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127 Cards in this Set
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- Back
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Progenitor cell of erythrocytes
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Erythroid cell
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Most important immature cell form of the erythrocyte
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Reticulocyte
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Increased reticulocytes in anemia
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Destruction or loss of RBCs
Functioning bone marrow |
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Decreased reticulocytes in anemia
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Decreased production caused by bone marrow failure or nutritional deficiency (B12, Fe, Folate)
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Left Shift
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Bacterial Infection:
Increased WBCs Increased PMNs Bands |
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Right Shift
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Low to normal WBCs with increased percentage of normal lymphs
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Reactive lymphocytes
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Infectious mono
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Where should lymphoblasts never be?
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Periphery
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Cells found in parasitic/helminth infection
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Eosinophils
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Cells associated with allergies
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Eosinophils
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Pancytopenia
Hypocellular bone marrow |
Aplastic anemia
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Diagnosis of Aplastic anemia
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Bone marrow
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Common causes of aplastic anemia
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Sulfa
Anticonvulsants Gold Penicillamine Chemo Radiation |
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Aplastic anemia Tx
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Monitor bone marrow for recovery
If not, intervene |
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Clonal disorder of the stem cell found in Pts with previous chemo/radiation exposure
Transformation to leukemia is common |
Myelodysplastic syndrome
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Myeloproliferative Disorders (6)
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Polycythemia Vera
Essential Thrombocytosis CML CLL AML ALL |
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Increased red cell mass not due to increased EPO (bone marrow issue, not kidney problem)
Splenomegaly Expanded blood volume Tinnitus, general pruritis, blurred vision |
Primary Polycythemia Vera
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Bluish skin, burning palms and soles
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Erythromalacia
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Due to decreased oxygenation caused by OSA, COPD, high altitudes, increased CO levels found in toll booth workers/smokers
Kidney is tricked into making excess EPO |
Secondary Polycythemia Vera
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Primary Polycythemia Vera Tx
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Phlebotomy
Myelosupression |
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Sustained thrombocytosis without a cause
Platelet count >500K DVT, PE, erythromalacia |
Essential Thrombocytosis
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Essential Thrombocytosis Tx
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Urea
Platelet lowering meds (hydroxyurea) |
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Markedly increased WBC count (>150,000)
Splenomegaly Sternal tenderness |
CML
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Philedelphia Chromosomes
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CML
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CML Tx
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Imitinib mesylate
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See blasts, think ___
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Cancer
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Acute leukemia transition
Blasts, few normal PMNs Death in weeks to months |
Blast crisis
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Asymptomatic at presentation
Mainly in elderly men Mature lymphs Typically chronic/indolent course |
CLL
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Smudge cells
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CLL
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Most common leukemia
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CLL
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Indications for Tx of CLL (3)
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Progressive fatigue
Severe anemia Younger pts |
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CLL Tx
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Fludarabine
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Pancytopenia with circulating blasts in peripheral smear
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AML
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How to distinguish subtype of AML
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Bone marrow Bx
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Auer rods
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AML
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Risk factors for AML
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Exposure to toxins (Benzene/Radiation)
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Rapid increase in PMNs
Bone pain, lemphadenopathy, bleeding from nose/mouth |
AML
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AML Tx
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Induction Chemo
Transplant can provide cure in younger pts |
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Most common childhood leukemia
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ALL
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Bleeding, fatigue, SOB, bone pain in kids
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ALL
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Plasma cell cancer of older adults
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Muliple Myeloma
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Lytic bone lesions with negative bone scan
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Multiple Meyeloma
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Bone pain, hypercalcemia, renal failure, cord compression, bone fractures
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Multiple Myeloma
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Bence-Jones Proteins
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Multiple Myeloma
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No fever
No increase in AlkPhos No splenemegaly |
Multiple Myeloma
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Multiple Myeloma Tx
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Chemo
Thalidomide Stem Cell Transplant |
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Hyperchromic anemia
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Spherocytosis
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Earliest and best indicator of Fe deficiency
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Serum ferritin
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Microcytic anemias (4)
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Iron deficiency
Thalassemia Sideroblastic anemia Anermia of chronic desease |
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Macrocytic anemias (2)
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B12
Folate |
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Anemia associated with lead poisoning
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Sideroblastic anemia
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Most common medical disorder worldwide
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Iron deficiency anemia
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Target cells
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Iron deficiency anemia
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Decreased retic count
Low ferritin/transferrin Decreased serum iron Increased TIBC |
Iron deficiency anemia
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IDA Tx
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Elemental Fe TID
Hgb should normalize in 6-10 weeks Monitor retic count |
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Reduction in production of either the alpha or beta chain
Inherited disorders |
Thalassemias
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Anemia mild compared to MCV
Target cells Normal Fe studies |
Thalassemia
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Severe anemia from infancy
Family history Massive splenomegally |
Beta-Thalassemia Major
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Mediterranean dissent
Mild/persistant anemia |
Beta-Thalassemia Minor
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Thalassemia Tx
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RBC Trans
Folic acid supplementation Splenectomy (Beta Major) |
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Bsophilic stippling
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Sideroblastic anemia
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Lead Poisoning
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Episodic paralytic ileus
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Lead poisoning
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Ringed sideroblasts seen with Prussian blue stain on bone marrow
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Sideroblastic anemia
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Lead Poisoning Tx
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Chelation Therapy
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Chelation Therapy is Tx for these diseases (2)
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Lead Poisoning
Wilson's |
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Where is B12 absorbed?
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Terminal Illieum of Small Intestine
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Autoimmune is cause of anemia
Associated with gastric cancer |
Pernicious anemia
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Anemia is caused by gastric bypass or Crohn's
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Vitamin B12 Deficiency
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Paresthesias early, then gait disturbances
Decreased position and vibratory sense AMS late |
B12 Deficiency
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High MCV
High RDW Serum B12 low Enlarged platelets Intrinsic factor antibodies Hypersegmented neutrophils |
B12 Deficiency Anemia
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Positive Shillings Test
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B12 Deficiency Anemia
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B12 Deficiency Anemia Tx
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Replace B12 (Cobalamin forever)
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Inadequate diatary intake
Common in ETOHism, pregnancy, liver disease, meds NO NEUROPATHY SYMPTOMS |
Folate Deficiency
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Which has neuropathy symptoms: Folate deficiency or B12?
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B12
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Howell-Jolly Bodies
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Folate Deficiency
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Increased retic count
No evidence of bleeding Indirect (unconjugated bilirubinemia) |
Hemolytic anemia
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Intrinsic causes of hemolytic anemia (3)
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G6PD
Spherocytosis Sickle Cell |
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Extrinsic causes of hemolytic anemia (4)
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Autoimmune
Drug reactions (malaria drugs) TTP/DIC/HUS Prosthetic heart valves |
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X-linked recessive disease found in Mediterranean and African American males
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G6PD Deficiency
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Heinz bodies
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G6PD Deficiency
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Drugs that cause hemolysis in pts with G6PD (3)
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Quinidine/quinine
Sulfas Nitrofurantoin |
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Mild autosomal dominant hemolytic anemia that typically presents with established infection
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Hereditary Spherocytosis
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Spherocytes found
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Hereditary Spherocytosis
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Hereditary Spherocytosis Tx
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Splenectomy
Folate Replacement |
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Hgb S Disease
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Sickle Cell
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Jaundice
Pigment Gallstones Splenomegaly Pretibial ulcers |
Sickle Cell
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Sickle Cell Management (6)
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Maintain adequate hydration
Analgesics Folate replacement (rapid turnover) Pneumo vaccination Transfusion Hydroxyurea |
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IgG autoantibody
Positive Coombs' test |
Autoimmune Hemolytic Anemia
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Autoimmune Hemolytic Anemia Tx
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Prednisone
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Normocytic, Normochromic Anemia
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Anemia of Chronic Disease
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Lymph Node Cancers
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Hodgkins Lymphoma
Non-Hodgkins Lymphoma |
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Most common lymphoma in young adults
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Hodgkin's Lymphoma
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Reed-Sternberg Cells
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Hodgkin's Lymphoma
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Painless, rubbery lympadenopathy usually in the neck
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Hodgkin's Lymphoma
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Painless lymphadenopathy gthat is widespread
Drenching night sweats |
Non-Hodgkin's
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Non-Hodgkin's Dx
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Lymph Node Biopsy
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Coagulopathies (9)
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ITP
TTP HUS Von Willebrand's Hemophilia A & B & C Vit K deficiency Coagulopathy of liver disease DIC Thrombotic diseases |
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What factor is not made inthe liver?
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VIII
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Extrinsic Pathway
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PT/INR
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Warfarin
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Intrinsic Pathway
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aPTT (Factor VIII)
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Heparin
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Well-appearing pt, mucosal or skin purpura, epistaxis, oral bleeding, no hemarthroses
Normal bone marrow |
ITP
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Adult who is acutely ill, usually febrile, has CNS abnormalities
Marked anemia, red cell fragments, thrombocytopenia Normal Coag panal |
TTP
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Schistocytes
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TTP
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Which has a normal coag panel: DIC or TTP?
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TTP
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Abnormal/excessive activation of clotting cascade
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DIC
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Always precipitated by a serious event/illness
Bleeding and thrombosis Abnormal lab values for all coag values |
DIC
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Most common inherited bleeding disorder
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VonWillebrand's
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VonWillebrand's Tx
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Avoid NSAIDs/ASA
Desmopressin before dental extractions |
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Factor VIII deficiency
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Hemophilia A
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Spontaneous hemarthroses
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Hemophilia
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aPTT prolonged but PT, BT all normal
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Hemophilia A
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Christmas Disease
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Hemophilia B
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Factor IX Deficiency
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Hemophilia B
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Rosental Syndrome
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Hemophilia C
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Factor XI Deficiency
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Hemophilia C
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Presents with bleeding after surgery or trauma, menorrhagia
No spontaneous hemarthroses |
Hemophilia C
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Hemophilia C Tx
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FFP
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Most common thrombosis
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Factor V Leiden
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Drug that causes renal impairment, nuropathy (auditory)
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Cisplatin
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Drug that causes cardiac toxicity
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Adriamycin
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Drug that causes peripheral neruopathy
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Vincristine
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Drug that causes pulmonary toxicity
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Bleomycin
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Tumor marker Ca 19-9
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Pancreas
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Tumor marker Ca 125
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Ovarian
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Tumor marker AFP
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Liver
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Tumor marker CEA
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Colon
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Tumor marker PSA
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Prostate
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