bleeding problem
6 cm
