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49 Cards in this Set

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Symptoms of Iron deficiency Anemia
(5)*
Fe KAP:

Fatigue;
Exercise tolerance decrease;
Koilonychia (spoon nails);
Angular Cheilosis (cracking at mouth corners);
Pica (eating clay or ice); Pallor
Fe KAP
Iron Deficiency Anemia labs (high or low):

1. Hemoglobin/hematocrit

2. MCV

3. TIBC, ferritin
1. low

2. low

3. low
Dx:
38-yo male w/ HIV on HAART w/ macrocytosis. What is cause?
AZT
Dx:
28-yo alcoholic w/ diarrhea, cheilosis and glossitis

Tx?
Folate deficiency


Tx: oral folate
what is seen in Blood smear w/ Folate deficiency or Vitamin B-12 deficiency?
(3)
1. Macrocytosis (inc MCV)

2. Basophilic stippling

3. Hypersegmented PMN
Etiology of Vitamin B-12 deficiency?
(8)*
VITAMIN B:
Vegan;
Ileal resection;
Tapeworm (D. Latum);
Autoimmune (pernicious anemia);
Megaloblastic anemia;
Inflammation of terminal ileum;
Nitrous Oxide;
Bacterial overgrowth
VITAMIN B
Dx:
Anemic patient w/ paresthesias, positive Rhomberg, slowed reflexes, ataxia, dementia and glossitis

Tx?
Vitamin B-12 Deficiency


Tx: B-12 replacement IM
Definition:
Absence of Intrinsic Factor due to Ab against parietal cells, causing Vitamin B-12 anemia
Pernicious Anemia
(2) Dx tests for Pernicious Anemia
1. Anti-IF Ab levels


2. Schilling Test
What can Pernicious anemia lead to?
Gastric Cancer
Causes of Normochromic normocytic anemia
(3)
Bone marrow problems

Anemia of Chronic dz

Early deficiency in Iron, B-12 or Folate
Definition:
X-linked condition resulting in reduced Glutathione; leads to hemolysis of RBC w/ oxidative stresses
G6PD Deficiency
Dx:
35-yo Italian male presents w/ weakness, back pain and jaundice. He was started on Cipro 2 days ago for pneumonia
G6PD deficiency
Smear Dx:

Microcytosis; schistocytes; Heinz Bodies
G6PD deficiency
Dx:
Marrow failure resulting in severe pancytopenia
Aplastic Anemia
Dx:
normochromic, normocytic pancytopenia; low reticulocyte count, weakness, fatigue, mucosal bleeding, pallor
Aplastic Anemia
What patients need to avoid Parvovirus B-12?
(2)
Sickle cell anemia pt


Immunocompromised pt
Tx of choice for Aplastic Anemia
Bone marrow (stem cell) transplant
Etiology of Anemia of Chronic Dz
(3)
TB;

Malignancies;

Rheumatologic disorders
Dx:
Ferrin is normal -> increased;
Iron, TIBC and transferrin are decreased;
Erythropoietin is high
Anemia of Chronic Dz
Thalassemia trait (genetic defect of the alpha chain)most common in:

1. Asians

2. Africans
1. aa/--

2. a-/a-
AA substitution in Sickle cell
Valine for glutamine on Beta-chain
Indication for exchange transfusion in Sickle cell Dz
(5)*
SAP IT:

Stroke/TIA;
Acute Chest syndrome;
Priapism;
Intractable vaso-occlusive crisis;
Third-term pregnancy
SAP IT
Signs of Sickle cell
(6)*
SICKLE:

Splenomegaly;
Infection;
Cholelitiasis;
Kidney - hematuria;
Liver congestion; Leg ulcers;
Eye changes
SICKLE
Smear Dx:

Howell-Jolly bodies; odd-shaped RBC
Sickle cell
What should be given to reduce the recurrence of a sickle cell crisis?
Hydroxyurea
Difference b/t Warm and Cold Hemolytic anemia
Warm:
IgG to Rh factor;
no complement involvement

Cold:
IgM antibodies;
Fixes complement
Tx for Warm or Cold hemolytic anemias
Steroids
With what Dx do you see Cold Hemolytic Anemias?
(3)*
MMM:

Mycoplasma;

Mononucleosis;

Myleoproliferative disorders
MMM
What causes acute hemolytic transfusion reactions?
ABO incompatability

(usually human error)
Definition:
Myeloproliferative Dz that results in an increase in RBC in addition to mild increase in Leukocytes and Platelets
Polycythemia vera
Etiology of Primary (1) and Secondary (3) Polycythemia vera

Which has low vs. high erythropoietin?
Primary:
Bone marrow cause
(low erythropoietin)

Secondary:
Hypoxia (high altitdues, lung dz);
Smoking;
Renal Cell CA
(high erythropoietin)
Dx:
pruritus, plethora, splenomegaly, epitaxis, neuro symptoms (vision changes), inc RBC
Polycythemia vera
Tx for polycythemia vera
(2)

what additional Tx for Primary type?
Both types:
Serial Phlebotomy (dec blood volume);
Aspirin (prevent thrombosis)

Primary only:
Hydroxyurea (myelosuppression)
What is a late complication of polycythemia vera?
Bone marrow fibrosis
Most accurate test if suspecting B-12 or folate deficiency?
B-12 and Folate levels
Dx:
middle-aged man w/ gradual onset of fatigue, massive splenomegaly, enlarged liver and Pancytopenia

Most accurate test?
Hairy Cell Leukemia

test:
Tartrate-Resistant Acid Phosphase (TRAP)
Dx:
Pancytopenia and blasts in peripheral smear; greater then 20% blasts in bone marrow; Auer Rod on smear
Acute Myelogenous Leukemia
(AML)
What hemolytic disorder creates "Bite Cells"?

Hemolytic anemia can occur with this d/o in response to what type of drugs?
G6PD Deficiency

(formed when Heinz bodies are removed from the cells by the spleen)

drugs causing it: Sulfonamides
(Dapsone and Sulfasalazine)
With what disorders do you see fragmented cells like Schistocytes and Helmet cells?
(7)*
SHIT PAD:

Snake bites;
HUS;
Incompatible blood groups;
TTP;
PNH;
Artificial heart valves;
DIC
Dx:
microcytic anemia w/ elevated serum iron level in an alcoholic

Dx test?
Sideroblastic Anemia

Dx test: Prussian Blue stain
Dx:
recurrent hemolysis, big spleen, family history of anemia. CBC reveals anemia and high MCHC.

most accurate test?
Spherocytosis


most accurate test: Osmotic Fragility test
Most accurate test to Dx Sickle Cell?
Hemoglobin Electrophoresis
what hemoglobinopathies are assoc w/ Target cells?
(4)*
HITS the target:

Hemoglobin C disese (MC Dx);
Iron Deficiency anemia;
Thalassemia;
Sickle cell Dz
What do Tear Drop cells indicate?
a Bone Marrow Disease

(such as Myelofibrosis)
What (2) antibodies are seen w/ Pernicious Anemia?
1. Anti-Intrinsic Factor Ab

2. Anti-Parietal Cell Ab
What does "Bleeding Time" test specifically?
Tests the ability of the platelets to adhere to the endothelial lining of the capillary
A patient has abnormal bleeding that stems from a platelet disorder but the platelet count is normal. What test?

what (2) possible Dx?
Bleeding time

possible Dx:

1. Von Willebrand's Disease

2. Uremia-induced platelet dysfunction
Dx:
patient has intermittent dark urine in the morning, pancytopenia and large vessel thrombosis

Most accurate test?
Paroxysmal Noctournal Hemoglobinuria (PNH)

most accurate test:
Decay-Accelerating Factor (DAF)
(also known as CD55/59)