Heme Flashcards
1
Q
CRAB: hyperCalcemia, Renal insufficency, Anemia and Bone/Back lesion pain. Dx?
A
Multiple Myeloma
2
Q
What is Thrombocytosis?
A
Too many platelets
3
Q
What is the Vitamin for Folate?
A
B9
4
Q
What is RDW? Explain.
A
- Degree of variation in RBC size.
- Normal is <15% variation.
5
Q
What does TIBC stand for?
A
Total Iron Binding Capacity
6
Q
Explain importance of TIBC
A
Carton of eggs →
- If carton is full (high) of eggs (Fe), binding capacity is low
- If carton is empty (low), binding capacity is high
7
Q
2 MC types of microcytic anemia
A
- Iron Deficiency Anemia
- Thalassemia
8
Q
What is leukocytosis?
A
Too many WBCs
9
Q
Pt. presents with headache, dizziness, pruritus after showering. He has HTN and splenomegaly. Dx?
A
Polycythemia Vera
10
Q
Pt. was treated for iron deficiency anemia 6 weeks ago. Today she presents with normal values. What should be done next? Why?
A
- Check serum ferritin level
- It takes 4-6 mo to replenish so Rx should continue for a 4-6 mo.
11
Q
Labs seen with Von Willebrand Disease (VWD):
A
Prolonged bleed time ± prolonged PTT
12
Q
In what population of pts. must a PA be aggressive with spotting and treating anemia? Why?
A
- Elderly
- They won’t survive a large GI bleed.
13
Q
What virus is Hodgkin’s associated with?
A
EBV
14
Q
How do we know the difference of Iron Deficiency Anemia vs. Thalassemia?
A
- Iron studies
- Normal RDW (USE THIS ONE), Serum Fe, TIBC and serum Ferritin in Thalassemia.
15
Q
MC presentation (color, size) of Anemia of Chronic Disease
A
Normocytic, Normochromic
16
Q
How do we Tx Anemia of Chronic Disease?
A
Tx underlying cause
17
Q
In a 45yo vs. 75 yo with B12 and Folate Deficiencies, what are the differences in presentation?
A
- Both: Unexplained weakness
- Younger: Paresthesias
- Elderly: Cognitive changes
18
Q
How do we check/Dx B12 Deficiency?
A
- Dx: Serum cobalamin levels
- ↑ Serum Homocysteine
- ↑Methyl-Malonic Acid (MAA)
19
Q
What presents with splenomegaly, gingival hyperplasia and Auer rods?
A
Acute Myelogenous Leukemia
20
Q
RDW in Chronic (>3 mo) would show what and why?
A
- Normal at <15 % variation in size.
- All RBCs are small and don’t vary like they would in acute.
21
Q
Tx for Polycythemia Vera
A
- Phlebotomy
- Hydroxyurea
- ASA
22
Q
What is thrombocytopenia?
A
Low platelet count
23
Q
What does it mean to have petechiae and purpura?
A
Bleeding under the skin.
-Many petechiae lead to purpura.
24
Q
If Polys and Lymphs are numerically nearby, think _____
A
Viral infection
25
Reed-Sternberg Cell pathognomonic in:
Hodgkin's
26
What is seen on x-ray for Multiple Myeloma?
Lytic lesions
27
Bariatric surgery is an RF for ____ D/T ____:
- Iron Deficiency Anemia
| - ↓ iron absorption
28
Oral Tx for Lead poisoning
Succimer
29
Tx for Sickle Cell
Hydroxyurea
30
Painless supraclavicular or anterior cervical triangle lymph node mass. Sxs: F, night sweats, wt. loss. Dx?
Hodgkin’s
31
BEST Dx lab test for Thalassemia
Hemoglobin Electrophoresis
32
What does it mean infection-wise when the Monocytes are elevated?
Infection >24 hr bc that's when Monos come out.
33
What iron is usually given Rx and why?
- Ferrous Sulfate
| - GI issues with highest and too many pills to take with lowest.
34
MC gene in Polycythemia Vera
Janus kinase 2 gene (JAK2)
35
What is the expected duration to treat for B12 deficiency?
Usually life-long
36
Koilonychia is seen in:
Iron Deficiency Anemia
37
If Polys and Lymphs are numerically REALLY far apart, think _____
Bacterial infection
38
MC marker of Thrombotic Thrombocytopenic Purpura (TTP). High or low?
Severe ↓ ADAMTS13
39
What is seen in Protein electrophoresis of Multiple Myeloma?
Bence-Jones proteins
40
What is the name of B12?
Cobalamin
41
2 MC conditions associated with Eosinophils
- Allergic reactions
| - Parasitic infections
42
What is seen on peripheral blood smear for Multiple Myeloma?
Rouleaux
43
Why is RDW normal in Thalassemia?
-There is no iron problem, the problem is making Hemoglobin.
44
What type of hemoglobin does hydroxyurea increase?
HbF (fetal hemoglobin)
45
What is the only vitamin deficiency to result in neuro symptoms?
B12 (Cobalamin)
46
What presents with splenomegaly and Philadelphia chromosome t(9;22)?
Chronic Myelogenous Leukemia (CML)
47
What makes a RBC red?
Hemoglobin
48
Tx for Primary Immune Thrombocytopenia
- Kids: observe ± IVIG (severe w/bleed)
| - Adults: Steroids > IVIG; Platelets <20K - transfusion, splenectomy
49
Pt. on chemo presents with temp >101 F and neutrophil < 500. Dx?
Neutropenic Fever
50
An elderly pt. is being treat for Iron Deficiency Anemia. After 1 mo of Tx, her Hgb and Hct haven't changed much. What is the next step? Why?
- Check Reticulocyte count
| - To see if bone marrow is producing RBCs.
51
Peripheral smear: spherocytes and Howell-Jolly body. Dx?
Hereditary Spherocytosis
52
Hyperdense lines at metaphyses ("lead lines") seen in:
Lead poisoning
53
How long does it take total WBC count to react to infection?
At least 12 hrs
- So polys and lymphs are already circulating in this time.
- Immunocompromised might not even show a difference.
54
↑ hemoglobin, ↑ RBC mass, leukocytosis, and thrombocytosis. Dx?
Polycythemia Vera
55
What does "chromic" mean in Anemia? What terms are used to differentiate?
- Color
| - Hypo, normo, hyper
56
What is MCH?
RBC color AKA Hemoglobin content
57
What Dx is complicated by Minimal Change Disease?
Hodgkin's lymphoma
58
Tx for Thrombotic Thrombocytopenic Purpura (TTP)
ASAP Plasma exchange + IV corticosteroids + Rituximab
59
What antipsychotic causes agranulocytosis (severely dangerous leukopenia/neutropenia)?
Clozapine
60
Tx for Tumor Lysis Syndrome
IVF + ER dialysis (with multiple electrolyte abnormalities)
61
How many days after chemo should nadir be in absolute neutrophil count?
7 days
62
Thrombocytopenia is usually the ONLY lab abnormality seen in:
Primary Immune Thrombocytopenia
63
What labs are seen in Aplastic Crisis?
↓ Hb + reticulocytopenia
64
Schistocytes are seen in what 2 Dx's?
Disseminated intravascular coagulation (DIC) and Thrombotic Thrombocytopenic Purpura (TTP)
65
- Platelet 10-20K + mucosal bleeding OR
| - Platelet < 10K and no bleeding are treated with:
Steroids or IVIG (or both)
66
In what Dx can we find recurrent DVTs, spontaneous abortions, or CV events?
Antiphospholipid Antibody Syndrome
67
Mgmt of Red Man Syndrome
- Antihistamine (Diphenhydramine) and stop offending agent.
| - Can restart med slower without true anaphylaxis and resolved Sxs.
68
Tx for Neutropenic Fever
PCN (or 4th gen. Ceph) + Vanco
69
What lab would be affected by Hemophilia A, B, C?
PTT
70
What is the ONLY D/O causing increase in mean corpuscular hemoglobin concentration (MCHC)?
Hereditary Spherocytosis
71
Which lab tests platelet function and health?
Bleed time
72
Tx for Hereditary Spherocytosis
Daily Folic Acid
73
Dx for Sickle Cell Disease
Hemoglobin electrophoresis: HgbS, ↑ HgbF, NO HgbA
----------------------------
↑ reticulocytes, ↓ Hct, Hgb
74
What risk does a high INR on Warfarin have?
Bleed risk
75
If INR is <5, what is the mgmt?
Lower dose or omit
76
Tx for Acute Chest Syndrome in SCD
Broad-spectrum antibiotics admit to ICU
77
Difference between Disseminated intravascular coagulation (DIC) and Thrombotic Thrombocytopenic Purpura (TTP):
- DIC has LOW Fibrinogen
| - TTP has normal Fibrinogen
78
Recurrent DVTs and pulmonary embolism. Dx?
Factor V Leiden
79
Labs seen in Beta Thalassemia
- ↑ HgbF
| - Codocytes (target cells)
80
Tx for severe Iron Deficiency Anemia
PO Ferrous Sulfate (unless showing Sxs CHF)
81
What is ESR?
Nonspecific marker of inflammation
82
MCC of mortality in sickle cell patients
Acute Chest Syndrome (ACS)
83
What anticoagulation med is CI in pregnancy?
Warfarin
84
Pt.: Short stature, deaf, skin hyper/hypopigmentation, cafe-au-lait spots, renal abnormalities. Labs: Macro anemia and↑ fetal hemoglobin (HgF). Dx?
Fanconi Anemia
85
Young kid with lymphadenopathy*, limping, bone pain. Lymphoblasts on peripheral smear. Dx?
Acute Lymphocytic Leukemia (ALL)
86
What PE is seen with Von Willebrand Disease (VWD)?
Mucosal bleeding
87
MC heme manifestation in chronic alcoholics
Macrocytosis
88
Dx for Hereditary Spherocytosis
Osmotic fragility test
89
What Dx presents post URI with thrombocytopenia?
Primary immune thrombocytopenia
90
What mandates antibiotic treatment for Neutropenic Fever?
Single oral temp. of 101F (38.3C) or 100.4 for >1 hr
91
Labs seen in Aplastic Crisis
↓ Hemoglobin and ↓Reticulocyte count
92
Dx for Polycythemia Vera
CBC
93
Hodgkin vs. Non-Hodgkin
H: Localized, single group of nodes
NH: Multiple, peripheral nodes
94
Post chemo initiation. HyperUricemia, HyperK, HyperPhos, HypoCa+. Dx?
Tumor Lysis Syndrome
95
In a person with normal marrow function, what is the mean life span of platelets?
7-10 days
96
What is a potential adverse effect associated with unfractionated heparin?
Thrombocytopenia
97
AA man is placed on Primaquine for travel to Africa. Within 5 wks he presents complaining of fatigue. CBC shows anemia. What diagnostic study should be performed? Why?
- G6PD assay
| - Antimalarials, sulfas, nitro cause oxidative stress
98
Your patient has been treated for Fe deficiency anemia. What do you check to see if treatment is working?
↑ Reticulocyte (immature/new RBCs)
99
Tx for Pernicious Anemia
Steroids + B12
100
Tx of choice for mild Hemophilia A Deficiency and for severe bleed
Mild: DDAVP daily
Severe: Factor VIII infusion
101
Pregnant pt. presents with sudden onset bleeding and severe pain (placenta abrupto). She has an elevated PT and PTT. How would you treat this?
- FFP/packed RBCs
| - D/T DIC
102
Pt. presents for routine check-up. He has ↓ serum iron, ↓ total iron binding capacity (TIBC), and ↑ ferritin. Dx?
Anemia of chronic disease (Normocytic, Normochromic)
103
Pt. presents for routine check-up. He has ↓ serum iron, ↓ total iron binding capacity (TIBC), and ↑ ferritin. What is the Tx?
- Monthly Erythropoietin (EPO) injections
| - Dx: Anemia of chronic disease
104
Pt. presents with labs showing target cells (ringed sideroblasts) and basophilic stippling. Also has ↑ serum iron. What would be the diagnosis?
Lead poisoning
105
What is the next step in mgmt with Fe deficiency in adults >60yo and microcytic hypochromic anemia? Why?
- Colonoscopy
| - Worry about colon CA until proven otherwise
106
What is the best treatment for a pt. with CKD and labs showing Cr 21, HgB 6.8?
-Transfusion (HgB <7, anytime)
107
47 yo female presents to the ED. She has Hx of DM and CHF and has darkening skin with elevated liver enzymes. What is the Dx?
Hemochromatosis "Bronze Diabetes"
