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General Surgery EOR > Hematology > Flashcards

Hematology Flashcards

1
Q

What is anemia of chronic disease?

A

normal of decrease MCV, decrease TIBC, increase ferritin (high iron stores), decrease serum erythropoietin

  • diagnostic studies: normochromic/normocytic anemia initially
  • causes: inflammation, CKD, cancer, RA, TB, inadequate iron delivery to the marrow
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2
Q

What is the tx for anemia of chronic disease?

A
  • erythropoietin 50-150 U/kg IV 3 x weekly

- treat the underlying disease

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3
Q

What is aplastic anemia?

A

the only anemia where all three cell lines are decreased, decrease WBC, decreased RBC, decreased platelets - will have normal MCV and decreased retic

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4
Q

How is aplastic anemia dx?

A

pancytopenia

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5
Q

What is folate deficiency?

A

decrease folate, increase MCV (macrocytic anemia) - looks like B12 but no neurologic symptoms
-population: alcoholics

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6
Q

How is folate deficiency dx?

A

diagnostic studies

  • megaloblastic anemia
  • elevated homocystine, normal MMA
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7
Q

What is hemolytic anemia caused by?

A

premature breakdown of RBCs

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8
Q

What is autoimmune hemolytic anemia?

A

(+direct coombs test)

-increase retic, increase LDH, decreased haptoglobin, and increase bilirubin (indirect)

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9
Q

What is hereditary spherocytosis?

A

(+) osmotic fragility test

-increase retic, increase LDH, decrease haptoglobin, and increase bilirubin (indirect) and the presence of spherocytes

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10
Q

What is G6PD deficiency?

A

after infection or medication (oxidative stress) in an African American male (x-linked) + Heinz bodies and bite cells on smear (damaged hemoglobin - G6PD protects RBC membrane)

  • hemolytic anemia
  • african, middle eastern, S. asian population
  • flare triggers: fava beans, antimalarials, sulfonamides
  • diagnostic studies: Heinz bodies and bite cells on smear
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11
Q

What is sickle cell anemia?

A
  • very increased retic count + pain in african american male
  • hemoglobin electrophoresis: Hemoglobin S
  • blood smear: sickled RBCs, Howell-Jolly bodies, target cells
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12
Q

What is thalssemia?

A
  • very decreased MCV (microcytic and hypochromic) with a normal TIBC and Ferritin
  • elevated iron and family history of blood cell disorder
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13
Q

What is iron deficiency?

A

decreased MCV (microcytic), decreased MCH (hypochromic), increased TIBC, decreased ferritin (best test, low iron stores), target cells, pica, and nail spooning

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14
Q

What are the characteristics of iron deficiency?

A
  • most common anemia in the US
  • always consider GI bleed
  • associated with pica and nail spooning
  • fatigue with exercise, palpitations, shortness of breath, weakness, headaches, and tinnitus
  • signs: tachycardia, tachypnea on exertion, pallor, glossitis, angular cheilitis, pica
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15
Q

What do you look for with lead poisoning?

A

basophilic stippling

-treatment is with EDTA

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16
Q

What are the diagnostic studies for iron deficiency?

A
  • decreased serum iron, ferritin, and transferrin saturation
  • microcytic (MCV <80) and hypochromic (decreased MCH and MCHC) anemia with low H/H
  • low ferritin <15 mg/ml (best test), high TIBC
  • target cells
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17
Q

What is the tx for iron deficiency?

A
  • FeSO4 325 mg TID or twice daily (20% elemental iron) - give between meals with juice (not milk)
  • ferrous fumarate (33% elemental iron) 100-200 mg/day in 2-3 doses
  • ferrous gulconate (12% elemental iron) 3-6 mg/kg/da in 3 doses
  • packed red blood cells when Hgb < 8
  • vitamin C helps to absorb iron
18
Q

What is sickle cell anemia?

A

African American, pain, family hisotyr of blood disorder, hemoglobin electrophoresis: Hemoglobin S, blood smear: sickled RBCs, howell-jolly bodies, target cells

19
Q

What is hemolytic anemia?

A
  • Population: African Americans. Presents in the 1st yar of life
  • Hemolysis, jaundice, splenomegaly, priapism, poor healing, pain/swelling hands and feet, acute chest syndrome, pigmented gallstones
  • Diagnosis: Hemoglobin electrophoresis: Hemoglobin S
  • Blood smear: sickled RBCs, Howell-Jolly bodies, target cells
  • Treatment: hydroxyurea
  • Vaccine: meningococcal, pneumococcal, H. influenzae, influenza
20
Q

What is thalassemia?

A

a family history of blood cell disorder, microcytic hypochromic, elevated iron

21
Q

What is beta thalassemia major?

A
  • most severe, mediterranean descent, failure to thrive
  • hemoglobin electrophoresis: hemoglobin A2 and F
  • treatment: transfusion dependent, iron chelation (deferoxamine)
22
Q

What is beta thalassemia trait?

A
  • mild anemia, often misdiagnosed as iron deficient

- hemoglobin electrophoresis: hemoglobin A2

23
Q

What is alpha thalassemia?

A
  • chinese and southeast Asians

- hemoglobin electrophoresis: Hemoglobin H (H disease), Hemoglobin Bart’s (hydrops fetalis), Hemoglobin A (trait)

24
Q

What is Vitamin B12 deficiency?

A

increased MCV (macrocytic anemia), hypersegmented neutrophils and normal folate, decreased vibratory and position sense

25
What is the etiology of Vitamin B12 deficiency?
``` pernicious anemia (antibody to intrinsic factor), gastrectomy, vegans -smooth beefy, sore tongue, neurologic symptoms (poor balance, low proprioception) ```
26
What are the diagnostic stuides for Vitamin B12 deficiency?
- megaloblastic anemia, hypersegmented neutrophils | - elevated serum MMA, elevated homocysteine
27
What is prenicious anemia?
Schilling test (less than 10% radiolabeled vitamin B12 in urine, normal results when repeated with administration of intrinsic factor)
28
What is the tx for Vitamin B12 deficiency?
Lifelong IM B12: 1-3 ug/d (animal products, fortified cereal) for pernicious anemia - IV cyanocobalamin 1 mg Im daily x 7 d, then weekly x 4 wk, then monthly for life - PO B12 1-2 mg PO daily for vegans and bariatric surgery - years to deplete stores
29
What is the preoperative testing for easy bruising/bleeding?
If the family history, patient history, and/or physical examaination suggests the presence of a bleeding disorder, appropriate screening tests should be performed - PT - aPTT - platelet count
30
What is the Differential Diagnosis of Bleeding in the Postoperative Setting?
- Surgical Bleeding: Bleeding from a major artery or vein that was missed during surgery must be ruled out first, especially in the immediate postoperative period - Medications: Inquire about aspirin, clopidogrel, heparin, warfarin, or any other antiplatelet or anticoagulant medication - Inherited coagulation disorders: Patients with von Willebrand disease may have a history of excessive bleeding after minor procedures or very heavy menses; hemophilia A and B usually present in childhood with spontaneous hemorrhage into joints (hemarthrosis) - Liver disease: reduced producion of clotting factors - Renal failure: uremia impairs platelet function - Disseminated intravascular coagulation (DIC): seen with severe sepsis, malignancy, and childbirth complicastions; leads to bleeding and microthrombi; manifests with diffuse bleeding from wounds and surgical sites, hematemesis, digital cyanosis, renal insufficiency, and stroke
31
An 8-year old boy with hemophilia A with spontaneous bruising and nosebleed
factor VIII
32
A 7-year-old boy with hemophilia B with large right knee hemarthrosis
factor IX
33
A 23-year old woman with von Willebrand's disease who develops bleeding complications
first try DDAVP; then cryoprecipitate prn
34
A 67-year old patient with liver failure and s/p fall in operating room for an exploratory laparotomy; the patient develops progressive oozing; the PT and PTT are normalized; platelets 300,000; fibrinogen 49.7
cryoprecipitate - provides fibrinogen
35
Patient with liver failure and poor nutrition with elevated PT that is refractory to multiple transfusions of FFP
Vitamin K
36
What is acquired FVIII inhibitors?
- increased PTT - acquired - occurs in postpartum, rheumatic disease, and malignancy; presents with purpura and soft tissue bleeding
37
What is antiphospholipid synrome (SLE)?
- increased PTT - acquired - young women with malar rash, arthritis, photosensitivity, renal/cardaic symptoms, fevers, malaise, and recurrent pregnancy loss
38
What is hemophilia A?
- increased PTT - congenital - presents early in childhood wtih spontaneous bleeding in joints (hemarthroses) or life-threatening hemorrhage following minor trauma
39
What is hemophila B?
- increased PTT - congential - same as hemophilia A
40
What is heparin?
- increased PTT - acquired - postoperative prophylaxis for DVT and PE, decreases post-MI thrombus risk
41
What is Von Willebrand disease?
- increased PTT - increased BT - young woman with bleeding after minor surgical procedure or history of excessive menses

General Surgery EOR (10 decks)

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