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35 Cards in this Set
- Front
- Back
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Iron deficiency anemia |
blood loss, elevate plt count - v ferritin - ^ TIBC - v Fe & Fe sat - ^ RDW most accurate - bone marrow biopsy (never do this) |
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Anemia of chronic disease |
RA, ESRD, chronic infec, inflam, connect tissue disease - ^ ferritin - v TIBC - V Fe & nml / v Fe sat |
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Thlassemia |
very small MCV + target cells - nml Fe studies Hb electrophoresis - nml in alpha, ^ HgA2 & HgF no Rx. DNA sequencin for alpha |
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Sideroblastic anemia |
Alcoholic, isoniazid, lead exposure - ^ Fe Dx: prussian blue stain Rx: remove exposure + pyridoxine replacement |
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Macrocytic anemia |
extravascular hemolysis via occurs in spleen & liver. Vit B12 or folate deficiency |
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Vitamin B12 deficiency |
-neuro findings: peripheral neuropathy -smooth tongue (glossitis) & diarrhea -metformine blocks b12 absorb -Dx: peripheral blood smear( hyperseg pmn's = megaloblastic). v reticulocytes, ^ LDH and indirect bilirubin |
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Methylamalonic acid level |
if suspect B12 def w/ a nml B12 lab value (will be elevated) |
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Pernicious anemia Dx test |
antiparietal cell antibodies anti-intrinsic factor antibodies (allergy to parietal cells) (old answer is schilling's test) |
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Hemolytic anemia |
-sudden onset of weakness & fatigue - ^ indirect bilirubin, retic count, LDH -v haptoglobin -spherocytes on smear -intravasc = + abn periph smear(schistocytes, helmet cells), hemoglobinuria, hemosiderinuria |
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Sickle cell anemia w/ visual distrubance, pulm infarct, priapism or stroke = Rx? |
Exchange transfusion |
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Parvovirus B19 in sickle cell pt |
sudden drops in hct (folate def can also cause this) most accurate: PCA for DNA Rx: transfuse + IV Ig |
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Rx for sickle cell |
-folate replacement -pneumococcal vaccine -hydroxyurea (^hgF) |
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Dx of autoimmue hemolysis |
=coombs test, "warm antibodies" IgG Rx: steroids (no response = IV Ig ->if responds well consider splenectomy) |
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Cold-Induced Hemolysis (cold agglutinins) |
-mycoplasma, epstein-barr virus -coombs test negative -complement test positive -no resonse to steroids, splenectomy, or IVIG -Rx: rituximab (AB CD20 via lymphocytes that make IgM) |
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G6PD deficiency |
-x-linked -mcc of hemolysis= infection -other causes: oxidizing drug (sulf, primaquine, dapsone), fava bean ingestion. -Dx: heinz body (collection of oxidized hg) or bite cells |
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Hemolytic Uremic Syndrome (HUS) |
ART -autoimmune hemolysis (intravasc) -Renal failure (^ BUN/Cr) -Thrombocytopenia look for E coli 0157:H7 in hx Rx: plasmapheresis |
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Thrombotic Thrombocytopenic Purpura (TTP) |
FAT RN -Fever -autoimmune hemolysis (intravasc) -Thrombocytopenia -Renal failure (^ BUN/Cr) -Neurological abn ADAMTS-13 level is down Rx: plasmapheresis |
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ADAMTS-13 |
metalloproteinase that breaks down vWF to release plt from one another - when this doesn't happen plt form abnormally |
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Paroxysmal Nocturnal Hemoglobinuria |
-pancytopenia + dark urine in am -MCC death = lg vessel venous thrombosis (ie portal vein) -transform into aplastic anemia or AML -Dx: CD55 or CD59 antibody (decay accelerating factor) -Rx; glucocorticoids (severe- eculizumab) |
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Methemoglobinemia |
brown blood + SOB w/ clear lungs and nml CXR + h/o exposure to -caine (lidocaine) |
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Acute Myeloid Leukemia (AML) |
-pancytopenia (fever, bleeding, infection) -Dx: periph smear w/ blasts auer rods |
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AML- M3 |
acute promyelocytic leukemia -assoc w/ DIC -Rx trans retnoic acid (ATRA) |
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Myelodysplasia |
-mild, slowly progressive preleukemia synd. -elderly pt w/ pancytopenia, ^ MCV, v retic count & macroovalocytes -Pelger-Huet cells (pmn's w/ 2 lobes) w/ nml B12 Rx: transfusions. lenalidomide (v transfusion dependence) |
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Chronic Myelogenous Leukemia (CML) |
- ^ WBC predom pmn's (w/ low LAP score) + splenomegaly - Dx: PCR (philadelphia chromosome) or FISH (BCR/ABL) -Rx: imatinib (gleevec), bone marrow transplant. |
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Chronic Lymphocytic Leukemia (CLL) |
->50YO + ^ WBC -asymptomatic -Dx: periph smear = smudge cell's Stage 0: ^ wBC alone Stage 1: enlg lymph nodes Stage 2: splenomegaly Stage 3: anemia Stage 4: low plts Rx: stages 2+ w/ Fludarabine. 2nd line = Alemtuzumab (anti-CD52) |
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Hairy Cell Leukemia |
-pancytopenia + massive splenomegaly - Dx: + TRAP on stain -Rx: Cladribine (2-CDA) |
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Myelofibrosis |
dido to hairy cell but neg TRAP teardrop cells on smear fibrosis on marrow + JAK2 mutation Rx: lenalidomide or BM transplant. Ruxolitnib (inhibs JAK2) |
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Polycythemia Vera |
-HA, blurred vision, dizziness, fatigue + pruritus after hot bath. -Dx: ^^^ Hct, v MCV & erythropoietin (order ABG to exclude hypoxia). JAK2 mutation -Rx: phlebotomy, hydroxyurea, ASA qday, anagrelide (if thrombocythemia) |
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Essential Thrombocythemia |
-^^ plt count + HA, visual distrub, pain in hands (erythromelagia) -Rx: hydroxyurea, daily ASA |
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Multiple Myeloma |
-bone pain w/ fracture from nml use + infection + renal failure -Dx: osteolytic lesions, serum protein e- = monoclonal antibody (igG or igA) urine protein e-: bence-jones protein periph smear: rouleaux formation of rbc ^^ Ca++, Beta2 microglobulin level, BUN/Cr ^^ |
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vWF disease Dx |
-vWF -if nml then test ristocetin (working properly?) Rx: desmopressin (release vWF and factor VIII) or DDAVP |
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antiphospholipid syndrome |
^PTT & nml PT, false + VDRL, SAB -heparin |
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Protein C deficiency |
skin necrosis w/ warfarin venous thrombosis |
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Factor V leiden mutation |
MCC thrombophilia venous thrombosis |
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antithrombin deficiency |
no change in PTT w/ heparin bolus venous thrombosis |
