Linger/Pales CIS Flashcards
what are myeloid growth factors used for
neutropenia to stimulate peripheral blood
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
how does ibuprofen affect iron
dec iron absorption
how do proton pump inhibitors affect iron levels
dec the uptake of iron
how does dairy products affect iron levels
dec absorption
what is the PO version of deferoxamine
deferasirox
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
what disorders are assoc with anemia of chronic disease
RA SLE chronic infections chronic renal failure AIDS
what chemotherapy agents can cause anemia
antimetabolites: folic acid analogs, hydrozyurea, purine antagonists, pyridimine antagonists
alkylating agents
which agent stimulates increase in production reticulocytes and most appropriate Tx for this patient? cyanocobalamin epoetin alpha filgrastim oprelvekin pegfilgrastim
epoeitin alpha
oprelvekin is used to Tx what
thrombocytopenia
what are they myeloid growth factor drugs
filgrastim and pegfilgrastim
what are balck box warnings of erythropoiesis stimulating agents
increased mortality in cancer patients
not rec for anemic cancer patients receiving myelosuppressive chemotherapy
causes of megaloblastic anemia
B12 def
folic acid deg
metabolic or inherited defects
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
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
no
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
no
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
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
low iron, high TIBC and low ferritin
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
