Rx Test Flashcards
Chest pain,dyspnea,splenomegaly, and mild normocytic anemia is most suggestive of an episode of …
sickle cell crisis (vaso-occlusive crisis), a complication ofsickle cell disease(SCD).
Acute chest syndrome in children
Pain is less frequent, and fever more common
Acute chest syndrome characteristics (in sicle cell disease)
Intense chest pain, dyspnea, coughing, normal WBC
Sickled RBCs …
Have more surface adhesion molecules than normal red cells, and they release inflammatory cytokines
Chloramphenicol used for?
Bacterial meningitis or rickettsial diseases, or used for patients who have life-threatening diseases and allergies to other antibiotics
Laboratory findings in aplastic anemia?
Normal TIBC , normal serum ferritin , normal haptoglobin , DECREASED reticulocyte count
Laboratory findings in B12/ folate deficiency?
Normal TIBC , normal serum ferritin , normal haptoglobin , INCREASED reticulocyte count
Basophilic stippling is observed in …
Lead toxicity , arsenic toxicity , sideroblastic anemia , and thalassemia
Burton lines?
Thin black-blue lines along the margin of the gums at the base of the teeth
Mutation type in sickle cell anemia?
Sickle cell anemia is an autosomal recessive disease caused by a MISSENSE MUTATION in the sixth position of the beta-chain of hemoglobin
Hereditary spherocytosis most commonly seen in patients of …
Northern European descent
Laboratory findings in sickle cell anemia?
Low hemoglobin and hematocrit, thrombocytosis and leukocytosis (due to vaso-occlusive crisis)
Sickling is facilitated by?
Increased temperature (fever), decreased pH (acidosis), and high mean corpuscular hemoglobin concentration (dehydration)
Pernicious anemia is associated with …
Other autoimmune disorders, such as thyroiditis
Pancytopenia
Low hemoglobin, hematocrit, WBC count, and platelet count
Cause of death in severe forms of beta-thalassemias?
Heart failure
Classic pentad of thrombotic thrombocytopenic purpura (TTP)?
Fever, neurological symptoms (delirium, seizure, and stroke), decreased renal function, thrombocytopenia, and microangiopathic hemolytic anemia
Risk factors in TTP?
Pregnancy, viral infections, malignancies, and autoimmune conditions.
TTP usually develops in previously healthy patients.
Laboratory findings in TTP?
Because the anemia is a microangiopathic hemolytic anemia, laboratory tests will demonstrate increased serumindirect bilirubin, decreased serumhaptoglobin, and visible schistocytes on a peripheral blood smear.
Target cells
RBCs with an outer ring of hemoglobin surrounding a central condensation of hemoglobin
RBC distribution width (RDW) in thalassemia and iron-deficiency anemia?
In thalassemia, the RBCs are fairly similar in size, meaning the RDW is either LOW or NORMAL.
While iniron-deficiency anemia, the RBCs get smaller and smaller as the iron deficiency progresses, leading to variability in RBC size and an INCREASE in the RDW.
Iron content in breast milk?
Approximately 0.35 mg/liter
Iron requirement in infants from 6 to 12 months old?
11 mg of iron per day
Decreased TIBC?
Hemochromatosis , hemosiderosis ,thalassemia ,hyperthyroidism ,nephrotic syndrome, andanemia of chronic disease.
Increased ferritin level?
Acute and chronicliverdisease,iron overload(hemochromatosis),end-stage renal disease, and chronic alcohol overuse, among others.
Increased reticulocyte count
Increasedreticulocytecounts occur afterbleeding, afterhemolysis, and in response to therapy.
Hemolysis indicatives?
Scleral icterus , increased reticulocyte count, increased lactate dehydrogenase , increased total bilirubin , and decreased serum haptoglobin
Oxidative stress in G6PD deficiency?
Oxidant drugs (eg,primaquineused formalaria,dapsone,rasburicase, fluoroquinolones, sulfonylureas), foods (fava beans), or infections triggers RBChemolysis, manifesting as fatigue (due to anemia), dark urine (due tourobilinogenin the urine), andjaundice(due to increasedindirect bilirubinafter hemolysis).
Sickle cell trait?
A heterozygous genetic condition in which there is one normal allele of hemoglobin beta and one of hemoglobin S (HbSA).
Patients are generally healthy ans asymptomatic, but may cause hematuria due to papillary necrosis.
In sickle cell trait papillary necrosis occurs …
Within the renal medulla, where sickling may occur because of its low partial pressure of oxygen andhypertonicand/or acidic environments. These conditions can be brought on by severepneumonia, high altitudes, or vigorous physical exercise with ensuingdehydration.
The papillary necrosis may cause?
Impaired ability to concentrate urine (isosthenuria). More uncommonly, patients may developchronic kidney disease(lowglomerular filtration rate) or increased urinary tract infections.
Complications in paroxysmal noctural hemoglobinuria (PNH)?
Chronic kidney disease,thrombosis, andpulmonary hypertension.
Pure RBCaplasiais characterized by?
Reducedhemoglobinandreticulocytecount in the presence of a normocytic,normochromic anemia.
Tha signs and symptoms of Fanconi anemia?
Pancytopenia(decreased RBCs, WBCs, and platelets) along with abnormal skin (pigmented spots), bones (wide thumbs), and facial findings (small eyes), predisposition to malignancy
Cause of morning hematuria in PNH?
Because of the concentrated nature of the morning urine (related to lack of fluid intake while sleeping) and due to increased hemolysis caused byhypoventilation, carbon dioxideretention, and decreased serum pH while asleep.
Bernard-Soulier syndrome is characterized by?
Mucocutaneous bleeding, increased bleeding times,thrombocytopenia, a lack of platelet aggregation on ristocetin and normal plasma testing, and giant platelets on peripheral blood smear.
vWD often presents with …
Epistaxis, menorrhagia, and prolonged bleeding immeadiately after an invasive procedure (ie, primary hemostasis)
Primary hemostasis?
Bleeding immediately after an invasive procedure
Secondary hemostasis (in hemophilia)?
Often exhibit appropriate hemostasis immediately after trauma or a procedure, they later exhibit hemorrhage into joints (hemarthrosis) or muscle compartments or even intracranial hemorrhage
Christmas disease?
Hemophiloa B (deficiency of factor IX ; X-linked recessive )
Factor XIIIa’s main function?
After being activated by thrombin in the presence of calcium, factor XIIIa’s main function is to covalently cross-link chains of fibrin and plasma fibronectin, reinforcing the fibrin plug (formation of covalent bonds between fibrin monomers and chains). Without factor XIII, a clot can form but is inadequate to maintain hemostasis
DIC noted by …
Multiple petechiae, ecchymoses, and active bleeding around the nose and mouth
Rhabdomyolysis
Or muscle necrosis, an acute, sometimes fatal disease in which the by-products of skeletal muscle destruction accumulate in the renal tubules and produce acute renal failure, other internal injury, and, occasionally, death
Classification of thrombolytics?
Nonfibrin-specific (streptokinase) , and fibrin-specific (alteplase - tPA)
Difference between nonfibrin-specific and fibrin-specific thrombolytics?
Evidence suggests that ribrin-specific thrombolytics work specifically on fibrin-bound plasminogen and are associated with less systemic plasmin activation and lower risk of bleeding compared with nonfibrin-specific thrombolytics
Chronic DIC presents with …
Malignancy, the more common presentation is thrombosis, which can result in depp venous thrombophlebitis (with the risk of pulmonary embolus), or superficial thrombophlebitis, and bleeding
Laboratory and clinical findings in chronic DIC?
Increased PT and D-dimers (also acute DIC), and mildly decreased hemoglobin, normal-to-low platelets in the setting of malignancy, mildly elevated INR, PTT
Prolonged wound bleeding, venous cords
HIT should be suspected as the cause of thrombocytopenia with significant thrombosis if any of the following conditions are observed:
- New-onset thrombocytopenia
- Venous or arterial thrombosis
- Necrotic skin injections at the heparin injection site
- Acute systemic reaction (eg, fever) after injection of heparin
Vitamin K deficiency bleeding of the newborn (VKDB)?
Presents 2 to 7 days after birth with gastrointestinal, intracranial, umblical, mucosal, circumcision site, and/or cutaneous bleeding
First-line therapy for patients with a PE?
Low-molecular-weight heparin
Blue-purple granules in RBCs after Wright staining?
Pappenheimer bodies, which are siderosomes, or iron bodies
Drepenocytes?
Crescent-shaped RBCs (sickle cells)
RBCs with missing semicircular portions?
Bite cells (in G6PD deficiency)