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Hematology/Lymph > MDT's Hematology > Flashcards

MDT's Hematology Flashcards

1
Q

What is Anemia defined as?

A

A HCT <41% in males or <37% in females

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2
Q

What are symptoms of Anemia?

A
  • Signs of primary Hematologic diseases
    • Lymphadenopathy
    • Hepatosplenomegaly
    • Bone tenderness
  • Mucosal changes (smooth tongue)
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3
Q

What labs do you get with Anemia?

A
  • CBC w/ differential
  • Iron with Total Iron Binding Capacity (TIBC)
  • Microscopic analysis
  • Hemoglobin electrophresis
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4
Q

Treatment of Anemia?

A
  • Identification of cause of blood loss, esp. occult blood loss
  • Specific once cause of anemia established
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5
Q

When to refer for Anemia?

A
  • Refer to Internal Medicine if cause of anemia is unknown
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6
Q

Essentials of Diagnosis of Iron Deficiency Anemia

A
  • Caused by bleeding unless proved otherwise
  • Responds to iron therapy
  • Serum Ferritin <12mcg/L
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7
Q

General considerations for Iron Deficiency Anemia

A
  • Most common cause of anemia is iron deficiency
  • Most important cause of iron deficiency anemia is blood loss
  • Menstruation, pregnancy, and frequent blood donors increase chances
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8
Q

Physical findings of anemia

A
  • Fatigue, Tachycardia, Tachypnea, and palpitations on exertion
  • Dysphagia
  • Pica (food cravings, i.e. ice chips)
  • Severe causes skin/mucosal changes:
    • smooth tongue
    • brittle nails
    • cheilosis
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9
Q

Labs for Iron Deficiency Anemia

A
  • CBC w/ differential (decreased Mean Corpuscular Volume, MCV)
  • Iron with Total Iron Binding Capacity (TIBC)
  • Ferritin value <12mcg/L
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10
Q

Treatment of Iron Deficiency Anemia

A
  • Identification of cause of blood loss
  • Ferrous Sulfate 325 mg
  • Parental Iron (only if intolerance to oral iron, GI disease)
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11
Q

What are the contraindications for Ferrous Sulfate?

A
  • Hemolytic anemia
  • Peptic ulcer disease
  • Ulcerative colitis
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12
Q

Essentials of Dx Vitamin b12 Deficiency

A
  • Microcytic anemia
  • Neutrophils of peripheral blood smear
  • Serum Vitamin b12 level <100pg/mL
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13
Q

General considerations of Vitamin b12 deficiency anemia?

A
  • B12 found in food products from animals
  • Vegans at risk
  • Have for life
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14
Q

Lab findings for Vitamin B12 deficiency?

A
  • *Hallmark: megaloblast anemia (large RBC’s) on CBC**
  • Mean Corpuscular Volume (MCV) strikingly elevated
  • Overt B12 deficiency <170 pg/mL
  • Symptomatic B12 deficiency <100 pg/mL
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15
Q

Physical findings of Vitamin B12 deficiency?

A
  • Glossitis
  • Anorexia
  • Diarrhea
  • Pale, paresthesia, and difficulty balance (neuro Sx’s)
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16
Q

Treatment for Vitamin B12 deficiency?

A
  • B12 injections IM
  • 1st week: Daily
  • 1st month: Weekly
  • Monthly for life
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17
Q

Post diagnostic considerations for Vitamin B12 deficiency?

A
  • MEDEVAC for late stage
  • Hematology referral early stage
  • Lifelong disease
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18
Q

As part of coagulation process, what factors lead to fibrin clot formation?

A

Factor XII to Factor II

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19
Q

The intrinsic pathway of coagulation includes what factors? How is it measured in the lab?

A
  • Factors XII, XI, IX, VIII

- PTT

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20
Q

The extrinsic pathway of coagulation includes what factors? How is it measured in the lab?

A
  • Factors VII- PT
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21
Q

What are the convergence pathways for coagulation?

A

Factors X, V, and II

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22
Q

What factors of coagulation are Vitamin K dependents?

A

Factors II, VII, IX, and X

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23
Q

What are the congenital disorders of coagulation?

A
  • Hemophilia A
  • Hemophilia B
  • Recurrent Hemarthroses and arthropathy
  • Development of inhibitory antibodies to factor VII or IX
  • From infection with HIV or Hep C from contaminated blood in older Pt’s
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24
Q

What is a congenital disorder of coagulation factor VIII?

A

Hemophilia A

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25
Q

What is a congenital deficiency of coagulation factor IX?

A

Hemophilia B

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26
Q

What is Disseminated Intravascular Coagulation (DIC)?

A

Systemic process with potential for causing thrombosis and hemorrhage

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27
Q

What coagulation can present as an acute, life-threatening emergency?

A

Disseminated Intravascular Coagulation (DIC)

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28
Q

Common causes of DIC?

A
  • Sepsis
  • Malignancy
  • Trauma
  • Obstetrical complications
  • Intravascular hemolysis
  • Less commonly seen in: Heat stroke, crush injuries, and Rattlesnake/viper bites
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29
Q

What is the major principle of management of DIC?

A
  • Treatment of underlying cause

- MEDEVAC

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30
Q

Medications for DIC?

A
  • Heparin
  • Coumadin
  • Rivaroxaban
  • Apixaban
  • Pradaxa
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31
Q

Symptoms/Physical findings DIC?

A
  • Ecchymosis (bruising) w/out any known trauma
  • Bleeding in joint spaces
  • Epistaxis
  • Bleeding from eyes
  • Very heavy vaginal bleeding
32
Q

Labs for DIC?

A
  • PT
  • PTT
  • INR
  • CBC
33
Q

Complications of DIC?

A
  • Anemia
  • Massive Hemorrhage
  • Hemoptysis
34
Q

Overview of Glucose-6Phosphate Dehydrogenase?

A
  • Commonly seen in American Black men, affecting 10-15%
  • Hereditary enzyme
  • Episodic hemolysis in response to drugs/infections
35
Q

What are Heinz bodies?

A
  • Oxidized hemoglobin denatures and forms a precipitant

- Causes membrane damage and removal of cell by spleen

36
Q

What is Hemolysis?

A

Process of RBC’s rupturing

37
Q

Symptoms/physical findings of G6PD?

A

Usually healthy without chronic hemolytic anemia or splenomegaly

38
Q

What drugs can cause hemolysis associated with G6PD?

A
  • Dapsone
  • Primaquine
  • Quinidine
  • Quinine
  • Sulfonamides
  • Nitrofurantoin
  • Aspirin
  • Ciprofloxin
39
Q

Treatment of G6PD

A
  • No Tx necessary except to avoid oxidants
  • Pt education to avoid oxidants
  • Supportive monitoring CBC
  • Severe cases: potential to require blood transfusions
  • Possession of red dog tag
40
Q

What is Sickle Cell Anemia?

A

An autosomal recessive disorder in which an abnormal hemoglobin (Hemoglobin S) leads to chronic hemolytic anemia
- abnormal RBC is shaped as sickle cell

41
Q

Why is Sickle Cell Anemia painful?

A

Sickle cells become trapped and cannot pass through capillary system causing lack of blood flow leading to ischemia

42
Q

Symptoms/physical findings of sickle cell anemia?

A
  • Jaundice
  • Pigment gallstones
  • Hepatosplenomegaly
  • Poor healing ulcers over lower tibia
  • Cardiomegaly
  • Chronic pain (esp. back and long bones)
43
Q

Treatment of sickle cell anemia?

A
  • Supportive care is mainstay
  • Maintained on folic acid supplements
  • Transfusions for aplastic or hemolytic crises
  • Keep hydrated
  • Search for underlying infection
44
Q

MEDEVAC if complications for sickle cell anemia?

A

Yes

45
Q

Pertinent physiology of sickle cell trait?

A
  • Clinically normal, but have acute painful episodes with extreme conditions such as exertion at high altitude
46
Q

Labs and Tx for Sickle Cell Trait?

A
  • Screening for Sickle Cell hemoglobin

- No treatment necessary

47
Q

What is leukemia?

A

Malignancy of the hematopoietic progenitor cells. These cells proliferate in an uncontrolled fashion and replace normal bone marrow elements

48
Q

What are the two acute types of leukemia and what age are they normally diagnosed?

A
  • Acute lymphoblastic leukemia (ALL): diagnosed in childhood

- Acute myeloid leukemia (AML): diagnosed about 60 yrs

49
Q

Where are blasts located in association with leukemia?

A
  • 20% in the bone marrow

- 90% in peripheral blood

50
Q

Symptoms/Physical findings of Leukemia?

A
  • Most usually only complain of fatigue
  • Bleeding in skin/mucosal surfaces (gingival bleeding, epistaxis, menorrhagia)
  • infection due to neutropenia (presentations include pneumonia, cellulitis, perirectal infection)
  • Gum hypotrophy
  • Bone/joint pain
  • Bone tenderness in sternum, tibia, femur
  • Enlargement of liver, spleen, and lymph nodes
51
Q

Labs/Studies for Leukemia?

A
    • Hallmark is combination of pancytopenia with circulating blasts**
  • Hyperuricemia may be seen
  • Mediastinal mass seen on CXR in Pt’s w/ ALL
52
Q

Treatment for Leukemia?

A
  • Refer to hematologist
  • MEDEVAC
  • Combo chemo and radiation therapy will be mainstay
53
Q

Initial care and follow up for leukemia?

A
  • Approx 70-80% of adults with AML under 60 achieve complete remission
  • Chemo leads to cure in 35-40%
  • Bone marrow transplant is curative in 50-60%
54
Q

What is Leukocytosis?

A

High white cell count relative to normal physiological numbers

55
Q

What is Leukopenia?

A

Low total white cell count (<4400 cells/microL)

56
Q

In regards to Leukocytosis, what is high neutrophils (called Neutrophilia) indicative of?

A
  • Bacterial infection
  • Inflammation
  • Metabolic disease
  • Stress
57
Q

In regards to Leukocytosis, what is high lymphocytes (lymphocytosis) indicative of?

A
  • Viral infection
  • Immune disease
  • Stress
  • Leukemia
58
Q

In regards to Leukocytosis, what is high Eosinophils (Eosinophilia) indicative of?

A
  • Skin diseases
  • Drug interaction
  • Parasite infection
  • Asthma
59
Q

In regards to Leukocytosis, what is high Basophils (Basophilia) indicative of?

A
  • Chronic myeloid leukemia
60
Q

In regards to Leukocytosis, what is high Monocytes (Monocytosis) indicative of?

A
  • Infection

- Autoimmune disease

61
Q

What are the different etiologies of leukopenia?

A
  • Infections (can be seen with viral: Hepatitis, HIV)
  • Medications
  • Nutritional vitamin deficiencies (B12, Folate, copper)
  • Hematological malignancies
  • Rheumatologic disorders
62
Q

Signs/symptoms of Leukocytosis/Leukopenia?

A
  • Evidence of infection:
  • Fever
  • Skin ulcerations, erythema, fissures, tenderness
  • Gingivitis, swelling, oral ulceration
  • Abnormal respiratory exam
  • Jaundice
  • Joint swelling/ bone pain
  • Rash
  • Lymphadenopathy
  • Neuro/psychiatric disorders
63
Q

Labs for Leukocytosis/Leukopenia?

A

CBC w/ differential

64
Q

Treatment for Leukocytosis/leukopenia?

A

Based on cause

65
Q

What is thrombocytopenia?

A

Abnormally low amount of circulating platelets

66
Q

What are potential causes of thrombocytopenia?

A
  • Bone marrow failure/ malignancy
  • Disseminated intravascular coagulation
  • Chemo and radiation therapy
  • Nutritional deficiency (folate or iron)
  • Medications
67
Q

Symptoms/physical findings for thrombocytopenia?

A
  • Petechia (helps determine that deficiency is platelets rather than coagulopathy)
  • Mucocutaneous bleeding
68
Q

Labs/Study of thrombocytopenia?

A

Platelet count below normal reference range

69
Q

Treatment of thrombocytopenia?

A
  • Stop potentially offending assignments
  • Evaluate for underlying cause
  • Referral to Hematologist or Internal Medicine
  • MEDEVAC if actively bleeding
70
Q

What is thrombocytosis?

A
  • Abnormally high amount of circulating thrombocytes (>450,000)
  • Elevated platelet count with absence of other causes
71
Q

What are the two different categories that thrombocytosis are broken into?

A
  • Reactive thrombocytosis

- Autonomous thrombocytosis

72
Q

Symptoms/physical findings of thrombocytosis?

A
  • Median age 50-60 yrs
  • 1st sign elevated platelets
  • Increased risk for thrombosis
  • Erythromelalgia
  • Splenomegaly in about 25%
73
Q

Labs/Studies/EKG’s thrombocytosis?

A
  • CBC w/ differential
  • Blood smear
  • Iron studies
  • Inflammatory markers
74
Q

Treatment of Thrombocytosis?

A
  • Refer to Hematology if:
  • No infectious cause
  • Does not resolve on its own within 2-4 weeks
75
Q

Initial care and follow up for thrombocytosis?

A
  • Good Hx and PE
  • CBC and blood smear
  • Refer to Hematologist if you cannot determine etiology

Hematology/Lymph (8 decks)

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