Systems - heme - anemia

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jonas112
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239498
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Systems - heme - anemia
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2014-05-08 18:27:47
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Systems heme anemia
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Systems - heme - anemia
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  1. What are the causes of microcytic anemia?
    • TAILS
    • Thalassemia
    • ACD
    • Iron def anemia
    • lead poisoning
    • sideroblastic anemia
  2. What are the causes of normocytic anemia
    • Increased retics:
    •   -bleed
    •   -hemolysis

    • Decreased retics
    •   -ACD
    •   -renal/liver failure
        -marrow failure (e.g. aplastic anemia)
        -early iron deficient anemia
  3. What are the causes of macrocytic anemia
    • -Megaloblastic anemia(b12, folate deficiency)
    • -etOH
    • -drugs (e.g. methotrexate)
    • -liver disease
    • -hypothyroid
    • -MDS
    • -reticulocytosis
  4. What are the following PBS smears characteristic of? target cells, tear drops, spherocytes, elliptocytes, bite cells, sickle cells, fragments, nucleated RBCs, Roleaux, Schistocytes, auer rods
    • -target cells: thalassemia (many, micro); Fe def (few, micro); liver disease (macro)
    • -Weird shapes
    •   -tear drops: myelofibrosis
    •   -spherocytes: immune hemolysis, heriditary spherocytosis
    •   -elliptocytes: Fe deficiency
    •   -bite cells: G6PD deficiency
    •   -sickle cells
    • -fragments: DIC, mech heart valve
    • -nucleated RBCs: marrow inf, severe hemolysis
    • -Roleaux: MM, inflammatory states
    • -Schistocytes: HUS/TTP
    • -auer rods: AML
  5. When do you see hypersegmented WBC nuclei in PBS?
    B12 or folate deficiency
  6. What are the 4 major causes of iron deficiency anemia with some examples?
    • 1) decreased intake: ask about red meat
    • 2) decreased abs: low acid, gastric/duod problems
    • 3) increased demands: normal growth, preg, post op
    • 4) bleeding
  7. What would the iron studies show for IDA, thalassemia, and ACD?
  8. What Hb electrophoresis do you expect to see in thal beta major, thal alpha, sickle trait and sickle cell disease?
  9. Describe what pernicious anemia is all about.
    • -AI disease that attacks the parietal cells of the stomach
    • -causes loss of stomach acid and intrinsic factor
    • -causes B12 malabsorption
  10. Complications of Sickle Cell Disease (SICKLE mnemonic)
    • S: Strokes, Swelling of hands and feet, Spleen problems, Salmonella causes osteomyelitis
    • I: Infections, Infarctions
    • C: Crises (painful, sequestration, aplastic), cholelithiasis, chest synd., cardiac probs
    • K: Kidney probs
    • L: Liver disease, Lung problems
    • E: Erection (priaprism), Eye probs (retinopathy)
  11. What is the triad of HUS, pentad of TTP?
    HUS: hemolytic anemia, renal insufficiency, thrombocytopenia

    TTP: HUS + neurological signs and fever
  12. What does hydroxyurea do?
    lower WBC count, tmt for sickle cell
  13. When you have an elderly patient with Fe def anemia, what MUST you rule out?
    CRC
  14. What causes most macrocytic anemias?
    processes that screw with DNA synthesis
  15. Describe the spectrum in beta thal. (2)
    • Thal-major (0/2 beta genes present): severe anemia in first year, need chronic transfusions to survive
    • Thal minor (1/2 beta genes present): asymptomatic, but microcytic and hypochromic on PBS
  16. Describe the spectrum in alpha thal (4)
    • Hydrops fetalis (0/4 alpha genes present): die in utero
    • Hemoglobin H disease (1/4): chronic hemolysis, elevated retic count to compensate, skeletal changes because of increased erythropoiesis
    • alpha thal trait (2/4): low MCV, but usually asymp.
    • silent carrier (3/4): no signs or Sx of disease
  17. What dose for iron supplementation
    150-200 mg/day
  18. Describe the purpose of the following blood components:
    -erythrocyte
    -reticulocytes
    -neutrophils
    -eosinophils
    -lymphocytes
    -monocytes
    -basophils
    -platelets (magakaryocytes are progenitor
    -plasma
    -serum
  19. What does a left shift mean?
    increase in granulocyte precursors (e.g. blasts, myelocytes, etc) in the peripheral blood. Mean that there is increased marrow production because of some process.
  20. What does it mean if you see a normal or low reticulocyte count in the setting of anemia?
    a sign of decreased production
  21. How does hydroxyurea help in sickle cell disease?
    increases the production of HbF (fetal heme.), which decreases the production of HbS
  22. Differentiate warm and cold autoimmune hemolytic anemia based on:
    -Ab type
    -direct coombs test
    -PBS
    -agglutination temp
    • Warm and cold
    • -Ab type: IgG, IgM
    • -direct coombs test: positive for IgG, positive for compliments
    • -PBS: Spherocytes, agglutination
    • -aggultination temp: 37, 4-37
  23. What should you never give alone to someone with megaloblastic anemia?
    folate. It will just mask a B12 deficiency, and the neurological symptoms will persist

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