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35 Cards in this Set

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Anemia
Decreased RBC Count &/or Hgb & Hct
Three Categories of Anemia
1. Normocytic, Normochromic
(MCV: 80-100 fl)
(MCHC: 32-36%)
2. Microcytic, Hypochromic
(MCV: <80 fl)
(MCHC: <32%)
3. Macrocytic, Normochromic
(MCV: >100 fl)
(MCHC: 32-36%)
Normocytic, Normochromic
Aplastic Anemia
Hereditary Membrane Defects
Enzyme Defects
Hemoglobinopathies
Mechanical Trauma
Immune Hemolytic Anemia
PNH
Aplastic Anemia
(Normocytic, Normochromic)
Pancytopenia
*Retic count decreased
*Bone marrow hypocellular
Erythropoietin levels increased
Membrane Defect
(Normocytic, Normochromic)
(Hereditary Spherocytosis)
*Abnormal red cell morphology (target cells, spherocytes, stomatocytes, ovalocytes)
Retic count increased
*Osmotic fragility test increased or decreased
Enzyme Defect
(Normocytic, Normochromic)
(Glucose-6-phosphate dehydrogenase deficiency)
Abnormal red cell inclusions (Heinz bodies)
*G6PD or Pyruvate Kinase level decreased
Hemoglobinopathy
(Normocytic, Normochromic)
**Sickle cell anemia:
Sickle cells
*Retic count increased
*sicklesol test positive
*Hemoglobin electrophoresis shows presence of hemoglobin S
**Hgb C disease:
Hemoglobin C crystals and target cells on peripheral smear
Hemoglobin electrophoresis shows presence of hemoglobin C
Immune Hemolytic Anemia
(Normocytic, Normochromic)
*Spherocytes of peripheral smear
DAT positive
Mechanical Trauma
(Normocytic, Normochromic)
*Schistocytes on peripheral smear
PNH (Paroxysmal nocturnal hemoglobinuria)
(Normocytic, Normochromic)
Sugar water test
Ham's test positive
Microcytic, Hypochromic
Iron Deficiency Anemia
Thalassemias
Anemia of chronic disorders
Lead poisoning
Iron Deficiency Anemia
(Microcytic, Hypochromic)
*Ferritin decreased
*Serum iron levels decreased
*% saturation decreased
*TIBC increased
Retic count decreased
*RDW increased
Thalassemias (minor)
(Microcytic, Hypochromic)
*Iron studies normal
*RDW normal
*Red count normal or increased
*Hemoglobin electrophoresis abnormal with increased A2 or F
Anemia of Chronic Disorders
(Microcytic, Hypochromic)
(May also be Normocytic, Normochromic)
*Serum Fe decreased
*TIBC decreased
*% saturation decreased
*Bone marrow demonstrates an increase in storage iron
Lead Poisoning
(Microcytic, Hypochromic)
Increased blood lead levels
Basophilic stippling
Cabot rings in RBCs
Macrocytic, Normochromic
Megaloblastic Anemias
(B12 deficiency, Folate deficiency)
B12 deficiency
(Macrocytic, Normochromic)
*B12 levels decreased (neuro probs)
*Schillings test abnormal
*Ab to intrinsic factor positive if due to Pernicious anemia
*Hypersegs
*tear cells
Folate Deficiency
(Macrocytic, Normochromic)
*Folate levels decreased
*Schillings test normal
*Hypersegs
*tear cells
Iron Deficiency Anemia vs. Thalassemia Minor
Both are microcytic, hypochromic. IDA has a deficiency of iron leading to decreased production of heme which is needed to make hemoglobin. In the thalassemias there is a decreased production of globin chains which also are needed to make hgb.
ANLL(Acute Non-lymphocytic Leukemia) *aka AML
-primarily adults
Labs:
-Low RBC, Hgb & Hct
-WBC variable but usually high
-Platelet count usually low
-Primarily Blasts (myelo, mono, erythro or megakaryo) seen in bone marrow.
-Auer rods seen in myelo or monoblasts
ANLL (Acute Non-lymphocytic Leukemia) *aka AML
-primarily adults
Tests to confirm:
-Cytochemical stains
-Flow cytometry
-Chromosome Studies on Bone marrow
ALL (Acute Lymphoblastic Leukemia)
-primarily in children
Labs:
-Low RBC, Hgb, Hct
-WBC count variable but usually high
-Plt count usually low
-Primarily lymphoblasts seen in bone marrow
ALL (Acute Lymphoblastic Leukemia)
-primarily in children
Tests to confirm:
-Cytochemical stains
-Flow cytometry
-Chromosome studies on bone marrow
CML (Chronic Myelogenous Leukemia)
-primarily in 40s (fatigue, night sweats and low-grade fever; hepatosplenomegaly and sternal tenderness)
Labs:
-WBC usually >100,000/ul
-Low RBC, Hgb, Hct
-Myeloid cells in peripheral smear
-Increased number of eos and basos
-Plt count variable, usually high
-LAP score low
CML (Chronic Myelogenous Leukemia)
-primarily in 40s (fatigue, night sweats and low-grade fever; hepatosplenomegaly and sternal tenderness)
Tests to confirm:
-LAP stain: low score
-Chromosome studies: Philadelphia chrom.
CLL (Chronic Lymphocytic Leukemia)
-Primarily a disorder of older adults with 90% of cases seen in those over 50 and a median age of 65
Labs:
-WBC is generally >20,000/ul
-75-98% of circulating WBCs are lymphocytes
-Smudge cells are common
-Plt Count normal
-No additional tests needed to confirm
Hairy Cell Leukemia aka Leukemic Reticuloendotheliosis
-primarily in middle aged men around the age of 55. Usually present with splenomegaly, fatigue and some type of infection
Labs:
-Total pancytopenia
-Hairy cell lymphs on peripheral smear
-Bone marrow: dry tap
Hairy Cell Leukemia aka Leukemic Reticuloendotheliosis
-primarily in middle aged men around the age of 55. Usually present with splenomegaly, fatigue and some type of infection
Tests to confirm:
-Tartrate Resistant Acid Phosphatase Stain (TRAP): positive
Multiple Myeloma
-older adults with a median age of 65. Patients present with anemia, bone pain due to lytic bone lesions, infection, renal failure
Labs:
-Low RBC, Hgb & Hct
-Excessive Rouleaux formation on blood smear
-Increased number of plasma cells in bone marrow and occasionally in peripheral blood.
-ESR >150 mm/hr
-Protein electrophoresis demonstrates a monoclonal peak.
-Elevated serum calcium levels
Multiple Myeloma
-older adults with a median age of 65. Patients present with anemia, bone pain due to lytic bone lesions, infection, renal failure
Tests to Confirm:
*Immunoelectrophoresis: increase usually in IgG, IgM or IgA
Hodgkin's Lymphoma
-20s & over the age of 50. Pts present with a painless mass most commonly in the neck. Other clinical features include fever, weight loss, night sweats or generalized purities
Labs:
-Most screening lab tests will be normal. May see increase in eosinophils on peripheral smear.
Hodgkin's Lymphoma
-20s & over the age of 50.
Pts present with a painless mass most commonly in the neck. Other clinical features include fever, weight loss, night sweats or generalized purities
Tests to confirm:
-Lymph node bx
-Reed-Sternberg Cells
Non-Hodgkins Lymphoma aka malignant lymphoma
-Variable in presentation and course; ranging from indolent disease to rapidly progressive illness
-Present with painless lymphadenopathy
-Peripheral blood smear normal
-Confirm dx with lymph node bx
-Often progress to a chronic or acute lymphocytic leukemia
Infectious Mononeucleosis
-WBC count low
-Reactive Lymphocytes high
INR
used to standardize reporting results on stable, long term coumadin therapy pts