Heme and Lymph Flashcards
Patients with _____ are at a significantly increased risk for infections compared to the population in general. They may also have infection present in an atypical fashion
CLL (CD 19, 20, 5, 23)
What organisms are pts wit CLL most at risk of? Why?
encapsulated organisms (strep pneumo, h flu), bc risk of infection wtih humoral immunosuppression inherent to dz and related ts.
What is the most frequent and severe of common localizations for infections in CLL?
pneumonia.
What is the most frequent and severe of common localizations for infections in neutropenic pts?
bacteremia and septicemia
Patients no longer require a bone marrow examination to substantiate or refute a diagnosis of ___. Instead,
________ done on lymphocytes can establish a diagnosis with a near-100% accuracy
CLL
peripheral blood FLOW CYTOMETRY (CD 19, 20, 5, 23)
What would you expect to see on a peripheral smear of CLL? What do the cells represent?
smudge cells - fragile malignant lymphocytes sheared by lab tech making smears
Typical “B” sx
unintential wt loss, fever, night sweats, fatigue
What sx is waxing and waning and non-resolving in CLL?
cervical LAD
Most are ASX and are diagnosed after CBC shows LYMPHOYTOSIS and further lab work is performed
Define the difference between petechiae and purpura
Petechiae 5mm
Is thrombocytopenia palpable or NON palpable?
NONpalpable
Is intussusception less common in adults or children?
less common in adults (happens after inflammation of intestinal lining secondary to vasculitis during normal peristalsis) –> to abd series
Always consider ___ with purpuric lesions
menigococcemia
Tetrad for __:
- Palpable purpura, no thrombocytopenia and coagulopathy
- Arthralgia
- Abdominal pain
- Renal disease - IgA nephropathy
Henoch Schonlein Purpura
What is this?
may follow a streptococcal infx (sore throat), and present with generalized arthralgias, myalgias, rash, palpable purpura, abdominal pain, and renal insufficiency.
HSP
Chief concern for management of HSP
Assess renal status, overall fluid and electrolytes, determine need for CS.
Goal of tx of HSP until labs return:
IV fluids (saline/D5/LR) and monitor
Activity of rHSP
up adlib
when are GC given in HSP?
for extremely bad abdominal pain
What is this: inflammation secondary to infection or fat embolism from necrotic bone in a person with HbSS
acute chest syndrome
In ACS, endothelial dysfunction of pulmonary microvasculature leading eventually to ___ and/or ___
endothelial dysfunction of pulmonary microvasculature leading eventually to thromboembolism and /or hemolysis
Define dx of ACS
- New pulmonary infiltrates on CXR AND
- One or more of the following: chest pain, temp >38.5, tachypnea, wheezing, cough, or increased WOB
Four characterisitc features of…
- splenic enlargement and tenderness/pain
- drop in Hgb concentration of at least 2g/dL
- thrombocytopenia
- reticulocytosis
splenic sequestration in HbSS
Parvovirus B19 and aplastic crisis may predispose a HbSS pt for what?
splenic sequestration.
What drug for HbSS:
reduces the incidence of painful episodes and hospitalization rates prolongs survival it basically boosts the level of HbF and reduces the amount of HbS
hydroxyurea
What prophylactic drug should be given for SSD pts 3mo-5 years? why?
Prophylactic penicillin because…patients with SSD are susceptible to infection with bacteria and viruses because of the functional asplenia (due to infarction) that begins to occur very early in childhood. This makes these kids particularly susceptible to encapsulated organisms (strep pneuo, H. flu, N. meningititis).
What is this: bilateral dorsal swelling of the hands and feet sometimes seen in patients with sickle cell anemia. It most often occurs early in childhood and is often the presenting symptom of HbSS disease in children.
dactylitis (Hand-Foot syndrome).
Rarely occurs after 3yo (poor prognostic indicator)
What causes dactylitis?
microinfarction of bones of hands/feet
What things can precipitate a sickling crisis?
Cold weather **hypoxia Infection **dehydration Acidosis **etoh intoxication Emotional stress *********Pregnancy
____ from from atelectasis, pulmonary edema, bronchospasm, and V/Q mismatch in ACS.
regional alveolar hypoxia
four etiologies of ACS
infection
vaso-occlusive crisis
asthma
chronic hypoxia
All are tx for…
- hydration
- pain control
- respiratory support
- **bronchodilators
- antibiotics
- ***transfusion
- maybe steroids?
ACS
**bronchodilators - asthma may predispose SS pt to ACS
Five key signs that suggest severe respiratory distress.
- Retracitons and use of accessory mm to breath
- inability to speak full sentences.
- inabilty to lie flat
- extreme diaphoresis
- restlessness, agitation, declining levels of conciousness
Three signs of IMMINENT respiratory arrest
- DECREASED LEVEL OF CONSCIOUSNESS
- inability to maintain resp effort
- cyanosis
CXR location in ACS
upper lobe
what will cover mycobacteria?
azithromycin
sand paper like sound on auscultation
pleural rub - fluid around lungs is inflamed…
MC cause of Community Acquired Pneumonia
S. pneumo
palmar purpuric lesions, think….
meningococcal disease
encapsulated orgs that prevail in SSD and CLL
Strep pneumo and H flu
rhabdo v. HSP
increased CPK in rhabdo
CURB mortality:
For CAPneumonia: confusion, BUN >20, >65yo, low BP, RR>30
an obscured R heart border indicates…
middle lobe consolidation
