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60 Cards in this Set
- Front
- Back
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Etiology of Aplastic Anemia
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bone marrow failure arising from injury, abnormal stem cell; leads to bone marrow hypoplastic and develping pancytompenia.
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Causes of Aplastic Anemia
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autoimmune suppression of hematopoiesis by T-cell mediated mechanism, cell injury via radiation, chemo, toxins, drugs & SLE
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Ss of Aplastic Anemia
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weakness, fatigue, vulnerbility to bacterial infections, mucosal & skin bleeding, pallor, purpura, petechiae
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Dx of Aplastic Anemia
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labs: pancytopenia, low retic, RBC morphology remarkable, neutrophils and platelets low. Bone marrow biopsy show hypocellular with scant amounts of normal hepatopoietic progenitors
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Tx for Aplastic Anemia
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Mild: RBC & platelet transfusion, abx
Severe: bone marrow transplant |
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Etiology of B12 deficiency
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impaired DNA synthesis, poor dietary intake, ileal disease, tropical sprue, fish tapeworm
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What type of anemia is B12
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megaloblastic
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SS of B12 deficiency
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pallor, fatigue, weakness, low exercise tolerance, purpura, beefy red smooth tongue, anorexia, weight loss, numbness, ataxia, sphincter disturbances, + romberg and babinski
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Dx of B12 deficiency
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labs: hemoglobin <12 MVC >110
Periph. smear: anisocytosis, poikilocytosis, nucleated RBC's, hypersegmented WBC's, misshapen platelets Vit. B12 <100 |
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Tx B12 deficiency
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1000 ug/day IM for 7 days
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Complications of B12 defeciency
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neurologic damage
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Etiology of Folate deficiency
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impaired DNA synthesis, folate deficiency most common in alcoholics or may be iatrogenic
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What type of anemiais folate deficiency
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megaloblastic
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SS of folate deficiency
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pallor, fatigue, weakness, decreased exercise tolerance, diarrhea, cheilosis, glossitis, signs of malnutrition
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Dx of folate deficiency
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labs: hemoglobin <12 MCV >100
peripheral smear: anisocytosis, poikilocytosis, nucleated RBC's hypersegmented WBC's misshapen platelets |
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Tx of folate deficiency
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folate 1mg PO qd
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Etiology of iron deficiency
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poor iron intake, menstrual blood loss, states of rapid growth, blood donation, bloos loss, pregnancy, malabsorption
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SS of iron deficiency
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fatigue, weakness, mailaise, palpitations, pallor, SOB, pica mouth sores (cheilosis) koilonychias (spooning nails)
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Dx of iron deficiency
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labs: low serum iron <30, increased TIBC >360, low ferritin <15, low transferrin saturation <1%
periph. smear: microcytic, hypochromic; anisocytosis, poikilocytosis, +/- increased platelets Bone marrow: low sideroblasts |
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Tx for iron deficiency
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tx underlying cause: iron supplements, stop bleeding, tx malabsorption. IM or IV iron dextran (must test dose to check for allergic symptoms)
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What kind of anemia is iron deficiency
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microcytic, hypochromic
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Etiology hemolytic anemia
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premature RBC destruction marked by excessive reticulocytosis
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SS hemolytic anemia
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fatigue, pallor, poor exercise tolerance, jaundice, hemoglobinuria, splenomegaly, sx of sickle cell anemia
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Dx hemolytic anemia
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peripheral smear: abnormal RBC morphology
Spherocytes: round RBC no central pallor Target cells, acanthocytes, heinz bodies sickle cells |
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Tx hemolytic anemia
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splenectomy
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Complications hemolytic anemia
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acute myelogenous leukemia
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Etiology G6PD deficiency
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premature RBC destruction marked by excessive reticulocytosis
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SS G6PD deficiency
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hemolytic crises in response to oxidative stresses (fava beans, antimalarials, sulfonamides, vit. K
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Etiology Thalassemia
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genetic disorder resulting in decreased amounts of functional hemoglobin
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Types of Thalassemia
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Alpha and Beta
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SS of Thalassemia
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pallor, fatigue, decreased exercise tolerance. Alpha: varies from severe to silent dependent on # of genes deleted. Beta: bone changes, chipmunk face (frontal bossing) copper skin, micocytic
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What type of anemia is Thalassemia
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microcytic, hypochromic
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Dx Thalassemia
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peripheral smear: microcytosis, hypochromia, abnormal cells, hemoglobin electrophoresis is diagnostic
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Tx Thalassemia
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supportive, genetic counseling, transfusions prn, splenectomy. Beta: folic acid supplementation, bone marrow transplant
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complications Thalassemia
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severe hemolysis, hydrops fetalis, death
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Etiology Thrombocytopenia
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decreased platelet count from low marrow production, increased splenic sequestration, accelerated destruction of platelets, immune platelet destruction (ITP, infection, drugs), nonimmune platelet destruction: vasculitis, DIC, TTP, HUS, intravascular prostheses
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SS thrombocytopenia
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superficial bleeding (easy bruising, petechiae, epistaxis, menorrhagia)
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Dx thrombocytopenia
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CBC: low platelet count
bone marrow w/decreased megakaryocytes, hx of viral illness for ITP, PT/PTT fibrinogen and D-dimer |
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Tx thrombocytopenia
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TTP-HUS-plasmapheresis. ITP: steroids, IVIG and/or antiRhD; splenectomy, cytoxic drugs (controversial.) DIC: tx underlying. Stop offending drugs. transfusion if low platelet count
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complications from throbocytopenia
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recurrence, hypovolemic shock
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Etiology of Von Willerbrands
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absence of VWF results in failure to form a primary platelet plug
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SS of Von Willerbrands
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prolonged bleeding, superficial bleeding (petechiae, purpura, bruising, oropharyngeal bleeding, epistaxis, GI bleeding, menorrhagia)
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DX Von Willerbrands
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prolonged bleeding time, VWF assay: VWF antigen immunoassay: VWF ristocetin cofactor assay: factor VIII assay. Electron microscopic assessment of platelet granules
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Tx Von Willerbrands
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administer factor VIII concentrates; desmopressin acetate (DDAVP, synthetic analog of ADH, induces release of VWF) dialysis for uremia, if drug-induced stop offending drug
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Complications of Von Willerbrands
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Hypovolemic shock, iron deficiency
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Etiology of thrombocytopenic purpura (ITP)
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autoimmune disorder - IgG autoantibody is formed in spleen and binds to platelets (destruction of plateles in spleen)
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SS thrombocytopenic purpura (ITP)
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mucosal or skin bleeding, epistaxis, menorrhagia, purpura, petechiae, childhood onset may vollow viral infection usually self-limiting, adult onset chronic disease, infrequently follows a viral disease
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Dx thrombocytopenic purpura (ITP)
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labs: thrombocytopenia
Periph: megathrombocytes Bone marrow: megakaryocytes |
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Tx thrombocytopenic purpura (ITP)
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high dose prednisone titrated as platelet count increases; will not usually return to normal. splenectomy is definitive tx. danazol may be sued for pt's who fail splenectomy
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Complications of thrombocytopenic purpura (ITP)
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cerebral hemorrhage, life-threatening bleeding
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Etiology of Acute Leukemia
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Malignancy of pluripotent hematopoietic stem cells of bone marrow; may be due to chromosome abnormalities, chromatin fragility, chemicals, x-ray treatment, drugs
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Types of acute leukemia
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ALL: acute lymphoblastic leukemia - lyphoid origin.
AML: acute myeloid leukemia - myloid origin |
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Sx acute leukemia
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anemia, thrombocytopenia, leukopenia (fever, infections) lymphadenopathy, hepatosplenomegaly, gingival hypertrophy/skin infiltration w/leukemic cells (chloroma) bone pain, nonspecific sx (fatigue, fever, weakness, anorexia/weight loss)
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Dx acute leukemia
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CBC: WBC >15K, platelets <100K. normocytic normochromic anemia. Bone Marrow: >30% blasts. LP symptomatic AML and all ALL pt's. Blood type/HLA typing. CXR, ECG, echo (eval LV ejection fraction). Labs: LFT, RFT, LDH, calcium uric acid, lysozyme, phosphorus, PT/PTT
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Tx acute leukemia
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chemo, bone marrow transplant
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Complications of acute leukemia
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DIC, death
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Etiology chronic leukemia
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lymphoid malignancy of mature B cells
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SS chronic leukemia
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lymphadenopaty, hepatosplenomegaly frequent infections, anemia, thrombocytopenia, constitutional symptoms are uncommon
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Dx chronic leukemia
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CBC: increase WBC w/lymphocytosis. Bone marrow: >30% lymphocytes. Associated w/autoimmune hemolytic anemia and thrombocytopenia
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Tx chronic leukemia
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supportive care with IVIG and splenoctomy; alkylating agents
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