HEME/ONC Flashcards
Normal Hgb for females
12-16g/100ml
Normal Hgb for males
14-18g/100ml
normal HCT for females
37-47%
normal HCT for males
40-54%
normal TIBC
250-450ug/dl
normal serum iron
50-150ug/dl
normal MCV
80-100fl
microcytic MCV
<80
normocytic MCV
80-100
macrocytic MCV
>100
normal MCH (mean corpuscular volume)
26-34pg
normal MCHC (mean corpuscular hgb concentration)
32-36% (aka -normochromic)
hypochromic
<32%
Differential dx of microcytic MCV
thalassemia IDA
Differential dx of normocytic MCV
anemia of chronic disease (renal failure) *blood loss *hemolysis sickle cell disease
Differential dx of macrocytic MCV
B12 or folate deficiency alcoholism liver failure drug effects
most common cause of anemia
IDA
causes of IDA
-blood loss (GIB) -inadequate iron intake -impaired absorption of iron
S&S of IDA
-**PICA -dyspnea, mild fatigue w/exercise -HA -palpitations -weakness -tachycardia -postural hypotension -pallor
LAB findings in IDA
-low Hgb/Hct -low RBC -low MCV (microcytic) -low MCHC (hypochromic) -low serum iron -**low serum ferritin **high TIBC -high RDW
Treatment of IDA
oral ferrous sulfate 300-325mg 1-2 hr AFTER meals (food dec absorption)
Teaching points necessary to teach patients who will be taking oral iron
-take 2 hrs after food -avoid w/antacids -do not take with Vit C (inc absorption)
Food high in iron
raisins green leafy veges red meats citrus products iron-fortified bread & cereals
LAB findings in thalassemia
-dec Hgb -low MCV (microcytic) -low MCHC (hypochromic) -*normal TIBC -normal ferritin -decrease alpha or beta Hgb chains
Management of thalasemia
-generally not needed if mild -if severe–> RBC transfusion, splenectomy **NO iron –> can lead to iron overload
what differentiates folate vs Vit B12 deficiency?
*no neuro sxs in folate deficiency
LAB findings in folate deficiency
-low Hct & RBC -high MCV (macrocytic) -NL MCHC (normochromic) -serum folate decreased
Treatment of folate deficiency
Folate 1mg PO q D
foods high in folic acid
bananas peanut butter fish green leafy veges iron-fortified breads & cereals
Cause of pernicious anemia
d/t lack of intrinsic factor which results in malabsorption of Vit B12
S&S of pernicious anemia
weakness
glossitis (beefy tongue)
palpitations dizziness
anorexia
**NEURO SXS paresthesia, loss of vibratory sense, loss of fine motor control, positive romberg &babinski
LAB findings in pernicious anemia
dec Hgb, Hct, RBC -inc MCV (macrocytic) NL MCHC (normochromic) dec serum B12 (<0.1mcg.ml)
Diagnosis of pernicious anemia
anti-IF & antiparietal cell antibody test -schilling test may help determine cause
Treatment of pernicious anemia
Vit B12 (cyanocobalamin) 100mcg IM daily x 1 wk *will require lifelong monthly injections
Second most common cause of anemia
anemia of chronic disease
most common cause of anemia in the hospital and in the elderly
anemia of chronic disease
LAB findings in anemia of chronic disease
-dec Hgb/hct -serum iron & TIBC low -serum ferritin high (>100ng/ml) MCV normal -MCHC normal
LAB findings in sickle cell disease
-Hgb decreased **peripheral smear shows classic distorted sickle cell shaped RBCs electrophoresis to confirm Hgb genotype
cause of VWD
mutation or deficiency in VWF & clotting Factor VIII –> unable to create blood clots
treatment of VWD
-Desmopression -recombinant vWF -vWF/Factor VIII concentrate
Definition of leukemias
neoplasmas arising from hematopoietic cells in bone marrow
Leukemias are more common in ____.
men
Which leukemia constitutes 80% of adult leukemia?
AML
Remission rates for AML?
50-85%
Long term survival for AML
40%
Which leukemia is more difficult to cure in adults than children?
ALL
remission rate in children w/ALL
90%
Hallmark of ALL
pancytopenia w/circulating blasts
Most common leukemia in adults
CLL
median survival of CLL
10yrs
onset of CLL
occurs in middle & old age
Hallmark of CLL
lymphocytosis
onset of CML
occurs in persons >/=40yr
median survival of CML
3-4yr
hallmark of CML
philadelphia chromosome in leukemic cells
S&S of leukemia
*lymphadenopathy -weight loss -fatigue -anorexia -weakness
What test is necessary to confirm dx of leukemia?
Bone marrow biopsy
Treatment of leukemias
CHEMO -allopurinol to prevent TLS in high risk pts -bone marrow transplant -sxs management
LAB derangements seen in TLS
-hypocalcemia -hyperuricemia -hyperphosphatemia -hyperkalemia
Diagnosis of lymphoma
biopsy of enlarged nodes
stage I lymphoma
disease localized to a single lymph node or group
stage II lymphoma
more than 1 lymph node gropu involved; confined to 1 side of the diaphragm
stage III lymphoma
lymph nodes or SPLEEN involved; occurs on both sides of diaphragm
stage IV lymphoma
liver or bone marrow involvement
Which lymphoma has a worse outcome?
non-hodgkins
Common presenting clinical manifestation of non-hodgkins lymphoma?
lymphadenopathy
most common neoplasm b/t 20-40yr
non-hodgkins lymphoma
Average age of hodgkins lymphoma
32
Classic presentation of hodgkins lymphoma
cervical lymphadenopathy & spreads in predictable fashion along lymph node groups
In which gender is hodgkins lymphoma more common?
men
hallmark of hodgkins lymphoma
Reed -sternberg cells
Treatment of lymphoma
**XRT -chemo -bone marrow transplant
NL Platelet Count
150-400,000
In which gender is ITP more common?
women (3:1) *usu seen in young females
Cause of ITP
thrombocytopenia resulting from autoimmune destruction of platelets
Diagnosis of ITP
bone marrow bx -other causes of TCP ruled out
Treatment of ITP
high dose steroids IVIg (*preferred to steroids is HIV patients)
Thrombocytopenia precautions
avoid constipation no flossing, shaving hold press x 5 min on cuts/lacs
Treatment of HIT
Argatroban Lepirudin (Refludan)
How to differentiate b/t ITP & SLE?
bone marrow biopsy
LAB derangements seen in DIC
-TCP (<150) -hypofibrinogenemia (<170) -dec RBCs -inc FDPs (>45mcg/ml or present at >1:100 dilution) -prolonged PT (>19sec) -prolonged PTT (>42sec) -D DImer (+ at 1:8 dilution)
Purpose of cryoprecipitate
replace fibrinogen
Purpose of FFP
replace clotting factors
