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Surgery > Hematology from PANCE Pearls > Flashcards

Hematology from PANCE Pearls Flashcards

1
Q

What are the 3 reasons anemia happens

A

Blood Loss
Increased RBC destruction
Decreased RBC production

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2
Q

Sx of Anemia

A

Palpitations, tachycardia, high output HF, SOB, Tachypnea, Chest Pain, pallor, purpura, headache, hepatosplenomegaly

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3
Q

What is workup for Anemia

A

CBC with RBC indices (Hgb, HCT, MCV, MCH, RDW, RBC count)
Peripheral Blood Smear
Bone marrow biopsy is gold standard (not done in most pts)

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4
Q

What does a reticulocyte count tell you

What if its elevated vs. decreased

A

Body’s response to anemia
Increased: Brisk bone marrow response to hemolysis or blood loss
Decreased: Deficient production of RBC

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5
Q

What are the 3 categories under Macrocytic Anemia

A

B12 Deficiency
Folate Deficiency
Alcohol Abuse/Liver Disease/Hypothyroidism

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6
Q

What are 2 causes of B12 deficiency

A 
Malabsorption (Pernicious, Alcohol, Crohn's)
Decreased Intake (Vegans)
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7
Q

Sx of B12 deficiency

A

Anemia
Pallor, Glossitis, Stomatitis
NEUROLOGIC SX: Peripheral neuropathy, ataxia, weakness, vibratory, sensory)

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8
Q

Dx of B12 deficiency

A

Peripheral smear: Large MCV, hypersegmented neutrophils
Decreased B12
Increase in serum homocysteine and increased methylmalonic acid

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9
Q

Tx of B12 deficiency

A

IM B12

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10
Q

Where is folate absorbed

A

Jejunum

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11
Q

What are reasons for Folate Deficiency

A

Malabsorption, pregnancy, hemolysis

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12
Q

Sx of Folate Deficiency

A

Anemia, Pallor

NO neurologic sx

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13
Q

Dx of Folate Deficiency

A

Increasd MCV, Hypersegmented neutrophils, decreased Folate, normal B12

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14
Q

Tx of Folate Deficiency

A

Folic Acid AND B12

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15
Q

What are the 3 most common forms of Microcytic Anemia

A

Iron Deficiency
Alpha/Beta Thalaseemia
Anemia of Chronic Disease

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16
Q

What is the most common cause of iron deficiency anemia

A

Bleeding

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17
Q

Sx of Iron Deficiency Anemia

A 
Anemia sx (fatigue, pallor)
Pagophagia (ice craving), pica, angular cheilitis, koilonychia (nail spooning)
18
Q

Dx of Iron Deficiency Anemia

A 
Decreased serum Fe
Decreased Ferritin
Increased TIBC
Increased RDW
Decreased RBC count
Decreased MCV
19
Q

Tx for Iron Deficiency Anemia

A

Iron Replacement

20
Q

What is Thalassemia

A

Decreased production of globin chains

21
Q

What should clue you into Thalassemia regarding lab values

A

Microcytic anemia with normal or increased serum Fe or no response to Fe treatment

22
Q

What is Alpha Thalassemia

A

Decreased alpha-globin chain production

23
Q

What is a silent carrier in Alpha Thalassemia

A

3 normal genes, clinically normal

24
Q

What is an Alpha-T minor alpha Thalassemia trait

A

2 normal genes

No sx with mild anemia

25
Q

What is alpha-T intermedia (Hgb H disease

Sx seen

A

1 normal gene
Severe anemia
See Heinz Bodies
Pallor, Hepatosplenomegaly, Microcytic Hemolytic Anemia

26
Q

What is Alpha-Thalassemia Major (Hydrops Fetalis)

A

No functioning alpha genes

Associated with stillbirth or death soon after from high output failure

27
Q

Dx of Alpha Thalessemia

A

Peripheral Smear: Target cells, Tear drop cells

HgB Electrophoresis: Normal HgbRatios

28
Q

Tx of Alpha Thalessemia

A

No tx for mild
Moderate: Folate, avoid oxidative stress (Sulfa drugs)
Severe: Blood Transfusion, Iron Cheleating Agents, Bone Marrow Transplant is definitive

29
Q

What is Beta Thalassemia

A

Decreased production of beta globin chains

30
Q

What is Beta-Thalassemia trait (minor)

A

1 defective gene

Asymptomatic or mild anemia

31
Q

What is Beta-Thalassemia Intermedia

A

Mild form

32
Q

What is Beta-Thalassemia Major (Cooley’s Anemia)

Sx

A

Both beta genes are mutated
Results in erythroid hyperplasia and extra medullary hematopoiesis
Hepatosplenomegaly, severe hemolytic anemia (jaundice, dyspnea, pallor), osteopenia, frontal bossing, iron overload, gallstones

33
Q

Dx of Beta-Thalassemia

A

Peripheral Smear: Target Cells
Microcytosis and normal/increased serum iron with increased RBC
Hgb electrophoresis: Increased HgbA2 or Increased HgbF

34
Q

Tx of Beta-Thalassemia

A

Trait: none needed

Major/Severe: Transfusions, Chelating agents, Bone Marrow Transplant

35
Q

What is Lead Poisoning Anemia (Plumbism)

A

Acquired sideroblastic anemia

36
Q

Sx of Lead Poisoning Anemia

A

Abdominal pain with constipation neurologic sx (ataxia, fatigue, learning disabilities, coma, shock)

37
Q

Dx of Lead Poisoning Anemia

A

Peripheral Smear: Microcytic hypochromatic anemia with basophilic stippling and ringed sideroblasts in bone marrow
Increased serum lead and increased serum Fe

38
Q

Tx of Lead Poisoning Anemia

A

Remove source of lad

Chelation therapy if severe

39
Q

What is Anemia of Chronic Disease

A

Chronic inflammatory conditions

40
Q

D of Anemia of Chronic Disease

A

Increased Ferritin
Decreased TIBC
Decreased Serum Fe

41
Q

Tx of Anemia of Chronic Disease

A

Tx underlying disease

Erythropoietin-alpha if renal disease

Surgery (12 decks)

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