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CPD I > Hematology I > Flashcards

Hematology I Flashcards

1
Q

What is anemia?

A

decrease in RBCs, HCT, or Hb

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2
Q

Erythropoiesis occurs in the:

A

bone marrow

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3
Q

Erythropoietin comes from:

A

the juxtaglomerular (JG) cells of the kidney

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4
Q

EPO is produced in response to:

A

decreased O2

increased androgens

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5
Q

RBC lifespan:

A

120 days

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6
Q

RBCs cleared by:

A

spleen, liver, bone marrow phagocytic cells

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7
Q

Heme is degraded into:

A

bilirubin

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8
Q

% of RBCs renewed daily:

A

0.5-1.5%

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9
Q

Mechanisms of anemia:

A

Blood loss
Decreased absorption
Deficient erythropoeisis
Excessive hemolysis

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10
Q

Hx risk factors for anemia:

A

Diet, menstruation, alcoholism, Rx drugs, cancer, COPD, marathon running, family hx of bleeding disorder.

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11
Q

S/sx of anemia:

A

Weakness, fatigue, SOB, DOE, angina, syncope, drowsiness, seeing spots.
[vertigo, HA, tinnitus, pica, RLS, amenorrhea, menorrhagia, loss of libido, GI complaints]

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12
Q

Signs of hemolysis:

A

jaundice, pruritis, dark urine (bilirubin, urobilinogen)

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13
Q

Anemia PE:

A

orthostatis BP (supine, seated, standing)
Inspect conjunctiva, palms, mucus membranes, skin color
Inspect nails (blueness, ridges, spooning, clubbing)
Cardiovascular exam

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14
Q

Microcytic causes:

A

Iron deficiency, thalassemia, Hb-synthesis defects, copper deficiency, zinc/lead poisoning, alcohol

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15
Q

Macrocytic causes:

A

B12/folate deficiency, chemo, alcoholism, HIV anti-retrovirals, myelodysplastic disorder, impaired DNA synth

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16
Q

Normocytic anemia causes:

A

blood loss, deficient EPO

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17
Q

Most common anemia:

A

iron deficiency

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18
Q

Iron deficiency anemia s/sx:

A

Mild - fatigue, HA, irritability, loss of stamina, pallor, difficult concentration.
Severe - pica, glossitis, cheilosis, spooning, tachycardia, dyspnea, RLS, glossal pain, xerostomia, alopecia

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19
Q

Increases non-heme iron absorption:

A

ascorbic acid

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20
Q

Daily iron requirement:

A

25mg/day (most from recycle/reabsorption)

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21
Q

Iron storage forms/locations:

A

Hemosiderin - liver, marrow

Ferritin - liver, marrow, spleen, RBCs, serum

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22
Q

Most frequent cause of iron deficiency anemia:

A

Men - chronic bleed (UC, colon cancer, PUD, ASA use)

Women - menstruation, repeated pregnancy

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23
Q

Dx for iron deficient anemia:

A

Stool occult blood
Iron absorption test
CBC w/peripheral smear, serum iron, TIBC, serum ferritin

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24
Q

Sideroblastic anemias are:

A

inadequate or abnormal utilization of marrow iron, with adequate stores. hereditary or 2° to drug/toxin (reversible)

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25
Q

RBC appearance in sideroblastic anemia:

A

Polychromatophilic, stippled, targeted RBCs

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26
Q

Dx for sideroblastic anemia:

A

CBC w/peripheral smear, iron, ferritin, BM bx, erythrocyte protoporphyrin, genetic studies

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27
Q

Causes of anemia of chronic dz:

A

infection, inflammatory, neoplastic dz, trauma, heart failure, DM

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28
Q

BM responsiveness to EPO mediated by cytokines:

A

IL-1 beta & TNF-alpha

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29
Q

Hypoproliferative anemias are:

A

low marrow activity d/t lack of EPO or ability of BM to respond; seen in thyroid regulation disorders, panhypopituitarism

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30
Q

Aplastic anemias are:

A

pancytopenia of all cell lines, or pure red cell aplasia

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31
Q

Causes of aplastic anemias:

A

chemical exposure (drugs, pesticides, anti-cancer agents)
infections (parvo, HIV, hepatitis, EBV, CMV)
Genetic inability to clear toxins
Fanconi’s anemia (inherited)

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32
Q

S/sx of aplastic anemia:

A

sudden acute onset or insidious, pallor, tachycardia, fatigue, dizziness
Thrombocytopenia (petechiae, ecchymosis, bleeding gums, ocular fundi)

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33
Q

Labs for aplastic anemia:

A

CBC w/peripheral smear, iron, reticulocytes, BM bx

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34
Q

Myelophthisic anemia is:

A

marrow replaced by tumor, granuloma, fibrosis, or lipid storage dz

35
Q

S/sx of myelophthisic anemia:

A

Fatigue (early, severe), splenomegaly, night sweats, low fever, bone pain
Could be asx

36
Q

Labs for myelophthisic anemia:

A

CBC w/peripheral smear, BM bx

37
Q

Macrocytic anemia is:

A

due to defective DNA synthesis

38
Q

causes of macrocytic anemia:

A

alcoholism, folate or B12 deficiency, chemo, hypothyroid, liver dz

39
Q

Anemia d/t B12/folate deficiency:

A

megaloblastic anemia

40
Q

S/sx of macrocytic anemia:

A

Usu none until severe
Then neuro signs (stocking/glove neuropathy, dementia)
Glossitis, diarrhea, muscle wasting

41
Q

Labs/dx for macrocytic anemia:

A

CBC w/peripheral smear, B12 (& PMN count), folate

42
Q

Causes of hemolytic anemia:

A

Intrinsic:
abnormal RBC membranes
RBC metabolism disorder
Hemoglobinopathies

Extrinsic:
Hypersplenism
Toxic exposure
Autoimmune dz
Mechanical injury (prosthetic valves, DIC, TTP)
Infectious agents (malaria, C. Perfringens)

43
Q

S/sx of hemolytic anemia:

A

May be acute, chronic, or episodic
Rapid onset pallor
Acute hemolytic crisis (uncommon) - fever, chills, back/abd pain, prostration, shock
Severe hemolysis: jaundice, splenomegaly, cholelithiasis

44
Q

Labs/dx for hemolytic anemia:

A

Peripheral smear - spherocytosis

Bilirubin, LDH, ALT

45
Q

Autoimmune hemolytic anemia is:

A

making antibodies to RBCs; may be severe & fatal

46
Q

Warm antibody hemolytic anemia:

A 
>37°C
more common in women
spontaneous or from viral inf, immune deficiency, drugs, SLE, CLL, lymphoma
primarily in the spleen
mild splenomegaly
47
Q

Cold antibody hemolytic anemia:

A

<37°C
commonly from infections (mycoplasma pneumoniae)
1/2 are idiopathic chronic
primarily in the liver
acrocyanosis, Raynauds, scleral icterus, splenomegaly

48
Q

Dx test for autoimmune hemolytic anemia:

A

Coombs - direct antiglobulin test

49
Q

Hereditary spherocytosis & elliptocytosis are:

A

congenital RBC membrane defects; autosomal dominant

50
Q

S/sx of hereditary -cytosis anemias:

A 
Jaundice
Splenomegaly
Cholelithiasis
Hepatomegaly (maybe)
Anemia sx
51
Q

Stomatocytosis is:

A

Rare, congenital (severe) or acquired (EtOH) RBC membrane disorders, display increased fragility
Show straight or rectangular central pallor

52
Q

Hypophasphatemia is:

A

d/t low phosphate, RBCs depleted of ATP -> rigid

small, spheroid RBCs

53
Q

G-6-P deficiency:

A

reduces energy available to maintain RBC membrane integrity
d/t abnormal enzymes, genetic polymorphism, drug sensitivity
x-linked
12% of African-American males fully express

54
Q

S/sx of G-6-P deficiency:

A

episodic
sudden onset jaundice, pallor, dark urine, anemia sx
may have back/abd pain
may lead to renal failure

55
Q

Labs/dx of G-6-P deficiency:

A

G6P assay

56
Q

Sickle cell anemia:

A

Chronic hemolytic anemia; African descent; homozygous inheritance of Hb S gene
(trait - heterozygous, varying expression)

57
Q

S/sx of sickle cell anemia:

A 
painful bony crises
renal damage
punched out leg ulcers
splenic infarcts
aplastic crises
anemia usually severe
developmental delays
avascular necrosis of femoral head
abd pain with vomiting
neurological disturbance
splenomegaly
58
Q

Sever complications of sickle cell:

A

death by middle age, usu d/t infection, pulmonary emboli, vessel occlusion

59
Q

S/sx of sickle cell trait:

A

myalgia

hematuria during hypoxia

60
Q

Hemoglobin C dz:

A

genetic hemoglobinopathy; African descent; may be assoc with sickle cell

61
Q

S/sx of hemoglobin C dz:

A

bone pain
splenomegaly
jaundice (mild)
anemia

62
Q

Thalassemia:

A

inherited defects in rate of synthesis of globin chains
ineffective erythropoiesis & low RBC production
Mediterranean, African, SE Asian, Pacific Islanders
may occur with sickle cell anemia

63
Q

Thalassemia major:

A

homozygous
most serious - beta thalassemia (autosomal dominant)
usually fatal

64
Q

Thalassemia minor:

A

heterozygous
milder dz
may be asx

65
Q

S/sx of thalassemia:

A 
heart failure
failure to thrive
splenomegaly
jaundice
leg ulcers
gallstones
thick zygomatic and cranial bones
66
Q

Leukopenia:

A

absolute decrease in number of WBCs circulating;
may be pancytopenia or one line;
<4000 c/mm

67
Q

Define neutropenia:

A

decrease in neutrophils (PMNs/granulocytes)

main defense against bacterial & fungal infections

68
Q

Neutropenia - normal resistance range:

A

> 1500/mm whites

>1200/mm blacks

69
Q

Neutropenia - mild risk:

A

1000-1500/mm

70
Q

Neutropenia - moderate risk:

A

500-1000/mm

71
Q

Neutropenia - severe risk:

A

<500/mm

72
Q

Neutropenia - rapidly fatal range:

A

<200/mm

73
Q

S/sx of neutropenia:

A

sx only occur w/infection -
fever (may be only sign)
cellulitis, liver abscess, furunculosis, pneumonia, septicemia
rash & LA if drug induced

74
Q

Intrinsic neutropenia:

A

due to defects in myeloid cells or precursors; rare; congenital, chronic idiopathic, benign

75
Q

Secondary neutropenia:

A 
drug induced (chemo); unpredictable, idiosyncratic
bone marrow infiltration - cancer, myelofibrosis
hypersplenism
infection, sepsis (childhood virus, HIV)
alcoholism
autoimmune - esp SLE
folate/B12 deficiency
leukemia
transfusion
76
Q

Lymphocytopenia:

A

reduction in lymphocytes

<2yo

77
Q

Lymphocytes account for what % of WBCs?

A

20-40%

30% - NLMEB

78
Q

Lymphocytes include:

A

T cells (75%) & B cells (25%)

65% of T cells are CD4

79
Q

Causes of lymphocytopenia:

A

infectious disease - TB, HIV, SARS, hep, EBV, CMV
dietary deficiency
Iatrogenic - immunosuppression, chemo, radiation
systemic dz w/autoimmune - SLE, RA, sarcoid, cushing
Other - EtOH, zinc deficiency

80
Q

S/sx of lymphocytopenia:

A

signs of primary illness
absent/diminished tonsils or lymph nodes
palpable LA if tumors are the cause
hematologic dz - jaundice, pallor, petechiae, splenomegaly
recurrent viral/fungal/parasitic infection

81
Q

Normal platelet count:

A

140-440K/uL

82
Q

Platelet lifespan:

A

7-10 days

destroyed by spleen

83
Q

Causes of thrombocytopenia:

A 
failure of production
increased sequestration, destruction, dilution
quinine drugs
liver dz
DIC
pregnancy, preeclampsia
ITP (idiopathic thrombocytopenia purpura) 
HIV
84
Q

RBC size:

A

microcytic 95

CPD I (2 decks)

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