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0 BOARDS > heme onc > Flashcards

heme onc Flashcards

1
Q

*What is the difference between Mean Corpuscular Hemoglobin and Mean Corpuscular Hemoglobin Concentration?
Normals for each?

A

MCH: avg WEIGHT (amount) of hg in one erythrocyte
- normal: 26 - 34

MCHC: avg CONCENTRATION of hgb, ie, the % proportion of an RBC occupied by hgb MORE ACCURATE
- normal: 32 - 36

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2
Q

What is the percentage of a volume of whole blood that is erythrocytes?

A

hematocrit

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3
Q

hematocrit normals

A

M 40 - 54%

F 37 - 47%

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4
Q

What is Mean Corpuscular Volume? Normals?

A

avg vol & size of individual erythrocytes

MCV value 80-100

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5
Q

Mean Corpuscular Hemoglobin Concentrations (MCHC)

A

average Hgb concentration

MCHC normal value 32-36%

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6
Q

*Differentials for LOW MCV

A

iron deficiency anemia

thalassemia

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7
Q

*Differentials for HIGH MCV

A

the megaloblastic anemias: B12 & folate deficiency

alcoholism, liver failure, drug effects

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8
Q

*Differentials for NORMOCYTIC MCV

A 
anemia of chronic disease
sickle cell anemia
renal failure
blood loss
hemolysis
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9
Q

microcytic hypochromic anemias

A

iron deficiency

thalassemia

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10
Q

macrocytic normochromic anemias

A

B12 (pernicious anemia)

folate deficiency anemia

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11
Q

normocytic normochromic anemias

A

anemia of chronic disease
sickle cell anemia
blood loss

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12
Q

What is iron deficiency anemia?

A

microcytic hypochromic anemia d/t overall decreased iron intake; less iron available for RBC formation

most common anemia

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13
Q

iron deficiency anemia: s/s x9

A

SLOW onset; symptoms really kick in when hct drops below 30

** pica **
dyspnea, mild exertional fatigue
palpitations, tachycardia, postural hypotension
weakness, pallor, HA

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14
Q

iron deficiency anemia: hallmark diagnostics x4

A

Low MCV & MCHC **
Low ferritin ** (stores)
High TIBC ** (capacity for more iron)

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15
Q

iron deficiency anemia: management

A

Ferrous Sulfate 300-325 mg PO 1-2 hours after meals

+ foods high in iron

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16
Q

Ferrous sulfate: indication and considerations x4

A

treatment for iron deficiency anemia

  • take 1-2 hours after meals
  • vitamin C increases absorption
  • do not take with antacids (interfere with absorption)
  • GI effects: n/v/d/ cramps
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17
Q

What is ferritin?

A

iron stores

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18
Q

What anemia is characterized by low ferritin and high TIBC?

A

iron deficiency anemia

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19
Q

What is thalassemia?

A
  • microcytic hypochromic anemia

genetic disease = abn hgb production

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20
Q

thalassemia: s/s

A

unremarkable unless severe

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21
Q

thalassemia: diagnostics

A

Low MCV & MCHC **
Normal ferritin & TIBC **
Decreased hgb & alpha or beta chains in hgb

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22
Q

thalassemia: mgmt

A

none if moderate disease
if severe: RBC transfusion, splenectomy
NO IRON; IRON OVERLOAD RESULTS

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23
Q

What is contraindicated in the management of Thalassemia?

A

iron - the body will be overloaded with iron because it can’t use it

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24
Q

What is folic acid deficiency anemia?

A

macrocytic normochromic; anemia resulting from lack of folic acid, duh
** d/t either malabsorption or decreased intake **
folic acid is needed for RBC production

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25
Q

folic acid deficiency anemia: s/s

A

glossitis **

the standard other anemia s/s: 
fatigue
pallor
palpitations
weakness
headache
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26
Q

folic acid deficiency anemia: diagnostics

A

High MCV (100+)
Normal MCHC (32-36%)
Low serum folate
Decreased HCT & RBCs

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27
Q

folic acid deficiency anemia: mgmt

A

Folate 1 mg PO QD

+ foods high in folic acid: naners, PB, fish, leafy greens, iron-fortified shits

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28
Q

What’s an easy way you can differentiate between folic acid deficiency and pernicious anemia?

A

pernicious has neuro symptoms, folic acid deficiency does not

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29
Q

Which anemia is most important to ask alcoholic patients about?

A

folic acid deficiency: because of poor PO intake

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30
Q

What is pernicious anemia?

A

macrocytic normochromic, aka B12 deficiency anemia

buuuuuuuut really it isn’t d/t lack of B12, it’s d/t a deficiency of INTRINSIC FACTOR that results in MALABSORPTION of B12

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31
Q

pernicious anemia: s/s

A

NEUROLOGICAL SX EXPLOSION: parasthesis, loss of vibratory sense and fine motor control, + romberg and babinski

oh yeah, and glossitis** then all the typical anemia stuff

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32
Q

Your patient has a beefy ol’ red tongue. “Oh shit,” you say to yourself, “It might be…” ???

A

folic acid or pernicious anemia

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33
Q

pernicious anemia: diagnostics

A

↑ MCV
Normal MCHC
↓ serum B12 (less than 0.1)
↓ H&H + RBCs

anti-intrinsic factor (IF) and antiparietal cell ab test affirms deficiency

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34
Q

pernicious anemia: mgmt

A

cyanocobalamin (B12) 100 mcg IM QD x 1 wk

maintenance: continuous life long monthly injections. that sucks

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35
Q

What is the dose and route of B12 indicated for B12 Deficiency Anemia?

A

B12 100 mcg IM x 1 week

B12 100 mcg IM x 1 month for life

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36
Q

What the boop is anemia of chronic disease?

A

normocytic normochromic anemia in which the life span of erythrocytes is decreased

second most common cause of anemia, #1 in them ol’ folks

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37
Q

anemia of chronic disease: causes

A

the etiology is unclear, but it is associated with

chronic inflammation
infection
renal failure
malignancy

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38
Q

Renal failure is associated with what -cytic/-chromic of anemia?

A

normocytic normochromic

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39
Q

anemia of chronic disease: diagnostics

A

Normal MCV & MCHC
↓ iron & TIBC
↑ ferritin

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40
Q

anemia of chronic disease: mgmt x3

A

TREAT UNDERLYING CAUSE
Nutritional support
Epoetin alfa (Epogen) - super third line option

IRON IS A NO NO - the body is already carrying tons

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41
Q

What is the most common type of anemia in the elderly?

A

anemia of chronic disease

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42
Q

Which two anemias is iron contraindicated in management plan?

A

thalassemia - body can’t do shit with it

anemia of chronic disease - the body already got too mucha dat shit

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43
Q

sickle cell anemia: pathophys

A

genetically transmitted disease → hemolytic and sickle shaped RBCs

acute exacerbations: RBC sickle & clump & occlude blood vessels (hyperviscosity)
→ cellular hypoxia → tissue ischemia & acidosis

murky blood + ischemia = pain pain pain

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44
Q

sickle cell anemia: precipitating factors

A 
dehydration **
emotional or physical stress **
infection
blood loss
surgery
high altitudes
acidosis
45
Q

What makes sickle cell crises so damn painful?

A

tissue ischemia & blood hyperviscosity

46
Q

sickle cell crisis: s/s

A

sudden, severe pain: back, chest, extremities, aching joints** d/t blocked circulation

47
Q

sickle cell anemia: mgmt

A

IVF first
analgesia: IV morphine & hydromorphone (Dilaudid)
O2

48
Q

Your patient is having a sickle cell crisis - what is your priority intervention?

A

IVF to increase production of RBC

49
Q

What anemia is characterized by:
↓ iron
↓ TIBC
↑ ferritin

A

anemia of chronic disease

50
Q

What is leukemia?

A

Neoplasms arising from hematopoietic cells in the bone marrow.

51
Q

Acute Myelogenous Leukemia (AML)

A

Leukemia: neoplasms arising from hematopoietic cells in the bone marrow.

80% of acute leukemias in adults

52
Q

Chromic Myelogenous Leukemia (CML) hallmark sign

A

philadelphia chromosome in leukemic cells

53
Q

Acute Lymphocutic Leukemia (ALL): hallmark lab **

A

pancytopenia with circulating blasts

54
Q

Chronic Lymphocytic Leukemia (CLL)

A

most common leukemia in ADULTS

lymphocytosis is disease hallmark

55
Q

Pancytopenia with circulating blasts is the hallmark of what?

A

acute lymphocytic leukemia (ALL)

56
Q

Philadelphia chromosome is associated with which kind of leukemia?

A

Chronic myelogenous leukemia (CML)

57
Q

leukemia presentation

A

can be asymptomatic!
generalized lymphadenopathy
acute weight loss
fatigue, weakness, anorexia

58
Q

leukemia diagnostics x3

A

definitive diagnosis: bone marrow aspiration
peripheral blood smear
bone marrow aspiration

59
Q

What can you order to distinguish acute from chronic leukemia?

A

peripheral blood smear

60
Q

leukemia: mgmt

A

chemotherapy
bone marrow transplantation
supportive care

RADIATION IS NOT A PRIMARY STRATEGY

61
Q

What is lymphoma?

A

a lymphocytic malignancy - lymphocytes are a kind of leukocyte
- examples include NK and B cells

62
Q

Describe Non-Hodgkin’s Lymphoma

A

most common neoplasm in 20-40 yo
often presents with lymphadenopathy, spread is less predictable than Hodgkin’s
advanced disease is usually apparent

63
Q

Describe Hodgkin’s Lymphoma

A

more common in males; avg age 32
usually presents with cervical adenopathy + a predictable spread
hallmark: Reed Sternberg cells

64
Q

Which cancer often presents as cervical adenopathy with a predictable spread?

A

Hodgkin’s lymphoma

65
Q

How do you diagnose a lymphoma?

A

biopsy enlarged lymph nodes and staeg

66
Q

lymphoma: general mgmt

A

radiation
chemo
bone marrow tx

67
Q

Reed Sternberg cells are a hallmark sign of what type of cancer?

A

Hodgkin’s lymphoma

68
Q

What is idiopathic thrombocytic purpura?

A

thrombocytopenia (platelet deficiency) caused by autoimmune destruction of platelets

sometimes thrombopoiesis can be suppressed

usually a chronic condition, can be asymptomatic for long intervals

69
Q

ITP: s/s

A

↑ bleeding & bruising
low platelet count

idiopathic thrombocytic purpura

70
Q

Where do adults bleed first?

A

gums
kidneys

(occult!)

71
Q

What is Disseminated Intravascular Coagulation?

A

acquired coagulation disorder

  • caused by intravascular activation of coagulation + fibrinolytic systems (thrombin + plasmin activated)
  • simultaneous hemorrhage & thrombosis
72
Q

** DIC: patho **

A

THROMBIN converts FIBRINOGEN → FIBRIN
= fibrin clots in microcirculation
= ↓ coagulation factors (fibrinogen, prothrombin, plts, V, VIII)

THROMBIN activates FIBRINOLYTIC SYSTEM
= lyses FIBRIN CLOTS → FIBRIN DEGRADATION PRODUCTS (FDP)
= FDP anticoagulant activity → hemorrhage + coag factor depletion

73
Q

What lab values are pretty diagnostic for DIC?

A

+ D-Dimer
↑ FDPs

predictive accuracy 96%

74
Q

DIC: mgmt *

A

TREAT UNDERLYING CONDITION

  • plt transfusion
  • FFP (replace clotting factors)
  • cryoprecipitate (maintain fibrinogen levels)

OVERALL GOALS
1. stop bleeding 2. ↑ fibrinogen + plt, 3. ↓ FDP

75
Q

What is the point of cryoprecipitate in DIC mgmt? *

A

maintain those fibrogen levels - this kills the crab I mean reverses the patho of DIC

76
Q

What is the duration of Ferrous Sulfate therapy for the treatment of iron deficiency anemia?

A

4 - 6 months

77
Q

What intervention is indicated in the correction of supra therapeutic PT and PTT?

A

FFP

78
Q

What electrolyte abnormalities are associated with blood transfusions

A

hypocalcemia

hyperkalemia

79
Q

Half life of warfarin (Coumadin)

A

36 - 42 hrs

80
Q

20 mg IV morphine is the equivalent of __ PO morphine?

A

60 mg PO morphine

81
Q

What is the most common type of anemia across all age groups?

A

iron deficiency

82
Q

Why do we care about Total Iron Binding Capacity? Normal?

A

Transferrin is the protein that carries loose iron around in the blood. TIBC tells us if the transferrin molecules are carrying a lot of Fe or if the body has the capacity to bind more.

250 - 450 ug/dL

83
Q

What are some examples of iron-rich foods?

A 
raisins
leafy greens
red meat
citrus
iron fortified shit
84
Q

Thalassemia is found mainly in which populations?

A

Mediterranean, African, Middle Eastern, Indian, Asian

85
Q

Why does anyone care about folic acid?

A

Because it is needed to make RBCs.

86
Q

What should you always think through when considering an anemia?

A

hgb & hct duh
MCV: volume of RBC
MCHC: % of an RBC that is hgb

87
Q

What’s the big fancy word for B12?

A

cyanocobalamin

88
Q

What’s a great analgesic combo for painful things like sickle cell crises or nephrolithiasis?

A

morphine + dilaudid

89
Q

Why do joints hurt in sickle cell crises?

A

blocked circulation

90
Q

sickle cell anemia: dx

A

↓ hgb
peripheral smear: classic distorted sickled RBCs
cellulose acetate and citrate agar gel electrophoresis confirm hgb genotype

91
Q

What do you order to confirm diagnosis of leukemia?

A

bone marrow aspiration

92
Q

What kind of cancer does not have radiation as a primary strategy?

A

Leukemia

93
Q

How can you differentiate Hodgkin’s from Non-Hodgkin’s lymphoma?

A

look for Reed Sternberg cells (Hodgkin’s)

lymphadenopathy has a less predictable spread in Non-Hodgkins; Hodgkins is cervical adenopathy with a predictable pattern

94
Q

How do you stage lymphomas?

A

biopsy enlarged node and decide:

Stage I: single node/group

Stage II: +1 group on 1 side of diaphragm

Stage III: spleen involved, nodes on both side of diaphragm

Stage IV: liver or bone marrow involved

95
Q

Your patient is a 29 yo male who presents with sudden weight loss and cervical adenopathy. What is an important ddx to consider? What lab is important to order?

A

Hodgkin’s Lymphoma

  • mostly males, avg age 32
  • cervical adenopathy + predictable pattern
  • order a lab to look for Reed Sternberg cells
96
Q

How serious is idiopathic thrombocytopenia purpura?

A

eh - it can be asymptomatic for long periods and patients only occasionally develop bleeding requiring hospitalization

mgmt may not be necessary until plt less than 20000

97
Q

ITP: mgmt

A

may not be necessary until platelets under 20,000

  • high dose CORTICOSTEROIDS: ↑ plt w/in 2 - 3 days
  • IV gamma globulin helps too
  • plt transfusions = occasional benefit
98
Q

Describe thrombocytopenic precautions *

A
  • avoid constipation (fiber, laxatives)
  • no flossing or shaving
  • hold pressure 5+ minutes for cuts, line insertion, etc
99
Q

Your patient has some thrombocytopenia going on. You have a few suspected etiologies, but how would you differentiate between idiopathic thrombocytopenia purpura from systemic lupus erythematosus? *

A

analyze dat bone marrow

100
Q

fibrinogen normal *

A

170 - 400

101
Q

FDP normal *

A

under 10 mcg/mL

40+ is considered critical

102
Q

normal PT + PTT *

A

PT 11 - 14 sec

PTT 25 - 35 sec

103
Q

RBCs normal *

A

just go with 4 - 5 million/uL

104
Q

difference between PT + PTT + aPTT *

A

how long does it take blood to clot?

PT: measures extrinsic system integrity
PTT: measures intrinsic system integrity
aPTT: used to monitor heparin

105
Q

how does heparin work? what do you use to monitor its efficacy?

A

inhibits factors X and thrombin, while activating anti-thrombin

aPTT

106
Q

how do you distinguish thalassemia from a GI bleed?

A

↓ MCV + MCHC

microcytic, hypochromic anemia

107
Q

what is considered high ferritin level in anemia of chronic disease? *

A

greater than 100 ng/mL

108
Q

DIC think…

A

FDP

109
Q

HIT tx *

A

direct thrombin inhibitor
argatroban
lepirudin

0 BOARDS (14 decks)

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