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Midwifery Boards > Primary Care: Hematologic Disorders > Flashcards

Primary Care: Hematologic Disorders Flashcards

1
Q

What is Anemia?

A

Abnormally low hgb concentration
<12 for women
< 11 in 1st tri
< 10.5 in 2nd tri
< 11 in third tri
<13 for men

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2
Q

What are the types of anemia?

A

Classified by RBC size:
- Microcytic (MCV < 80)
- Macrocytic (MCV > 100)
- Normocytic (MCV 80-100)

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3
Q

What Causes Microcytic Anemia?

A
  • IDA - usually d/t chronic low volume blood loss (menorrhagia, GI bleeds/colon cancer). dietary insufficiency, pregnancy d/t increased metabolic demand
  • thalassemia trait
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4
Q

What causes Macrocytic Anemia?

A
  • Vit B12 deficiency - PPIs can decrease B12, iron absorption; metformin can decrease B12 absorption
  • Folate deficiency
  • Liver disease
  • hypothyroid
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5
Q

What causes Normocytic anemia?

A
  • anemia of chronic disease - reduced RBC production/lifespan d/t inflammation
    hemolysis - anemia of chronic disease can contribute
  • sickle cell disease
  • renal failure - CRF (reduced erythropoetin)
  • ACUTE blood loss
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6
Q

What is the most common anemia

A

IDA

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7
Q

What is the etiology for IDA?

A
  • slow, persistent blood loss (GI bleed, heavy menstrual periods)
  • Inadequate dietary intake (not common)
  • Metabolic demands in excess of intake - like in pregnancy
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8
Q

What lab values would lead to IDA?

A

MICROCYTIC/HYPOCHROMIC
Hgb: Low
Hct: Low
RBC: Low
MCV: Low (small size/microcytic)
MCHC: Low (pale/hypochromic)
RDW: increased (cells different sizes)
Reticulocytes: decreased

If above is on CBC –> next step ferritin for estimate of iron stores
Ferritin: low
TIBC: high
Serum FE: normal or low

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9
Q

What is the etiology of anemia of chronic disease?

A
  • hypoproliferative anemia associated with underlying chronic disorders like infection, inflammatory disorders (lupus/RA), malignancy
  • reduced production and repose to erythropoeitin, decreased RBC life span (CRF)
  • Defect in iron reutilization
  • Common in elderly/autoimmune
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10
Q

What are the lab values for anemia of chronic disease?

A

Normocytic, Normochromic, NL RDW
Hgb: Low
Hct: Low
RBC: Low
MCV: wnl
MCHC: wnl
RDW: wnl

Next step: ID cause/dictated by suspected cause (lupus, RA, CRF… ACUTE BLOOD loss also has these labs)

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11
Q

What is the etiology of Vit B12 deficiency anemia?

A
  • Vit B12 deficiency alters DNA synthesis and maturation of RBCs
  • Vit B12 deficiency develops secondary to lack or relative deficiency of intrinsic factor that leads to impaired vitamin B12 absorption (pernicious anemia) –> d/t autoimmune reaction involving gastric parietal cells OR hx of gastrectomy
  • Secondary to nutritional deficiency of vitamin, vegan diet is at risk
    -alcoholism
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12
Q

What are the lab values for vit B12 deficiency?

A

Macrocytic Normochromic
hgb: low
hct: low
rbc: low
MHC: high
MCHC: wnl
RDW high

Follow up labs: serum vit B12, RBC folate
vit B12 will be low

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13
Q

What is the etiology of folate-deficiency anemia?

A
  • folate deficiency alters synthesis of DNA and RBC maturation
  • folate deficiency can be caused by: malabsorption syndromes, increased demand (pregnancy), inadequate intake (alcoholics/elderly)
  • certain drugs can inhibit folate absorption: antacids, H2 antagonists, PPIs, metformin
  • MOST common megaloblastic anemia in pregnancy
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14
Q

What are the lab values for folate-deficiency anemia?

A

Macrocytic, Normochromic
hgb: low
hct: low
rbc: low
MCV: high
MCHC: wnl
RDW: high

Next steps: B12 and folate
- folate will be low

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15
Q

What is the etiology for sickle-cell anemia?

A

Chronic hemolytic anemia characterized by sickle-shaped RBCs
- autosomal recessive disorder where Hgb S develops instead of hgb A
- persons with ssd are homozygous for Hgb S
- prevalent in AA ancestry, also mediterranean

Labs:
hgb 7-9
mild leukocytosis
reticulocytosis
Hgb S 85-95% in SCD; 40% in trait

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16
Q

What is the etiology of beta thal/alpha thal?

A

through inherited genetic variation, small (microcytic), pale (hypochromic) cells that are all around the same size (NL RDW)
autosomal recessive
alpha thal: asian, african ancestry (AAA)
beta thal: african, mediterranean, Middle Eastern (BAMME)

17
Q

What are the lab values of beta thal/alpha thal?

A

microcytic, hypochromic, RDW wnl
hgb: low
hct: low
RBC: ELEVATED (make extra RBCs because they are small and pale)
MCV: low (microcytic)
MCHC: low (hypochromic)
RDW: wnl - all new cells are the same size

Next steps: hgb electrophoresis for evaluation of hemoglobin variants

18
Q

What are the causes of drug-induced macrocytosis, usually without anemia?

A

excess alcohol - most common (>/= 3 drinks/day for women, 5 for men))
Anti-epileptic drugs (carbamazepine, phenytoin)
methotrexate

19
Q

Lab values for macrocytosis without anemia:

A

hgb: wnl
hct: wnl
mcv: increased (macrocytic)
MCHC: wnl
RBC: wnl

20
Q

Treatment for macrocytosis without anemia?

A

Reversible when use of offending medication is discontinued… but usually not a reason to curtain the drug’s use, except for excessive alcohol intake

21
Q

S/S of ALL anemia

A

fatigue, weakness, exertional dyspnea, lightheadedness, anorexia
PE: palor, tachycardia, tachypnea

22
Q

S/S of specific to IDA

A

pica, HA
PE: nail changes (spoon shaped koilonychias); brittle nails, brittle/fine hair

23
Q

S/S specific to B12 deficiency anemia

A

insidious onset
GI disturbances - anorexia, bloating, diarrhea
SORE tongue
neurologic: peripheral paresthesia, ataxia
loss of taste and smell
PE: smooth, beefy-red tongue (glossitis), hepatomegaly/splenomegaly, jaundice, ataxia (+ Romberg), hyperactive reflexes, peripheral loss of sensation, change in mental state

24
Q

S/S specific to Sickle cell anemia

A

vaso-occlusive crisis: malaise, chills, pain esp in bones, abdomen, chest, lower legs, HA, epistaxis, vomiting, difficulty walking
PE: jaundice, cardiomegaly, renal disease

25
Q

S/S specific to folate deficiency

A

dryness of skin and mucous membranes
brittle nails and hair

26
Q

IDA Treatment

A

ID the cause of IDA and treat it!

Non Pharm:
- diet with increase iron content
- check 3 weeks after initiation of tx, and recheck in 6-8 weeks
- check every 3 months until stable
- continue increased iron at least 2-3 months after stable to increase stores

Pharm:
-Ferrous sulfate –> may need to continue 4-6 months to replenish iron stores; may d/c when serum ferritin is >/= 50mg/L

Patient ed:
- Iron absorption may be inhibited with concurrent use of antacids or calcium supplementaion
- Iron inhibits tetracycline absorption
- constipation and black stools are common SEs
- take with vit C to help absorption
- take on empty stomach to increase absorption
- take with food to decrease GI upset

27
Q

Tx of anemia of chronic disease

A

treat underlying condition

28
Q

Tx of vit B12 deficiency anemia

A

Vitamin B12 injections IM daily for 1 week, then weekly until Hct is wnl, then monthly for life
CI:
- alcohol decrease B12 absorption
-avoid if hypersensitivity to cobalt

29
Q

Tx for Folate deficiency anemia

A

Nonpharm: increase dietary sources of folic acid: legumes, leafy green vegetables, fruits, liver
Pharm:
- folic acid

CI
- long term corticosteroid use increases folic acid requirements
- folic acid may inhibit absorption of tetracyclines, can lower some anticonvulsant drugs

30
Q

Sickle cell anemia tx

A

treat infections to decrease risk of crisis
maintain oxygenation and hydration

31
Q

What supplements increase risk of bleeding?

A

Ginseng, Gingko, Fish oil

32
Q

What is neutrophilia and what is it associated with?

A

Increased neutrophils
bacterial infection
Increased Bands (young neutrophils) indicative of infection

33
Q

What is lymphocytocis and what is it associated with?

A

increased lymphocytes
virus

34
Q

What is monoocytosis and what is it associated with?

A

Increased monocytes/macrophages
cleans up debris –> elevated levels associated with the END of an infection

35
Q

What is Eosinophilia and what is it associated with?

A

increased eosinophils
allergens, parasites (worms, wheezes, weird diseases)

36
Q

What is Basophilia and what is it associated with?

A

Increased basophils
anaphylaxis

Midwifery Boards (11 decks)

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