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Heme/Onc > Signs & Symptoms of Hematologic/Oncologic Disease > Flashcards

Signs & Symptoms of Hematologic/Oncologic Disease Flashcards

1
Q

Is Venipuncture a Clean or Sterile procedure?

A

Clean.

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2
Q

Is a Blood Culture a Clean or Sterile procedure?

A

Sterile.

Blood cultures look for infection in the blood (bacteria or fungi).

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3
Q

In venipuncture, where would you obtain blood from an adult? A child?

A

Adult - Cubital fossa

Child - Heel, or Scalp

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4
Q

When would you obtain an Arterial Sample?

A

When you need fresh blood - for coma & critically ill patients.

Determines gas exchange levels in the blood in relation to respiratory, metabolic, and renal function.

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5
Q

What symptom(s) is/are shared among anemias?

A

Fatigue & Pallor.

  • Pallor on conjunctiva, nails, and lips.
  • Oxygen is not getting to body tissues.
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6
Q

What is the minimal laboratory work-up you need to determine anemia?

A

CBC w/ diff Peripheral Blood Smear (usually)

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7
Q

Where is Multiple Myeloma located?

A

In the bones, specifically plasma cells

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8
Q

What is in a CBC w/ Differential?

A
  • Hemoglobin (Hgb) - oxygen carrying protein in RBCs
  • Hematocrit (Hct) - % of RBCs in blood
  • Red blood cell count
  • White blood cell count
  • Platelet count
  • Reticulocyte count - Bone Marrow function assessment
  • RDW
  • MCV - measures RBC volume
  • MCH
  • MCHC - measures Hgb concentration
  • Neutrophils; Neutrophils, Absolute
  • Lymphocytes; Lymphocytes Absolute
  • Monocytes; Monocytes Absolute
  • Eosinophils; Eosinophils Absolute
  • Basophils; Basophils Absolute
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9
Q

Normal Peripheral Blood Smear

A

“A normal peripheral blood smear indicates the appropriate appearance of red blood cells, with a zone of central pallor (of the RBC) occupying about 1/3 of the size of the RBC.” - Utah School of Medicine (see image below)

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10
Q

Iron Deficiency Anemia - CBC example

A
  • Decreased MCV
  • Decreased Hgb
  • Decreased Hct
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11
Q

Anemic - Hemoglobin Level

A
  • Men:
    • Hgb >13.5g/dL
    • (or) Hct <41%
  • Women
    • Hgb <12.0g/dL
    • Hct <36%
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12
Q

Falsely Anemic, or normal “H+H” levels in:

A
  • Acute Active Bleeding
    • H+H levels may appear normal, but…
      • ~36-48 hours after blood loss, you will see the levels decrease due to compensattion
  • Pregnancy
    • “physiologic” or dilutional anemia
  • Volume depletion
    • (hemo-concentrated)
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13
Q

Microcytic RBC

A
  • Mean corpuscular volume (MCV)
  • Iron deficiency
  • Talassemia
  • Lead poisoning

Mean corpuscular volume = avg. volume of RBCs

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14
Q

Macrocytic RBCs

A
  • MCV >100
  • Larger RBCs
    • Vit. B12 deficiency
    • Folate deficiency
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15
Q

Just like this image for reference sake…

A
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16
Q

Normocytic RBC

A
  • MCV btwn 80-100
    • Anemia of chronic disease
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17
Q

Anemia - Low RBC Count

A
  • Fatigue
  • Pallor
  • Exertional dyspena (compensatory)
  • Dyspnea at rest
  • Palpitations
  • Roaring pulse heard in ears
  • Rare: Lethary, confusion, CHF, angina, arrhythmia, AMI
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18
Q

Anemia - Low RBC Count

Other signs of anemia

A
  • Bounding pulses (3+)
  • Lymphadenopathy
  • Hepatosplenomegaly
  • Bone tenderness, esp over the Sternum
    • Lots of blood cells made in sternum
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19
Q

Iron Deficiency Anemia

A
  • Most common medical disorder WORLDWIDE
  • Children = poor diet
  • Adults = blood loss (Melena, Menses)
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20
Q

Iron Deficiency Anemia

Signs & Symptoms

A
  • Fatigue
  • Cheilitis & glossitis
  • Pica & pagophagia
  • Koilonychia
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21
Q

Iron Deficiency Anemia

Labs

A
  • Serum Ferritin <15mcg/L
  • Increased Total Iron Binding Capacity (TIBC)
    • Elevated b/c transferritin not binding to iron
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22
Q

Vitamin B12 & Folate Deficiency

A
  • Megoblastic anemias
  • High risk for Development:
    • Older Adults
    • Alcoholics
    • Pure Vegans
    • Malnourished
    • Pts. w/ gastric bypass & GI Diseases
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23
Q

How long does it take Vit. B12 deficiency to develop? Folate?

A
  • Vit B12: Takes years to develop
  • Folate: 4-5 months
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24
Q

Work-up for Vit. B12 & Folate Deficiency

A
  1. Check Vit. B12 & Folate levels
    1. If low B12 - not good b/c neurologic issues
  2. Check Methylmalonate (MMA) & Total Homocysteine levels
    1. If Vit. B12 Deficiency: Both are elevated
    2. If Folate Deficiency: Only Total Homocysteine is elevated
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25
Q

Vit. B12 Deficiency

Signs/Symptoms

A
  • Paresthesias:
    • ​Decreased proprioception/postion & vibratory sense
  • Gait disturbance
  • Glossitis
  • Anorexia/Diarrhea
  • Late Finding: Alerted Mental Status

**Irreversible Neurological Damage can occur if not diagnosed correctly!!

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26
Q

Treatment of Vitamin B12 Deficiency

A
  • Parenteral B12
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27
Q

Pernicious Anemia

A
  • B12 Deficiency caused by lack of Intrinsic Factors
  • Associated with other autoimmune d/o (thyroid & T1DM)
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28
Q

Pernicious Anemia

Signs and Symptoms

A
  • Skin tingling/burning
  • Glossitis
  • Fatigue, dyspnea
  • Leg weakness or spasms
  • Imbalance while standing (especially at night)
  • Dementia
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29
Q

Pernicious Anemia

Lab Finding

A
  • Antibodies to Intrinsic Factor (IF)
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30
Q

Pernicious Anemia

Treatment

A

B12 (intramuscular; shots or pills)

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31
Q

Thalassemia

A
  • Genetic Defect
    • Impaired production of globin chains
  • Beta and Alpha Minor are Asymptomatic
  • Beta Major - not good…
  • Alpha Major - Incompatible with extra-uterine life
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32
Q

Thalassemia

Beta Major

A
  • Profound hypochromic, microcytic anemia w/ bizzare RBC Morphology
    • Target Cells
  • Heterozygotes - Much more mild symptoms
  • Homozygotes - More severe; life-long transfusions
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33
Q

Thalassemia

Beta Major

A
  • Signs/Symptoms of Beta Major:
    • ​Pallor
    • Growth retardation
    • HSM, Jaundice
    • Abnormal skeletal development
    • “Chipmunk” face
34
Q

Thalassemia

Beta Major

A
  • Treatment:
    • Life-long transfusions
35
Q

Sickle Cell Anemia

A
  • Production of Abnormally-Shaped RBCs
    • Subtype causing anemia
    • Homozygous Hemoglobin S
  • Will present by age
  • RBCs lose function
    • Vaso-occulsion
    • Hemolysis
  • Autosomal Recessive Diease
    • Must inherit gene from both parents
36
Q

Sickle Cell Anemia

Signs & Symptoms

A
  • Dactylitis
    • Acute pain in hands and/or feet
  • Joint Pain
  • Splenic Sequestration: Pooling of blood in Spleen
  • Splenomegaly - b/c spleen is trying to clean this up!
  • Multiorgan/Multisystem Dysfunction or Failure
  • Infections, Pain, Fatigue
37
Q

Sickle Cell Anemia

Tests

A
  • Peripheral Blood Smear
  • Blood test screens for hemoglobin S — the defective form of hemoglobin that underlies sickle cell anemia
  • “Every state in the United States, the District of Columbia, and the U.S. territories require that every baby is tested for SCD as part of a newborn screening program.” -NIH
38
Q

Sickle Cell Anemia

Painful Episode

(previously known as “Sickle Cell Crisis”)

A
  • No identifiable cause
    • Lasts 2-7 days
  • Can affect any area of body
  • Pain is Trivial to Excruciating!!
  • 1/2 of episodes accompained by:
    • Fever
    • Swelling
    • Tenderness
    • Tachypnea
    • HTN
    • N/V
39
Q

Sickle Cell Anemia

Acute Chest Syndrome

A
  • Leading cause of Death in Patients w/ SCD
  • Unclear etiology
  • Vaso-occulsive crisis
  • “Radiodensity (consolidation) on chest XR plus Fever and/or Respiratory Symptoms
40
Q

Sickle Cell Anemia

Acute Chest Syndrome

Signs & Symptoms

A
  • Temperature >38.5ºC
  • Tachypnea
  • Intercostal retractions, nasal flaring, accessory muscle use
  • Chest Pain
  • Cough, wheezing, rales
  • Do not miss this Dx – Progresses Rapidly!!!
  • Can see on XR
41
Q

Sickle Cell Anemia

Acute Chest Syndrome

Treatment

A

Broad Spectrum Abx

ICU Admission

42
Q

Glucose-6-phosphate deydrogenase (G6PD) Deficiency

A

Most common enzymatic disorder of RBCs in the world!

  • Found most often in those w/:
    • African
    • Middle-Eastern
    • Mediterranean
    • or Asian descent
43
Q

G6PD Deficiency

A
  • G6PD protects RBCs against oxidant injury
    • Hemolysis occurs
  • Triggers: Infection, Drugs, Chemicals, Fava Beans
44
Q

G6PD Deficiency

Signs & Symptoms

A
  • Asymptomatic
  • Jaundice (neonatal, hyperbilirubinemia)
  • Pallor
  • Dark Urine
    • +/- Abdominal Pain
45
Q

G6PD Deficiency

Tests

A
  • Peripheral Blood Smear:
    • Heinz Bodies
    • Bite cells
  • Screening Tests:
    • Fluorescent Spot Test
      • Detects:
        • Generation of NADPH from NADP
46
Q

G6PD Deficiency

Treatment

A
  • Avoid Triggers- Drugs, chemicals, fava beans
  • Transfusions
47
Q

Aplastic Anemia

A
  • Types:
    • Inherited congenital bone-failure syndromes:
      • “Fanconi’s”
  • Potential Causes of Acquired:
    • Viral Infection
    • Drugs
    • Toxic Chemicals
    • Autoimmune
48
Q

Aplastic Anemia

A
49
Q

Aplastic Anemia

Inherited Bone-Failure Syndromes

A
  • Signs & Symptoms:
    • Abnormal Skin Pigmentation
    • Short Stature
    • Renal, Cardiac, GI Abnormalities
    • Microcephaly
    • Hypogonadism
    • Skeletal anomalies
50
Q

Aplastic Anemia

Acquired Aplastic Anemia

A
  • Signs & Symptoms (insidious onset):
    • Pallor
    • Petechiae
    • Purpura
    • Ecchymosis
    • Mucosal & Gingival Bleeding
    • Vaginal Bleeding
    • Active Bacterial Infections

*Lots of associations w/ different things; have not found exact cause

*Unable to clot, lots of bleeding

51
Q

Anemia of Chronic Disease

A
  • Associatedd with infectious, inflammatory, or neoplastic disease
    • CKD, RA, leukemia, HIV, Hep B/C, etc…
  • Typically, normochromic, normocytic, hypoproliferative & mild in degree
  • Treat the cause!
52
Q

Anemia of Chronic Disease

Pathogenesis

A
  • Reduction in RBC production by bone marrow
  • Mild shortening of RBC survival
  • Inability to increase erthyropoesis in response to anemia
53
Q

Lead Poisoning

A
  • Often caused by:
    • Lead Exposure at Work
    • Look at Pt. Hx and occupation during exam
    • Painters, construction workers, etc…
    • Those who live in older houses
  • Dx: Blood Lead Level >80mcg/dL
  • Tx: Chelation
54
Q

Lead Poisoning

Signs & Symptoms

A
  • “Lead colic”
    • Abdominal Pain
  • Anemia - Microcytic
  • Headache, Irritability
  • Confusion

*Don’t miss this Dx!!! – Irreverisible damage to the Nervous sys, kidneys, other organs…

55
Q

Lead Poisoning

A
56
Q

Polycythemia Vera

A
  • Myeloproliferative Disorder
    • Bone Marrow can Overstimulate
  • Often incidental finding on CBC
    • Hemoglobin >18.5 in men or 16.5 women
    • Persistent Leukocytosis & thrombocytosis
      • Elevated Platlets & WBCs
57
Q

Polycythemia Vera

Signs & Symptoms

+

Treatment

A
  • Signs/Symptoms
    • Splenomegaly
    • Headache
    • Generalized puritis (post-bath)
    • Unusual thrombosis
    • Erthromelalgia
      • Hands change colors!
      • Normal pulse
  • Treatment: Phlebotomy
    • Try to get rid of the RBCs
58
Q

Coagulopathies

A
59
Q

Coagulopathies

Factor V Leiden

A
  • Most common
    • Inherited hypercoagulability
      • Caucasian
  • Risk of venous thromboemolism
    • DVT
  • Ask patient about Hx of clotting
    • PMH and FH
  • Tx: Anticoagulation if clot, decrease clotting risk via lifestyle
    • Do NOT go on estrogen
60
Q

Coagulopathies

Immune Thrombocytopenia

A
  • Acquired
  • Caused by autoantibodies against platelet antigens
    • Viral infections, autoimmune
  • Triggers: Viral infections & systemic conditions (ex: SLE)
    • Disrupt immume homeostasis
  • Exam: Petechaie, purpura, epistaxis
  • TX – glucocorticoids, IVIG
61
Q

Coaglopathies

Hemophilia

A

Lacks clotting factors

  • X-linked recessive
  • Hemophilia A - lacks Factor VIII
  • Hemophilia B - lacks Factor IX

Usually presents around age 1-1.5yo

62
Q

Coagulopathies

Hemophilia

Signs and Symptoms

A
  • Easy bruising
  • Hemarthrosis
    • 80% of hemorrhage occurs in joints

*Late complications: Intracranial hemorrhage, Joint destruction

63
Q

Coagulopathies

Hemophilia

Labs & Treatment

A
  • Lab Test: Prolonged PTT
  • Treatment: Prothrombin complex concentrates (PCC) & Human Factor VIIa
64
Q

Coagulopathies

Von Willebrand Disease

A
  • Most common inherited bleeding disorder
  • Platelets have normal morphology, but lack Factor VIII/vWF complex
    • Adherance issues
  • Platelet count is normal, just CANT adhere
65
Q

Coagulopathies

Von Willebrand Disease

3 Types

A

3 Types:

  1. Mild to Moderate Decrease in vWF
  2. Dysfunction of vWF
  3. Absolute lock of vWF
66
Q

Coagulopathies

Von Willebrand Disease

Signs & Symptoms

A
  • Easy bruising w/ hematoma
  • Skin bleeding
  • Prolonged bleeding from mucosal surfaces
    • Epistaxis, Dental/Surgery, GI, menorrhagia

Ask:

  • Do you bleed a lot after the dentist?
  • Do you have a very heavy period?
67
Q

Coagulopathies

Von Willebrand Disease

Diagnosis & Treatment

A
  • Diagnosis:
    • Increased Bleeding time
    • Normal Platelet Count
  • Treatment:
    • DDAVP for mild mucosal bleeding
      • Desmopression
        • Acts by increasing circulation levels of Factor VII and vWF
    • Von Willebrand factor replacement therapy
    • Antifibrinolytic medications
    • Some contraceptives
68
Q

Oncology

Multiple Myeloma

A
69
Q

Multiple Myeloma

Complaints, signs, symptoms

A
  • Common complaints:
    • atraumatic back pain
  • Signs/Symptoms:
    • Bone pain
    • Fatigue/generalized weakness
    • Weight loss (unexplained)
    • Compression fractures
70
Q

Multiple Myeloma

XR, Tests, Biopsy, PE

A
  • XR:
    • “punched-out” lesions
      • See through the skeleton
      • Radiolucent - air instead of bone
  • Lab:
    • Hypercalcemia
    • Renal Insufficiency
    • Anemia
  • Bone Marrow Biopsy (sup/inf iliac crest)
  • PE:
    • Decreased reflexes
71
Q

Leukemia

Types

A
  • Acute lymphoblastic leukemia (ALL)
  • Chronic lymphocytic leukemia (CLL)
  • Acute myeloid leukemia (AML)
  • Chronic Myeloid Leukemia (CML)

*Acute - Rapid increase in immature WBCs; “Blast Cells”

**Chronic - Excessive buildup of mature, but still abnormal WBCs

72
Q

Leukemia

A
  • Cause - unknown
  • Common in children
    • 90% in adults
73
Q

Leukemia

Risk Factors

A
  • Risk Factors:
    • Smoking
    • Ionizing Radiation
    • Chemicals (eg Benzene)
    • Prior Chemo
    • Down Syndrome
    • Family Hx of Leukemia
74
Q

Leukemia

Signs & Symptoms

A
75
Q

Leukemia

Diagnostic Studies

A
  • CBC w/ diff
    • Leukocytosis
      • Increase in WBCs
        • A hallmark
    • Anemia: Low H+H
    • Thrombocytopenia
  • Peripheral Blood Smear & Bone Marrow Biopsy Abnormalities
  • Gene Testing
    • Philadelphia Chromosome
      • in CML
76
Q

Leukemia

Treatment

A
  • Combination of:
    • Chemo
    • Radiation
    • Bone Marrow Transplant
    • and/or watchful waiting!
77
Q

Lymphoma

Signs and Symptoms

A
  • Painless Lymphadenopathy
  • “B” Symptoms (in agressive lymphoma)
    • Fever >38C
    • Weight Loss >10% over past 6 months
    • Night Sweats (drenched)
  • Pruritis (generalized)
  • Anorexia
  • SOB (if nodes become restrictive)
  • Mediastinal Mass
78
Q

Lymphoma

Hodgkin’s

vs.

Non-Hodgkin’s

A
  • Hodgkin’s =
    • Reed-Sternberg Cell
  • Non-Hodgkin’s
    • Reed-Sternberg Cell NOT Present!

Diagnosis: Lymph node biopsy

79
Q

Lymphoma

Hodgkin’s Lymphoma

A
  • Most common malignancy of head & neck in children (mostly teens)
  • Ages:
    • 15-35, >55
  • Exam:
    • Non-tender, firm, rubbery consistency cervical and/or supraclavicular node(s
    • Mediastinal mass on routine chest x-ray
80
Q

Lymphoma

Non-Hodgkin’s Lymphoma

A
  • Most common type
    • 60,000/yr in U.S.
  • Can die quickly
  • Group of 20+ types
    • eg. Burkitt lymphoma - fastest growing tumor, most common in abdomen
  • Exam findings:
    • Lymphadenopathy below clavicles, multiple peripheral nodes
81
Q

Neutropenic Fever

A
  • Cancer patients receiving chemotherapy - at risk for invasive infection due to colonizing bateria and/or fungi that translocate across GI muscosal surfaces
    • Bacteria can translocate
  • Fever may be earliest and only sign of infection
  • Recognize it early!
    • Initiate broad-spectrum abx to avoid sepsis/possible death
82
Q

Neutropenic Fever

A
  • Neutropenia defined as:
    • Absolute Neutrophil count
      • <500 cells/microL
  • Fever >38.3°C
  • Onocologic Emergency!!!
  • ANC = total WBC count x percentage of polymorphonuclear cells (PMNs) and bands
  • Chemo kills all WBCs

Heme/Onc (5 decks)

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