heme Flashcards
Lab value indicative of alcohol withdrawal
AST:ALT ratio 2:1 and less than 300
AST and ALT >1000
Tylenol intoxication, ischemia, or viral hepatitis
Normal serum osmolarity
280-300
Normal levels for neutrophils, lymphocytes, myocytes, eosinophils, basophils
60, 30, 6, 3, 1 No one Likes My Educational Background
Ideal LDL
< 100
Near/above optimal: 100-129
Borderline high: 130-159
High: 160-189
Very High: >190
Ideal Total Cholesterol
< 200
Borderline high: 200-239
High: >240
Ideal Triglyceride level
< 150
Ideal HDL
> 40 for women; > 50 for men
Enzyme that suggests alcoholic liver disease
AST
Normal Hgb
12-15 for women
13.5-17 for men
Types of microcytic anemia
Iron deficiency, Anemia of chronic disease, thalassemia, sideroblastic anemia
Iron deficiency anemia
Microcytic anemia. The most common type of anemia overall.
Labs: Ferritin low Serum iron low TIBC elevated RDW elevated
Thalassemia
Microcytic anemia present since birth. Genetic mutation that does not allow the person to make hgb normally.
Iron indices are usually normal
RDW is WNL
Microcytosis is typically disproportionate to the anemia
Most common in African Americans, Asians, Mediterraneans.
Tx: Do Not give iron! Transfusions in severe forms.
Macrocytic Anemia Definition and types
Due to abnormalities of DNA synthesis with resultant problems in RBC division and formation.
MCV >100
Pernicious anemia, folic acid deficiency, B12
Pernicious anemia
Occurs as a result of insufficient B12 usually due to deficiency in intrinsic factor.
Only anemia to cause neuropsychotic changes that are irreversible
Elevated MMA is the indicator of pernicious anemia. Antibodies to IF and parietal cells may also be measured.
Treatment: B12 (cyanocobalamin) 100 mcg IM daily for one week, weekly for the next 4-6 weeks and then monthly for life
Folic acid deficiency
A result of dietary folate deficiency.
Some drugs can contribute: Phenytoin, bactrim, INH, oral contraceptives
Anemia of chronic disease
Second most common form of anemia after IDA
Generally a mild anemia
Causes: thought due to decreased life span of the erythrocyte. Renal failure - due to deficiency of erythropoietin production, also iron and folic acid are lost during dialysis.
Sickle cell anemia
When exposed to lower oxygen tension, RBCs assume a sickle shape, resulting in stasis of RBCs in capillaries. Painful crises are caused by ischemic tissue injury resulting from obstruction of blood flow produced by sickled erythrocytes. Microinfarcts occur and predispose the pt. to infections and anoxia.
Treatment: prevention of crisis, O2, IV antbx for infection, aggressive pain management, hydrea only or extreme cases (can cause malignancy)
Idiopathic thrombocytopenia purport (ITP)
autoimmune process of platelet dysfunction
Steroids boost plt count
Only transfuse platelets when pts. are actively bleeding
CLL
- Major pathophysiologic deficit in CLL is failure of B cells to mature into plasma cells that synthesize immunoglobulins, resulting in hypogammaglobulinemia. This leads to…
- Suppression of humoral immunity caused by reduction in normally functioning B cells is the most significant effect of CLL.
- Individuals are at risk for both infections and development of autoimmune diseases resulting in secondary cancers.
- Median age of presentation is 65 (90% of cases occur after age 50)
- Most common type of leukemia in older adults
- Poorer prognosis with increased age
- Incidental discovery is common as this type of leukemia is often asymptomatic.
- Isolated lymphocytosis is the hallmark of CLL; Minimum level is >5000; usual range is 40,000 to 150,000
CML
- A myeloprolifeative disorder characterized by overproduction of myeloid cells.
- CML is characterized by a specific chromosomal abnormality, the Philadelphia chromosome.
- Early CML does not behave like a malignant disease and bone marrow function is retained.
- CML is unstable and without treatment, the disease progresses to an accelerataed and acute blast phase. The acute effects are similar to those of acute leukemia but with more prominent and painful splenomegaly.
- Median age of presentation is 55 years of age
ALL
- 80% of all childhood leukemias, with peak onset at ages 3-7.
- 20% of all adult leukemias with second peak at age 60.
- ALL is the most common cancer and the leading cause of death in children younger than 15 years.
- Pancytopenia with circulating blasts is the hallmark of ALL
AML
- Comprises 80% of leukemias in adults over 20
- Median age of presentation is 50-60 years of age
- Long-term survival is 40%
- Auer’s rods are present
Earliest indicator of success of Heparin therapy in a pt. with DIC
increased fibrinogen
Felty’s Syndrome
Immune neutropenia that can be seen with sero positive rheumatoid arthritis
Hodgkins Lymphoma
- A malignant disorder of lymphoreticular origin, characterized histologically by the presence of multinucleated giant cells (Reed-Sternberg cells).
- Bimodal age distribution - 15-34 yrs. and again at >50 yr.
- More common in males, whites, and those from higher socioeconomic classes.
Non-Hodgkins Lymphoma
- Heterogeneous group of lymphocytic cancers predominantly of B-cell origin and lacking Reed-Sternberg cells that produce a diverse group of malignancies.
- Average age of patients is early 40s.
- Median survival is 6-10 years; overall prognosis is not favorable.
- Complete remission may occur in 60-65% of all patients.
Ann Arbor staging of lymphoma
Stage 1: single lymph node or single extralymphatic origin
Stage 2: 2 or more lymph node regions or sites on the same side of the diaphragm
Stage 3: involvement of lymph node regions or sites on both sides of the diaphragm
Stage 4: diffuse or disseminated involvement of more than one organ with or without associated lymph node involvement. Bone marrow involvement confers stage IV designation.
Disseminated Intravascular Coagulation (DIC)
An abnormal stimulus results in the formation of excess thrombin, which in turn, causes:
fibrinogen consumption, irreversible platelet aggregation, activation of the fibrinolytic system
Most sensitive lab is d-dimer; hypofibrinogenemia is also a very important finding.
DIC panel: fibrinogen decreased, fibrinogen monomer positive or elevated, d-dimer, PT INR
Acute DIC due to blood exposure to tissue factor (TF), normally seen with vascular injury
Chronic DIC due to constant/intermittent low amounts of tissue factor exposure
TF: procoagulant (clotting)
FFP transfusion
o FFP should be administered only to provide coagulation factors or plasma proteins that cannot be obtained from safer sources.
o FFP may be indicated for emergency removal of the coagulopathy induced by warfarin anticoagulants.
o Should be administered as boluses as rapidly as feasible so that the resulting factor levels allow hemostasis.
o The half-life is only 2-6 hours, so repeat boluses are commonly needed.
o Prophylactic use of FFP for procedures is usually not needed. Pts. do not usually bleed as a result of coagulation factor insufficiency when the INR is < 2.0
Platelet transfusion
Usually withheld until the count is <10
Each unit is expected to raise the count by 10; usual dose is 6 units
Recheck count one hour post transfusion
Cryoprecipitate transfusion
o Each bag is a concentrated source of factor VIII, vWF, fibrinogen, factor XIII, and fibronectin.
o Commonly used to treat pts. with inherited coagulopathies such as hemophilia A, vWD, or factor XIII deficiency.
o In the ICU, it is more commonly used to replenish fibrinogen.
o Usual dose is 10 bags, then 6-10 bags every 8 hours or as needed to keep fibrinogen level >100.
Heparin Induced Thrombocytopenia (HIT) type II
autoimmune, immune system attacks platelets causing clotting and bleeding at the same time.
Order PF4 antigen
If bleeding or clot is present, switch to a thrombin inhibitor: argatroban or lepirudin
IgA
X
IgG
X
IgM
x
IgE
x
Hemolysis lab workup
x
