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DOOS 2 > Heme > Flashcards

Heme Flashcards

1
Q

In general what are the 3 most common symptoms of anemia?

A

Fatigue
Headache
Exertional dyspnea

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2
Q

What is hyperkinetic circulation and in what disease is it seen?

A

Large pulse volume & tachycardia

Seen in chronic anemia

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3
Q

A beefy red tongue and koilonychias is usually seen in:

a) acute anemia
b) chronic anemia
c) pronounced anemia
d) nutritional deficiency anemia

A

c) Pronounced anemia

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4
Q

A smooth tongue and other mucosal changes are usually seen in:

a) acute anemia
b) chronic anemia
c) pronounced anemia
d) nutritional deficiency anemia

A

d) nutritional deficiency anemia

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5
Q

What is the most common cause of anemia in the world?

A

Iron deficiency anemia

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6
Q

Pica is the hallmark for what disease?

A

Iron deficiency anemia

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7
Q

What labs need to be done for anemia?

A

1) Hemoglobin
2) Hematocrit
3) RBC indicies (MCV, MCH, MCHC)
4) RBC distribution width
5) Peripheral smear

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8
Q

Describe the following labs for Iron Deficiency anemia:

1) Hemoglobin
2) Hematocrit
3) Peripheral smear
4) Plasma ferritin
5) TIC

A

1) Low
2) Low
3) Hypochomic microcytic RBC, anisocytosis, poikilocytosis
4) <30
5) high

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9
Q

Tx for Iron deficiency anemia

A

Ferrous sulfate PO or IV

take with orange juice to enhance absorption

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10
Q

What is the genetic issue in alpha thalassemia?

A

gene deletion

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11
Q

What is the genetic issue in beta thalassemia?

A

point mutation

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12
Q

Describe the following labs for Thalassemia syndrome:

1) Serum iron
2) Ferritin
3) Peripheral smear

A

1) Normal or high
2) Normal or high
3) Hypochromic Microcytic (<80)

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13
Q

If a infant has a thalassemia disorder that is found at 1 month what type is it?

A

Alpha

Beta–begins at 4-6 months

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14
Q

If growth retardation, severe anemia, osteopneina, pathological fractures are seen at 5 months of age what would someone suspect?

A

Beta Thalassemia (cooley anemia)

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15
Q

What is the treatment for Thalassemias?

A

Mild–no iron
Hemoglobin H–follic acid supplement
Beta–transfusions & Deferoxamine, (allogenic bone marrow transplantation, splenectomy)

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16
Q

Prussian blue staining bone marrow is seen in:

A

Sideroblastic anemia

shows ringed sideroblasts

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17
Q

Sideroblastic anemia is caused by:

A

Myelodysplasia
Chronic alcoholism
Lead Poisoning

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18
Q

What lab is necessary for the evaluation of sideroblastic anemia?

What does a peripheral smear show?

A

Bone marrow evaluation

peripheral smear: normal & hypochromic cells

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19
Q

Tx for Sideroblastic anemia

A

Treat underlying cause

Transfusion

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20
Q

What are the 3 big types of Hypochromic Microcytic anemia? What is the MCV?

A

MCV<80

1) Iron deficiency anemia
2) Thalassemia syndromes (alpha & beta)
3) Sideroblastic anemia

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21
Q

What is the MCV for Normochromic Normocytic anemia?

What are the 2 main causes?

A

MCV= 80-100

1) organ failure (renal, endocrine, thyroid, liver)
2) Impaired marrow function

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22
Q

What is the most common cause for normochormic normocytic anemias?

A

T-cell mediated autoimmune suppressionof hematopoiesis

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23
Q

Pancytopenia is the hallmark for what disease?

A

Aplastic anemia

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24
Q

What is the treatment for the following:

1) anemia of chronic disease
2) anemia of RF, cancer, inflammatory disorders
3) Aplastic anemia

A

1) tx underlying disease
2) Erythropoietin
3) transfusion of RBC & pllatelets
(if severe bone marrow or immunosuppression)

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25
Q 
What disease would you consider with the following symptoms?
Fatigue, tachycardia, anorexia, pallor
Brittle nails
Cheilosis
Smooth tongue
Formation of esophageal webs
A

Severe Iron Deficiency Anemia

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26
Q

What disease would you consider with the following?
Alcoholic with tachycardia, pale, faint
works in a lead factory

A

Sideroblastic anemia

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27
Q

What disease would you consider with the following symptoms?
weakness, fatigue, vulnerability to infection, pallor, purpura, petichiae, hepatospenomegaly, lymphadenopathy, bone tenderness

A

Aplastic anemia

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28
Q

Macrocytic anemia

1) What is the MCV?
2) Name the 2 types

A

1) >100

2) Folic acid deficiency & vitamin B12 deficiency

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29
Q

An alcoholic person with anorexia has glossitis and vague GI symptoms?

A

Folic acid deficiency anemia

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30
Q

Labs for an anemic person shows:

  • macro-ovalocytes**
  • pathognomonic hypersecgmented polymorphoneclear cells
  • Howel Jolly bodies

What other labs would you want to order?

A

Folic acid deficiency anemia

order folic acid levels <150

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31
Q

Tx for folic acid deficiency anemia

A

1st: PO follic acid

also avoid alcohol & follic acid metabolism antagonists–MTX

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32
Q

Which type of anemia can cause neurologic damage?
Some s/s include: stocking-glove paresthesia, clumsiness, dementia, ataxia, loss of position, fine touch and vibratory sensation

A

Vitamin B12 deficiency

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33
Q

What is the most common cause of Vit B12 deficiency?

A

Pernicious namia

atrophic gastritis–>incr risk of carcinoma

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34
Q

Where does Vit B12 absorption occur?

A

terminal illeum

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35
Q

Elevated reticulocyte count is hallmark for:

A

Hemolytic anemia

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36
Q

Labs for an anemic person shows:

  • Elevated MCV
  • anisocytosis, poikilocytosis
  • macro-ovalocytosis
  • hypersegmented neutrophils
  • low retic count

What other labs would you want to order?

A

Vitamin B12 deficiency

order vit B12–low

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37
Q

A person has a virus infection showing jaundice, gallstones, pallor, and symptoms of decreased oxygen. They have an elevated retic count, and elevated unconjugated bilirubin. What do you suspect? How do you treat?

A

Hemolytic anemia

tx: depends on underlying disorder

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38
Q

A black male looks really sick after going to Denver to play Football.

1) What do you suspect?
2) what is happening to his vascular system? his organs?
3) Acidosis or Alkalosis?
4) at risk an infection of what type of organism?

A

1) Sickle cell anemia
2) vascular occlusion with organ swelling
3) Acidosis (hypoxemia)
4) encapsulated organisms

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39
Q

Labs shows:

  • Hemoglobin S in red cells (electrophoresis)
  • target cells
  • nucleated RBC
  • Howell-Jolly bodies
  • High retic count, WBC, & indirect bilirubin

What other labs would you want to order?

A

Sickle cell anemia

order peripheral smear that reveals sickled cells

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40
Q

Tx for sickle cell anemia

A

1) analgesics
2) fluids
3) oxygen
4) pneumococcal vaccine
5) folate supplementation
6) genetic counseling

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41
Q

X-linked recessive disorder in black & mediterranean males.
Pt usually present as healthy

A

G6PD deficiency

42
Q

Labs show:

  • high retic count
  • high indirect bilirubin
  • bit cells
  • Heinz bodies

What other labs would you want to order?

A

G6PD deficiency

order G6PD (low)

43
Q

Tx for G6PD deficiency

A

Episodes are self-limited

Avoid oxidative stress

44
Q

JAK2 mutation is diagnostic for:

A

Polycythemia vera

45
Q

What are secondary causes of polycethemia vera?

A

1) chronic hypoxia
2) cigarette smoking
3) renal tumors

46
Q

A 60 yo male smoker presents with the following symptoms:

  • splenomegally
  • normal arterial oxygen saturation
  • burning pain
  • red extremities
  • generalized pruritus after bathing

1) What is the condition?
2) What are you concerned of happening to his patient that leads to increased morbidity and mortality?

A

1) Polycythemia vera

2) Thrombosis

47
Q

What is the treatment for polycythemia vera?

A

1 Phlebotomy

Then:

  • Hydroxyurea: myelosuppresive therapy
  • Low dose aspirin
48
Q 
Risk factors for this disorder include:
-family hx
-ionizing radiation exposure
-benzene
certain alkylating agents
A

Leukemia

49
Q

What is the most common type of Acute leukemia?

A

ALL

50
Q

What type of acute leukemia is seen primarily in adulthood?

A

AML

51
Q

s/s include:

  • gingival bleeding
  • epistaxis
  • menorrhagia
  • (DIC less common)
A

Acute leukemia

52
Q

A child with gingival bleeding, epistaxis, and an abrupt onset of fever and joint pain. What would you consider is the issue?

A

Acute leukemia (ALL)

53
Q

An older adult has slow progressive onset with lethargy, anorexia, dyspnea, gingival bleeding and auer rods. What would you consider is the issue?

A

Acute leukemia (AML)

Mediastinal mass on CXR = ALL
auer rods = AML

54
Q

Pancytopenia with circulating blasts is hallmark for:

A

ALL

55
Q

Mediastinal mass on CXR =

Auer rods =

A

Mediastinal mass on CXR = ALL

auer rods = AML

56
Q

Tx for Acute leukemia

A 
induction chemo
consolidation therapy
Allopurionl
diuretics
allogenic bone marrow transplantation
57
Q

What is the most prevalent of all leukemias?

A

CLL

58
Q

Men 60 yo with clonal malignancy of B lymphocytes

A

CLL

59
Q

Leukemia seen in young to middle aged adults

A

CML

60
Q

Three phases of CML

A
  1. chronic
  2. accelerated
  3. acute
61
Q

s/s develop gradually and include:

  • fatigue
  • anorexia
  • weight loss
  • low grade fever
  • excessive sweating
  • abd fullness
  • splenomegaly
  • blurred vision
  • respiratory distress
  • priapism
A

CML

62
Q

s/s include:

  • recurrent infection
  • splenomegaly
  • lymphadenopathy
A

CLL

63
Q

Hallmark:

  • isolated lymphocytosis
  • leukocytosis >20,000 cells/mL
A

CLL

64
Q

Hallmark:

  • leukocytosis
  • median WBC count 150,000 cells/mL
  • Philadelphia chromosome
A

CML

65
Q

Tx for CML

A

imatinib mesylate
desatinib or milotinib
allogenic bone marrow transplant

66
Q

Tx for CLL

A

palliative once disease is advanced

67
Q

A 20 yo male with painless cervical, supraclavicular and mediastinal lympahdenopathy. Has pain in node after drinking alcohol.
On exam has enlarged lymphoid tissue, spleen, and liver.
On labs can see Reed Sternberg cells.

A

Hodgkin’s disease

68
Q

Tx for Hodgkin’s disease

A 
chemo
radiation
Adriamycin
Bleomycin
vinblastine
dcacrabazine
69
Q

A 30 yo with diffuse, unexplained, painless, persistent lympahdenopathy (upper and lower body).

What is a useful prognostic marker

A

Non-hodgkin lymphoma (can also be isolated lymphadenopathy)

serum LDH is useful prognosis

70
Q

Tx for Non-Hodgkin lymphoma

A 
Radiation
Rituximab
Allogeneic transplant
Chemo
autologous stem cell in high grade
71
Q

Dx Hodkin’s vs Non-Hodgkin lymphoma

A

biopsy lymph node

Reed Sternberg cell in Hodkin’s

72
Q

A 65 yo pt with osteoporosis, lytic lesions, hypercalcemia comes in for the 4th infection in the last 2 months.
Pt has anemia, proteinuria, elevated ertythrocyte sedimentation rate.

What do they have?

A

Multiple myeloma

73
Q

Monoclonal spike on serum protein electrophoresis is hallmark for

A

Multiple myeloma

74
Q

Tx for Multiple Myeloma

A

Lenalidomide
Dexamethasone
Doxorubicin

75
Q

Drugs associated with bleeding disorders include:

A 
NSAIDS
ASA
certain antibiotics
Anticoagulants
Thiazides
Gold 
Heparin
76
Q

What are common causes of secondary thrombocytopenic purpura? (2)

A

SLE

CLL

77
Q

A child comes in with petechia, purpura, and hemorrhagic bullae on the skin and mucous membranes. They have a decreased number of platelets in their blood. What do you suspect?

A

ITP

in children ITP is usually self limited autoimmune disorder

78
Q

Tx for acute ITP

A

-resolves spontaneously

or

  • cotocosteroids
  • splenectomy
79
Q

Chronic ITP

A 
high dose prednisone
IV immunoglobulin
danazol
immunosupppressivess
stem cell transplant
80
Q

In what disease can someone have mild anemia and peripheral smear showing megathrombocytes?

A

Thrombocytopenia

81
Q

A 30 yo previously healthy female has purpura, petechia, pallor, abd pain, microangiopathic hemolytic anemia, and abnormal neurologc signs.
She has severe thrombocytopenia, red cell fragmentation, and metallopreatase enzyme is low.
High LDL and indirect bili

What does she have?

A

TTP (thrombocytopenic purpura)
*fatal

(also associated w/ HIV)

82
Q

Tx for TTP

A

fatal
Emergency large volume plasmapheresis
Prednisone
Antiplatelet agent

83
Q

A 6 yo has an E. coli infection and has CVA tenderness.
Labs show severe thrombocytopenia, red cell fragmentation, and metallopreatase enzyme is low.
High LDL and inderect bili

What does the pt have?

A

HUS (hemolytic uremia syndrome)

84
Q

TX for HUS

A

Conservative management

fluids and electrolytes

85
Q 
A cancer patient presents with bleeding and high fever due to sepsis, and in shock.
Labs show: 
-hypofibrinogenemia
-prolonged PT
-schistocytes
A

DIC (Disseminated intravascular coagulopathy)

86
Q

Tx for DIC

A

Propt/aggressive tx for underlying cause

Component blood transfusion

87
Q

Autosomal dominant congenital bleeding disorder.

Bleeding time is prolonged

A

Von Willenbrand disease

88
Q

Tx for Von Willenbrand disease

A

Desmopressin

Factor 8

89
Q

X-linked recessive disorder affecting factor 8.

PTT is prolonged

A

Hemophilia A

90
Q

X-linked recessive disorder affecting factor 9

PTT is prolonged

A

Hemophilia B

91
Q

Tx for Hemophilia A & B

A

Desmopressin

+ infusion of factor 8 (A), 9 (B)

92
Q

Tx for Factor XI (11)

A

fresh frozen plasma

93
Q

Most common acquired coagulopathies

A

Vit K dependent factor deficiencies

94
Q

Which factors are Vit K dependent?

A

2, 7, 9, 10

95
Q

Tx for vit K dependent factor deficiencies

A

Tx underlying cause

PO or IV vit K
fresh frozen plasma

Prevenstion: diet w/ high leafy vegetables & tx malabsorption

96
Q

s/s for vit k dependent factor deficiencies

A

postoperative*
not eating well
received broad spectrum abx
soft tissue bleeding

97
Q

Thrombosis = Effective clotting

Acronym for things that cause thrombosis.

A

5Ps HHAD CAUSED CLOTTTS

Pregnancy/post partum
Prothrombin mutation
Protein S or protein C def
Polycethemia vera
Porxysmal nocturnal hemoglobinuria
Smoking
Heparin therapy
Hyperhomocysteinemia
Antithrombin III def
Dysfibrinogennemia
CHF
Antiphosphilipid syn
Uremia
Surgery
Estrogen
DM
CA
Leiden factor 5 mutation
Obesity
Trauma/Travel
Thyroid
Thalassemia/sickle cell
Sepsis
98
Q

What is prolonged in thrombotic disorders?

A

PTT

99
Q

Russell’s viper venom time is specific to detect:

A

Lupus anticoagulant

100
Q

Tx for thrombotic disorders/ hypercoagulable conditions

A

Low molecular weight heparin

Prednisone–Lupus anticoagulant

DOOS 2 (6 decks)

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