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6030 Primary Care Test 3 COMPLETE ☑️ > Module 10: Hematologic Diseases > Flashcards

Module 10: Hematologic Diseases Flashcards

1
Q

Anemia

-Definition/Epidemiology

A
  1. Reduction in # of RBC’s, hemoglobin concentration, or hematocrit
  2. Anemia diminishes capacity of blood to carry oxygen
  3. Diagnosis is often based on lab data alone*
  4. Women <65 yrs and adult men >85yrs MOST at risk
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2
Q

Anemia

-Causes

A
  1. RBC production disorders —aplastic anemia, ⬇️epoetin production, Bone marrow infection/malignancy
    —Ex: Anemia of CKD & Iron deficiency anemia
  2. RBC destruction disorders — Autoimmune, mechanical, or enzymatic factors present
    —Ex: Sickle Cell & Thalassemia
  3. RBC blood loss —Trauma, mensuration, GI bleed, hematuria, hemorrhage
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3
Q

Anemia Pathophysiology

A
  1. When Anemia occurs there is a ⬇️ in blood viscosity causing it to flow faster (Turbulent flow)
  2. Hemoglobin releases oxygen to tissues more rapidly causing hypoxia of tissues causing Respiratory and cardiovascular dysfunction
  3. Cardiac response to hypoxia and viscosity causes dilation of heart and vessel damage
    —Increase Contractility occurs and increase in respiratory rate and depth —SOB
  4. Hemodilution occurs to expand plasma volume
    —Anemia becomes evident when the MAX amount of hemodilution occurs (Usually 3 days) s/p acute blood loss
  5. Blood is shunted to vital organs — Heart and brain
  6. Renin-angiotensin system activation
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4
Q

Diagnosis and Treatment of Anemia

-Ferritin

A
  1. Used to measure Iron Storage

- Ferritin concentration less than 12 indicates absence of iron stores

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5
Q

Diagnosis and Treatment of Anemia

-Transferrin Saturation

A
  1. Measures dietary iron absorption in transport

2. Transferrin is the protein that iron is bound for transport w/in the body

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6
Q

Diagnosis and Treatment of Anemia

-Most useful test for type of anemia?

A
  1. MCV
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7
Q

Microcytic Anemia’s

-Definition/Causes*

A
  1. Small, hypochromic, RBC’s — LOW MCV <80fL
  2. Most common cause is IRON Deficiency — affects women of reproductive age and older adults
    —Most common cause is chronic blood loss* — GI, Menorrhagia, surgery, trauma, excessive blood donation
  3. Iron deficiency anemia is more likely to occur when — Increase Iron metabolism, or stores become depleted
    —Conditions include: Pregnancy, childhood and adolescent growth through milestones
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8
Q

Iron-Deficiency Anemia

-Clinical Presentation

A
  1. Fatigue/Weakness, HA, Tachycardia
  2. Chest pain
  3. Jaundice
  4. Orthostatic BP changes
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9
Q

Iron-Deficiency Anemia

-Subjective Hx

A
  1. Physiologic blood loss
  2. Recent trauma
  3. Meds? — NSAIDS, Oral steroids, ASA
  4. Alcohol abuse
  5. Fam hx
  6. PMH
  7. Change in bowel habits & Diet
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10
Q

Iron-Deficiency Anemia

-Conditions contributing to New Iron-deficiency Dx

A
  1. Blood disorders
  2. Cancer
  3. HIV
  4. Liver & Autoimmune disorders
  5. Lead exposure
  6. Gastritis
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11
Q

Iron-Deficiency Anemia

-PE

A
  1. General ROS — Fatigue, weight loss, irritability
  2. CV — Systolic Flow Murmur, tachycardia — More forceful apical pulse (severe)
  3. Respiratory — SOB
  4. HEENT — Pale conjunctiva, glossitis, Cheilitis
  5. Integumentary — Pallor, koilonychia
  6. Lymph — lymphadenopathy
  7. GI — Liver/spleen enlargement, FOBT, mass, neoplasia
  8. GU — pelvic mass, neoplasia
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12
Q

Iron-Deficiency Anemia

-Diagnostics

A
  1. CBC w/diff + Anemia Profile
    - Start with MCV — If <80, suspect iron deficiency
    - Low Hgb ,14 g/dl in MALE, <12 g/dl in FEMALE
    - Low Ferritin <12 g/dl
    - Low Iron <10
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13
Q

Thalassemia

-Presentation on Labs**

A
  1. Moderate to severe microcytosis w/ varying degrees of anemia
  2. Most have normal RDW & Normal Iron studies
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14
Q

Iron-Deficiency Anemia

-Diagnostics

A
  1. GI studies — FOBT, Colonoscopy
  2. Hgb electrophoresis
  3. US to ID a mass
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15
Q

Iron-Deficiency Anemia

-Differential’s for Microcytic Anemia’s <80fL

A
  1. Iron deficiency
  2. Thalassemia — Most have normal RDW and Iron studies — varying degrees of anemia
  3. Anemia of chronic dz
  4. Sideroblastic anemia
  5. Hemoglobin E disease
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16
Q

Iron Rich Foods?

A

Highest Iron

  1. Prune Juice
  2. Olives
  3. mulberries

Other Iron rich foods

  1. Fortified cereals
  2. Cooked oysters, organ meets (liver), soy beans. Lentils and spinach
17
Q

Iron-Deficiency Anemia

-Management

A
  1. Non-Pharm — Iron rich foods
  2. Pharm
    —Daily Iron 30 minutes before meals x4-6 months or serum ferritin levels >50
    —Hgb rises w/2 weeks.
    —MCV will correct in 1-2 months
  3. Follow-up
    —6 wks to 3 months
18
Q

Oral Iron S/E’s

A
  1. Nausea
  2. Constipation
  3. Heart burn
  4. Upper GI discomfort
  5. Black stools and Diarrhea
  • Take Iron 30 minutes before meals
  • Slow release for those who do not tolerate GI symptoms
19
Q

Indications for Referral or Hospitalization

A
  1. URGENT
    - Symptomatic — Dyspnea, fatigue, chest pain
    - Transfusion: Hgb 8=symptoms; Hct <30%
    - Immediate referral to Hematologist
    - Acute bleeds — ER
  2. EMERGENT
    - Symptomatic — hypotension, pallor, cold clammy skin bruising, tachy and thready pulse
    - Acute severe hemorrhage
    - Immediate ER Referral
20
Q

Patient Education with Iron Supplementation

A
  1. Metal based foods (supplements with calcium or magnesium — Chelates iron and BLOCKS Iron absorption
  2. Dairy or Antacids should NOT be taken 2 hours before or after Iron therapy
  3. Coffee, Tea, Bran, and soy products can also interfere w/ absorption
  4. Vitamin C increases absorption —Meat, poultry and fish also increase absorption
21
Q

Iron Deficiency

-Health Promotion and Risk Groups?

A
  1. Strict Vegetarians should supplement diet with Iron fortified vitamins or iron fortified foods
  2. Screening recommended in:
    - All children 1 year of age
    - All “AT-RISK” Groups
    - Screen ALL PREGNANT women in pregnancy
22
Q

Macrocytic Anemia

-Definition & Causes

A
  1. Overly large red blood cells — HIGH MCV (Greater than 100fL)
  2. Vitamin B12 and Folate Deficiency is MOST COMMON cause of macrocytic anemias
    —Ex: Alcoholism, bariatric surgery, low protein diets, pregnancy or lactation
23
Q

Macrocytic Anemia

-Clinical Presentation

A
  1. Develops VERY slowly in chronic diseases over 20-30 years
  2. Early Stages of Dz — Infections, mood swings, weakness/fatigue GI dz’s, & Kidney Dz
  3. Severe Stages of Folate deficiency — Abdominal pain, Glossitis, stomatitis, ulceration, Dysphagia & GI
  4. Severe B12 Macrocytic Anemia — Neuropathy, memory loss Parasthesias of feet and fingers & difficulty walking
  5. Macrocytic anemia in nutritional deficiency — Normal MCV in elderly patients, those w/ Chronic Infections, or lack ability to produce stomach acids to aid in digestion
  6. Folate Deficiency may cause HIGH MCV
24
Q

Macrocytic Anemia

-Subjective Hx

A
  1. B12 or Folate Deficiency — Alcoholism, dietary fat, malabsorption, & low veggie diet
  2. GI Malabsorption — s/p removal of parts of the stomach (Gastritis), infections, or pancreatic insufficiency
    —This can decrease the secretion of INTRINSIC factor or ability to produce IF
  3. Liver Involvement — Causes jaundice and enlarged liver — Leads to Right HF
  4. Autoimmune Conditions — Production of antibodies against gastric parietal cells — leads to macrocytic anemia
25
Q

Macrocytic Anemia

-Diagnostics

A
  1. Signs of Macrocytic Anemia — Low Hgb, Elevated MCV >100, Elevated RDW
  2. If macrocytic anemia is considered, evaluate B12 and FOLATE

REFER to Hematology/Oncology**

Other Diagnostics:

  • FOBT X3
  • UA
  • PT/INR/LFT’s/CMP
  • US Pelvic/Abdo
  • Endoscopy/colonoscopy
26
Q

Macrocytic Anemia

-Differential Dx’s (Macrocytic Anemia’s

A
  1. Pernicious Anemia — B12 deficiency d/t lack of intrinsic factor —MVC increases >100. Parasthesias, difficulty walking when severe
  2. Folate Deficiency Anemia — Vit needed for RBC production/maturation —absorbed in upper intestine and stored in liver
    —GI symptoms and a BEEFY RED TONGUE when folate deficiency is severe
    —Pregnant or lactating women require HIGHER folate level to prevent Neural tube defects
    —Symptoms of folate deficiency are similar to pernicious anemia — EXCEPT NO Neurologic changes In Folate Deficiency**
27
Q

Macrocytic Anemia

-Other important info?

A
  1. Damage to the posterior and lateral columns of the spinal chord cause neurologic symptoms
    —Ex: loss of position, loss of vibration sense, ataxia, spasticity, loss of appetite, memory loss
  2. G6PD Deficiency — Sickle cell dz & thalassemia
    —MCV is typically normal with hemolysis or destruction of RBC’s
  3. Normal MCV is found with
    - Aplastic anemia/malignancy
    - Chronic Renal Failure (Order Creat)
    - Hypothyroidism (Order TSH)
28
Q

Normocytic Anemia’s

-Anemia of Chronic Disease

A
  1. Normal size RBC but fewer in number — Total Iron stores are normal or elevated
  2. Anemia of Chronic Disease
    -Mild to moderate and a results of — Inflammatory disorders, infection, or malignancy
    -AKA anemia of inflammation
    -Occurs in:
    —Elderly men and women >85 yrs
    —Autoimmune disorders (Ex: Lupus, RA)
    —Chronic illness contributing to CKD (Ex: DM HTN) — symptoms associated w/ underlining disease, not anemia
  3. Anemia of Chronic Disease WILL NOT respond to iron supplementation
29
Q

Hemolytic Anemia

A
  1. RBC’s are destroyed faster than they can be made

S/S Include:
-abdominal pain, palpitations, jaundice, dark urine, fever, weakness, confusion, dizziness, inability to handle physical activity, Paleness

Treatment:
-Blood transfusions, meds, plasmaphoresis, surgery, blood and bone marrow stem cell transplants, lifestyle changes

30
Q

Anemia

-Management

A
  1. DO NOT treat if asymptomatic
  2. Hospitalization may be required if severe

PHARM

  • Monthly B-12 injections for pernicious anemia
  • Folate replacement w/ supplementation

Non-Pharm
-Folate-rich foods — beef liver, Green leafy veggies, peas, beans, avocados, eggs & milk

31
Q

B12 Deficiency

-Complications?

A
  1. Complication of undiagnosed or mistreated Vit B12 deficiency — Irreversible neurological damage
    —mental status change, weakness, ataxia and poor coordination may not resolve
32
Q

Anemia

-Health Promotion

A
  1. Screening recommended for all women of childbearing age

2. Newborns should also be screened for sickle cell and hemoglobinopathies

6030 Primary Care Test 3 COMPLETE ☑️ (7 decks)

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