Linger/Pales CIS Flashcards by Amanda Beach

what are myeloid growth factors used for

neutropenia to stimulate peripheral blood

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35 y.o weakness, dizziness, epigastric pain
peptic ulcer disease
heavy menstrual bleeding
chronic HA
Hb low Hct low serum ferritin low and 4+ guaiac stools
takes tetracycline, ibuprofen and esomeprazole

iron deficient anemia from drug combination and high Fe baseline needed from recent pregnancies

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how does ibuprofen affect iron

dec iron absorption

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how do proton pump inhibitors affect iron levels

dec the uptake of iron

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how does dairy products affect iron levels

dec absorption

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what is the PO version of deferoxamine

deferasirox

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38 y.o F with advanced epithelial ovarian cancer
3/6 cycles chemo of carboplatin and paclitaxel
SOB and fatigue when walks up stairs
low Hb, low Hct, normal chromic and normocytic RBC
most likely Dx?

anemia of chronic disease

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what disorders are assoc with anemia of chronic disease

RA
SLE
chronic infections
chronic renal failure
AIDS

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what chemotherapy agents can cause anemia

antimetabolites: folic acid analogs, hydrozyurea, purine antagonists, pyridimine antagonists
alkylating agents

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which agent stimulates increase in production reticulocytes and most appropriate Tx for this patient?
cyanocobalamin
epoetin alpha
filgrastim
oprelvekin
pegfilgrastim

epoeitin alpha

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oprelvekin is used to Tx what

thrombocytopenia

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what are they myeloid growth factor drugs

filgrastim and pegfilgrastim

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what are balck box warnings of erythropoiesis stimulating agents

increased mortality in cancer patients

not rec for anemic cancer patients receiving myelosuppressive chemotherapy

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causes of megaloblastic anemia

B12 def
folic acid deg
metabolic or inherited defects

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normal WBC elevated RBC
Hb low, Hct low
low MCV
normal RDW
normal platelets
does he have anemia

lead poisoning,
anemia of inflammation
sideroblastic anemias
thalassemia trait

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lead poisoning,
anemia of inflammation
sideroblastic anemias
thalassemia trait
labs?

peripheral smear
iron levels, ferritin levels
TIBC total iron binding capacity

does having normal ferritin rule out iron deficiency

normal WBC elevated RBC
Hb low, Hct low
low MCV
normal RDW
normal platelets
normal ferritin, iron and TIBC
now ddx

thalassemia

how to Dx thalassemia

Hb electrophoresis

does a normal Hb electrophoresis rule out thalassemia

how do you Tx thalassemia

don’t give anything

just let them know and educate them

35 y/o M with fatiuge, exercise intolerance, SOB and cravings for ice
gastric bypass surgery 3 yrs ago
pale no abdominal tenderness
taking omeprazole
MVI and B12 shots
norm WBC, low RBC, low Hb, low Hct low MCV, normal RDW platelets normal
what labs do you what? ddx?

iron panel
thalassemia
lead poisoning
sideroblastic anemias

iron deficiency anemia

causes iron deficiency anemia

gastric bypass surgery can change pH and affect duodenum absorption of Fe
lack of intake
chronic blood loss

why does patient with gastric bypass surgery take B12 shots

because parietal cells are bypassed which produce IF | B12 coated with IF

common problem from IV iron

anaphylaxis

quickest way to replace iron

blood transfusion

elevated RDW means what

microcytic and macrocytic mixture

alcoholic male with cirrhosis and grade 3 esophageal varices presents with anemia and delerium Hx RA and DM what MCV would you expect

macrocytic- cirrhosis | mixed

cirrhosis causes what type anemia

macrocytic

how does alcohol affect bone marrow

suppression of blood marrow production

portal HTN leads to what

varices, ascites and splenomegaly (sequestration RBC)

how Dx anemia of chronic disease

iron studies norm- elevated ferritin TIBC!! and Fe will be low!! binding sites available for iron are low

how do you rule out hemolytic anemia

-Haptoglobin!!!! (would be dec in hemolytic anemia) -measure unconjug bilirubin (indirect) should be elevated in hemolytic anemia -LDH

what should reticulocyte count be in anemia

high because need more production RBC, if normal or low then bad because bone marrow is not responding

35 y.o F with weakness, fever, dysuria nd abdominal pain, type I DM, RA and HTN insulin, methatrexate, diclofenac, adalimumab lethargic, hypotensive, suprapubic and LUQ pain, lloydsis + on L ddx?

pyelonephritis

woman with pyelonephritis taking methetrexat and adalimumab has high WBC, low RBC, low Hb, low Hct, hgih MCV, high RDW, low platelets, high reticulocytes additional tests? ddx?

increased MCV: Tx with drugs that interfere with DNA synthesis and cell division, myelodyspplasia, folate deficiency, vit12 def, hypothyroidism, liver disease