\ 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

Heme-onc Flashcards by Robert Bergen

HGB

Male - 14 to 18g/100ml

Female - 12 to 16g/100ml

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HCT

Male - 40 to 54%

Female - 37 to 47%

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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)

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MCHC

Normal = 32-36

Avg HG concentration %

Chromic=color

Hypochromic <32, hyperchromic >36

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Serum Iron / ferritin

50-150 ug/dl

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TIBC

250-450 ug/dl

Capacity for binding more iron

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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

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Low MCV Conditions

Iron deficiency, thalassemia

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High MCV Conditions

B12 or folate deficiency, alcoholism, liver failure, drug effects

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Normocytic anemia

Anemia of chronic dz, renal failure, sickle cell dz, blood loss, hemolysis

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Thalassemia

Genetically inherited resulting in abnormal Hgb production mediterranian, indian, asian, (not western european)

*Micro/Hypo

TIBC normal, ferritin (stores) normal

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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

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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

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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

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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

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Leukemia types

4 types:

ANL/AML

ALL

CLL

CML

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Lymphoma

Cancer arising from lymph tissue

Confirmed by lymph node bx

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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

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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