Heme/Onc Flashcards
TIBC normal values
250-450
Serum iron normal values
50-150
MCV
volume/size of RBCs
100: macrocytic
MCHC
concentration/color of the RBCs
hypochromic:
Possible anemia that is microcytic
IDA, thalassemia
Possible anemia that is macrocytic
B12 deficiency
folate deficiency
also called “megaloblastic anemia” = high MCV)
Possible anemia that is normocytic
anemia of chronic disease, sickle cell, blood loss
Iron deficiency anemia (IDA): incidence, causes, distinguishing sx
most common cause of anemia
slow blood loss, inadequate intake
Pica
IDA: Lab/Dx, Tx
Lab/Dx: low MCV, low MCHC (microcytic, hypochromic)
low serum iron, low serum ferritin, high TIBC
Tx: ferrous sulfate 300-325mg 1-2 hours after meals
Dietary intake: raisins, green leafy vegetables, red meats, citrus (Vitamin C increases absorption)
Thalassemia: incidence
mainly in Mediterranean, African, Middle Eastern, Indian, Asian populations
ferritin
iron stores
Thalassemia: Lab/dx, Tx
Low MCV, low MCHC (microcytic, hypochromic)
normal TIBC and ferritin
decreased alpha or beta hemoglobin chains
Tx: no treatment for mild-moderate; blood transfusion or splenectomy for more serious forms (refer); iron is contraindicated (can overload)
Folic Acid deficiency: Lab/Dx, Tx
macrocytic, normochromic (MCV up, MCHC normal), low serum folate
inadequate intake of folic acid (common in alcoholics)
Sx: glossitis
Tx: folate 1mg PO qday
dietary sources: bananas, peanut butter, fish, green leafy vegetables
Pernicious Anemia: Lab/Dx, Sx, Tx
Vitamin B12 deficiency due to malabsorption of B12
macrocytic, normochromic (MCV up, MCHC normal), serum B12 low
Sx: glossitis, POSITIVE NEURO SIGNS
Tx: B12 100mcg IM daily x1 week, then maintenance monthly administration (lifelong)
Anemia of chronic disease: Lab/dx, Tx
normocytic, normochromic (MCV and MCHC normal)
serum iron and TIBC LOW, serum ferritin high
Tx: treat associated disease, nutritional support, epogen (NOT iron)
Sickle cell anemia: Sx, Sx of crisis, Lab/dx, Tx
Sx: delayed growth/development, increased infections
Sx crisis: sudden onset of severe pain in back/chest, abd, joint pain
Lab/dx: Peripheral smear shows sickled RBCs
Tx: fluids, analgesics, oxygen
Acute myelogenous leukemia (AML)
80 percent of acute leukemia
high remission rates
Acute lymphocytic leukemia (ALL)
high remission rates in children, harder to cure in adults
pancytopenia with circulating blasts is hallmark of disease
Pancytopenia
all lab values are LOW
Chronic lymphocytic leukemia (CLL)
most common leukemia in adults
Hallmark of disease is lymphocytosis (extremely high WBC)
Chronic myelogenous leukemia (CML)
most often in ages 40+
poor survival rates
Hallmark: Philadelphia chromosome seen in leukemic cells
S/sx leukemia
fatigue, weak, anorexia, weight loss, generalized lymphadenopathy
symptoms tend to be vague or asymptomatic
Diagnosing leukemia
CBC, elevated ESR, peripheral blood smear
Bone marrow aspiration required to confirm diagnosis
Treatment of leukemia
Chemotherapy, bone marrow transplant
USUALLY not radiation
Diagnosis and staging of lymphoma
Dx: biopsy of enlarged lymph nodes
Stage I: single LN
Stage II: >1 LN, one side of the diaphragm
Stage III: >1 LN, both sides of the diaphragm
Stage IV: liver or bone marrow involvement
When to biopsy swollen lymph nodes?
Lasting 4-6 weeks
>1 cm
Not associated with infection
Non-Hodgkin’s lymphoma
presents with lymphadenopathy
most common ages 20-40
cause unknown, may have viral etiology
Hodgkin’s Lymphoma
more common in males, 32 years old
Usually presents with cervical adenopathy and spreads in predictable fashion along LN groups
Hallmark: Reed-Sternberg cells differentiate from non-Hodgkins
Treatment of lymphoma
Radiation
Chemo
Bone marrow transplant
TNM classification of malignant tumors
T (0-4): size of primary tumor
N (0-3): spread to regional lymph nodes
M (0-1): distant metastasis
“Immunosenescence”
immune system’s diminished function with age
decline in response to infection
decrease in symptoms with illness
diminished response to vaccines
Hgb + Hct normal values
Males: 14-18, Hct 40-54 percent
Females: 12-16, Hct 37-47 percent
