Heme-Onc

Question 1

Hemoglobin

Answer 1

main component of RBCs; essential protein that combines with and transports O2 to the body
Normal Males: 14-18 g / 100 mL
Normal Females: 12-16 g / 100 mL

Question 2

Hematocrit

Answer 2

measures the percent of a given volume of whole blood that is occupied by erythrocytes; the amount of plasma to total RBC mass (RBC concentration)
Normal Males: 40-54%
Normal Females: 37-47%

Question 3

TIBC: Total Iron Binding Capacity

Answer 3

Normal: 250-450 ug/dL
High in: iron deficiency anemia
Low in: anemia of chronic disease

Question 4

Serum Iron

Answer 4

Normal: 50-150 u/dL

Low in: iron deficiency anemia, anemia of chronic disease

Question 5

MCV: Mean Corpuscular Volume

Answer 5

expression of the average VOLUME and SIZE of individual erythrocytes
Normal: 80-100 fl
Microcytic: < 80
Macrocytic: > 100

Question 6

MCH: Mean Corpuscular Hemoglobin

Answer 6

expression of the average amount and weight of hgb contained in a single erythrocyte
Normal: 26-34 pg

Question 7

MCHC: Mean Corpuscular Hemoglobin Concentration

Answer 7

expression of the average hgb concentration or proportion of each RBC occupied by hgb as a percentage (more accurate than MCH)
Normal: 32-36%
Hypochromic: < 32%
Hyperchromic: > 36%

Question 8

Normocytic Anemias

Answer 8

MCV = 80-100

anemia of chronic disease, sickle cell disease, renal failure, blood loss, hemolysis

Question 9

Macrocytic Anemias

Answer 9

MCV > 100

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

Question 10

Microcytic Anemias

Answer 10

MCV < 80

iron deficiency anemia, thalassemia

Question 11

Acute Anemia Signs & Symptoms

Answer 11

cool, clammy skin
tachycardia & tachpnea
decreased BP
narrowing pulse pressure
decreased urine output
decreased LOC
EARLY:  thirst, feeling cold

Question 12

Acute Anemia Treatment

Answer 12

ABCs
supplemental O2
large bore IVs
NS/LR
blood

Question 13

Acute Anemia Diagnosis

Answer 13

CBC
type & cross
coags
serum electrolytes

Question 14

Herbal Agents Decrease Clotting Time

Answer 14

cinnamon
parsley
ginseng

Question 15

Herbal Agents Increase Clotting Time

Answer 15

evening primrose
garlic
skullcap

Question 16

Definition: Sickle Cell Anemia

Answer 16

chronic hemolytic anemia that is genetically transmitted

characterized by sickle shaped RBCs

Question 17

Pathophysiology: Sickle Cell Crisis

Answer 17

RBCs become sickle shaped and cause vessel obstruction
cellular hypoxia results in acidosis and tissue ischemia
pain occurs from tissue ischemia and blood hyperviscosity

Question 18

Factors Which Precipitate Sickling of RBCs

Answer 18

hypoxia
infection
high altitudes
dehydration
physical or emotional stress
surgery
blood loss
acidosis
alcohol intoxication
pregnancy

Question 19

Epidemiology: Sickle Cell Disease

Answer 19

AFRICAN descent mainly, but also
Mediterranean
Indian
Middle Eastern
Caribbean
Central/South American

Question 20

Sickle Cell Disease Genetics

Answer 20

autosomal recessive
1 hgb S gene = trait
2 hgb S genes = disease

Question 21

Signs & Symptoms: Sickle Cell Disease

Answer 21

develop in infancy or childhood
delayed growth and development & increased susceptibility to infection are common
in a crisis, patients experience:
- sudden onset of severe pain in extremities, back, chest and abdomen
- aching joint pain
- weakness
- dyspnea

Question 22

Diagnostics: Sickle Cell Disease

Answer 22

decreased hgb
peripheral smear shows classic distorted sickle-shaped RBCs
cellulose acetate and citrate agar gel electrophoresis confirms hgb genotype

Question 23

Complications: Sickle Cell Disease

Answer 23

priapism
acute chest syndrome (vaso-occlusion of pulmonary vessels)
stroke

Question 24

Treatment: Sickle Cell Disease

Answer 24

treat both acute and chronic complications
acute:
- fluids for dehydration
- analgesics for pain
- oxygen for hypoxemia
meds:
- hydroxyurea stimulates production of Hgb F which does not sickle when deoxygenated

Question 25

Definition & Pathophysiology: Leukemia

Answer 25

neoplasms arising from hematopoietic cells in the bone marrow
uncontrolled increase in immature WBCs decreases the function and production of normal WBCs
bone marrow becomes crowded with immature blood cells, reducing ability to create other precursor cells, such as to RBCs and platelets

Question 26

Classifications of Leukemia

Answer 26

acute vs. chronic
myelogenous vs. lymphocytic
myelogenous - cancerous growth of granulocytes (eosinophils, basophils, neutrophils)
lymphocytic - cancerous growth of B lymphocyte, T lymphocyte, natural killer cells

Question 27

Acute Lymphocytic Leukemia

Answer 27

s/s: fatigue, tendency to bruise easily, infections, dyspnea
more difficult to cure in adults than children (90% remission rate in children)
pancytopenia with circulating blasts is hallmark of the disease
can cause leukostasis if WBCs rise above 50,000 > stroke or PE
associated with genetics, radiation & meds

Question 28

Chronic Lymphocytic Leukemia

Answer 28

s/s: spleen and liver enlargement, fatigue, easy bruising, weight loss, infections
most common leukemia in adults
median survival is 10 years
lymphocytosis (increased B lymphocytes, T lymphocytes and natural killer cells) is the hallmark of the disease

Question 29

Signs and Symptoms: Leukemia

Answer 29

may be asymptomatic
fatigue
weakness
anorexia
generalized lymphadenopathy
weight loss
fever
bone pain
liver and spleen enlargement
neurologic findings
elevated uric acid level

Question 30

Acute Myelogenous Leukemia

Answer 30

s/s: fever, fatigue, bruising, infections
80% of leukemia in adults
remission rates from 50-85%
long term survival approx 40%
auer rods - formed by aggregation of myeloid granules
increasing prevalence with age

Question 31

Chronic Myelogenous Leukemia

Answer 31

s/s: weight loss, sweating, fatigue, spleen enlargement, higher risk of tumor lysis syndrome and leukostasis
occurs most often in those aged 40 or older and men
median survival is 3-4 years
philadelphia chromosome is seen in leukemic cells (hallmark of disease)

Question 32

Diagnostics: Leukemia

Answer 32

CBC with subnormal RBCs and neutrophils
elevated ESR
peripheral blood smear usually distinguishes acute and chronic leukemia, but a bone marrow aspiration is required to CONFIRM the diagnosis

Question 33

Platelets

Answer 33

150,000-400,000 /uL

< 150,000 is thrombocytopenia

Question 34

Causes of Thrombocytopenia

Answer 34

decreased bone marrow production
increased splenic sequestration
peripheral consumption
accelerated destruction of platelets
menses
nutrition
severe deficiencies in iron, folate, B12
sepsis
tumors
medications (such as ASA)
bleeding

Question 35

Definition: Idiopathic (Immune) Thrombocytopenia Purpura

Answer 35

thrombocytopenia (platelets < 150,000) resulting from an autoimmune destruction of platelets with or without suppression of thrombopoiesis