Hematology Flashcards
1
Q
Blood loss of 15% or higher results in
A
Orthostatic hypotension
Systolic drop more than 20mm ahh
2
Q
What is defined as an absolute neutrophil count of less than 1500 mm
A
Neutropenia
3
Q
What condition is consistent with a gradual onset of symmetrical peripheral neuropathy starting in the feet and or arms
A
Vitamin B 12 deficiency
4
Q
Neurological signs such as numbness, ataxia “positive Romberg test”, loss of vibration and positive sense, impaired memory, And dementia “severe cases”
A
Vitamin B 12 deficiency
5
Q
What type of cancer affects the beta lymphocytes “B cells”
A
Hodgkin’s lymphoma
6
Q
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
A
Hodgkin’s lymphoma
7
Q
What type of cancer affects the lymphocytes “usually B cells” and killer cells
A
Non-Hodgkin’s lymphoma
8
Q
What type of cancer affects older adults greater than 65 years of age, with night sweats, fever, weight loss, generalized lymphadenopathy “painless”.
A
Non-Hodgkin’s lymphoma
9
Q
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
A
Multiple myeloma
10
Q
What is defined as a platelet count of less than 150,000
A
Thrombocytopenia
11
Q
When a patient presents with thrombocytopenia, you have to look for
A
Bleeds
Easy bruising, bleeding gums, nosebleeds, hematuria
12
Q
Bruising on the distal lower and upper extremities is usually related to
A
Physical activity
13
Q
Aspirin, NSAIDs, heparin, Washington, SSRI, steroids can all cause
A
Bruising
14
Q
If a patient presents with bruising what should they be evaluated for
A
Von Willebrand’s disease, vitamin C deficiency, or scurvy. Possible coagulation disorder
15
Q
What is the proportion of red blood cells in 1 mL of plasma
A
Hematocrit
16
Q
What is the measure of the average size of red blood cells
A
MCV
17
Q
What is the measure of the average color of red blood cells
A
MCH
18
Q
What is a measure of available transferrin that is left unbound to iron
A
Total iron binding capacity
19
Q
If the iron count is high, the total iron binding capacity he is
A
Low
20
Q
If The iron count is low, the total iron binding capacity is
A
High
21
Q
What is the storage form of iron
A
Serum ferritin
22
Q
What is the most sensitive test for iron deficiency anemia
A
Serum ferritin
23
Q
In iron deficiency anemia, serum ferritin is
A
Decreased
24
Q
In thalassemia trait, serum ferritin is
A
Normal to high
25
What is decreased in iron deficiency anemia
Serum iron
26
Serum iron is normal to high in
Thalassemia and macrocytic anemia's
27
When testing Serum levels
The patient needs to avoid iron supplements 24 hours before testing the serum ferritin level
28
A measure of the variability of the size of red blood cells in a given sample
RDW
29
Immature red blood cells
Reticulocytes
30
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
31
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
32
What is poikilocytosis
Peripheral smear
33
Poikilocytosis or peripheral smear is seen with
Severe iron deficiency anemia. Red blood cells abnormal with variable shapes seen in the peripheral smear
34
If there is a deficiency in folate or B 12 what type of anemia would this be
Macrocytic anemia
35
What test is the gold standard for sickle cell anemia and the thalassemias
Hemoglobin electrophoresis
36
What types of patients have secondary polycythemia
Chronic smoker, long time COPD, long-term residents at high-altitude's, or EPO treatment
37
What is and elevated immaculate and hemoglobin
Polycythemia
38
What is a decrease in the hemoglobin and hematocrit value below the norm for the patient's age and gender
AnemiA
39
What is a microcytic hypochromic anemia
Iron deficiency anemia
40
What is the term for spoon shaped nails often found in Iron deficiencyanemia
Koilonychia
41
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
```
42
Giving an infant cows milk before 12 months of age can cause
G.I. bleeding
43
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
44
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
45
What type of anemia would cause an increase in the MCV, MCH in normal limits, and a decrease in folate level
Folate deficiency
46
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
47
What type of anemia would produce Howell jolly bodies and target cells on the peripheral smear with a normocytic normochromic anemia
Sickle cell anemia
48
What is the norm value for a red blood cell count
4.2 to 4.9
49
What is the normal value for hemoglobin
12 to 15
50
What is the norm value for hematocrit
37 to 51%
51
Does COPD increase or decrease hemoglobin and hematocrit
Increase
52
Measure of iron in circulation
Serum iron
53
Indicates ability of bone marrow to produce red blood cells usually immature red blood cells
Reticulocyte count
54
What labs should you always order with a patient that presents with anemia
Peripheral smear
55
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
56
What test is very useful with mixed anemias
Peripheral smear
57
Hey macrocytic normochromic anemia would be consistent with
Folate or B 12 anemia
58
What is two distinct populations of red blood cells
Dimorphic smear
59
If the iron count is high, The total iron binding capacity is
Love
60
If the iron count is low the total iron binding capacity is
High
61
What is the average lifespan of a normal red blood cell
Three month or 100 to 120 days
62
What is the average lifespan of a platelet
Three days
63
What are two common causes of microcytic anemia
Iron deficiency anemia and thalassemia
64
What is the mostcommon reason for Iron deficiency anemia
Blood loss
65
What is another cause of microcytic anemia that may not be as common
lead toxicity
66
Most people with microcytic anemia's are a symptomatic until their H&H reach
30/10
67
Weakness, headache, irritability, fatigue, exercise intolerance are all classic presentation of
Microcytic anemia's
68
Older adults may present with exacerbation of co-morbids such as angina, worsening dementia in
Microcytic anemia's
69
In Iron deficiency anemia the RDW count is greater or less than 15%
Greater than 15%
70
What is the average lifespan of red blood cells
100 to 120 days
71
In long-standing iron deficiency anemia RDW is greater or less than 15%
Less than 15%
72
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.
73
How much elemental iron is needed to correct iron deficiency anemia
150 to 200 mg per day of elemental iron
74
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
75
What are common side effects of iron supplementation
G.I. upset and constipation
76
What is the most common form of iron replacement
Ferrous sulfate
77
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
78
What must be rolled out with iron ore deficiency anemia
G.I. malignancy
79
How should supplemental iron be taken for better absorption
It should be taken between meals with vitamin C or orange juice for better absorption
80
What are some drug interactions with supplemental iron
Antacids, dairy products, quinolones, or tetracycline
81
A genetic disorder in which the bone marrow produces abnormal hemoglobin and results in a microcytic hypochromic anemia
Thalassemia
82
What ethnic groups are more destined for Thalassemia
Mediterranean, north African, Middle Eastern and South Asians
83
Alpha thalassemia is most common in what ethnic group
South east Asians such as Chinese, Cambodian, Filipinos and Thai
84
What is the gold standard diagnostic test for thalassemia
Hemoglobin electrophoresis
85
what is recommended for patients with thalassemia
Genetic counseling
86
Does thalassemia minor trait need treatment
No
87
What is the screening test for all anemias
CBC "hemoglobin/hematocrit"
88
What is a diagnostic test for thalassemia and sickle cell anemia
Hemoglobin electrophoresis
89
If the ferritin level is low, the patient has
Iron deficiency anemia
90
If the ferritin level is high, the patient has
Thalassemia minor/trait
91
Patients with chronic illness and or auto immune disease have a higher risk of what type of anemia
Normocytic
92
If a patient up and an acid, they must wait how many hours before taking their iron pill
Four hours
93
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
94
Iron poisoning in children less than the age of six may cause
DEAth
95
In beta thalassemia types, what must be avoided
Excessive consumption of iron
96
What type of anemia is caused by the destruction of the pluripotent stem cells in side the bone marrow
APlastic anemia
97
Radiation, adverse effect of a drug, and viral infection can cause what kind of anemia
Aplastic anemia
98
What is the gold standard diagnostic test for aplastic anemia
Bone marrow biopsy
99
How do you treat aplastic anemia
Refer to hematologist as soon as possible if septic refer to ED
100
Mild to moderate normocytic normal chronic anemia is what type of anemia
Anemia of chronic disease or chronic inflammation
101
How do you treat anemia of chronic disease
Treatment is aimed at control of underlying disease
102
What are the types of macrocytic anemia's
B 12 or pernicious anemia and folate deficiency
103
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
104
Chronic B 12 deficiency causes
Severe nerve damage and brain damage i.e. dementia. Neurologic damage may not be reversible
105
And auto immune disorder caused by the distraction of parietal cells in the fun death resulting in cessation of intrinsic factor production.
Pernicious anemia
106
What is necessaryin order to absorb B12 from the small intestine
Intrinsic factor
107
What are some other causes of B 12 deficiency
Gastrectomy, strict vegan, alcoholics, small bowel disease
108
What foods are B12 sources
All foods of animal origin such as meat, poultry, eggs, milk, cheese
109
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
110
What value represents a normal reflex
+2
111
What value represents a sluggish reflex
+1
112
Abnormal Rhomberg test is consistent with what type of anemia
Pernicious anemia or 12 deficiency
113
B12 is also known as
Cobolamin
114
When you check a B 12 level what other level needs to be checked. These two levels must always be checked together
Folate
115
Alcohol and substance abuse consumption is a cause of
Macrocytosis
116
What deficiency is characterized by neurological changes
B 12 deficiency
117
If a patient has a normal MMA level and an elevated homocysteine level this is consistent with
Folate deficiency
118
If a patient has an elevated MMA level and an elevated homocysteine level this is consistent with
B12 deficiency
119
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.
120
How is folic acid deficiency treated
Folic acid given PO
121
Neurologic deficit of B12 deficiency is usually reversible an improvement should be seen and how many days
5 to 10 days
122
How long does a patient need to be treated for B 12 deficiency
Lifelong
123
How long do you treat folate deficiency
1 to 4 months or until hematologic recovery
124
What value represents a decreased B 12 level
Less than 200
125
What are antibody tests for B 12 deficiency
Anti-parietal and anti-intrinsic factor antibody
126
Homocysteine level is elevated or decreased in B12 and folate deficiency
Elevated
127
MMA is elevated or decreased in B12 deficiency
Elevated
128
B12 deficiency anemia, macrocytic anemia, neurologic symptoms are all associated with
Pernicious anemia
129
A cheap screening test for sickle cell anemia is
Sickledex
130
If the parietal antibody test and or the intrinsic factor antibody test are elevated the patient has
Pernicious anemia
131
Any patient complaining of neuropathy or dementia should have what levels checked
B 12
132
If there is a decrease in platelet count but the rest of the CBC is normal the patient has
Thrombocytopenia
133
What is the platelet count in thrombocytopenia
Less than 150,000
| White blood cells usually within normal limits
134
What are some causes of thrombocytopenia
Recent infection either viral or bacterial, idiopathic, drug induced, SLE, leukemia
135
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
136
What is the most common cause of folic acid deficiency anemia
In adequate dietary intake
137
What drugs interfere with folate absorption
Phenytoin, trimethoprim-sulfa, methotrexate, zidovidine
138
What constitutes as the most white blood cells in the body at greatest quantity
Neutrophils
139
When poly and lymphs are close together think
Viral
140
When poly And lymphs are far apart think
Bacterial
141
When mono is high on a CBC it is most likely that
The person has been inspected for greater than 24 hours
142
If you see bands on a CBC it means
Immature red blood cells. Really bad infection
143
Patients with sickle cell have an increased resistance to what type of infection
Malaria
144
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
145
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
146
What isThe screening test for sickle cell anemia
CBC
147
What is the gold standard diagnostic tool for sickle cell anemia
Hemoglobin electrophoresis
148
How do you treat sickle cell anemia
Refer patients with disease to hematologist
149
Only what type of anemia has neurologic symptoms i.e. tingling and numbness
B 12 deficiency anemia
150
With mixed in the me as such as iron deficiency and B12 the MCV is usually
Within normal limits
151
What is the most common type of thrombocytopenia found in children between the ages of two and four
Idiopathic thrombocytopenia purpura
| ITP
152
How is iron better absorbed
On an empty stomach
153
What is an expected finding if a laboratory identifies metamyelocytes in a patient
Splenomegaly
154
What type of medication for arthritis contributes to iron deficiency anemia
Nonsteroidal anti-inflammatory drugs (NSAIDS)
155
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
156
A measure of the degree of variation in red blood cell size is indicated by
RDW
157
If a patient has leukocytosis this means
They have an infection of unknown origin
158
Patients with pernicious anemia may be observed to have
Glossitis
159
What disease is characterized By Low platelet count and other red or white cell abnormality's
Acute lymphocytic leukemia
160
The nurse practitioner differentiates physiologic jaundice from pathologic jaundice by assessment of the
Timing of the onset of the jaundice
161
If a newborn develops a cephalomatoma the newborn is at an increased risk for
Jaundice
162
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
163
What symptom is associated with B 12 deficiency anemia
Tingling and numbness of both feet
164
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
165
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
166
The most appropriate therapy for an elderly patient with pernicious anemia is
Intramuscular injections of vitamin B 12
167
Is shakiness or jitteriness associated with anemia
No
168
A 17-year-old has mononucleosis. His CBC is best categorized by
Increased lymphocytes and decreased total white count
169
The INR for a patient taking Coumadin for a fib is expected to be increased or decreased
Increased
170
Ecchymotic lesions greater than how many centimeters without a history of significant trauma is most likely to indicate an underlying bleeding problem
6 cm
