Lecture 4 - Haematology

Question 1

Causes of polycythemia (Hb)

Answer 1

Intrinsic disease of the bone marrow
Chronic Obstructive Pulmonary Disease (COPD)
Congenital heart  disease
Congestive heart failure (CHF)
Dehydration (hemoconcentration)
Severe burns

Question 2

S/s of polycythemia (hb)

Answer 2

Dizziness  
Arrhythmias
Seizure
TIA-symptoms  
Symptoms of MI (chest pain)

Question 3

Causes of anemia (hb)

Answer 3

Hemorrhage (i.e. surgery, trauma, stomach ulcers)
Nutritional deficiency
Neoplasia 
Lymphoma  
Systemic lupus erythematosus 
Sarcoidosis 
Kidney disease
Sickle cell anemia
Stress to bone marrow
RBC destruction
Liver disease (Splenomegal

Question 4

s/s anemia (hb)

Answer 4

Decreased endurance
Decreased activity tolerance (fatigue)
Orthostatic hypotension, syncope
Pallor 
Tachycardia

Question 5

Resistive exercise usually tolerated hemodynamically when Hb = ?

Answer 5

Resistive exercise usually tolerated hemodynamically when Hb>100 g/L

Question 6

Hb=? symptoms-based approach for appropriateness of activity; collaborate with interprofessional team (regarding possible need for/timing of transfusion prior to mobilization).

Answer 6

< 80 g/L: symptoms-based approach for appropriateness of activity; collaborate with interprofessional team (regarding possible need for/timing of transfusion prior to mobilization).

Question 7

Monitor vitals including SpO2 to predict tissue perfusion during exercises why?

Answer 7

May present with tachycardia and/or orthostatic hypotension.

Question 8

Causes of polycythemia (ht)

Answer 8

Burns  
Eclampsia
Severe Dehydration
High altitude
CHF
Dehydration

Question 9

Polycythemia s/s (ht)

Answer 9

Fever  
Headache  
Dizziness
Weakness  
Fatigue  
Bruising/bleeding

Question 10

Causes of anemia (ht)

Answer 10

Leukemia  
Multiple myeloma  
Pregnancy
High altitude
Hyperthyroid  
Cirrhosis  
Rheumatoid  Arthritis  
Hemorrhage

Question 11

s/s of anemia (ht

Answer 11

Pale skin
Headache
Dizziness
Chest pain  
Arrhythmia  
Dyspnea

Question 12

high or low ciritcal value of hb results in what?

Answer 12

High: blood clotting
Low: Cardiac failure/death

Question 13

If 25-% Ht what approach toward PT?

Answer 13

< 25%: Symptoms-based approach when determining appropriateness for activity; collaborate with interprofessional team (regarding possible need for/timing of transfusion prior to mobilization).

Question 14

Leukocytosis causes

Answer 14

Infection
Primary bone marrow disease (leukemias or myeloproliferative neoplasm)  
Trauma/surgery (pain)
Stress/pain
Medication-induced (i.e. corticosteroids,& epinephrine) 
Chronic inflammation, 
Smoking
Obesity   
Connective tissue disease, RA

Question 15

s/s leukocytosis

Answer 15

Fever
Malaise
Lethargy  
Dizziness
Bleeding  
Bruising  
Weight loss (unintentional)
Lymphadenopathy
Painful inflamed joints

Question 16

causes leukopenia

Answer 16

Viral infections,
Some blood-borne cancers (leukemias and lymphomas)
Bone marrow suppression (chemotherapy, radiation, HIV/acquired immunodeficiency syndrome [AIDS])
Aplastic anemia
Hepatitis

Question 17

s/s leukopenia

Answer 17

Anemia  
Weakness  
Fatigue
Headache  
Dyspnea  
Fever

Question 18

Leuko: when is physio contraindicated?

Answer 18

Physiotherapy contraindicated if count > 150,000 x 106/L : risk of low flow state in vessels (brain)

Question 19

causes of thrombocytosis

Answer 19

Acute infection/inflammation
Neoplasm/Cancer
Stress/Trauma/post-surgery
Hemorrhage
Strenuous exercise 
Iron deficiency 
Hemolysis

Question 20

s/s thrombocytosis

Answer 20

Weakness  
Headache  
Dizziness
Chest pain  
Tingling in hands/feet

Question 21

causes of thrombocytopenia

Answer 21

Viral infection  
Leukemia  
Radiation/chemotherapy
Malignancy  
Liver disease  
Aplastic anemia

Question 22

s/s of thrombocytopenia

Answer 22

Petechiae  
Ecchymosis  
Fatigue  
Risk for bleeding
Jaundice  
Splenomegaly

Question 23

Fall risk awareness (risk of spontaneous hemorrhage) at which thrombocytopenia?

Answer 23

In presence of severe thrombocytopenia (< 20,000 x106/L): Fall risk awareness (risk of spontaneous hemorrhage).

Question 24

Rule of thumb for acute resp acidosis

Answer 24

For a 10 mm Hg increase in PaCO2, the HCO3- increases 1 mEq/L

Question 25

Rule of thumb for acute resp alkalosis

Answer 25

For every 10 mm Hg decrease in PaCO2, HCO3- decreases 2 mEq/L

Question 26

Rule of thumb for chronic resp acidosis

Answer 26

If the HCO3- is greater than 30 mEq/L then a chronic respiratory acidosis is present

Question 27

Rule of thumb for metabolic acidosis

Answer 27

PaCO2 =(1.5x HCO3-) + 8+2

Question 28

Rule of thumb for acute resp alkalosis

Answer 28

PaCO2 change is variable; PaCO2 usually does not elevate above 50-55 mm Hg

Question 29

What are some causes of hypoxia (5) & results of PaO2, PaCO2, P(A-a)O2

Answer 29

Alveolar hypoventilation
- ↓ PaO2, ↑ PaCo2, P(A-a)O2 normal

Diffusion impairment
- ↓ PaO2, PaCO2 normal or ↓, P(A-a)O2 ↑

V/Q mismatch
- ↓ PaO2, PaCO2 normal, P(A-a)O2 ↑

Shunt
- ↓↓ PaO2, PaCO2 normal, P(A-a)O2 ↑

Low FiO2 (altitude)

Question 30

Rule of thumb: if hypoventilation is th major cause of hypoxemia

Answer 30

If hypoventilation is the major cause of the hypoxemia, the PaO2 should only be decreased 1mm Hg for every 1 mm Hg increase in PaCO2.

If the decrease is greater, there is likely another cause for the hypoxemia
i.e. V/Q mismatch, shunt, diffusion abnormality

Question 31

Respiratory failure is defined as

Answer 31

PaO2 < 55 mm Hg

+/- PaCO2 > 45 mm Hg