Heme/onc Flashcards
HgB
Main component of RBC’s and the essential protein that combines with and transports O2 to the body.
Males: 14-18
Females 12-16
Hct
Measures % of a given volume of whole blood that is occupied by erythrocytes; the amount of plasma to total RBC mass.
Males: 40-54%
Females: 37-47%
TIBC
Total iron binding capacity
Normal= 250-450
Serum iron
Normal 50-150
MCV
Expression of the average volume and size of individual erythrocytes
Normal: 80-100
Microcytic= <80
Macrocytic= >100
MCH
Expression of average amount and weight of Hgb contained in a single erythrocyte
Normal: 26-34
MCHC
Normal: 32-36%
Hypochromic= <32
Hyperchromic= 36%
Low MCV
Iron deficiency and thalassemia
High MCV
B12 or folate deficiency, alcoholism, liver failure and drug effects
Normochromic
Anemia of chronic disease, sickle cell disease, renal failure, blood loss, hemolysis
Iron deficiency anemia
Microcytic (<80), hypochromic (<32)
Most common cause of anemia
Iron loss exceeds intake–decrease in iron available for RBC formation!
S/S of IDA
Usually slow onset w/ few symptoms if Hgb >30 Pica dyspnea HA palpitations weakness tachycardia postural hypotension pallor
Labs for IDA
LOW: Hgb, hct, MCV, MCHC, RBC, iron, ferritin
HIGH: TIBC, RDW
Management of IDA
Oral ferrous sulfate 300-325mg 1-2 hours after meals
DO NOT take with antacids
Vitamin C INCREASES absorption
Foods high in iron
Raisins, green leafy veggies, red meats, citrus products, and iron fortified foods
Thalassemia
Genetically inherited disorders resulting in abnormal Hgb production and Microcytic, Hypochromic anemia
Typically Mediterranean, African, middle eastern, indian and Asian populations
S/s of thalassemia
Typically unremarkable unless severe
Labs for thalassemia
LOW: Hgb, MCV, MCHC
Normal: TIBC, ferritin
Management of thalassemia
No tx for mild to mod
Severe= RBC transfusion/splenectomy
IRON is contraindicated
Folic Acid deficiency
Macrocytic (>100), normochromic (32-36%)
Inadequate intake/malabsorption of folic acid (needed for RBC production)
S/S of FAD
Fatigue Dyspnea on exertion Pallor HA Tachycardia Anorexia Glossitis Aphthous ulcers NEUROLOGIC symptoms are what differentiates FAD from B12 deficiency
Labs for FAD
LOW: Hct, Hgb, folate
HIGH: MCV
Normal: MCHC
Management of FAD
Folate 1mg orally daily
Foods high in folic acid
Bananas, PB, fish, green leafy veggies, iron fortified
Pernicious Anemia
Macrocytic (>100), normochromic (32-36%)
Deficiency of intrinsic factor, which results in malabsorption of B12
S/S of PA
Weakness Glossitis Palpitations Dizziness Anorexia Parasthesia Loss of vibratory sense Loss of fine motor control \+ Romberg, + Babinski
Labs for PA
Low: Hgb, Hct and RBC’s, B12
High: MVC
Anti-IF (intrinsic factor) and antiparietal cell antibody tests affirm a deficiency
Schilling test may help determine cause
Management of PA
B12 (cyanocobalamin) 100 IM daily x1 week
Maintenance tx requires continuous, lifelong monthly admin
Anemia of chronic disease
Chronic normochromic, normocytic anemia associated with chronic inflammation, infection, renal failure, and malignancy
Involves decreased erythrocyte life span
Second most common cause of anemia
S/S of anemia of chronic disease
Fatigue, weakness, dyspnea on exertion, anorexia
Labs for anemia of chronic disease
Low hgb & hct
Low iron and TIBC
MCV and MCHC normal
High ferritin
Sickle cell anemia
Chronic, hemolytic anemia that is genetically transmitted
Acute, periodic exacerbation in which RBC’s become sickle-shaped and cause vessel obstruction
Cellular hypoxia results in acidosis and tissue ischemia
Factors that precipitate sickling
infection Hypoxia high altitudes dehydration physical/emotional stress surgery blood loss acidosis
S/S of SCD
Delayed growth and development in infancy or early childhood Sudden onset of severe pain aching joint pain weakness dyspnea
Labs for SCD
Decreased Hgb
Peripheral smear shows classic distorted sickle-shaped RBC’s
Cellulose acetate and citrate agar gel electrophoresis to confirm Hgb genotype
Management of SCD
Acute: fluids, analgesics, oxygen
Acute Nonlymphocytic Leukemia/Acute Myelogenous Leukemia
ANL/AML
80% of acute leukemia in adults
Remission rates from 50-85%
Long term survival rates about 40%
Acute Lymphocytic Leukemia
ALL
More difficult to cure in adults than children
Pancytopenia with circulating blasts (hallmark)
Chronic Lymphocytic Leukemia
CLL
Most common leukemia in adults
Lymphocytosis (hallmark)
Chronic Myelogenous Leukemia
CML
Philadelphia chromosome seen in leukemic cells (hallmark)
Labs for leukemia
CBC with subnormal RBC’s and neutrophils
Elevated ESR
*Peripheral blood smear usually distinguishes acute and chronic leukemia’s but a bone marrow biopsy is required for confirmation
Stage 1 Lymphoma
Disease localized to single lymph node or group
Stage 2 lymphoma
more than one lymph node group involved; confined to one side of the diaphragm
Stage 3 lymphoma
Lymph nodes or the spleen involved; occurs on both sides of the diaphragm
Stage 4 lymphoma
Liver or bone marrow involvement
Non-Hodgkin’s lymphoma
Lymphadenopathy
Most common neoplasm between 20-40
Less predictable pattern of spread then Hodgkin’s
Hodgkin’s lymphoma
Unknown cause
More common in males
Cervical adenopathy and spread in a predictable fashion through the lymph nodes
Reed-Sternberg cells*** differentiate non-hodgkins from hodgkins
TNM classification of Malignant tumors
Cancer staging system developed and maintained by the Union for international caner control
Not all cancers have TNM classifications (brain tumors)
TNM
T: A, is, 0, 1-4 Size or direct extend of the primary TUMOR
N: 0-3, spread to regional NODES
M: 0/1, Distant METASASIS
Polycythemia
Idiopathic and chronic marrow disorder, due to genetic mutation, resulting in INCREASED RBD and Hct
S/S of polycythemia
Fatigue, weakness, visual disturbances, HA
Labs for polycythemia
Hgb >18.5 in men and > 16.5 in women
Presence of JAK2617VF or similar genetic mutation
Management of polycythemia
Phlebotomy
Aspirin
Referral
Hemochromatosis
Disorder that results in excessive levels of iron
S/s of hemochromatosis
Fatigue
Joint pain
pain in knuckles or pointer and middle fingers
-Liver disease, hyperpigmentation and diabetes
Management of hemochromatosis
Iron chelation
Don’t eat iron containing foods
Immunosenescence
the immune systems diminished function with age which leads to a decline in response to infection
