Anemia Flashcards.txt

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BostonPhysicianAssist
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Anemia Flashcards.txt
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2012-01-30 08:12:24
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Anemia MMD II exam I
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  1. Anemia Flashcards
  2. What % of normal blood is made of RBCs?
    45%
  3. What is a normal WBC range?
    4.5-11.0K/uL
  4. Segs is the lab aka for what type of cell?
    Mature Neutrophil
  5. What is a Band?
    Immature Neutrophil
  6. What are the normal Ranges for a WBC differential?
    • Nobody Likes My Bad Education (60,30, 6,3,1)
    • Neutrophil
    • Segs- 54-62%
    • Bands- 3-5%
    • Lymphocyte 25-33%
    • Monocyte 3-7%
    • Eosinophil 1-3%
    • Basophil 0-0.75%
    • Atypical Lymphocytes 0
  7. What are the granulocytes?
    • Neutrophils
    • Eosinophils
    • Basophils
  8. What are the agranulocytes?
    • Monocytes
    • Lymphocytes
  9. What are the 3 types of Hemoglobin?
    • Hgb Type A (97%)
    • Fetal Hgb (1%)
    • Hgb A2 (2%)
  10. What 2 chromosomes contain genes to code for the hemoglobin molecule?
    Chromosome 16 and 11
  11. A myeloblast gives rise to which WBCs?
    • Neutrophil
    • Basophil
    • Eosinophil
  12. What is an immature RBC called?
    Reticulocyte
  13. Horomone made in the liver that is increased with an increase of the cytokines IL6, IL-1 and TNF alpha
    Hepcidin
  14. Hepcidin causes a (increase or decrease) in iron absorbtion and release from cells
    Decrease. Thus inflammation causes a rise in hepcidin release which causes a decrease in available iron for RBC synthesis. Anemia of Chronic disease
  15. Hypoxemia in the kidneys triggers the release of ____, which causes the bone marrow to (increase or decrease) RBC production
    EPO, Increase
  16. Sx of Anemia include
    • Weakness
    • Tiredness fatigue
    • Dyspnea
    • Dizzy
    • Palpitations
    • New Angina
  17. A patient with Hx of alcohol abuse, gait problems and chief complaint of weakness and fatigue most likely has what anemia?
    B12 deficiency, Macrocytic anemia
  18. Hx of gastric surgery predisposes a person to this anemia
    B12 deficiency anemia
  19. Abnormal craving of ice, clay or starch is called
    Pica
  20. In a patient with Icterus you would want to consider what group of anemias?
    Hemolytic anemias
  21. Glossitis and Cheilitis are symptoms of which anemias (2)?
    Iron deficiency anemia, B12 deficency anemia
  22. Koilonychia is a sx of what anemia?
    Iron deficiency anemia (spoon fingernails)
  23. Decreased vibratory and position sense is a sign of what anemia
    B12
  24. Normal adult male Hgb
    15.5 +/- 2 mg/dL
  25. Normal adult female Hgb
    13.5 +/- 2 mg/dL
  26. Normal adult female Hct
    41.0 +/- 6%
  27. Normal adult Male Hct
    46% +/- 6%
  28. Normal RBC cell count in normal adult male
    4.3 to 5.9 million/uL
  29. Normal RBC cell count in normal adult female
    4.0-5.2 million/uL
  30. What is a normal reticulocyte count?
    0.5-2.0%
  31. The number of new young red blood cells found in 100 RBCs in circulation is called the what?
    Reticulocyte count
  32. Test that differentiates the difference between an anemia that occurs because of bone marrow failure vs hemorrhage or hemolysis
    Reticulocyte count
  33. What is a normal corrected reticulocyte percentage?
    1-2%
  34. How do you correct a reticulocyte count?
    • Raw reticulocyte count multiplied by pts hematocrit/45 OR
    • Raw reticulocyte count multiplied by the pts hemoglobin/14
  35. Macrocytic anemias have an MCV > ______
    94
  36. Microcytic anemias have a MCV < ____
    80
  37. Normocytic anemias have a MCV of between ___ and ___
    80-94
  38. This value measures the weight of the hemoglobin in average RBCs
    MCH (mean corpuscular hemoglobin) low= hypochromic high= hyperchromic
  39. This value measures the concentration of hemoglobin inside the RBCs
    MCHC (mean corpuscular hemoglobin concentration) Hypochromic vs hyperchromic
  40. This lab value measures the space occupied by the average RBC
    MCV microcytosis vs normocytosis, vs macrocytosis
  41. This lab value indicates the variation in RBC width
    Red Blood cell distribution width
  42. This lab value helps to determine if you have anicytosis
    Red blood cell distribution width
  43. Blood condition characterized by red blood cells of variable and abnormal size
    Anicytosis
  44. What is a normal platelet count?
    150-400K cell/uL
  45. Poikilocytosis
    An increase in abnormal red blood cells of any shape where they make up 10% or more of the total population
  46. What test is used to detect different types of Hgb? (especially in hemoglobinopathies)
    Hemoglobin electrophoresis
  47. Name the Microcytic anemias
    TICS- Thalassemias, Iron deficiency anemias, Chronic inflammation, Sideroblastic anemia
  48. This anemia is associated with Lead poisoning
    Sideroblastic anemia
  49. Normal daily Fe requirements for a male is __mg, a menstruating female is __mg and a pregnant female is __mg
    1,2,3-4
  50. Name a few causes of Iron deficiency anemia
    • Occult GI bleed
    • Excessive menstrual losses
    • Poor dietary intake
    • Pregnancy
    • Blood donation
  51. Anemia of Iron deficiency will have a ___ reticulocyte index, a ___ MCV, ___ serum iron, ____TIBC, ____ saturation of transferring and ____ serum ferritin
    Anemia with a low reticulocyte index, a low MCV, a Low serum iron, a HIGH TICB, a LOW saturation of transferritin and a Low serum ferritin
  52. What is the treatment for Iron deficiency anemia?
    Ferrous Sulphate 300mg 3X daily with Vit C for better absorbtion and a Workup for the cause of the anemia
  53. What should you NOT give to a pt with Thalassemia?
    Iron supplements
  54. This anemia is characterized by genetic abnormalities which cause a decreased synthesis of the alpha or beta chains leading to decreased production of hemoglobin A
    Thalassemia
  55. This Anemia has normal or elevated serum iron, abnormal hemoglobin electrophoresis, abnormal peripheral blood smear, an increase in indirect bilirubin an increase in LDH and an increase in serum haptoglobin
    Thalassemia
  56. Severe anemia that presents in the first year of life with Jaundice, Hepatosplenomegaly, growth retardation, frequent infections, skeletal changes from expanded marrow and iron overload with skin pigmentation and cardiac decompensation
    Beta Thalassemia Major
  57. Target cells and Basophilic stippling
    Beta thalassemia
  58. Pts with beta thalassemia will have an (increased or decreased) reticulocyte count, a (increased or decreased) serum iron percent saturation, a (increased or decreased) ferritin, a (increased or decreased) marrow iron
    • Increased reticulocyte count
    • Increased serum iron percent saturation
    • Increased ferritin
    • Increased marrow iron
  59. What is the treatment for beta thalassemia major?
    Supportive with chronic infusions, chelation therapy with desferoxamine for iron overload and early bone marrow transplant if suitable donor exists
  60. Alpha thalassemia has a higher incidence in what populations?
    Southeast asia, Mediterranean area, African/African decent
  61. Is hemoglobin electrophesis normal or abnormal in alpha thalassemia?
    Normal
  62. Microcytic, hypochromic anemia with Normal ferritin but decreased serum iron and a decreased TIBC with low saturation
    Anemia of Chronic inflammation
  63. In this anemia, cytokines and hepcidin block the transport of iron stores to bone marrow
    Anemia of Chronic inflammation
  64. How do you treat Anemia of Chronic inflammation?
    Treat the underlying disorder
  65. What are the causes of Sideroblastic anemia?
    • Lead toxicity
    • Genetic or myelodysplastic syndromes
    • Medications such as Isoniazide or pyrazinamide
    • ETOH abuse/chronic inflammation
  66. A microcytic hypochromic anemia with basophilic stippling increased serum iron, TIBC normal, Increased iron saturation and increased serum ferritin
    Sideroblastic anemia
  67. What is the treatment for Sideroblastic anemia?
    • Supportive transfustion
    • Desferrioxamine (chelating agent) used for iron overload secondary to transfusions
    • Bone marrow transplant
  68. What are some tests you would run on a patient whom you suspect has a normocytic anemia?
    • Blood urea nitrogen (BUN)
    • Creatinine
    • AST
    • Alakaline phosphatase
    • Bilirubin
    • Erythrocyte sedimentation rate
    • Creactive protein
    • Urinalysis
    • Thyroid profile
    • Pregnancy test
  69. Name some causes of Aplastic anemia
    Radiation, chemotherapy, toxins, drugs, SLE, Autoimmune suppression of hematopoiesis by Tcell mediated cellular mechanism
  70. Anemia resulting from bone marrow failure from injury to or abnormal expression of hematopoietic stem cell
    Aplastic anemia
  71. �Pancytopenia�
    Aplastic anemia
  72. There are NO immature or abnormal forms seen on the blood smear of this anemia that stems from hypocellular bone marrow
    Aplastic anemia
  73. Causes of Aplastic anemia
    Radiation, chemotherapy, toxins, drugs, SLE, Autoimmune suppression of hematopoesis
  74. You have a pt who is being treated for a liver cancer for which they are receiving alternating rounds of Chemo and Radiation. They present to you for their check up with weakness, fatigue, signs of diffuse candidal infection in the mouth along with purpura and petchiae on the buccal mucosa when you scrape the white plaque for a KOH, You do a complete exam on them and find no splenomegally and some hepatomegally that you noted is unchanged from when you found their cancer, they also have not lymphadenopathy that would indicate cancer spread, what type of anemia do you suspect? AND how would you treat?
    • Aplastic Anemia
    • Mild cases are treated with supportive care, transfusions, antibiotics as needed, for severe aplastic anemia they can be treated with allogenic bone marrow transplantation
  75. What is the cause of Megaloblastic anemias in general?
    Impaired nuclear maturation secondary to defective DNA synthesis
  76. Group of anemias with a decreased reticulocyte count an increased MCV and macroovalocytes
    Macrocytic anemia
  77. Which group of anemias will you also see neutropenia, hypersegmented neutrophils and thrombocytopenia with large platelets?
    Macrocytic
  78. You see cells that indicate a macrocytic anemia on a peripheral smear what tests do you want to order on that patient?
    Measurement of the serum B12, serum folate, RBC folate, THEN� TSH and bone marrow biopsy
  79. What class of drugs blocks vit B12 absorbtion?
    PPIs
  80. Pts on Metforman are at risk for what anemia?
    B12
  81. Your pt with macrocytic anemia has low levels of recovered cobalamin on the Schilling�s test, what does this mean?
    They have malabsorbtion or a deficiency of intrinsic factor which is causing their pernicious anemia
  82. How is a Schilling�s test performed and what does it measure?
    Patients are administered cyanocobalamin IM on day 1 to saturate their intestinal mucosal cells. This first dose is then followed by an oral dose of radiolabled B12 on day 2 excess cobalamin that is not absorbed is excreted in the urine and collected over 24 hours. If the levels of collected cobalamin are low then this indicates a malabsorbtion of B12 presumably due to a lack of intrinsic factor, if the levels are normal they may indicate diet insufficiency.
  83. Lack of intrinsic factor is what anemia
    Pernicious anemia
  84. You have an adventurous 21 y.o. m patient who just came back from a trip to Africa where he states he ate all the local foods even though some looked raw still. He says that despite this, he ate well while he was there and had adequate food intake in the week since he has been back, but despite this he has lost 15 pounds. He is also worried about his other symptoms of fatigue, paresthesias and inability to �think straight� in college. Upon exam you note a smooth tongue and decreased vibratory sense on his toes, with normal exam on his hands and ankles. You suspect what anemia secondary to what other disease process? What is the treatment?
    TAPEWORM EWWWWW it is impairing his absorbtion of B12 causing pernicious anemia, Kill the tapeworm, and cobalamin 1,000 mg IM
  85. What are some signs and symptoms of B12 deficiency
    Anemia, weakness, fatigue, syspnea, paresthesias mental clouding, edema, pallor, jaundice, smooth tounge, decreased vibratory and position sensation and peripheral neuropathy
  86. What is the treatment for vitamin B12 deficiency
    Cobalamin 1,000mg IM injection for 8 wks followed by monthly injections for life
  87. What are some lab findings that you will see with B12 deficency
    • Megalocytic red cell indicies
    • Low hemoglobin, hematocrit and RBC levels
    • Peripheral smear shows anisocytosis and pokilocytosis
    • Hypersegmented granulocytes
    • Pancytopenia
    • Positive schillings test
    • Decreased serum B12
    • Nucleated red blood cells on blood film
    • Decreased reticulocytes and RPI
    • Megaloblastic cell morphology in marrow
  88. What will you see on a peripheral blood smear of a pts with vitamin B 12 deficency
    Anisocytosis and pokilocytosis and pancytopenia
  89. Who is more likely to get folic acid deficiency a young pregnant woman or an older male who takes a vitamin supplement
    Young pregnant woman
  90. How can you increase folic acid in your diet?
    Fruits and vegetables uncooked
  91. Folic acid deficiency is caused by several different mechanisms give an example of each of the following, dietary deficiency, decreased absorbtion, increased requirement, loss, inhibition of ability to convert to active form
    • EtOH or anorexix patients
    • Phenytoin, trimethoprim sulfamethoxazole, sulfasalazine tropical sprue (decreases absorbtion)
    • Chronic hemolytic anemia, pregnancy, exfoliative skin disease
    • Dialysis
    • Methotrexate
  92. Anemia with decreased serum iron, decreased serum folate and decreased RBC folate
    Folic acid deficiency
  93. What is the treatment for folic acid deficiency
    Folic acid 1mg PO a day
  94. In folic acid deficiency what drops first? The serum folate? Or the RBC folate?
    Serum
  95. Your patient has elevated indirect bilirubin, elevated serum lactate dehydrogenase and decreased haptoglobin levels what type of anemia do you suspect?
    Hemolytic anemia
  96. What is the HALMARK of hemolysis?
    Elevated reticulocyte with stable or falling hemoglobin
  97. You have a pt with hemoglobinemia and hemoglobinuria what type of anemia?
    Hemolysis
  98. �Heinz Body�
    G6PD deficiency
  99. This is an X-linked genetic syndrome that is precipitated by oxidant drugs
    G6PD deficiency
  100. What are Heinz bodies and how do they lead to anemia?
    Denatured hemoglobin in the RBCs they cause membrane damage that leads to their removal by the spleen
  101. What are some things a pt with G6PD deficiency should avoid?
    Antimalarials, aspirin, sulfa drugs, fava beans
  102. Pt comes into your ER complaining of something called a
    • �pain crisis� what do they have?
    • Sickle cell
  103. You see crescent shaped RBCs on smear
    Sickle cell
  104. What can you give a sickle cell pt long term to help decrease the number of pain crises?
    Hydroxurea and hydration
  105. You have a sickle cell pt in aplastic crisis what should you do to treat
    Transfusion

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