Heme/Urology Flashcards
Normal or ↓ MCV, ↓ TIBC, ↑ Ferritin (high iron stores), ↓ serum erythropoietin
Anemia of chronic disease
Tx of anemia of chronic dz
Treatment:
-
Erythropoietin 50-150 U/kg IV 3 × weekly
- Treat the underlying disease
The only anemia where all three cell lines are decreased ↓ WBC ↓ RBC ↓ Platelets - will have normal MCV and ↓ Retic
Aplastic anemia
- (+) osmotic fragility test
- ↑ Retic, ↑ LDH, ↓ Haptoglobin, and ↑ Bilirubin (indirect) and the presence of spherocytes
Hereditary spherocytosis
- Very ↓ MCV (microcytic and hypochromic) with a normal TIBC and Ferritin
- Elevated iron and family history of blood cell disorder
Thalassemia
↓ MCV (microcytic), ↓ MCH (hypochromic), ↑ TIBC, ↓ Ferritin (best test, low iron stores), Target cells, pica, and nail spooning
Iron deficiency
- Chinese and southeast Asians
- Hemoglobin electrophoresis: Hemoglobin H (H disease), Hemoglobin Bart’s (hydrops fetalis), Hemoglobin A (trait)
Alpha thal
↑ MCV (macrocytic anemia), Hypersegmented Neutrophils and normal folate, decreased vibratory and position sense
Vitamin B12
What is the Differential Diagnosis of Bleeding in the Postoperative Setting?
- Surgical bleeding: Bleeding from a major artery or vein that was missed during surgery must be ruled out first, especially in the immediate postoperative period
- Medications: Inquire about aspirin, clopidogrel, heparin, warfarin, or any other antiplatelet or anticoagulant medication
- Inherited coagulation disorders: Patients with von Willebrand disease may have a history of excessive bleeding after minor procedures or very heavy menses; hemophilia A and B usually present in childhood with spontaneous hemorrhage into joints (hemarthrosis)
- Liver disease: Reduced production of clotting factors
- Renal failure: Uremia impairs platelet function
- Disseminated intravascular coagulation (DIC): Seen with severe sepsis, malignancy, and childbirth complications; leads to bleeding and microthrombi; manifests with diffuse bleeding from wounds and surgical sites, hematemesis, digital cyanosis, renal insufficiency, and stroke
An 8-year-old boy with hemophilia A with spontaneous bruising and nosebleed
Factor VIII
A 7-year-old boy with hemophilia B with large right knee hemarthrosis
Factor IX
A 23-year-old woman with von Willebrand’s disease who develops bleeding complications
First try DDAVP; then cryoprecipitate prn
Patient with liver failure and poor nutrition with elevated PT that is refractory to multiple transfusions of FFP
Vitamin K
Painless hematuria in a smoker
Bladder cancer = transitional cell carcinoma is the most common type
How to classify 5 stages of kidney disease
- Stage 1: normal GFR (≥ 90 mL/min/1.73 m2) plus either persistent albuminuria or known structural or hereditary renal disease
- Stage 2: mild GFR 60 to 89 mL/min/1.73 m2
- Stage 3: moderate GFR 30 to 59 mL/min/1.73 m2
- Stage 4: severe GFR 15 to 29 mL/min/1.73 m2 (symptomatic stage)
- Stage 5: kidney failure GFR < 15 mL/min/1.73 m2
What kind of castas are found in renal failure?
Broad waxy casts in urinary sediment are a specific finding in chronic renal failure
A 31-year-old man with right flank pain radiating into the scrotum, gross hematuria, right-sided hydronephrosis, and normal abdominal x-ray
Nephrolithiasis
- Colicky flank pain radiating to the groin, hematuria, CVA tenderness, and nausea and vomiting
Nephrolithiasis
Four main types of kidney stones
- Calcium oxalate (80%): Most common, excess oxalate, hyperparathyroidism, radiopaque - avoid grapefruit juice (makes calcium oxalate stones worse)
- Struvite (10%): Associated with chronic UTI with Klebsiella and Proteus species, radiopaque
- Uric Acid (7%): Form in individuals with persistently acidic urine - Excess meat/alcohol, gout, radiolucent
- Cystine (1%): Rare genetic, radiolucent (young boy with kidney stones)
What size stones will pass spontaneously vs needing stent or nephrostomy
Stones < 5 mm will have an 80% chance of spontaneous passage
- Stones > 10 mm are not likely to pass spontaneously. Ureteral stent or percutaneous nephrostomy (gold standard) should be used if renal function is jeopardized. Urgent treatment with extracorporeal shock wave lithotripsy can be used for renal stones of less than 2 cm or for ureteral stones of less than 10 mm
Dx imaging of renal vascular disease (1st line vs gold standard)
DX: ultrasound = first imaging in age <60
- Renal Arteriography is Gold Standard for diagnosis
- May hear a renal artery bruit on auscultation
A 22-year-old male who develops a right scrotal hydrocele with elevated serum β-HCG
Testicular cancer
MCC testicular carcinoma
- Seminoma is the most common type (60%)
Postop urinary retention (POUR) causes
- Obstructive causes: Urethral stricture, bladder calculi or neoplasm, foreign body
- Neurogenic causes: Multiple sclerosis, Parkinson disease, CVA, postoperative retention
- Traumatic causes: Urethral, bladder, or spinal cord injury
- Extraurinary: Fecal impaction, AAA, rectal or retroperitoneal mass
- Infectious: Local abscess, cystitis, genital herpes, zoster
Acute urinary retention is painful or painless?
Acute = Painful
Chronic = Painless
Acute urinary retention has how much in the bladder?
Child < 4 years of age with an abdominal tumor that does NOT cross the midline
Wilms tumor
Child with painless, unilateral abdominal mass with no other signs or symptoms, also known as
Wilms tumor → nephroblastoma
Average age of Wilms tumor
Mean age is 3.5 years
