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SUMMED2 > HEME-CBC eval, Anemia > Flashcards

HEME-CBC eval, Anemia Flashcards

1
Q

What is the initial start of erythropoiesis- blood cell formation?

A

Tissue low oxygenation status
Kidney produce EPO=erythropoietin hormone tells stem cells in the bone marrow to make more RBC.
EPO– growth and differentiation progenitor into normoblasts–reticulocyte–loss of RNA—RBC
last 120d
MAC engulf dead RBC

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2
Q

What ​is diff. btwn Hgb vs Hct?

A

Hgb- A (98%) A2 (1-2%) F (<1)concentration of the major oxygen carrying pigment of whole blood

Hct -is the percent/ratio intact red blood cells to total BV.

RBC- #/ specific volume of blood
M-Hgb<13.5 or Hct<41%

F-Hgb <12.0 or Hct < 36%

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3
Q

What are changes CBC in pregnant, smoker, and Blacks?

A

Pregnant- changes
Smokers- High HCT d/t High CO from cigs
HIGH Altitudes High
AA- Lower Hgb

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4
Q

What measure the avg size for RBC?

A

Mean corpuscular volume (MCV)​ measures the ​average RBC volume (size)
■ Normocytic anemia​ = MCV 80-100 fL
■ Macrocytic > 100
■ Microcytic < 80

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5
Q

Ms. Massaro has MCV <80. What are the DDX for her microcytic anemia?

A

Iron deficiency Anemia
Thalassemia
Copper deficiency, zinc poison
drugs, Etoh

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6
Q

Ms. Jenny has MCV >100. What are the DDX for her macrocytic anemia

A 
Etoh abuse
Vit B12/Folate dyfx
Myeloplasitc syndrome
AML
Reticulocytosis- blood loss
Drug induced- chemo, AZT
LIver dz
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7
Q

What is #1 cause of anemia in US?

A

GIB; LAB- Stool occult blood- guaiac
Anemia- abnormal lack of blood, color, size, etc.
1. Bleeding acute or chronic
2. Hemolysis-HSM, Jaundice, rash, dark urine, fever
3. Bone marrow- reticocyte
4. IDA- Why- folate, preg, cyanobalamin Vb12
Consider CA, vitamin, Heart Dz

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8
Q

What is L reticulocyte shift?

A

worsening anemia and INC erythropoietin stimulation, bone marrow reticulocytes leave in earlier immature stage

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9
Q

What do these conditions cause:
bone marrow suppression,
hypersplenism,
vitamin B12/folate deficiencies?

A

Leukopenia + anemia

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10
Q

What WBC count indicates infection, inflammation, or hematologic malignancy

A

Leukocytosis + anemia
INC neutro- INFX, band, LEFT
INC monocytes = myelodysplasia
INC eosinophils= parasites or allergic

DEC neutrophils= s/p chemo;
DEC lymphocyte= HIV or steroid tx

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11
Q 
What platelet count is R/T
hypersplenism
malignancy bone marrow;
autoimmune platelet destruction; 
sepsis; 
vitamin B12 or folate deficiency
A

Thrombocytopenia with anemia

Low platelets

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12
Q 
What platelet count is R/T
myeloproliferative disease; 
chronic iron deficiency;
inflammatory,
 infectious, 
neoplastic disorders​/ cancer
A

Thrombocytosis with anemia

High platelets

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13
Q

What is w/in Hgb, forms heme, stored in ferritin, absorbed in gut, lost through mucosal exfoliating and menses?

A

Iron

MCC of anemia

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14
Q

What are s/s of anemia

A 
Signs:
Stool occult blood
Fall in Hgb- blood loss late
Bounding pulses
CHF, Arryhtmias, MI
Blood loss- shock death, HypoTN
Jaundice, Pallor, petechia-Liver
LAD
HSM
Bone tener
Sx
DOE
DOR
fatigue, lethargy, 
Palpitations
Dysphagia-IDA
Roaring EAR sounds
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15
Q

What is workup of anemia?

A

CBC w/ platelets
WBC differential
Reticulocyte count- cause. LOW-aplastic anemia, BM dz.
Blood smear

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16
Q

Ms. Julia is easily fatigue, tachycardia, palpitations, dysphagia; DOE,
PMH-Pica​ d/o
PE: smooth tongue, brittle nails, cheilosis​:dry cracked mouth. What could be the cause?

A 
DDX:
Acute or Chronic
Blood loss- GIB​ -*MCC of IDA NSAIDs
Iron deficiency anemia
Diet,
Celiac, IBD, Biatric surgery
Pregnancy and lactation​
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17
Q

What lab changes are seen as iron stores become depleted?

A 
Low serum ferritin- 1st
LOW Transferrin, 
HIGH-Total Iron Binding Capacity; TIBC
Iron level initially normal
RBC DEC-microcytic (small, hypochromic (pale)
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18
Q

What education is provided to Pt taking oral iron?

A 
​ferrous sulfate = 1st line
FeSO​4​ 325mg PO TID ​,titrate slowly
Take w/ orange juice
AVOID taking w/ milk- DEC absorptions
Dietary better- red meat, spinach, prunes, cast iron
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19
Q

How often should iron be rechecked?

A

2m- Check H/H. Repeat monthly
Takes longer if GI dz
Entire iron panel at 6m

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20
Q

What can be done if the person has the following Intolerance to oral iron, refractory IDA, GI disease, uncorrectable continued blood loss?

A

Parenteral iron therapy

Iron- cause constipatin, GI upset, dark stools

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21
Q

Which disease has more severe anemia?

A

Chronic Renal L/2 DEC EPO- bone marrow fails
TX-SubQ inj

Other dz
Chronic infx-
Sarcoidosis, RA
Cancer
Liver disease
22
Q 
●Low Hgb/Hct- define anemia
● N or  DEC MCV​ 78-90
● N reticulocyte count and smear
● Low serum iron, TIBC, transferrin saturation; 
● Normal or INC serum ferritin
● Low serum EPO in CKI
A

Lab Chronic Anemia d/o

diagnostics

23
Q

What is ideal treatment for ACD?

A

NON needed
Replace Iron/folate/B12
INj EPO-CKI, Cancer, RA
Hemodialysis- CKI

24
Q

What is the reduction in the synthesis of globin chains α or β leading to reduction in Hgb synthesis with **Microcytosis out of proportion to the degree of anemia​?

A

Thalassemia, A/B/H

CBC: Major DEC MCV. DEC HGb, Iron.
*HCT NORMAL +/-

DX. HgB electrophoresis

25
Q

What condition affects Asians, pt is clinically healthy, w/ mild microcytic anemia?

A 
Thalassemia A minor trait, 2 a-globin
CBC:
Hct 28-40%
MCV 60-75
N- RBC count
Peripheral smear: microcytic, hypochromic RBC​, target cells +/-
N- Reticulocyte and iron
HgB electrophoresis​ ​-no sig findings
26
Q

This person will have a ​hemolytic s/s: HSM, Jaundice, rash, dark urine, fever anemia​, ​pallor​. 1 normal ​α​-globin gene, and severely low MCV.

A 
Hgb H
CBC: very low Hgb and iron
hemolytic anemia: Reticulcytsosis 
Hct- 22-32%
MCV 60-70
Peripheral smear: hypochromia, microcytosis, target cells, poikilocytosis; abnormal shape
*Reticulocyte elevated
Hgb electrophoresis​- H Hgb 10-40%

TX 1. w/ folate supplements,

  1. transfusions;
  2. iron chelation
  3. splenectomy
27
Q

An anemia via point mutations → premature chain termination or problems with transcription of RNA. L/2 to INC in Hgb A2, F, A.
Excess a chains unstable and damage RBC= hemolysis

A

Beta Thalsessemia

Mediterranean​

●minor (trait):​ microcytic anemia

● major:​ Kids develop severe anemia at 6m- Hgb F doesn’t switch to A: Growth failure, bony deformities, HSM, jaundice;
TX-transfusions
Risk- cardiac failure, cirrhosis, endocrinopathies​

28
Q

CBC: mild anemia, Hct 28-40%, MCV 55-75 normal RBC count
○ Peripheral smear: hypochromia, microcytosis, target cells, basophilic stippling
○ Reticulocyte- normal/slight increase
○ Hgb electrophoresis-INC of Hgb A2+F

A

β-thalassemia minor:

NO TX

29
Q

CBC: severe anemia with very low Hct
Peripheral smear: severe poikilocytosis, hypochromia, microcytosis, **nucleated RBC, target cells, basophilic stippling,
○ Hemoglobin electrophoresis​- **INC Hgb F, +/-Hgb A/A2,

A

β-thalassemia major:

30
Q

What is treated with allogenic ​bone marrow transplant?

A

**β-thalassemia major

31
Q

What is result Folic/Folate and vitamin B12 deficiency?

A

Megaloblastic Anemias
INC MCV 130-140
Peripheral blood smear: macro-ovalocytes, , *hypersegment neutrophils lobes

32
Q

What is the important cofactor for enzyme reactions in humans bc we don’t make it?

A

Vitamin B12
All from diet, animals
Bound to intrinsic factor absorbed in SI-ileum
Stored in Liver
deficient develops >3y after absorption stops

33
Q

How is B12 deficiency developed?

A
  1. MC- Pernicious anemia​ = lack of intrinsic factor in stomach, bariatric gastrectomy, parietal cell damage
  2. H. pylori
  3. Competition for vitamin B12 in the gut
    4 Pancreatic insufficiency
  4. DEC ileal fx- resection; Crohn’s
34
Q

Ms. Massaro has smooth, shiny tongue​; dyspepsia, anorexia, diarrhea, Pale, jaundice​; *paresthesias​, dysequilibrium, *dementia.
PE:, pale, decreased position or vibration
What workup is next? What else is considered?

A 
VB12 deficiency
CBC- MCV-110-140, WBC- +/- DEC, pancytopenia
Smear
Reticulocyte- DEC
Low serum B12

DDX- DM

35
Q

What is result of parenteral vb12 1000mcg IM monthly?

A

Hypokalemia

For Pernicious Anemia: 2 months
100mcg IM daily/1 week 
THEN, weekly x 1 month 
THEN, monthly for life
PO- for life
IM quick 1000mcg
36
Q

What is difference btwn folate and B12 defiency?

A

FOLATE- **No neurologic abnormalities
SX- fatigue, tachycardia, palpitations, DOE
Labs- **NO WBC abnormality, MCV 110-140,
DEC reticulocyte, RBC folate
NORMAL- B12

Causes- alcoholics, anorexia, overcooked, PHY, sulfsalzine, MTX, Preg, skin d/o, dialysis

37
Q

What is key treatment for folate deficiency?

A

Folic acid 1mg PO qd- fruits and veggies
TX- GI dz, Alcohol abuse, etc
RAPID symptoms improved
Recheck 2m

38
Q

Which anemia is RBC survival reduced and the bone marrow in unable to sufficiently compensate?

A

Hemolytic Anemias

  • *Reticulocytosis- INC count 15-25%
  • *HCT- dec >3%/wk

ETi- G6PD, malaria.
Intrinsic- acquriedd
Extrinsic- Liver, Infx, Leukemia
Intravascular Destruction- transfusions

39
Q

What diagnostic study is a normal plasma protein that binds and clears Hgb released into the plasma produced in liver, APR?

A

DEC in serum haptoglobin- **KEY DX of hemolysis
INC LDH- microangiopathic hemolysis and others​ (also cancer)
HSM
Petechia
Jaundice

40
Q

What are micturition concerns with intravascular hemolysis?

A

Hemoglobinuria

hemosiderin - iron storage complex in cells

41
Q

Which LFTs and Lipid panel suggest hemolysis?

A

INC UNconjugated Bilirubin

42
Q

Mr. Heme c/c fatigue, palpitations, DOE. PE- tachycardia. Smear show bite-like denatured hemoglobin precipitates..Which condition?

A

Heinz body prep

hemolytic anemia

43
Q

Mrs. Heme smear shows helmet cells-flat top, and red cell fragments?

A

microangiopathic hemolytic anemia

Thromocytopenia

44
Q

Ms. Tboz is 45yo w/ chronic pain, slow growth as a child. PE- ulcers on tibia
CHF
VA- retinopathy
Mild jaundice

A

Sickle cell anemia-AR- Chronic hemolytic anemia, enzyme dfx hemoglobinopathy- substitute DNA error
8% of AA d/t malaria protection progression

LOW O2-Affects S-Hgb chain- form polymers that damage RBC membrane- sickling
AS trait-60% A + 40% S
SS- 90% S+ 10% F

TX- LIVE 40-50yo

45
Q

Ms.Tboz c.c of chest pain after recent URI. Vital- low grade fever for 24h.

A

Sickle cell crisis- acidosis, hyoxemia. Hr-days
All organs- cluster of sickled cell occlude vasculature
Spleen sequestered sickled cells
BM decompensated
Acute from dehydration, hypoxia, infx., Spontaneous

46
Q

What does Howell jolly bodies along with sickled cells indicate?

A

DX- confirmed by Hgb electrophoresis
Hyposplenism- splenic infarction- splectomy VC**

LABS
nucleated RBC
Target cells
CBC- Hct 20-30%, 
Reticulocytosis- 10-25% INC **
WBC INC 12-15k
Thrombocytois
INC indirect/uncong Billi
47
Q

Ms. Tboz daughter Psmear show folded, partially shaped RBC, with inc. target cells. What is the condition?

A

Hgb SC disease (trait)
Pita bread
Canoes

48
Q

Ms.Tboz c.c of chest pain after recent URI. Vital- low grade fever for 24h. what is TX?

A

SC crisis
TX: oxygen, fluids, blood transfusion, and infection
Maintenance- Folate ACdi

49
Q

What is important w/ Pt education for prevention of SC crisis?

A

Hydroxyurea​ 500-750mg/d PO -DEC frequency of pain crises

TX for SC
Allogenic bone marrow transplant- young
Immunization -Pneumococcal*

50
Q

Ms. Tboz has 30% loss of BV w. sx dizzy, SOB, fatigue? What is next step?

A

RBC transfusion
10/30 Rule
Hgb<10g/dl
Hct <30%

Ea unit of RBC- will INC HCT 3-4%, HgB 1g
Goal 9-10% inc

51
Q

What are concerns about transfusions?

A 
Replace fluids
Rapid loss- control bleeding
Cross reaction of antibodies
Type O universal
Monitor- N/V fever w/in 24-48h
52
Q

Ms. Tboz has more than one type/cause of anemia w/ abnormal variability in blood cell lines circulation. This may be:
Aplastic anemia,
myelodysplastic syndrome,
leukemia

Nothing is improving w/ transfusion, or Hydrourea.
What is next?

A

Refer to Hematoloy or Oncology

SUMMED2 (38 decks)

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