Hematology- Jaynstein (Red Bold) Flashcards
If H & H are low, what does this mean and what is the next thing we check?
Anemia (decrease in # RBCs) and then we check MCV
Normal Hgb range for males? For females?
13-16 & 12-15
Normal Hct range for males? For females?
41-50 & 36-44
What does macrocytic anemia mean?
MCV > 100
Two types of macrocytic anemia?
Vitamin B12 (penicious anemia) and folate deficiency
What does microcytic anemia mean?
MCV <80
What does normocytic anemia mean?
MCV 80-100
What are the types of microcytic anemia?
IDA, Thalassemia, Sideroblastic (lead poisioinig)
What is a reticulocyte count?
of immature RBCs (marker of if the bone marrow is working or not)
What is a normal platelet count?
100,000-450,000
<150,000 is low
Name three causes of anemia
- RBC loss
- Decreased RBC production
- Increased RBC destruction
Name a few symptoms of anemia
- Fatigue
- Tachycardia
- Hepatosplenomegaly
- Dyspnea on exertion
- Pallor
- Bone Tenderness
What does normochromic mean?
MCH is 26-34 or MCHC is 31-37%
What does hypochromic mean?
MCH <26 or MCHC is <31%
What does hyperchromic mean?
MCH >34 or MCHC is >37
What disease does this apply to? “If you have a finger and they have a butt, you need to check”
IDA (DRE looking for GI bleed)
Ferritin and transferrin are LOW in what disease?
IDA
TIBC is HIGH in which disease?
IDA
Which disease shows target cells on a blood smear?
Thalassemia
A disease in which there are normal iron studies and microcytic anemia, bone marrow shows ringed sideroblasts in what disease?
Sideroblastic Anemia
If a basic led level is > or equal to _______ and a patient is asymptomatic, what should we do?
> 45 = Treat! Always treat over 45
Chelation therapy
If a basic led level is >or equal to 70 what should we do?
Hospital & Chelation therapy
What disease goes with pernicious anemia? What type of anemia is this?
Vitamin B12 deficiency & macrocytic anemia
What symptoms may someone with Vitamin B12 deficiency have?
Anemia symptoms + CNS symptoms like loss of vibratory sense
If prescribing methotrexate, sulfa or phenytoins, what other thing should we give?
Folate supplements
If H& H is low and MCV is normal, what is the next test should we order?
Retic count
If we check MCV and its normal and then we check retic count and its high, what type of anemia are we looking at? And what test should we do?
Haemolytic anemia & blood smear
If retic count is normal or low, the next thing we ask is h/o underlying chronic disease or renal failure? If yes, then what?
Eval for anemia of chronic disease or chronic renal failure
If retic count is normal or low, the next thing we ask is h/o underlying chronic disease or renal failure? If no, then what?
Bone marrow exam
If we do a bone marrow exam and its normal, then what?
Anemia of chronic renal failure or anemia of chronic disease
If we do a bone marrow exam and its abnormal, then what?
Anaplastic anemia, ineffective erythropoesis or myeloplastic anemia
This disease leads to frequent infections?
Anaplastic anemia
“Anna plays with dirty people” (Anna-plastic)
This disease shows pancytopenia on labs?
Anaplastic anemia
“Anna plays with dirty people so all her cells are low” (Anna-plastic-pancytopenia)
This disease causes an elevated reticulocyte count?
Hemolytic anemia
This disease causes episodic hemolytic anemia?
G-6-P (dashes in G6P make it seem intermittent to remember)
When labs show Heinz Bodies, you should think of what?
G-6-P deficiency
H comes after G in alphabet
Labs showing sickle cells and Howell Jolly Bodies should make you think of which disease?
Sickle Cell
Petichae measure
less than 3 cm
Purpura measure
3-10 cm
Ecchymosis measure
> 10 mm
What are three things that cause the body to have low platelets (aka thrombocytopenia)
- Decreased platelet production
- Increased platelet production
- Other (sepsis, blood loss)
This type of thrombocytopenia is common in KIDS after a viral infection?
ITP (idiopathoic thrombocytic purpura)
When you see an enzyme defect ADAMTS13 think of what disease?
TTP (thrombocytic thrombocytopnenic purpura)
TTP mostly in adults so ADam13 and ADults
Eval for a kid with diarrhea but also renal failure?
HUS (hemolytic uremic syndrome)
This triad goes with which disease?
Thrombocytopenia
Renal Failure
Hemolytic anemia
HUS (hemolytic uremic syndrome)
HELLP Syndrome stands for what?
H-emolysis, E-levated L-iver enzymes, and a L-ow P-latelet count
This disease typically occurs in combo with pre-eclampsia in pregnant women
HELLP
When you hear RUQ pain in a pregnant woman, think of what?
HELLP
This disease involves simultaneously bleeding and clotting and bleeding from MULTIPLE SITES
DIC (Disseminated Intravascular Coagulation)
You should stop heparin if you have this disease?
HIT (Heparin Induced Thrombocytopenia)
What is the most common congenital coagulopathy?
Von Willebrand’s Disease
Hemophilia A does not produce which factor?
Factor VIII (8)
Ate
Hemophilia B does not produce which factor?
Factor IX (9)
In this disease, the liver produces all coag factors except factor _______?
Factor VIII (8)
Late (liver + eight)
The liver produces all coagulation factors except factor VIII in which disease?
Coagulopathy of Liver Disease
Vitamin K is necescary for synthesis of which factors?
Factors 2, 7, 9, 10
which disease is the most common inherited form of coagulopathy, affecting between 3 and 8 percent of Caucasians
Factor V Leiden
After taking a hot shower, a patient complaints of uncontrolled, diffuse pruritis without rash. This correlates to which disease?
Polycythemia Vera
When you think of lupus, think of this clotting disorder
APS
Hallmark finding of this disease is Hct >60%
Polycythemia Vera
Treatment for IDA
diet, ferrous sulfate, IV
Treatment for THalassemia
Folate
What to avoid in thalessemia
IRON or SULFA
Only cure for Thalessemia
Stem cell transplant
Sideroblastic tx
No tx or blood transfusion
Treatment for anemia of chronic dz
Treat based on comorbidity
OR transfusions or epo
Treatment for mild aplastic anemia
blood/platelet transfusions
Treatment for severe aplastic anemia
bone marrow transplant and poor prognosis
Treatment for hemolytic anemia
transfusions
Treatment for G-6-P
AVOID known oxidative stresses (Sulfa, dapsone)
Treatment for sickle cell
no cure or tx pain for crisis
Prophylaxis for sickle cell
Hydroxyurea
Treatment for ITP in children
no tx
Treatment for ITP in adults
Platelets >20k no tx
Platelets <20k prednisone, IVIG, transfusions
Treatment for TTP
EMERGENT- Admit, corticosteroids, pRBCs, plasmapharesis, vWF, ASA, splenectomy
Treatment for HUS
EMERGENT- Admit, corticosteroids, pRBCs, plasmapharesis, vWF, ASA, splenectomy (SAME AS TTP)
You should avoid abx in which condition?
HUS
Treatment for HELLP
Delivery >34 wks
Treat pre-eclampsia
Treatment for DIC
Hospitalize
- Supportive care (ABCD)
- Treat underlying disorder
- pRBCs
- Heparin
Treatment for HIT
Stop HEPARIN, NOT WARFARIN, replace with another anticoag (hospitalize)
Treatment for Von Willebrands
Most mild and no tx
Avoid ASA
If surgery, Desmopressin
Tx for hemophilia
Avoid ASA and NSAIDS
Give their factor prophylactically or blood transfusions
Treatment for coagulopathy of liver disease
FFP transfusion
Treatment for Vitamin K deficiency
Vitamin K
Treatment for clotting disorders (APS, Factor V Leiden, Protein C, Protein S)
Acute: Heparin
Prevent: ASA, anticoags
Avoid OCP
Treatment for polythycemia very
Phlebotomy