Week 8 - Lecture 3 Flashcards
IgM, IgG, IgA, IgD, and IgE are all known as ___ ___.
gamma globulins
___ is the first antibody formed in response to the acute phase of an infection. (1st time of activation of Herpes)
IgM
___ is the second antibody formed in response to reactivation of an infection. (2nd, 3rd, 4th time of activation of Herpes).
IgG
___ is known as the barrier antibody, and is found in breast milk, saliva, tears, and urine. (Helps protect against life-threatening diarrhea).
IgA
___ is the antibody of allergies, responsible for anaphylaxis. It drills a hole in the ___ cells.
IgE, mast
What do you need to make happy healthy RBC’s?
good genes
Bad genes and hemoglobinopathies l/t ___ ___ anemia.
sickle cell
Can’t determine Hgb disorder until infant is ___-___ months of age. This is when the “adult” Hgb is formed.
5-6
Too much ___ can cause clotting.
erythropoietin
___ causes a low metabolic rate. And decreased metabolism decreased the prod of ___.
Hypothyroidism, RBC’s
Low Hgb in adult, think ___ ___. Low Hgb in peds, think ___ ___.
GI bld, iron defic.
Children need iron from ___ for ___ growth.
food, vertical
Pregnant pt’s need extra ___ for baby to develop properly.
iron
Kids w/___ dis tend to be shorter in stature compared to other children their age.
celiac
You need a healthy ___ to absorb iron. ___ dis primarily involves the duodenum.
duodenum, Celiac
Pt’s w/gastric by-pass and duodenal exclusion sgy’s need to be on ___ supplement.
iron
You need ___ in the stomach in order to absorb iron.
acid
PPI’s (prilosec, nexium, protonix) suppress ___, which doesn’t allow for ___ absorption.
acid, iron
Consider log-term ___ suppression w/PPI’s as a cause of ___ defic.
acid, iron
Tests for iron excess/defic include: serum ___, total iron ___ ___, and serum ___.
ferritin, binding capacity, iron
Serum ferritin in male = ___-___
female = ___-___
20-250
10-120
Serum ferritin levels ___ in menopausal women.
increase
Need ___ for RBC prod. Stored in the liver for 5-7 yrs.
B12
Pork, eggs, dairy, fish, brewer’s yeast, and meat all have high levels of ___.
B12
Vegetarians are at high risk for ___ deficiency.
B12
___ is a co-factor in the prod of serotonin, and maintains CNS myelin and PNS myelin.
B12
B12 deficiency is also known as ___ anemia.
pernicious
Small intestines are involved in Crohn’s dis, so need ___ shots.
B12
___ is transported to ___ for storage, and ___ ___ for RBC prod.
liver, bone marrow
Pt’s w/liver failure will most likely have ___ defic.
B12
High risk groups for B12 defic include: over age ___ (probs w/absorption), lack of ___ ___, ___ (no animal protein in diet), pt’s in ___ ___, ___ (deplete B12 storage in liver), ___ (celiac dis, crohn’s dis, gastric by-pass sgy), and meds like ___ and ___.
55, intrinsic factor, vegetarians, liver failure, malabsorption, Metformin, PPI’s
B12 defic is the #1 cause of ___. However, this is reversible by giving supplement. This is when B12 levels are below ___.
dementia, 200
S/E of too much Vit B12 is ___ ___.
anal itching
___ ___ maintains neural tube in pregnant pt’s.
Folic acid
Need ___ ___ for maintenance of healthy RBC’s.
folic acid
Foods high in ___ ___ include: green leafy’s, citrus fruits, fortified cereals, and breads.
folic acid
Bactrim/TMP, methotrexate, phenytoin/dilantin, and OCP’s are all drugs that block ___ ___ synthesis. Need to supplement pt’s on these meds.
folic acid
Stem cells, erythroblasts, pronormoblasts, normoblasts, and reticulocytes all reside in ___ ___.
bone marrow
Reticulocytes and erythrocytes reside in ___ ___.
peripheral blood
Normal RBC count = ___-___ million.
4.5-6
All “blast” cells should be in ___ ___, not in ___ ___.
bone marrow, periph bld
If the cell contains a nucleus, it is a ___ cell.
blast
It takes 7-12 days to make and release a ___ from the bone marrow. Therefore, need to wait this amt of time before getting a ___ count if injured.
reticulocyte, reticulocyte
Spleen can regenerate before age ___.
12
High retic counts means that the bone marrow is making ___, but something is destroying them rapidly.
RBC’s
___-___ are the population at highest risk for sickle cell anemia and is ___.
African-Americans, genetic
Normal retic count = ___-___%
0.5-1.5%
1 autoimmune hemolytic anemia dis in African-American women is ___.
lupus
+ Coombs test would most likely indicate ___. It means an autoimmune process w/antibodies against ___.
lupus, RBC’s
A low retic count is underproduction ___. Can be caused by deficiency of ___, ___, or ___ ___, and also ___.
anemia, B12, iron, folic acid, chemo
Normal Hgb females = ___-___
males = ___-___
11-15.5
13-17.3
The ___ of the RBC also helps define anemias.
size
MVC stands for ___ ___ ___. Normal MCV = ___.
mean cell volume, 90
MCV of 65 is ___ anemia. MCV of 90 is ___ anemia. MCV of 120 is ___ anemia.
microcytic, normocytic, macrocytic
Marathon runners, pumping too much iron, NSAIDS, and PPI’s typically cause ___ defic anemia
iron
Lead poisoning is cause of ___ anemia.
microcytic
___ is best value to look at to help determine true anemia dx.
MCV
___ (aka SGOT) is ___-___ and is found in many tissues.
AST, non-specific
___ (aka SGPT) is found almost exclusively in liver cells and is highly specific for the ___.
ALT, liver
If ALT elevated, question ___ exposure, too much ___, and drug effects such as ___.
hepatitis, alcohol, tylenol
Normal AST = ___-___
Normal ALT = ___-___
8-20
10-40
Normal AST/ALT ratio ~ ___. If > 1, consider ___. ___ is especially sensitive to alcohol.
1, alcohol, AST
If alcohol dmges liver cells, the ___ will increase higher than the ___.
AST, ALT
Will see elevated ___ in liver enzymes w/hypothyroidism.
TSH
3 most common causes of unexplained ALT elevations include: chronic ___ ___, ___ liver dis, and ___ ___ liver dis.
hepatitis C, alcoholic, nonalcoholic fatty
Pt’s who received bld trans before July 1992 at higher risk for ___ ___
Hepatitis C
Nonalcoholic steatohepatitis (NASH) is defined as steatosis + significant liver ___, characterized by presence of ___ infiltrates l/t ___, ___, and ___.
inflam, inflam, fibrosis, cirrhosis
Obesity, diabetes, males more than females, drugs (prednisone, methotrexate, amiodarone, tamoxifen, nifedipine, diltiazem) are all causes of ___-___ ___ liver dis.
non-alcoholic fatty
Other causes of elevated liver enzymes include: cleaning ___, Vit ___ toxicity (by eating too much liver), ___, and ___ products (yerba tea, skull cap, mistletoe)
chemicals, A, alcohol, herbal
Meds that can cause drug-induced liver injury include: ___ (not to exceed 4gm), ___ steroids (used by athletes), ___ (risovastatin), ___ (motrin), ___ (tx for a-fib), ___ (mood stabilizer), ___ (anti-seizure), ___, and ___.
acetaminophen, anabolic, statins, NSAIDS, amiodarone, rheumatrex, depakote, ING, Imuran
Viral causes of elevated liver enzymes include: ___ ___, caused by ___-___ transmission (salad bar/buffet)
Hepatitis A, fecal-oral
Hepatitis B risk factors include: ___ transmitted, transmitted via ___ in NB, ___ drug use, and ___ ___ before July 1992.
sexually, placenta, IV, bld trans
Hepatitis C risk factors include: ___ drug users, ___ ___ injury, ___ ___ before July 1992, pt’s who have ever received ___, children born to ___-infected moms.
IV, needle stick, bld trans, hemodialysis, HCV
Secondary risk factors for Hepatitis C include: sexual transmission w/___ partners, ___ ___ use, ___, and ___.
multiple, intranasal cocaine, tattoos, piercings
Any disturbance in the synthesis, secretion, or excretion of bile l/t the accumulation of ___ ___ in the liver. This in turn increases the synthesis of ___ ___.
bile acids, alkaline phosphatase (ALP)
ALP is a sensitive indicator of ___.
cholestasis
___ is bound to bone, so will be ___ during growth spurts in kids. Will also see elevated in ___ dis, ___, and metastatic dis to ___.
ALP, increased, Paget’s, osteosarcoma, bone
W/pancreatitis, you will see a fast and high rise of ___ w/in 12 hrs.
amylase
2 major causes of pancreatitis are:
alcohol, gallstones
Creatine kinase (CK) is stored in ___-energy tissues. Is found in ___ muscle, ___ muscle, and the ___.
high, skeletal, cardiac, brain
CK-MB = \_\_\_ muscle CK-MM = \_\_\_ muscle CK-BB = \_\_\_
skeletal
cardiac
brain
When on statins and c/o muscle aches/pains, draw a ___ to r/o ___.
CK-MB, rhabdo
LDH___ is most common elevation usually d/t ___ muscle dmg (banged knee or bumped into something)
5, skeletal
Draw a ___ ___ if pt c/o CP or having MI.
troponin T
___ ___ is a structural protein, not a serum enzyme.
Troponin T
___ ___ is elevated in ___ necrosis and is more specific than ___ b/c remains elevated for 3-14 days.
Troponin T, cardiac, CK-MB
___ ___ rises in 3-12 hrs, peaks at 24, down in 3-14 days.
Troponin T
If Troponin T not elevated 6-9 hrs after CP onset, ___ ___ ___ not likely.
acute coronary syndrome
