Heme Flashcards by Adriana Blakely

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

Fatigue
Headache
Exertional dyspnea

How well did you know this?

Not at all

Perfectly

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

Large pulse volume & tachycardia

Seen in chronic anemia

How well did you know this?

Not at all

Perfectly

A beefy red tongue and koilonychias is usually seen in:

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

c) Pronounced anemia

How well did you know this?

Not at all

Perfectly

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

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

d) nutritional deficiency anemia

How well did you know this?

Not at all

Perfectly

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

Iron deficiency anemia

How well did you know this?

Not at all

Perfectly

Pica is the hallmark for what disease?

Iron deficiency anemia

How well did you know this?

Not at all

Perfectly

What labs need to be done for anemia?

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

How well did you know this?

Not at all

Perfectly

Describe the following labs for Iron Deficiency anemia:

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

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

How well did you know this?

Not at all

Perfectly

Tx for Iron deficiency anemia

Ferrous sulfate PO or IV

take with orange juice to enhance absorption

How well did you know this?

Not at all

Perfectly

What is the genetic issue in alpha thalassemia?

gene deletion

How well did you know this?

Not at all

Perfectly

What is the genetic issue in beta thalassemia?

point mutation

How well did you know this?

Not at all

Perfectly

Describe the following labs for Thalassemia syndrome:

1) Serum iron
2) Ferritin
3) Peripheral smear

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

How well did you know this?

Not at all

Perfectly

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

Alpha

Beta–begins at 4-6 months

How well did you know this?

Not at all

Perfectly

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

Beta Thalassemia (cooley anemia)

How well did you know this?

Not at all

Perfectly

What is the treatment for Thalassemias?

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

How well did you know this?

Not at all

Perfectly

Prussian blue staining bone marrow is seen in:

Sideroblastic anemia

shows ringed sideroblasts

How well did you know this?

Not at all

Perfectly

Sideroblastic anemia is caused by:

Myelodysplasia
Chronic alcoholism
Lead Poisoning

How well did you know this?

Not at all

Perfectly

What lab is necessary for the evaluation of sideroblastic anemia?

What does a peripheral smear show?

Bone marrow evaluation

peripheral smear: normal & hypochromic cells

How well did you know this?

Not at all

Perfectly

Tx for Sideroblastic anemia

Treat underlying cause

Transfusion

How well did you know this?

Not at all

Perfectly

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

MCV<80

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

How well did you know this?

Not at all

Perfectly

What is the MCV for Normochromic Normocytic anemia?

What are the 2 main causes?

MCV= 80-100

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

How well did you know this?

Not at all

Perfectly

What is the most common cause for normochormic normocytic anemias?

T-cell mediated autoimmune suppressionof hematopoiesis

How well did you know this?

Not at all

Perfectly

Pancytopenia is the hallmark for what disease?

Aplastic anemia

How well did you know this?

Not at all

Perfectly

What is the treatment for the following:

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

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

How well did you know this?

Not at all

Perfectly

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

Severe Iron Deficiency Anemia

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

Sideroblastic anemia

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

Aplastic anemia

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

1) >100 | 2) Folic acid deficiency & vitamin B12 deficiency

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

Folic acid deficiency anemia

Labs for an anemic person shows: - macro-ovalocytes** - pathognomonic hypersecgmented polymorphoneclear cells - Howel Jolly bodies What other labs would you want to order?

Folic acid deficiency anemia order folic acid levels <150

Tx for folic acid deficiency anemia

1st: PO follic acid | also avoid alcohol & follic acid metabolism antagonists--MTX

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

Vitamin B12 deficiency

What is the most common cause of Vit B12 deficiency?

Pernicious namia | atrophic gastritis-->incr risk of carcinoma

Where does Vit B12 absorption occur?

terminal illeum

Elevated reticulocyte count is hallmark for:

Hemolytic anemia

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?

Vitamin B12 deficiency order vit B12--low

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?

Hemolytic anemia tx: depends on underlying disorder

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?

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

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?

Sickle cell anemia order peripheral smear that reveals sickled cells

Tx for sickle cell anemia

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

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

G6PD deficiency

Labs show: - high retic count - high indirect bilirubin - bit cells - Heinz bodies What other labs would you want to order?

G6PD deficiency order G6PD (low)

Tx for G6PD deficiency

Episodes are self-limited | Avoid oxidative stress

JAK2 mutation is diagnostic for:

Polycythemia vera

What are secondary causes of polycethemia vera?

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

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?

1) Polycythemia vera | 2) Thrombosis

What is the treatment for polycythemia vera?

#1 Phlebotomy Then: - Hydroxyurea: myelosuppresive therapy - Low dose aspirin

``` Risk factors for this disorder include: -family hx -ionizing radiation exposure -benzene certain alkylating agents ```

Leukemia

What is the most common type of Acute leukemia?

ALL

What type of acute leukemia is seen primarily in adulthood?

AML

s/s include: - gingival bleeding - epistaxis - menorrhagia - (DIC less common)

Acute leukemia

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

Acute leukemia (ALL)

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

Acute leukemia (AML) Mediastinal mass on CXR = ALL auer rods = AML

Pancytopenia with circulating blasts is hallmark for:

ALL

Mediastinal mass on CXR = | Auer rods =

Mediastinal mass on CXR = ALL | auer rods = AML

Tx for Acute leukemia

``` induction chemo consolidation therapy Allopurionl diuretics allogenic bone marrow transplantation ```

What is the most prevalent of all leukemias?

CLL

Men 60 yo with clonal malignancy of B lymphocytes

CLL

Leukemia seen in young to middle aged adults

CML

Three phases of CML

1. chronic 2. accelerated 3. acute

s/s develop gradually and include: - fatigue - anorexia - weight loss - low grade fever - excessive sweating - abd fullness - splenomegaly - blurred vision - respiratory distress - priapism

CML

s/s include: - recurrent infection - splenomegaly - lymphadenopathy

CLL

Hallmark: - isolated lymphocytosis - leukocytosis >20,000 cells/mL

CLL

Hallmark: - leukocytosis - median WBC count 150,000 cells/mL - Philadelphia chromosome

CML

Tx for CML

imatinib mesylate desatinib or milotinib allogenic bone marrow transplant

Tx for CLL

palliative once disease is advanced

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.

Hodgkin's disease

Tx for Hodgkin's disease

``` chemo radiation Adriamycin Bleomycin vinblastine dcacrabazine ```

A 30 yo with diffuse, unexplained, painless, persistent lympahdenopathy (upper and lower body). What is a useful prognostic marker

Non-hodgkin lymphoma (can also be isolated lymphadenopathy) serum LDH is useful prognosis

Tx for Non-Hodgkin lymphoma

``` Radiation Rituximab Allogeneic transplant Chemo autologous stem cell in high grade ```

Dx Hodkin's vs Non-Hodgkin lymphoma

biopsy lymph node | Reed Sternberg cell in Hodkin's

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?

Multiple myeloma

Monoclonal spike on serum protein electrophoresis is hallmark for

Multiple myeloma

Tx for Multiple Myeloma

Lenalidomide Dexamethasone Doxorubicin

Drugs associated with bleeding disorders include:

``` NSAIDS ASA certain antibiotics Anticoagulants Thiazides Gold Heparin ```

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

SLE | CLL

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?

ITP | in children ITP is usually self limited autoimmune disorder

Tx for acute ITP

-resolves spontaneously or - cotocosteroids - splenectomy

Chronic ITP

``` high dose prednisone IV immunoglobulin danazol immunosupppressivess stem cell transplant ```

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

Thrombocytopenia

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?

TTP (thrombocytopenic purpura) *fatal (also associated w/ HIV)

Tx for TTP

*fatal* Emergency large volume plasmapheresis Prednisone Antiplatelet agent

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?

HUS (hemolytic uremia syndrome)

TX for HUS

Conservative management | fluids and electrolytes

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

DIC (Disseminated intravascular coagulopathy)

Tx for DIC

Propt/aggressive tx for underlying cause Component blood transfusion

Autosomal dominant congenital bleeding disorder. | Bleeding time is prolonged

Von Willenbrand disease

Tx for Von Willenbrand disease

Desmopressin | Factor 8

X-linked recessive disorder affecting factor 8. | PTT is prolonged

Hemophilia A

X-linked recessive disorder affecting factor 9 | PTT is prolonged

Hemophilia B

Tx for Hemophilia A & B

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

Tx for Factor XI (11)

fresh frozen plasma

Most common acquired coagulopathies

Vit K dependent factor deficiencies

Which factors are Vit K dependent?

2, 7, 9, 10

Tx for vit K dependent factor deficiencies

Tx underlying cause PO or IV vit K fresh frozen plasma Prevenstion: diet w/ high leafy vegetables & tx malabsorption

s/s for vit k dependent factor deficiencies

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

Thrombosis = Effective clotting | Acronym for things that cause thrombosis.

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 ```

What is prolonged in thrombotic disorders?

PTT

Russell's viper venom time is specific to detect:

Lupus anticoagulant

Tx for thrombotic disorders/ hypercoagulable conditions

Low molecular weight heparin | Prednisone--Lupus anticoagulant