S/S and Dx Flashcards
Pt diagnosed with iron deficiency, but did not respond to tx.
What test will you use to diagnose?
How will you treat?
Alpha thalassemia
Get Hgb electrophoresis (Hgb H)***
Indirect bilirubin high. Hgb low. All other CBC studies could be normal.
Periph smear: Microcytosis, target cells, poikilocytes more pronounced than anemia
Treat with folic acid supplements
(Bone marrow transplants and splenectomy also used)
Your 6 month old patient is growing slowly, and seems to have an abnormal face structure with jaundiced skin. His family is concerned with his fast heart beat and how he sleeps more than other babies.
Whatcha think?
Dx?
Tx?
Beta thalassemia major
Get Hgb electrophoresis (Hgb F, A2)***
Indirect bilirubin high. Hgb low. All other CBC studies could be normal.
Periph smear: Microcytosis, target cells, poikilocytes more pronounced than anemia
Treat w/ transfusions
Prophylactically tx with deferoxamine or deferasirox
Can also do bone marrow transplant or splenectomy
Pt comes in with general complaints of fatigue, irritability, and a very heavy period.
Dx?
Tx?
Iron deficiency anemia
Dx by CBC: low Hgb, Hct
Iron panel: Fe, Ferritin low. TIBC high
Periph smear: hypochromic, microcytic. anisocytosis, poikilocytosis.
Tx by ferrous sulfate 325 mg po daily in escalating doses
Supplement with Vit C
Pt is fatigued, irritable, and has cravings for cold food and drink.
?
PICA = IRON deficiency
Pt has symptoms of anemia as well as brittle nails and dryness at corners of mouth. Tongue is smooth and shiny.
?
Severe iron deficiency
Pt has symptoms of anemia, but CBC labs and peripheral smear is completely normal. What could be going on? What should you order?
How should you treat?
Anemia of chronic disease - order BMP to find hepatic, kidney problems
Treat underlying disease; could give epo, transfusions, transplant
Your patient is 7 with a fever, fatigue, and pain over his sternum. You order a peripheral smear and a bone marrow biopsy. What are you expecting to see?
>20% blast cells to confirm leukemia
(acute lymphocytic leukemia)
Your patient is 27 with a history of cancer that has been treated with radiation therapy. She presents today with fatigue, easy bruising, recurrent nosebleeds, pain in her leg bone, and recurrent infections. Is it best to order a CBC or a peripheral smear? What will it show you?
Because she is symptomatic, this is most likely an acute leukemia.
Therefore, order a peripheral smear to look for blast cells. You will also want to look for Auer rods in AML.
Your patient is 57 presenting to you with non-specific symptoms of fatigue, weight loss, and loss of appetite. You order a CBC and see leukocytosis. If you are suspecting CML, what do you expect to see with a bone marrow bx?
What should you give for treatment?
Philadelphia chromosome - t(9,22)
Tx with imatinib
Your patient is 77 and is coming in for a routine physical. You get a CBC for the hell of it, and notice that his WBC count is at 100k. What should you do for treatment?
(CLL)
Since he’s over 65, probably watchful waiting.
Other options: chemotherapy
Option for younger candidate: stem cell transplant
