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**Old DOOS > Heme 1 > Flashcards

Heme 1 Flashcards

1
Q

a high WBC can indicate what?

A

infection

leukemia

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2
Q

a low WBC can indicate what?

A

acute leukemia

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3
Q

first line of defense in a patient

A

neutrophils

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4
Q

release histamine

seen in patients w/ allergies

A

eosinophils

basophils

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5
Q

what carries the oxygen in the RBCs?

A

hemoglobin

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6
Q

normal hemoglobin in men

A

13-18

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7
Q

normal hemoglobin in females

A

12-16

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8
Q

normal hematocrit in males

A

45-52

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9
Q

normal hematocrit in females

A

37-48

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10
Q

tells you the size of the red cells

A

MCV

normal is 80-100

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11
Q

Average amount of hgb in average red cell

A

MCH

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12
Q

Average concentration of hgb in given volume of red blood cells

A

MCHC

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13
Q

variability of red cell size and shape

A

RDW-Red Cell Distribution Width-

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14
Q

what is the cutoff for low platelet count (start to get concerned)

A

50,000

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15
Q

normal platelet count

A

150,000-450,000

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16
Q

decrease in one or more of major RBC measurements from a CBC

A

anemia

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17
Q

Hct is usually ___X’s the hgb

A

3

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18
Q

Erythropoeisis occurs in the____________

A

bone marrow

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19
Q

who can you see elevated RBC levels in?

A

higher elevation
athlete
smoker

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20
Q

what is the life of a RBC

A

110-120

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21
Q

Reticulocyte count __% of total circulating cells.

A

1%

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22
Q

with an acute episodes leading to anemia what symptoms will you have?

A 
exertional dyspnea 
dyspnea at rest
fatigue
boudning pulse
palpitations
'roaring in ears'
leg pain
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23
Q

what are the 3 mechanisms in the kinetic approach?

A

decreased RBC production
increased RBC destruction
blood loss

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24
Q

low levels of what hormones can lead to decreased RBC production

A

lack of TSH
lack of testosterone
lack of EPO

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25
Q

with aplastic anemia what will be seen?

A

low level of all counts (RBC, WBC)

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26
Q

what cause macrocytic anemias (MCV>100)

A

Folate, B12 deficiency
Abnormal RBC maturation
Alcohol Abuse, liver disease

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27
Q

what can cause microcytic anemia

A

Decreased iron content within RBC (MCH)
Decreased iron availability
Decreased heme synthesis
Decreased globin production

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28
Q

what are the 3 most common causes of anemia?

A

IDA, thalassemia, anemia of chronic disease.

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29
Q

what poisonings can interfere w/ RBC production

A

lead and copper

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30
Q

what other levels are affected with IDA?

A

Decreased ferritin, increased TIBC, decreased iron concentration

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31
Q

what will be normal with anemia of inflammation?

A

ferritin (or can be increased (artificial)

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32
Q

what is seen with bone marrow supression

A

differences in white count and platelets as well as RBC s

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33
Q

Main cause of VIt B12 deficiency?

A

people who have undergone gastric bypass

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34
Q

what OTC products should you ask someone w/ anemias about?

A

NSAIDs (affects the kidneys and gastric ulcers)

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35
Q

a new onset of neuropathy w/ anemia is probably due to what?

A

B 12 deficiency (can also cause pancytopenia)

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36
Q

if you see Schistocytes what is going on?

A

hemolysis somewhere

cells are torn apart

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37
Q

infection with what can cause chronic hemolysis and blunt erythropoiesis?

A

parvovirus

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38
Q

how do you treat chronic hemolysis?

A

steroids (need to cover w/ PPI to prevent more anemia)

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39
Q

are bone marrow biopsies usually indicated in anemia?

A

no

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40
Q

who is iron deficiency anemia seen more in?

A

women and children

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41
Q

what does absolute iron deficiency mean?

A

Iron stores absent in BM, liver and spleen

42
Q

what is ferritin used for?

A

iron deficiency anemia

43
Q

causes of iron deficiency

A

Blood loss-overt or occult
Decreased iron absorption (celiac, gastritis)
Foods and medications can impair iron absorption
Hemodyalysis
Gastric Bypass
Congenital Iron deficiency

44
Q

what is pica for ice?

A

pagophagia

45
Q

symptoms of iron deficiency?

A

Headache, weakness, irritability, fatigue, exercise intolerance, PICA
Many are asymptomatic
Glossal pain, decreased salivation, dry mouth

46
Q

normal ferritin levels

A

18-200

47
Q

Preverted appetite for substances not fit for food

A

Pica

48
Q

what is an Excellent picture of iron stores

A

serum ferritin (but can be falsely elevated)

49
Q

Girls ages 12-18, nonpregnant women of childbearing age, screen for anemia every how many years?

A

5-10 years

50
Q

pregnant women should be on how much iron each day?

A

30 mg/day

51
Q

Patients with hgb <__ should be referred onto hematologist

A

9

52
Q

if a person takes an antacid when can they take their iron?

A

2 hours before or 4 hours after

53
Q

how much elemental iron do people w/ IDA need?

A

120-150 mg of elemental iron

54
Q

indications for IV iron

A

Indicated for excessive blood loss
Inflammatory disease
Chronic Kidney disease

55
Q

what is one of the biggest iron infusions that can cause anaphylaxis

A

Infed (Iron Dextran)

pretreat w/ bendaryl

56
Q

what is an IV iron that is magnetic. Can interfere w/ MRI results

A

Feraheme

57
Q

what will be seen on a peripheral smear w/ B12 and folate deficiencies

A

hypersegmented neutrophils on smear

58
Q

causes of a folate deficiency?

A 
nutritional;
 substance abuse; 
depressed patients, nursing homes;
 celiac disease; 
inflammatory bowel disease;
 short bowel syndrome; 
pregnancy/lactation; medications
59
Q

causes of a B12 deficiency?

A 
Pernicious anemia; 
bariatric surgery;
 gastritis; Chrons  disease;
 tapeworm; pancreatic insufficiency;
 vegans; 
medications
60
Q

what meds can cause a B12 deficiency

A

neomycin
metforminn
PPI and H2

61
Q

what drugs can cause a folate deficiency?

A

methotrexate
trimethoprim
ethanol
phenytoin

62
Q

what lab do you need for pernicious anemia

A

parietal cell antibody test

63
Q

what are metabolic intermediates w/ B12 and folate anemias

A

MMA and homocysteine

64
Q

tx for folate deficiency

A

Folate-1-5 mg/day orally for 1 to 4 months

65
Q

tx for B12/ pernicious anemia

A

1000 mcq SQ daily X 1 week, q week X 4, then monthly

66
Q

when does Hgb rise w/ B12 and folate deficiency?

A

rises in 10 days, returns to normal in 8 to 10 weeks.

67
Q

when do neuro problems w/ b12 or folate deficiencies resolve?

A

3 months

68
Q

are blood transfusions usually indicate in Vitamin B 12 and folate def?

A

no

69
Q

if anemia in the older adult usually severe or mild?

A

mild, usually sits above 10

70
Q

causes of anemia in older adults

A

1/3 nutrition
1/3 CKD or chronic disorders
1/3 is unknown

71
Q

median age of anemia of the older adult

A

> 65

72
Q

what do you need to dx myelodysplasia

A

bone marrow biopsy

73
Q

A hemoglobinopathy which manifests as a chronic hemolytic anemia occuring almost always in people of African origin

A

sickle cell anemia

74
Q

what is there an increased risk of w/ sickle cell anemia?

A 
stroke
intracrnail hemorrhage
neurocognitive decline
cardiac complications
restrictive and obstructive lung dz
renal failure
75
Q

what is the RBC of sickled cells?

A

17 days

76
Q

what level will be elevated w/ sickle cell anemia?

A

LDH

77
Q

how do you diagnose sickle cell dz?

A

Hb electrophoresis (HbS is elevated generally)

78
Q

how do you treat sickle cell dz?

A

analgesics and IV
may need transfusions
Rx- hydroxyurea (fetal Hb), folate
splenectomy

79
Q

what type anemia is often seen with sickle cells?

A

normocytic hemolytic anemia

80
Q

with hemolytic anemias what is retic count increased to?

A

Normal retic count increased to 4 to 5 %

81
Q

Anemia due to shortened survival of RBC

A

hemolytic anemia

82
Q

Intracorpuscular Defects that can lead to hemolytic anemia

A

membrane injuries
unstable or missing RBC membrane proteins
PNH (paroxysmal nocturnal hemoglobinuria)

83
Q

Extracorpuscular factors causign hemolytic anemia

A

Antibodies directed against RBC membrane components. Stasis, trapping of RBCs in spleen

84
Q

what other random things can cause hemolytic anemias?

A

valves, ventricular assist devices, DIC, TTP
malaria
snake bites, insects, thermal burns
certain strain of C Diff

85
Q

why is haptoglobin decreased in a hemolytic anemia?

A

Release of hgb, binds to haptoglobin, resulting in hgb-haptoglobin complex that is removed by the liver,

86
Q

what will you see w/ someone in hemolytic anemia?

A

jaundice
splenomegaly
abnormal cells on smear (schistocytes, tear drop)

87
Q

tx for hemolytic anemia

A

glucocorticoids 1mg/kg
next move to Cytoxan, Rituxan, splenectomy
immunosupressives and cytoxic agents (1 months for effect)

88
Q

Hgb >16.6 in women, >18.5 in men

A

polycythemia

89
Q

what is the median age for polycythemia?

A

60

90
Q

Acquired or inherited mutation leading to an abnormality within RBC progenitors

A

primary polycythemia

91
Q

symptoms of polycythemia

A 
Pruritis
Erythromelalgia
Thrombosis
Visual Disturbances
GI complaints
92
Q

what do people w/ secondary polycythemia look like a lot

A

smokers, overweight, sleep apnea

93
Q

how to approach polycythemia

A 
Confirm with second test
H & P
Pulse oximetry
CBC, urinalysis
LFTs
CXR
94
Q

concern w/ polycythemia

A

burnout of the bone marrow
can move into myelofibrosis
or a type of leukemia

95
Q

causes of secondary polycythemia

A 
Living at high altitudes
Intracardiac or intrapulmonary shunts
Renal transplant
Family history of PC
Medications
Smoking
Volume depletion
Carbon Monoxide
96
Q

what mutation causes primary polycythemia?

A

JAK2 mutation

97
Q

is EPO increased in secondary or primary polycythemia

A

secondary

98
Q

what can polycythemia transform into?

A

AML/MDS

99
Q

tx for polycythemia?

A

phlebotomy to keep hct <42

100
Q

if someone w/ polycythemia has a high risk of thrombosis what do you give them?

A

hydrea

ASA

**Old DOOS (11 decks)

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