Heme-onc Flashcards
HGB
Male - 14 to 18g/100ml
Female - 12 to 16g/100ml
HCT
Male - 40 to 54%
Female - 37 to 47%
MCV
Normal: 80-100
*Cytic=Size (avg volume and size of individual blood cell)
Micro (iron def vs thalessemia)
Macro >100 (B12 vs folate def)
MCHC
Normal = 32-36
Avg HG concentration %
Chromic=color
Hypochromic <32, hyperchromic >36
Serum Iron / ferritin
50-150 ug/dl
TIBC
250-450 ug/dl
Capacity for binding more iron
Iron deficiency
*Micro/Hypo (due to overall deficiency of iron)
Causes:
- Blood loss is most common due to slow GI bleed (SCOPE the patient)
- dysmenorhhea
- Rarely absorption issue
- Decreased intake
*Exhibit Pica*
TIBC is high, capacity for more iron is high
Ferritin (stores) low
Low MCV Conditions
Iron deficiency, thalassemia
High MCV Conditions
B12 or folate deficiency, alcoholism, liver failure, drug effects
Normocytic anemia
Anemia of chronic dz, renal failure, sickle cell dz, blood loss, hemolysis
Thalassemia
Genetically inherited resulting in abnormal Hgb production mediterranian, indian, asian, (not western european)
*Micro/Hypo
TIBC normal, ferritin (stores) normal
Folic acid Deficiency vs Pernicious Anemia
Folic Acid Deficiency:
Fatigue, dyspnea, pallor, glossitis
*No neuro signs in folic acid def., check alcohol intake
*Both are macrocytic, normochromic
Tx: Folic acid replacement, PB, fish , bananas, green leafy
Pernicious Anemia
Deficiency of intrinsic factor leading to malabsorption of B12
PERnicious has POSitive neuro signs
Schilling test (radioactive) may help determine cause
Tx: B12 (cyclobenazprine) 100mcg IM daily x 1 week load then monthly injections for life
Anemia of chronic disease
Most common in-hospital and in elderly
*Normocytic, normochromic
Associated with chronic inflammation, infection, renal failure and malignancy
TIBC and serum iron low, ferritin (stores) high
Correct underlying first, good diet, epoitin alpha
Sickle cell
Chronic hemolytic anemia
Cellular hypoxia results in acidosis and tissue ischemia
*Precipitated by infection, high altitude, stress, hypoxia, blood loss, dehydration, surgery or acidosis
Testing by cellulose acetate and citrate agar gel electrophoresis
Fluids first, O2 with pain management
Morphine or Dilaudid IV
Leukemia
Neoplasms from hematopoietic cells of bone marrow
More common in men, unkown cause
Tx: Chemotherapy, BM transplant, symptomatic care
(No surgery or radiation)
Lymphadenopathy and weight loss, fatigue
Confirm with bone marrow aspiration
Leukemia types
4 types:
ANL/AML
ALL
CLL
CML
Lymphoma
Cancer arising from lymph tissue
Confirmed by lymph node bx
Hodgkins vs Non-Hodgkins Lymphoma
Non-hodgkins, possibly viral cause, presents with lymphadenopathy, most common neoplasm between ages 20-40, advanced dz usually on dx
Hodgkins-better prognosis, more common in men, age 32, presents with cervical adenopathy and spreads predictably, Unknown cause
*Reed Sternberg cells
Idiopathic Thrombocytopenic Purpura
ITP
Normal platelets 150-400,00
Autoimmune destruction with or w/o suppression of thrombopoiesis, ususally chronic, women> men 3:1
Dx: bone marrow evaluation, hx,
Sx: gingival bleeding first, then hematuria (check a UA)
DIC
Acquired disorder from intravascular activation of coag and fibrinolytic systems (thrombin and plasmin)
Mortality 50-85%
Causes:
Acute leukemia, amniotic fluid embolus, burns, shock, sepsis, liver disease, trauma, malignancy
DIC Diagnostics
Hypofibrinoginemia =Fibrin <170
Thrombocytopenia= plts<150,000
Decreased RBC, Increased FDP>45
Prolonged PT (>19),
pTT (42),
+ Ddimer >1:8 dilution (reflects simultaneous activation of thrombin and plasmin)
DIC Tx
- Thrombocytopenia=plt transfusion
- Coag factors low = FFP
- Fibrinogen= Cryoprecipitate
- Heparin is controversial
Therapy is aimed at decreasing bleeding and FDP’s and increasing fibrinogin and platelet count
Heme Gero Considertions
Immunosenescence
Decreased thymic production=decreased T cells
Decreased immune cells and response to antigens
Waning of induced antibody response
Lifespan of the avg RBC
25 days
2 types of microcytic anemias
iron deficiency
thalessemia
2 types of macrocytic anemias
folic acid deficiency
pernicious (b12)
DIC cascade
1) Thrombin causes conversion of fibrinogen to fibrin and causes fibrin clots in the microcirculation
2) Coag factors are reduced (Fibrinogen, prothrombin, fplatelets, actors V and VIII)
3) Circulating thrombin activates the fibrinolytic system which lyses fibrin clots into fibrin degradation products FDP’s
4) Hemorrhage results from anticoagulant activity of FDP’s and depletion of coag factors
What is the most common anemia in adults?
(not elderly)
Iron-deficiency
Treament for iron deficiency anemia
Tx: iron 300-325 oral , take on empty stomach or with juice
Source: Raisins, red meat, green leafy
Thalessemia tx
No treatment indicated unless severe, RBC transfusion or splenectomy
Iron tx is contraindicated
Which anemia has associated neuro signs?
Pernicious anemia
Positive neuro signs=Pernicious
Diagnosis/Treatment for ITP
Tx: high dose corticosteroids, gamma-globulin preferred in HIV, plt transfusions (<20,000)
ITP vs SLE: Need a BM asp to differentiate
Treatment for HIT
Tx: Stop the heparin
Anticoagulate with: Argatroban, Lepirudin if HIT induced
(usually from unfrac hep, not LMW heparin)
Bleeding occurs from what 2 things in DIC?
Circulating FDP’s
Decreased coag factors
What is the role of cryoprecipitate in DIC?
Maintain fibrinogen
difficult to cure in adults, pancytopenia with circulating blasts (hallmark of dz)
ALL
Most common leukemia in adults, middle and old age
Hallmark is leukocytosis
Long term survival 10 years
CLL
Age >40 years, survival 3-4 years,
philidelphia chromosome marker (hallmark of dz)
CML
What autoimmune condition causes neutropenia?
Felty’s syndrome- RA
accounts for 80% ACUTE in adults
Remission rates 50-85
Long term survival 40%
AML
Criteria to perform a lymph node bx
perform for any node >1 cm, not associated with infection lasting longer than 4-6 weeks
Staging of lymphoma:
Stages: I-IV
I : Single node or group
II: > 1 lymph node group on 1 side of diaphragm
III: >1 Lymph node or spleen on both sides of diaphragm
IV: Liver or bone marrow involvement
What is the diagnostic testing regimen for lymphoma?
Testing: CT, XR US, MRI for localization and staging
bx with histology confirmatory
Treatment strategy for lymphoma
Radiation
Chemotherapy
BM transplant
Non-Hodgkins lymphoma
do Not want Non-Hodgkins
Not predictable
does NOT have Reed-sternbergs cells
