Hematology Day 2

Question 1

which anemia is a/w restless leg?

Answer 1

iron deficiency anemia

Question 2

what is the rule of 3 for ferritin?

Answer 2

take ferritin, divide by 3, gives iron level (less than 20 is iron deficiency)

Question 3

what should you tell pt about iron supplements?

Answer 3

take with OJ or vit. C (if DM)

take with stool softener

Question 4

who should get parental iron supplementation?

Answer 4

more severe cases

carries risk of allergic rxn

Question 5

what are sxs of B12 deficiency?

Answer 5

dementia
weakness
sensory ataxia
parasthesias
positive rhombergs
loss of vibratory sense

Question 6

who is at risk for B12 deficiency?

Answer 6

older/malnutrition
alcoholics
strict vegans
bariatric surgery
blind loop syndrome

Question 7

which drugs cause B12 deficiency?

Answer 7

methotrexate
bactrim/neomycin
phenytoin
metformin

Question 8

which inactivates B12?

Answer 8

nitrous oxide

Question 9

what labs do you do on B12 suspicious pts?

Answer 9

B12, folate levels
MMA-intermediate metabolite
homocysteine-intermediate metabolite
intrinsic antibodies

Question 10

what test is used to determine if a pt has a hemoglobinopathy?

Answer 10

hgb electrophoresis (specific for sickle cell)

Question 11

what type of hemoglobin might be protective in sickle cell?

Answer 11

F

Question 12

when does B thal major start to become symptomatic?

Answer 12

6 months

Question 13

what is the prognosis for B thal major?

Answer 13

80% die in 1st 5 yrs of life

Question 14

why do you have Fe overload with transfusions?

Answer 14

EPO increases the guts absorption of Fe

Question 15

which virus would cause a B thal major pt to become aplastic?

Answer 15

parvovirus B19

Question 16

what are smear findings of B thal major?

Answer 16

microcytosis
hypochromic
tear drops
targe cells
inclusion bodies

Question 17

what is B thal minor?

Answer 17

asymptomatic b/c of being a trait carrier

-will show target cells on smear

Question 18

what are the classes of A thal?

Answer 18

minima-silent carrier (lose one chains)
minor- mild anemia, hypochromic (loses two chains)
major-die w/in hours of birth (loses all chains)

Question 19

what are sxs of sickle cell?

Answer 19

painful vasocclusive pain
splenic sequestration
acute/chronic multi-organ failure
reduced overall survival
leading cause of death is acute chest syndrome and multi-organ failure, sepsis

Question 20

what are common triggers of pain crises?

Answer 20

infections

Question 21

what is the progression of SC?

Answer 21

1st few decades: infections struggle
2nd couple decades: vasocclusive pain crisis become more common
later decades: deal with multi-organ failure

Question 22

what are signs of pain crises?

Answer 22

fever
swelling (DVT)
tenderness on PE
tachypnea
HTN
N/V
pain can be anywhere but some may have a typical pattern of pain

Question 23

what is a neurological complication of sickle cell?

Answer 23

stroke

ischemia w/impaired neurocognitive function

Question 24

what can methadone cause?

Answer 24

cardiac arrhthmias

Question 25

what is priapism?

Answer 25

erection lasting more than 4 hours

Question 26

<p>

| how do you treat a pain crisis?</p>

Answer 26

<p>
careful transfusion O2 IV fluid folic acid chelating therapy (bind up iron) pain mgmt hydroxyurea? (prevents body from creating sickled cells) pt education</p>

Question 27

what is the most common finding of aplastic anemia?

Answer 27

petechiae (oozing from the mouth)

Question 28

what is the DDx for aplastic anemia?

Answer 28

leukemia
MDS (myelodysplastic syndrome)
marrow replacement (small cell lung CA)
PNH (infection)
overwhleming infection

Question 29

what heart correction could cause hemolysis?

Answer 29

mechanical heart valve

Question 30

what kind of genetic disorder is G6PD?

Answer 30

x-linked disorder

Question 31

what is the problem in G6PD?

Answer 31

RBC membrane is fragile and can have complications b/c of foods (fava beans) and medicines

Question 32

what is used to help improved cell membrane synthesis?

Answer 32

folic acid

Question 33

what is warm agglutin AIHA?

Answer 33

IgG related antibodies-need to stay in cool settings

Question 34

what is cold agglutin AIHA?

Answer 34

igM antiboides-need to stay warm

Question 35

where is ferritin stored?

Answer 35

liver
spleen
bone marrow

Question 36

when are ferritin levels increased?

Answer 36

acute phase illness

Question 37

which Hgb is protective

Answer 37

HgF

Question 38

which virus can cause aplastic crises?

Answer 38

parvovirus 19

Question 39

what are common drugs that cause immune hemolysis?

Answer 39

cephs
pcn
Nsaids
Quinine
cancer drugs