heme test Flashcards
what is the inherited hypercoagulable state he said to know?
factor V leiden mutation
what are some causes of venous stasis?
immobility, hyerviscosity, increased central venous pressure
venous thromboembolism includes what?
dvt and PE
what are the classic VTE hx?
cancer, airplane, surgery, long drive, hospital
DVT signs and symptoms?
unilateral lower extremity swelling, warmness, erythema, tenderness, cyanotic hue, and decreased pulses
what is post thrombotic syndrome?
reflux due to valvular incompetence and venous HTN due to thrombotic obstruction usually 6 months after DVT
acute pe signs and symptoms and MC ecg manifestations?
sudden shortness of breath, pleuritic chest pain, tachypnea, hemoptysis, syncope, sinus tach, non specific ST and T wave changes
what do you order if the well’s criteria is greater than 4?
ct pulmonary angiography
what is D-dimer?
degredation of fibrin, elevated in thrombus. if <500 low likely hood of VTE
what is the treatment for VTE
LMWH (enoxaparin) w/ warfarin. Trx for 5 days and until 24 hrs of INR >2
how long to treat w/ warfarin if unprovoked or provoked VTE?
3 months
what is trx for VTE w/ cancer?
LMWH 3-6 months/ when cancer is healed
what does the PESI tell you?
30 day mortality
when would you screen for inherited thrombophilia?
family hx of unprovoked, unprovoked DVT <45, recurrent VTE, recurrent pregnancy loss
explain platelet hematopoiesis
myeloid stem cells develop into a megakaryocyte, that splinters, and gets covered by a plasma membrane
3 functions of blood
protection, regulation, transportation
when should HgB a be present?
6 months after birth
where is the hematopoiesis before the bone marrow?
yolk sac then spleen and liver
why does extramedullary hematopoiesis occur?
as a result of a clonal disorder crowding out the normal hematopoiesis
what will be elevated in extramedullary hematopiesis?
hemoglobin F
what are the two types of stem cells?
myeloid and lymphoid
where is erythropoietin made?
kidneys
where is thrombopoietin made?
liver
how long does a RBC survive?
120 days then removed from circulation by the reticuloendothelial system (spleen)
what is HCT?
percentage of total blood volume occupied by RBCs
what is globin?
4 chains combined, 2 alpha and 2 beta
what is heme broken into?
bilirubin and Iron
what is globin broken into?
amino acids
what transfers free hemoglobin?
haptoglobin
how long do WBCs live?
few hours or days, excepty lymphocytes live for months or years
what is th MC form of leukocyte?
neutrophil
monocytes mature into what?
macrophages
what is the life span of a platelet?
5-9 days
Hgb x 3 should equal what?
HCT
what can give a falsely elevated HCT?
dehydration
what is mean corpuscular volume?
acerage sice of RBCs, imporant for anemia!!
what is red cell distribution width?
range of sizes of RBCs (anisocytosis)
what is leukocytosis?
WBCs above 10,000
what is leukemoid reaction?
a benign condition in which a high number of WBC found on a blood test resembles numbers seen in leukemia, but is a result of stress or infection, drugs
what is leukopenia?
absolute neutrophil count <500 most frequently caused by chemo
what determines the severity of polycythemia?
RBC mass
if a retculocyte count is high what is it usually indicating?
bleeding/ hemolysis
When is PBS definitively diagnostic?
Sickle cell and malaria
What do schistocytes represent?
TTP, HUS, DIC
What are shistocytes?
Irregular fragmented RBCs that area crescent, bitten, or helmet inappearance
What are spherocytes?
Round shaped usually present if the there is severe hemolysis
When is a hypersegmented neutrophil present?
Megaloblast anemias
When is a bone marrow biopsy helpful?
Diagnosis and staging of lymphomas, plasma cell tumors, and leukemia’s
What is the normal amount of hemoglobin A, A2, F?
97%, 2.5%, 1%
What are the clinical manifestations of anemia?
Fatigue, pallor, weakness,tachycardia, dyspnea, angina
What is ferritin?
Directly related to iron stored in your body, specifically the liver
What is transferrin?
Directly related to TIBC, used to transport iron in the body
What is hepcidin?
Acute phase reactant, helps regulate the storage of iron by inhibiting ferroportin, it is decreased in hypoxia or anemia typically.
What is hemosiderin?
Insoluble form of iron, formed when there is an excess in the body
What pathologies are associated w/ microcytic anemia?
Anemia or chronic disease, iron deficiency, thalassemia, sideroblastic anemia
What is the MC cause of anemia world wide?
Iron deficiency?
At are some signs of iron deficiency anemia?
Gloss it is, cheilosis, koilonychia, nail dystrophy, PICA
What is Plummer-Vinson syndrome?
- Dysphasia, esphageal webs, iron deficiency anemia MC in post menopausal women
What is diagnositic for iron deficiency anemia?
Decreased ferritin
What is the work up for iron deficiency anemia after it has been established?
GI blood loss, EGD and colonoscopy, (spruce, gastric bypass, H. Pylori), decreased intake
What is the preferred therapy for iron deficiency anemia?
Oral replacement w/ a response in 3 weeks and a full return to baseline after 2 months, continue 3-6 months or until ferritin returns to normal
Complications of IM iron?
Extreme pain and hemosiderin deposition
What is the key phrase for describing thalassemias?
Significant microcytosis out of proportion to the degree of anemia
What thalassemia is not compatible w/ life?
Barts-hydrops fetalis
What causes alpha thalassemia?
Deletion of genes coded to make alpha hemoglobin chains
What causes Beta thalassemia??
Point mutation
How can you tell if there is a beta thalassemia?
There will be higher portions of HbF and HbA2
Thalassemia affects what groups more commonly?
Asians and Africans, its a heterogeneous disorder
Target cells are associated w/ what microcytosis?
Thalassemia
What is the method for detecting a beta thalassemia?
Electrophoresis
What is the treatment for thalassemia?
Mild: avoidance of unnecessary iron replacement
Severe: frequent transfusions, folate supplementation, splenectomy
What is the treatment for anemia of chronic disease?
EPO
What is associated w/ acquired sideroblastic anemia?
Drugs ethanol, isoniazid, toxins LEAD,
What will the peripheral blood smear show for sideroblastic anemia?
Basophils stippling especially w/ lead poisoning
What is the treatment for sideroblastic anemia?
Discontinue the offending agent and trial of pyridoxine (B6)
What is the MC cause of macrocytosis?
Vitamin B12 and folate deficiency
What are hyper segmented neutrophils associated w/?
Megaloblastic anemia
What deficiencies will have both macro and microcytosis?
Thalassemia and iron deficiency
What are the MC causes of megaloblastic anemia?
B12 and folic acid deficiency
Megaloblastic anemia is associated w/ what when caused by b12 deficiency?
Neuropsychiatric symptoms, first peripheral then posterior and lateral columns of the spinal cord and cortex w/ neuropsychiatric s s
What will be found sooner folate or B12 deficiency?
Folate because it’s used more
What is myelodysplastic syndromes?
Pre leukemia, heterogenous bone marrow disorders characerized by ineffective blood cell production and dysphasia due to mutation in a hematopoietic stem cell. >60 and children, BIG BIG CELL >105, incrrreased risk for AML
Evidence of hemolysis?
Jaundice, icterus, inc. reticulocytes, decreased haptoglobin
The increased inflammatory process in anemia of chronic disease causes what release?
Hepcidin the thing that’s responsible for helping iron get absorbed
For a patient that has anemia of chronic disease that’s symptomatic and Hb <10 what is the treatment?
EPO if they have cancer w/ chemo, CKD <30, HIV w/ myelosuppresion
Who are the weird acute blood loss patients?
Post surgical or retroperitoneal hemorrhage
What is the difference between aplastic and myelodyplastic bone marrow?
Myelodyplastic is hypercellular and aplastic is hypocellullar
What are causes of secondary inherited and acquired aplastic anemia?
Fanconi, drugs like NSAIDs
What causes dark colored urine?
Paroxysmal nocturnal hemoglobinuria
What is the best screening test and treatment for paroxysmal nocturnal hemoglobinuria?
Flow cytometry, eculizumab
What is the MC hemolytic anemia due to RBC membrane defect?
Hereditary spherocytosiis
What cells are associated w/ G6pd deficiency?
Heinz’s bodies and bite cells
What cells are associated w/ sickle cell?
Howell jollie bodies and target cell
When are transfusions indicated?
HgB <7 or active significant hemorrhage
For one pack of RBCs what is the HCT and HB increase?
3-4% and 1 g/dL
What contains all the coal factors?
Fresh frozen plasma, cryoprecipitate doesn’t have all, but is good for vWd and hypofribrinogenemia
What is a leukoagglutination reaction?
Febrile non-hemolytic reaction, w/in 12 hrs, treat w/ diphenhydramine, Tylenol, corticosteroids
What is a true hemolytic transfusion reaction?
Mismatched ABO/RH, MC clerical error, fever rigors, hypotension, if surgery Liguria
What is delayed hemolytic transfusion reaction?
From low allocation day levels not detected in screen, it’s occurring extravascularly, 5-10 days
What infections are associated with fucked up transfusions?
Hep B and C, HIV, and HTLV
What are the things that are infused together for a massive transfusion?
PRBC, platelets, FFP
What does Coumadin initially inhibit that causes hyper coaguability?
Vitamin k and that fucks protein C
What is depleted in DIC?
Fibrinogen
What measures the extrinsic pathway?
Prothrombin time
What does the partial thromboplasin time measure?
Intrinsic
INR has a direct correlation to what?
PT
If a mixing study corrects what is the problem?
Factor deficiency
If a mixing study does not correct what is the problem?
Inhibitor (antibody) to a coagulation factor
What does bleeding time measure?
Platelet function
What is the thing that effects all the pathways?
Liver disease
What does heparin bind to?
Antithrombin III
How do you rule out pseudo thrombocytopenia?
Repeat the plt count in non-EDTA containing tube like sodium citrate tube
