HEME Flashcards
Iron low
TIBC/ Transferrin high
Ferritin low
Iron Deficiency
Iron low
TIBC/ Transferrin low
Ferritin high
Chronic Disease
Physical exam findings of iron def
Kiolnychia
Angular Cheilosis
Tachycardia - heart is pumping harder with low o2
Glossitis
EKG of IRON deficiency
Global ST depression
Treatment for Thalassemia
Blood transfusions but ultimately splenectomy
key terms - kid with pica
Lead poisoning
Alcoholic with microcytic
Sideroblastosis
Name all the microcytic anemias
Iron def
Thalamssemia
Lead poisoning
Sideroblastosis
Name all the Normocytic Nomrochromic anemias
Chronic disease
- kidney disease
- infection
Name all the hemolytic anemia
Sickle cell
G6PD
what genetic disorder is sickle cell
X-linked recessive
which anemia
Bilirubin high
LDH high
Haptoglobin low
Hemolytic anemias
usually -> Sickle cell
Parvovirus B19 commonly causes what anemia
Aplastic Anemia
pancytopenia
shuts down the bone marrow
What is vasooculsive crisis
From massive sickle cells
- > acute chest syndrome
- > Pain in joints, ABD
- > Pripsm
- > stoke
What is the most lethal complication of sickle cell crisis
acute chest syndrome
they are tiny infarcts happening in the chest
Treatment for sickle cell
Hydroxurea
DONT GIVE NSAIDS LIKE TORADOL- will shut down kidneys
What does Hydroxurea do?
Increases the amount of Fetal Hemoglobin
really important for Sickle cell anemia
What causes G6PD
Fava beans Dapsone Primaquine Sulfonamides- bactrium Chloriquines Primaquine
Another name for Factor 8 deficiency
Hemophilia A
Another name for Factor 9 deficiency
Hemophilia B
What genetic disorder is Hemophilia
X-linked Recessive
Mendelian genetics
What is the hallmark of Hemophilia
Think kid with no history of trama
with red joint
not swollen but painful
What is the dose for Factor 8 deficency
mild
Moderate
severe
12.5
25
50
What is the dose for Factor 9 deficency
mild
Moderate
severe
25
50
100
Most common inherited bleeding disorder
Von Willebrand disease
Plts normal
Bleeding time - prolonged
PT normal
PTT normal
Von Willebrand disease
von williebrand activity level- decreased * most important test
Treatment for Von Willebrand disease
Cryoparcipitate F8 itself DDAVP *Tranexamic Acid- Block fibrinolysis *Amino-Caproic Acid - Blocks fibrinolysis
Treatment for an acute bleed due to Von Willebrand disease
Estrogen
What are some inherited Hypercoaguable states
- Factor V leidin
2. protein C or S deficiency
Treament for Idiopathic Thrombocytopenic purpura - ITP
- Steroids
- IVIG *
- Platelets
- Splenectomy
- new drugs- Rhogam, Rituximab
Key terms for this diagnosis -
Kid with recent infection or vaccines then bruising, low plt levels, enlarged spleen
Idiopathic Thrombocytopenic purpura - ITP
Key terms for this diagnosis -
Fever, confused/lethargic , Low RBC count, low plts, elevated BUN
Thrombotic Thrombocytopenic Purpura - TTP "FATRN" Fever Anemia Thrombocytopiena low plts renal failure cNs symptoms
Key terms for this diagnosis-
Microangiopathic hemolytic anemia with gross hematuria
CNS symtoms- headache, aphasia
low plts
Thrombotic Thrombocytopenic Purpura - TTP
What drug is most commonly the cause of Thrombotic Thrombocytopenic Purpura - TTP
Clopidogrel
others- Quinine, Ticlopidine
What can kill a patient with Thrombotic Thrombocytopenic Purpura - TTP
accidentally giving them plts
What enzyme is absent in TTP causing plt & vWF not to get broken down leading to plt clots “thrombpocytopenia”
ADAMTS-13
it is the enzyme needed to break down the VWF /PLT strand
Treatment for TTP
- Freash Frozen Plasma
PLTS WILL KILL THEM - Splenectomy
- IVIG
Key terms for this diangosis-
kid with Microcytice hemolytic anemia, low plts, and acute renal failure
Hemolytic Uremia Syndrome
Hemolytic Uremia Syndrome
what in the history should make you think this
KID
history of BLODDY DIARRHEA ! - Ecoli
ate rare meant, petting zooe, daycare, swimming
Most common cause of Hemolytic Uremia Syndrome
E Coli - O157-H7
Shiga like toxin
Treatment for Hemolytic Uremia Syndrome
Support them admit for fluids RBC sometimes need hemodialysis NO ANTIBITOICS CAN MAKE WORSE
What is Heparin Induced Thrombocytopenia HIT
<150 platelets
OR
Drop of 50% from their baseline
What drug blocks the conversion of Factor X to Xa and
Prothrombn to thrombin
Heparin
What drug blocks the conversion of Factor X to Xa
Low molecurlar weight heparin - LMWH
Key terms for this diangosis- Had a hostpital stay and was given IV medication,
one week later now present with DVT, PE, Gangrene, storke, MI DIC
Heparin Induced Thrombocytopenia HIT
Treatment for Heparin Induced Thrombocytopenia HIT
STOP HEPARIN do not give platelets give direct thrombin inhibitors - Argatroban -Bivalirudin -Lepirudin
Key terms for this diagnosis
Adult with extreme fatigue weight loss,
CBC- Myeloid stem cells with Auer Rods
Acute Myelogenous Leukemia
AML
Key terms for this diagnosis
Child with recurrent infections, bloody nose, burising easily
CBC- Blasts, Lymphid stem cell line
Acute Lymphocytic Leukemia - ALL
Treatment for ALL
Huge blast of Chemo then
consolidation chemo
Treatment for AML
Chemotherapy
What is a major complication when treating ALL or AML with chemotherapy ?
Tumor lysis syndrome when you kill the cancer cells their insides are free around the body and get suck in the kidneys and can cause renal failure Also can cause metabolic changes like high K+ High uremia High Phosphates Low Calcium
Key terms for this diagnosis
Adult male 55yrs with fatigue, weight loss, anemia
physical exam shows englarged spleen
CBC- WBW 100,000
Chronic Myeloid Leukemia - CML
it can go acute very quickly
Philadephlia Chromosome 9:22
Chronic Myeloid Leukemia - CML
Key terms for this diagnosis
Adult male 70yrs with fatigue, weight loss, recurrent infections
CBC- WBW 100,000 & Smudge cells
Chronic Lymphoid Leukemia - CLL
BCR-ABL gene
what lukemia
Chronic Myeloid Leukemia - CML
Reed Sternberg cell on lymph node biopsy
Hodgkin Lymphoma
Key terms for this diagnosis
Teenage kid that noticed a painless swollen lymph node
when he drank alcohol at a party the node became painful
Hodgkin Lymphoma
What type of Lymphoma is most common with HIV patients
Non- Hodgkin Lymphoma
Which Lymphoma is the worst prognosis ?
Non- Hodgkin Lymphoma
What is the ANN arbor Staging for Lymphoma
- single lymph node chain
- 2 or more lymph nodes above the belly button
- Lymph nodes above and below the belly button
- Anything that has spread beyond nodes, bone,lungs, brain
EXAM * Treatment for Lymphoma
AVBD * Adriamycin Bleomycin Vinblastine Dacarbazine with chem and localized radiation
What lab value correlates with prognosis with Lymphomas
LDH
high bad - cells are proliferating
low good - cells are dying
Malignant proliferation of plasma cells
Multiple Myleoma
Xray- punched out skull lesions
Multiple Myleoma
key terms for this diagnosis-
Adult with Anemia, Bone pain, seems to get a lot of colds, lower extremity weakness
Multiple Myleoma
lower extremity weakness due to spinal cord compression
CBC shows Rouleaux
serum protein electrophoresis - monoclonal spike
Multiple Myleoma
Key terms for this diagnosis- Low blood count, High BUN count, hypercalcemia
Multiple Myleoma
Treatment for Multiple Myleoma
- Thalidomide - do not give if pregnant
- Steroids
- Doxorubicin