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101 Cards in this Set
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- Back
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progenitor cells develop where
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in the marrow - b lymph migrate to the lymph tissues and make antibodies
t lymph migrate to thymus and fight infection |
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EPO is produced in the kidneys and is stimulated by what
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presence of low blood o2 tension
increased androgens increases number of stem cells for rbc formation |
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stem cells turn to RBCs in how long
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one week
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retic mature in how long
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24 hours
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when RBCs break down to iron and billirubin, the iron then binds to what to develop new RBCs
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transferrin
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these cause what in retic count:
pregnancy newborn hemolytic anemia sickle cell thallesemia hemorrhage with successful treatment of anemia |
increase
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this causes a what in retic count:
iron def aplastic pernicious anemia chronic infection radiation marrow tumor endocrine disorder myelodyplastic syndrome |
decrease
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how do you calculate the retic index and what is normal
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HCT/HGBx2, then x retic count
>2% normal >3% hemolysis or bleed <1% decreased production of RBCs |
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what is anisocytosis and poiklocytosis
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variation in RBC size
variation in shape of RBC |
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what does a bone marrow aspiration reveal
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MM
plasma cell myeloma leukemia anemias neoplastic disease agranulocytosis - decreased WBCs platlet dysfunction |
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on PE
1. causes koiolonychia - spoon nail 2. jaundice, splenomegaly 3. glossal sings, neuro signs 4. lymphadenopathy or HIV |
1. iron def
2. hemolytic 3. pernicious 4. malignancy |
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what are the two basic mechanisms of anemia
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1. decreased RBC production
2. Increased RBC destruction or loss |
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What are some causes of decreased RBC production in anemia
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nutrition - iron, vitamin b12 or folate
endocrine disorder - thyroid or adisons anemia of chronic disease EPO deficiency Bone marrow depression - aplastic anemia Marrow replacement - leukemia myelodysplastic syndrome |
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what are the causes of increased RBC destruction or loss
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acute blood loss
hemolytic - intrinsic: G6PD, sickle cell extrinsic: Immiune, TTP, HUS, mechanical heart valve |
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what are MCV type anemias
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microcyctic - iron, thalessemia, ACD, lead toxicity
macrocytic - Vit b12 or folate, liver disease, myxedema, myelodysplasia, increased retic count |
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in microcytic anemia:
what is the MCV, retic count, and MCV:RBC ratio |
MCV <80
Retic <1% MCV:RBC >13 unless thallesemia |
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what are causes of iron def anemia
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child - food
women - menses pathologic - colon cancer NSAID/ASA pregnancy or lactation intestinal parasite inadequate iron intake - elderly, ETOH, IBD PICA |
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what are the 3 most common causes of iron def anemia
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1. GI loss - colon, ulcer, IBD, cancer, intestinal parasite
2. GU loss - uterine cancer, myoma, menses, hemorrhage 3. Diet - poor iron from fasting, malabsorption, celiac |
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what are signs of anemia
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pallor
tachy chelitiis glossitis koilonychia nails |
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in iron def anemia what is:
MCV MCHC peripheral smear Retic count platlets serum ferritin and iron TIBC transferrin transferrin % |
MCV - low
MCHC - low peripheral smear - pencil, aniso or poilkocytosis Retic count - low platlets - high serum ferritin - low serum iron - low TIBC - high transferrin - low transferrin % - low |
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what is management of iron deficiency of anemia
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FIND CAUSE
if elderly - r/o GI bleed if need iron - sulfate 325mg TID Fumarate Niferex - expensive, less GI SE |
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when do you prescribe parental iron
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intolerant to oral
GI disease - IBS gastric bypass |
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when will you see improvements in iron def anemia
1 week 3 weeks 2 months 6 months |
1 week - increase retic count
3 week - HCT 50% improved 2 months - back to normal 6 months - until stop treatment |
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what are causes of ACD
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secondary to infection, inflammation,
have adequate iron stores, just not available or EPO, shortened RBC life bc of inflammation or neoplasm MM Hodgkins leukemia RA - trap iron into macrophages chronic organ faliure - kidney or liver Thyroid Pituitary tumor Gonad or adrenal issue |
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what laboratory findings will you see with ACD:
MCV MCHC Retic count serum iron serum ferritin TIBC transferrin transferrin % |
MCV - low or normal
MCHC - low or normal Retic count - low serum ferritin - elevated or normal TIBC - low serum iron - low transferrin - low transferrin % - low |
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this is a genetic disorder common in SE asia and china, mediterranean
alpha and beta chain issue |
thallesemia
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what is contraindicated in thallesemia
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iron
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what will you see on labs for thallesemia
MCV RBC H and H Ferritin TIBC Hemoglobin electrophoresis LDH Billirubin |
MCV - low
RBC - normal H and H - low Ferritin - high or normal TIBC - low or normal Hemoglobin electrophoresis - low alpha or beta chains LDH - high Billirubin - high |
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this is a genetic disorder with abnormal hemoglobin that l/t chronic hemolytic anemia
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sickle cell
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what is some sequela of sickle cell
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retinolpathy
necrosis of bone pulmonary htn vascular occlusion |
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this is an x-linked enzyme defect affecting 10-15% of black males
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G6PD
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what happens in G6PD and what does the peripheral smear show
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episodic hemolysis in response to oxidative drugs - bacterium, macro bid, plaquenal, nitrites, and to infection, moth balls, lava beans
peripheral smear - Heinz bodies and bite cells |
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what are causes of normocytic anemia
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1. decreased production buy marrow or ACD
2. increase destruction - acute loss, hemolytic anemia, hyperspleenism |
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what are causes of normocytic anemia and increased retic count
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hemolytic anemia
hyperspleenism |
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what are causes of normocytic anemia and low retic count
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bone marrow failure or ACD
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what are causes of extrinsic hemolytic anemia
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intravascular hemolysis
TTP ITP Malignant hypertension Preeclampsia/eclampsia Lupus Scleroderma Chemicals - arsenic, copper, lead infection - malaria, parasitic |
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what are extrinsic causes of autoimmune hemolytic anemia
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Warm - idiopathic, CLL, lymphoma, SLE
Cold - idiopathic, mycoplasma, mono newborn - RH, ABO incompat |
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what laboratory findings are in hemolytic anemia
bilirubin haptoglobin LDH CO2 production Glycosated hgb Reticulocytosis Urobilirubin |
bilirubin - high
haptoglobin - absent LDH - high CO2 production - high Glycosated hgb - low Reticulocytosis - high Urobilirubin - high |
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what are causes of folate deficiency
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dietary - malabsorbtion
ETOH Elderly Pregnancy - increased utilization Chemo Genetics Hemolytic anemia |
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what lab value is elevated with folate def
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homocystene
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what is the treatment for folate deficiency
what else should you screen and who should automatically be treated with folate |
1-2mg daily of folate
always check b12 women of childbearing, on anti-sz or INH |
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what are causes of B12 def
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vegans
autoimmune - pernicious gastric bypass, illeal resection gastrectomy IBD - crohns parasitic infection atrophic gastritis - elderly LT PPI |
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what are symptoms of B12 and Folate deficiency
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B12 - parasthesias, gait disturbance, weakness, intellectual or personality change, dementia, diminished proprioception, vibratory sensation
smooth tongue yellow pallor folate - malnurished |
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can neuro symptoms occur without anemia
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yes - peripheral nerves and parasthesias are first
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what laboratory findings do you see in macrocytic anemia
MCV Folate B12 LDH Billirubin Anti-intrinsic antibodies Platlets WBC |
MCV - high
Folate - low in folate def B12 - low in b12 def LDH - high Billirubin - high Anti-intrinsic antibodies - positive in b12 Platlets - low WBC - low |
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when do you check a methylmalonic acid level
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with B12 at borderline 170-240 - if anemia will be above 1000
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what is the treatment for b12 def
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injection 1g weekly x6
PO 1200mg daily will have transient low K |
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what are other anemias caused by decreased production of RBC:
anemias and endocrine |
hypothyroid
pituitary disfuncton addisons disease loss of androgen production in males aplastic anemia - pancytopenia |
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what anemia causes pancytopenia - decreased RBC, WBC, Platlets
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aplastic anemia
|
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what are causes of aplastic
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chemicals
hereditary virus idopathic - most |
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what are causes of bone marrow failure
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ETOH
sulfa drugs Antisz Chemo Aplastic anemia most common Retic <0.5% hypo cellular bone marrow |
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this is malignant proliferation of totipotential marrow stem cells. Increased production of RBC, WBC, and platelets independent of EPO or tissue hypoxia
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polycythemia vera
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what is relative polycythemia
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plasma volume increase
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what is absolute polycythemia
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increased RBC, abnormal EPO production bc of cyst, tumor, or from hypoxia - COPD, high altitude, OSA, cyanotic heart disease
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secondary polycythemia shows what lab values
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normal WBC and platelets
RBC indices normal seen with hypoxia |
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primary polycythemia shows what lab values
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increased RBC, WBC, splenomegaly all with normal O2 saturation
platelets increased, B12 increased |
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what are symptoms of polycythemia
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HA, dizziness, vertigo, tinnitus, visual change, pruritis
thrombosis enlarged spleen engorged retinal veins |
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what does spontaneous bleeding occur with platlets
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<20,000
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what are causes of thrombocytopenia
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decreased bone marrow production
increased peripheral destruction - autoimmune, lupus, graves, HIT, drugs - ASA/NSAID, TTP, DIC, prosthetic heart valve congentitial - von wilderband uremia |
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this is a female with history of lupus, in for fatigue, jaundice and weakness
labs: RDW increased Retic increased No Haptoglobin Increased Billirubin |
hemolytic anemia
|
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this is a 72 year old female here for fatigue, tired, pale, thin
FH - cancer and stroke Hx - gerd and anxiety Labs: LOW: rbc, h and h, mcv, mchc, serum iron, ferritin HIGH: TIBC |
iron deficiency anemia
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this is a 64 year old female with fatigue x 12 months, on exam no vibratory sensation and decreased sensation.
what labs will you check on her |
b12 anemia -
b12 folate cbc - wbc TSH CMP - kidneys intrinsic factor |
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this is a 75 year old with spontaneous bleeding
HX - ESRD, DM, HTN, HL, Hyperthyroid, Bcomplex def, CAD Labs: LOW RBC, H and H, MCV, MHCH WNL Platlets 12 what tests do you check, what do you suspect |
TTP
HIT panel DIC panel Retic count |
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what are the granulocytes in WBC
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neutrophils
eosinophils basophils |
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what are the agranulocytes in WBC
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monocytes
lymphocytes |
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what is granulopoesis
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process of differentiation from earliest to mature neutrophil - 7-11 days if on demand mature in 48-72 hours
metamyelocyte, myelocyte are neutrophils in bone marrow |
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what are bands
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new immature replacement cells for aged neutrophils, usually small number
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what is the difference between degeneration shift and regeneration shift to the left with bands
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regeneration is increase in bands with leukocytosis - good prognosis
degeneration is with no leukocytes - poor |
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what are causes of neutropenia
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nutrition - b12, folate, copper
infection - mono, hepatitis, TB aplastic anemia endocrine disorder leukemia lymphoma |
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what are the levels of neutropenia
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<500 severe
mild 1000-1500 |
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what is at risk with neutropenia
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infection - gram + - and fungi
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this is elevated in allergic responses, parasites and others - lupus, scleroderma, RA, sordid and hashimotos
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eosinophils
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these are increased in allergic responses and mechanical irritation, becomes mast cells, contain histamine, bradykinin, serotonin, and heparin
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basophils
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these are immature macrophages, live in circulation for 36 hours then migrate to lymphoid tissue where they remain for months to years
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monocytes
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these are mature b-cells and t-cells
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lymphcytes
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when are monocytes elevated
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TB
recuperation from sepsis or bacteria leukemia |
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what are causes of lymphocytosis
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viral infections - first cell to enter, seen with leokocytosis or leukopenia - EBV, CMV, Mono, Hepatitis
CLL and ALL |
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Lymphopenia is caused by what
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Hodgkins
steriods immunosuppresents - chemo HIV |
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this is leukemia in childhood, issues with relapses and sequel of chemo
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ALL
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what are symptoms of ALL
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malaise
bone pain bruising, ecchymosis hepatosplenomegaly CN palsy lymphadenopathy |
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what will you see on exam with ALL
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low - platelets, neutrophils, RBC
elevated lymphocytes |
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this affects the lymph tissue, b-lymphocytes, there is an accumulation of normal but ineffective lymphocytes
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CLL - most common form
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what are symptoms of CLL
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fatigue
night sweats bleeding anorexia satiety lymph and spleen enlarged |
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what are hallmark lab findings of CLL
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isolated lymphocytosis - WBC >20,000 and lymph 75-98%
normal hgb, platlets bone marrow shows small lymphocytes |
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this is cause by increased production of granulocytes, incidence increases with age, about 25-30% survival rate
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AML
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what are symptoms of AML
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SOB
fatigue bleeding HA MS change |
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what are lab findings of AML
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pancytopenia with blast cells
low platelets, neutrophils high uric acid increased LDH + DIC |
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this is associated with philadelphia chromosome, disorder of middle age - 42 years, genetic
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CML
|
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what are symptoms of CML
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leukocytosis
anemia, low platelets - or normal increased LDH and uric acid philadelphia chromosome |
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what disease is positive for Reed-Sternberg Cells in the lymphocyte line
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Hodgkins
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what are the RF for hodgkins
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ages 20-30 and over 50
in white males, high socio EBV excellent cure |
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this is increased with increased HIV
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non-hodgkins
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how is non-hodgkins different than hodgkins
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less orderly spread of lymph, asymptomatic swelling of lymph nodes, enlarged spleen and liver
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what is a common plasma cell disorder
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MM
|
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what are hallmark diseases in MM
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anemia, RF, bone destruction, increased calcium, infection
|
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what are RF for MM
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males
blacks radiation enviromental toxins 50-70 years |
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what are symptoms of MM
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bone pain
pathological fractures - lumbar/thoracic, ribs, skull, pelvis recurrent infections n/v confusion |
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what is tested in MM for diagnosis
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plasma protiens - M
urine protiens - M by electrophoresis - abnormal immunoglobulins **BENZ-JONES PROTIEN in urine - RENAL INSUFFICIENCY |
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a 22 yr female with seizures, on seizure meds
Labs: normal WBC 5300 Lymph 75% Neutrophils 10%, absolute 530 what is your diagnosis and how would you manage |
neutropenia
need precautions - report fever talk with neurologist about switching medication |
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a 36 year old female with URI/malaise, night sweats x 4 weeks presents with pancytopenia. what do you suspect
|
AML
|
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78 year male with 6 weeks of LBP after moving fridge
15pound weight loss Hx prostate cancer Labs: CBCD, X-ray of back, get serum protein electrophoresis - + what do you suspect |
MM
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