Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

DSE > Heme/onc > Flashcards

Heme/onc Flashcards

1
Q

Definition of anemia

A

Hgb <12 g/dL in females
Hgb <14 g/dL in males
Decrease in the oxygen carrying capacity of blood
Underproduction of nl erythrocytes
Loss or destruction of circulating erythocytes
A condition, not a dz. Must ID underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hx components of iron deficiency anemia

A 
Prior GI surgeries?
Blood loss from GI tract, either BRB or melena
-Ask pt to quantify if possible
-How much blood loss?
Female pts- blood loss
-Are they menstruating?
-If so, quantify the amount of flow on a daily basis and the duration of the cycle
Hematuria
-Ask pts to quantify if possible
-Microscopic: seen on UA
-Gross or macroscopic hematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PE of iron deficiency anemia

A 
There may be no PE findings
Acute (blood loss)
-Tachycardia
-Orthostatic changes
-Heart murmur
-Extreme pallor (severe)
Chronic- more often asymptomatic
-Pallor
-Fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lab and workup for iron deficiency anemia

A

CBC and iron panel
-CBC will show a decreased hgb, and MCV of <80, MCH of <27 and an MCHC of <32
-Microcytic, hypochromic anemia
Iron panel
-Ferritin and serum iron will be decreased, TIBC will be increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Tx of iron deficiency anemia- general principles

A

Can usually be managed by PCP, however, if not improving or requires IV iron therapy, a hematology consult may be necessary.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Meds for iron deficiency anemia

A

Start with oral iron 325 mg TID after meals

-Ferrous gluconate is generally more easily tolerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Side effects of iron

A

Dark stools
GI upset
Constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pts’ response to iron

A

Some pts will not be able to absorb oral iron d/t poor absorption, esp elderly or with a hx of gastric bypass
These pts will require IV iron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

F/u of iron deficiency anemia

A

Recheck H/H, Fe, ferritin 6-8 wks after starting oral iron.

If there is no improvement or minimal improvement, pts may need to be treated with IV iron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

IV meds for iron deficiency anemia

A

Ferllecit or InFed is given as loading dose weekly to build iron stores. Once anemia is corrected, may treat with maintenance dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How should symptomatic anemia be treated?

A

With blood transfusion
Females with heavy menstrual periods should be referred to GYN for exam and possible hormonal manipulation to decrease frequency and flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hx of anemia of chronic dz

A 
Any medical hx including:
Kidney dz
CA
Chronic infection
Inflammatory dz (such as lupus)
Hepatic dz
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Lab and workup for anemia of chronic dz

A

CBC: MCV may be nl or microcytic
Serum iron: nl
Ferritin: may be elevated because ferritin is an acute phase reactant
Some pts may have an undiagnosed chronic dz, so check TSH, RF, ANA, hepatitis serologies
CMP: Creatinine will be elevated in CKD, and AST/ALT may be elevated in liver dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How to diagnose anemia of chronic dz

A

A dx of exclusion, which means that other causes of anemia have been excluded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tx of anemia of chronic dz

A

Tx of choice is erythropoietin injections
Hgb must be <11.0 in order to receive EPO injections
Procrit 20,000 u SQ given weekly or monthly in order to stimulate the production of RBCs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hx of vit B12 deficiency

A

Important to ask about diet in hx. If pt is vegan/vegetarian

Previous surgeries? Gastrectomy or ileal resection?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

S/sx of vit B12 deficiency

A 
Glossitis
Anorexia/diarrhea
Paresthesias
Gait disturbances
Decreased position and vibratory sensation
AMS (in late presentation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Lab and workup for vit B12 deficiency

A

CBC: hgb decreased; however, this is macrocytic anemia, therefore, the MCV is >100
Vit B12 decreased
If pernicious anemia, + intrinsic factor antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tx of vit B12 deficiency

A

Vit B12 injections
1,000 mcg weekly x4 and then monthly
Can generally be managed by PCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

DDx of anemia with low MCV

A 
Iron deficiency anemia
Thalassemic disorders
Anemia of chronic dz
Sideroblastic anemia
Copper deficiency, zinc poisoning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

DDx of anemia with nl MCV

A 
Acute blood loss
Iron deficiency anemia (early)
Anemia of chronic dz
Bone marrow suppression
-Bone marrow invasion
-Acquired pure red blood cell aplasia
-Aplastic anemia
Chronic renal insufficiency
Endocrine dysfunction
-Hypothyroidism
-Hypopituitarism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

DDx of anemia with high MCV

A 
Ethanol abuse
Folic acid deficiency
Vit B12 deficiency
Myelodysplastic syndrome
Acute myeloid leukemias
Reticulocytosis
-Hemolytic anemia
-Response to blood loss
-Response to appropriate hematinic
Drug-induced anemia
Liver dz
23
Q

Hx of thrombophilias

A

Thrombosis at a young age (age <50 yrs)
FHx of thrombosis
Recurrent thrombosis
Thrombosis in an unusual site (hepatic, mesenteric, or cerebral)
Pregnancies complicated by frequent miscarriage
Idiopathic thrombosis (no known predisposing factors)

24
Q

What is the most common thrombophilia?

A

Factor V Leiden

25
What are other types of hereditary thrombophilias?
Prothrombin gene mutation MTHFR PAI
26
Inheritance pattern of Factor V Leiden
Autosomal dominance | May be heterozygous or homozygous
27
Dx of Factor V Leiden
APC resistance test Factor V Leiden genetic testing -When a mutation is identified, we encourage pts to have family members tested
28
Tx of Factor V Leiden
Refer to hematology If a thrombotic even present: Lovenox 1 mg/kg SQ q12h x 7 days with concurrent Coumadin therapy Coumadin therapy will be needed for at least 6 mos. If another clot occurs, the pt will require lifelong therapy
29
Hx of thrombocytopenia
``` FHx? Hx of liver dz? Pregnancy? Alcohol consumption? Meds? -Heparin? Sulfonamides? Thiazides? Cimetidine? Recent illness? ```
30
PE of thrombocytopenia
Petechiae (< 3 mm) Purpura (0.3-1.0 cm) Ecchymoses (>1.0 cm) Generalized hemorrhage
31
What is the hallmark of thrombocytopenia?
Mucocutaneous bleeding
32
Hallmark numbers of thrombocytopenia
Platelet count < 150K/mm cubed >80,000/mm cubed- withstand all but most extreme hemostatic challenges (sx, major trauma) <20,000/mm cubed- spontaneous bleeding
33
Acute ITP- who does it most commonly occur in?
Children, usually preceding a viral URI
34
Acute ITP
Self-limited, autoimmune IgG disorder | Antibodies are formed against the platelet membrane
35
Characteristics of acute ITP
Characterized by an abrupt onset of petechiae, purpura, and hemorrhagic bullae on the skin and mucutaneous membranes No splenomegaly. -If splenomegaly and pos thrombocytopenia, look for another underlying cause
36
Chronic ITP
Develops at any age More common in women Usually coexists with another autoimmune disease. Pts develop petechiae on the skin and mucous membranes
37
Lab findings of acute ITP
CBC will reveal a platelet count, which is significantly decreased to usually 10,000-20,000 May also see lymphocytosis Coagulation studies will be nl
38
Lab findings of chronic ITP
CBC will only reveal platelet count, not as significantly decreased to 25,000-75,000
39
Tx of acute ITP
Usually resolves spontaneously. Rarely requires prednisone or splenectomy
40
Tx of chronic ITP
Rarely resolves, and most of the time requires high-dose prednisone. If no response to prednisone, pts require IVIG. If pt is still not responding, then splenectomy may be warranted
41
Characteristics of thrombotic thrombocytopenic purpura
``` Severe thrombocytopenia With: Purpura Petechiae Pallor Abd pain Microangiopathic hemolytic anemia Fever CNS abnormalities (HA, aphasia, and AMS) Renal failure ```
42
Who usually gets TTP?
Usually seen in ages 20-50
43
Causes of TTP
``` Sometimes unknown Associated with: Chemo drugs Possibly shigella toxin Pregnancy can increase risk ```
44
Lab evaluation of TTP
CBC will reveal anemia, red cell fragments on peripheral smear (schistocytes) and thrombocytopenia ADAMTS 13 is decreased Indirect bilirubin is elevated
45
PE of TTP
Febrile Skin: petechiae, purpura, jaundice Neuro: AMS Abd: splenomegaly
46
Effects of TTP
``` Blood vessel blockage -Hemolytic anemia (RBC degradation) Neuro/cardio problems Thrombocytopenia: leads to purpura Kidney failure ```
47
Tx of TTP
This is a hematological emergency, so early consultation with hematology is imperative Corticosteroids Aggressive plasmapheresis Avoid transfusion unless catastrophic bleeding, such as intracranial hemorrhage
48
Median age of onset of AML
60
49
RFs for AML
Chemical exposures: -Benzene, previous chemo Radiation
50
S/sx of AML
``` Pallor Fatigue Joint pain Fever Wt loss SOB Persistent and frequent infections Gingival bleeding ```
51
PE of AML
Petechiae Pallor Gingival edema (d/t leukemic infiltration) Chloroma (mass of leukemic cells outside of the bone marrow)
52
Lab evaluation of AML
CBC may reveal: leukocytosis or leukopenia, anemia, thrombocytopenia Auer rods present in peripheral smear Uric acid elevated Cytogenetic studies reveal different chromosomal abnormalities Definitive dx is done by bone marrow bx -Reveals pos leukemic blast cells
53
Tx of AML
Induction (remission inducing chemo) followed by consolidation (destroys the remainder of leukemic cells) -Cytarabine and idarubicin are generally used Uric acid levels may become elevated d/t cell breakdown, so allopurinol is taken daily

DSE (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions