Hematology Module 2B Flashcards
Anemia of chronic disease is often associated with what?
chronic infection, inflammatory disease, trauma, neoplastic disease
Is the patient with anemia of chronic disease iron deficient?
No, the iron exists but remains trapped and not utilized.
what are 4 characteristics of anemia of chronic disease?
Decreased RBC lifespan, suppressed production of erythropoietin, ineffective bone marrow progenitor response to erythropoietin, altered iron metabolism
think major effect is on iron metabolism
what is the treatment of anemia of chronic disease?
Treat the underlying cause of anemia
In anemia of chronic disease, the ferritin would be what?
normal or increased
in anemia of chronic disease, the serum iron would be what?
decreased
in anemia of chronic disease, the total iron binding capacity would be what?
decreased
in anemia of chronic disease, the transferrin saturation would be what?
decreased
in anemia of chronic disease, the blood smear would be?
normocytic and normochromic
Normocytic describes what?
the average size of RBCs
Normochromic describes what?
the average amount of hemoglobin in the red blood cell
what are common symptoms associated with anemia of chronic disease/inflammation?
weight loss
anorexia
fever
chills
myalgias
arthralgias
most are asymptomatic
what is macrocytosis mean?
erythrocytes that are larger than normal
what is the difference between pernicious anemia and vitamin B12 deficiency megaloblastic anemia?
pernicious anemia is lack of vitamin B12 caused by an autoimmune destruction of the gastric parietal cells, leading to lack of intrinsic factor.
Megaloblastic anemia, vitamin b12 deficiency is caused by low intake, medications, alcohol, disorders of the intestine causing vitamin b12 to be low
what are some clinical signs and symptoms to vitamin b12 (pernicious) anemia?
fatigue
weakness
mental changes–depression
low grade fever
pallor
numbness and tingling in hands and feet
what is the test that confirms vitamin B12 deficiency?
the Schilling test
How is the schilling test done?
In stages, first stage the patient is given radioactive vitamin b12 orally and then injected with unlabeled vitamin b12. the goal is for the radioactive vitamin b12 to pass in the urine while the injected vitamin b12 is absorbed by the liver.
what is considered a normal (negative) test for the schilling test?
radioactive vitamin b12 excreted in the urine
what is considered a positive test for the schilling?
radioactive vitamin b12 is not excreted in the urine, which proceeds to stage 2 with a repeat of stage 1 only with the addition of intrinsic factor–which if it results in a normal test, you have a diagnosis of pernicious anemia likely.
what two lab levels should be checked specifically to confirm vitamin b12 deficiency in asymptomatic patients at high risk and to exclude vitamin b12 deficiency in symptomatic pts? what would rule it in with these lab results?
MMA (methylmalonic acid) and homocysteine
both will be increased
what is the replacement therapy for vitamin b12 deficiency/pernicious anemia?
start off with 100 mcg/ml IM/SQ B12 injection once daily for one week, then 100 mcg IM/SQ weekly for 5-6 week.
Intranasal is 500 mcg/spray once a week
Patients with vitamin b12 deficiency need to be referred to a GI specialist because of what?
For an endoscopy every 5 years due to increased risk of gastric carcinoma (there is a threefold increase in gastric carcinoma).
what does folic acid do?
it is a water-soluble vitamin that helps make DNA, repair DNA, and produce RBCs.
what medications are capable of lowering vitamin b12 levels?
metformin, histamine H2 blockers, oral contraceptives, hormone replacement therapy, proton pump inhibitors
what medications are capable of lowering folic acid levels?
methotrexate, sulfa drugs-Bactrim, triamterene, phenytoin, and metformin
what is the daily folate requirement for women of child bearing age?
400-800 mcg daily
what is the daily folate requirement for women who are pregnant??
600 mcg daily
how long does a person with folic acid deficiency need to take oral replacement?
For about 4-5 weeks, though if not resolved, continue taking 1 mg po indefinitely
what is the folic supplementation for treatment?
1-2 mg po daily for 4-5 weeks
when should you follow up with a patient who has started folic acid supplementation to treat folic acid deficiency?
follow up in 2 weeks for reevaluation then monthly
what type of genetic trait do people with sickle cell disease have?
they have an autosomal recessive disorder
what is the first manifestation of sickle cell disease in infants?
Dactylitis (hand-foot syndrome)
irritability and refusal to walk are also common
what is dactylitis?
painful swollen hands and/or feet in children, makes them look like sausages
what is the newborn screening test for sickle cell disease?
Sickeldex test
its a small blood sample that looks at how many rbcs have the sickle shape
what is the newborn screening test for sickle cell disease?
Sickledex test
its a small blood sample that looks at how many rbcs have the sickle shape
what medication is prescribed for infants who have sickle cell disease?
Penicillin V 125 mg-250 mg po BID, age start at 2 months.
d/c after age 5 if s/p splenectomy
stop at age 6 if no pneumococcal infections
what vaccine is recommended to sickle cell patients?
Pneumococcal vaccine
why is hydroxyurea prescribed to infants that have sickle cell disease?
It increases fetal hemoglobin which decreases the production of sickle-shaped red blood cells, decreasing sickling events
what confirms the diagnosis of sickle cell disease?
hemoglobin electropheresis
what supplement should sickle cell patient be taking regularly?
folic acid 1mg/day
what are the three most common symptoms of pernicious anemia?
weakness, sore tongue, and tingling of the extremities
where is erythropoietin secreted?
It is secreted by the kidney
folic acid and vitamin b12 are involved in what process in erythropoiesis?
They are involved in RBC DNA synthesis, maturation and division
what role does iron have in erythropoiesis?
Iron is the central element that binds hemoglobin together and binds the oxygen
what is anemia?
It is the reduction of a total number of erythrocytes in the circulating blood or a decrease in the quality or quantity of hemoglobin.
what are the 3 causes of anemia?
impaired erythrocyte production
blood loss (acute or chronic)
increased erythrocyte destruction
combination of the above
Aplastic anemia
anemia of chronic disease
mild iron deficiency
Hypoathyridism
these are what associated with what cause of anemia?
Hypo-proliferative anemia (decreased production)
myelodysplasia
severe iron deficiency
thalassemia syndrome
are associated with what cause of anemia?
maturation disorder (impaired destruction)
autoimmune hemolysis
drug or chemical-induced hemolysis
acute or chronic blood loss
sickle cell anemia
are associated with what cause of anemia?
hemolytic-hemorrhagic anemia (increased destruction)
what is included in iron studies?
serum iron
total iron binding capacity
transferring iron saturation
serum ferritin
what is hemoglobin?
the oxyg protein of the RBC
what is MCV?
Mean corpuscular volume
measures the average size of each red blood cell, it is used to classify anemias (normocytic, macrocytic, microcytic)
what does an increased MCV mean?
RBC is abnormally large, macrocytic anemia
think anemia due to B12 or folic deficiency
what does a decreased MCV mean?
RBC is abnormally small or microcytic
think iron deficiency anemia or thalassemia
what is MCHC?
mean corpuscular hemoglobin concentration
measure of the average concentration or percentage of hgb within a single RBC
what does a decreased MCHC mean?
Deficiency of hgb, hypochromic
a decreased MCHC is associated with which type of anemias?
Iron deficiency and thalassemia
what info does a peripheral blood smear give?
size, shape, color of RBCs
what is the most sensitive blood test to determine iron deficiency?
serum ferritin
this is a good indicator of available iron stores in the body
what is serum ferritin tell us ?
it tell us the amount of stored iron in the body
what does serum iron tell us?
how much iron is in the blood
what does TIBC stand for?
total iron binding capacity
What does TIBC measure?
it is a measurement of all proteins available for binding iron
it is an indicator for how much the cells want to bind to iron
if iron levels are high, TIBC will be low
if iron levels are low, TIBC will be high
what is transferrin?
it is a protein that binds to iron, its the carrier or transport molecule for iron
transferrin saturation tells us what?
it tells us how much iron is available
what does the reticulocyte count measure?
it measures the number of baby/immautre red blood cells in your bone marrow
an increased reticulocyte count would mean what?
increased number of immature rbcs due to hemolysis or hemorrhage
an decreased reticulocyte count would mean what?
bone marrow is not producing adequate rbcs due to iron deficiency, folic, vitamin b12, bone marrow failure
what does mch stand for?
mean corpuscular hemoglobin
what does the MCH measure?
Mean corpuscular hemoglobin measure the average mass of hemoglobin per red blood cell
is iron deficiency anemia known as macrocytic or microcytic?
microcytic anemia
is iron deficiency known as Hyperchromic or hypochromic?
Hypochromic anemia
Koilonchia (spoon nails) are associated with what type of anemia?
iron deficiency anemia
what is lab is considered the gold standard diagnostic in adults and the earliest lab abnormality noted in iron deficiency anemia?
Serum ferritin
what is the recommended daily dose of elemental iron?
150-200 mg/day
when should patients take iron supplements
1-2 hours before meals on empty stomach
if taken with food, it will reduce absorption by 50%
what meds should patients not take iron supplements with?
should avoid taking with antacids, tetracyclines, dairy products
what vitamin enhances absorption of iron?
vitamin C
what level is considered safe for lead?
less than 10 ug/dL
what are common clinical symptoms of lead toxicity?
myalgias, irritability, headache, general fatigue, abdominal cramping, constipation, weight loss, paresthesias, peripheral neuritis
when should kids be screened for lead toxicity?
For low risk children, routinely start at age 1
for high risk children, routinely start at age 6 months
encephalopathy at diagnosis of lead poisoning has what prognosis?
poor prognosis, residual neurologic deficits will be present
what is the most common form of leukemia in children?
ALL
acute lymphoblastic/lymphocytic leukemia
what is the most common form of leukemia in adults?
CLL
chronic lymphocytic leukemia
what leukemia is this?
monoclonal expansion of B-lymphocytes
chronic lymphocytic leukemia (CLL)
what leukemia is this?
monoclonal disorder of bone marrow lymphopoietic precursor cells
acute lymphoblastic leukemia
what leukemia is this?
disorder of hematopoietic precursor cells; six categories related to morphology
acute myeloid leukemia (AML)
what leukemia is this?
uncontrolled proliferation of granulocytes; erythroid cells and megakaryocytes usually present
chronic myelogenous leukemia
lymphadenopathy, splenomegaly, hepatomegaly are most common in which type of leukemia?
chronic lymphocytic leukemia (CLL)
describe thalassemia in a few words
decreased or absent production of hemoglobin
thalassemia often gets confused for what type of anemia?
iron deficiency
what type of anemia is thalassemia?
hypochromic and microcytic anemia
what is the best initial test for polycythemia vera?
serum erythropoietin
decrease serum erythropoietin level highly suggestive of polycythemia vera
what is polycythemia vera?
a chronic myeloproliferative disorder that has increased red blood cell mass which leads to increased blood volume and impaired function
what is the major concern with polycythemia vera?
blood clots are the most serious complication of PCV, they can lead to a heart attack, stroke, or hepatosplenomegaly
what is the treatment of low risk patients with pcv?
phlebotomy and low dose ASA (80 mg or BID)
what labs are most likely seen with PCV?
increased: rbc count, hgb, hct, wbc, platelets, alkaline phosphate, serum vit b12, uric levels, decreased erythropoietin level
polycythemia occurs in what demographics?
list sex and age
older than 60
occurs in males more often
what are the 3 criteria for diagnosis of polycythemia vera?
increased rbc mass
splenomegaly
Normal arterial O2 sat (greater than 92%)
what are assessment findings associated with PCV?
bleeding from gums
burning pain in feet or hands
diaphoresis
excessive sweating
transient neuro complaints: headache, dizziness, tinnitus, blurred vision, paresthesias
hepatomegaly
splenomegaly
sob
fatigue
hemorrhagic events
what are potential causes of immune thrombocytopenic purpura?
false low platelet count
viral infections (HIV, mono, rubella)
drug induced
hypothyroidism
SLE, TTP, hemolytic-uremic syndrome
what is the treatment for immune thrombocytopenic purpura?
avoid anything that can cause injury or bruising
stop offending drugs
avoid meds that increase bleeding
observation and monitor asymptomatic pts with platelets greater than 30k
solumedrol, IV immunoglobulin, platelet infusion, danazol
what is the treatment for thrombotic thrombocytopenia purpura (TTP)? what is the cutoff platelet limit
referral to er
especially if platelets less than 50k
what is the cause of hodgkin lymphoma?
unknown causes
link to epstein barr virus
what is the cause of non-hodgkin’s lymphoma?
chromosomal translocations
infections
environment factors
what is the primary difference between Hodgkin and non-Hodgkin’s lymphoma?
the type of lymphocyte that is affected
Which lymphoma has the reed-sternberg lymphocytes?
hodgkin’s lymphoma
