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71 Cards in this Set

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O2 content eqn
Hb + PO2
chronic adjustments to hypoxia made by the body
skeletal muscle inc mitochondria
secrete EPO
clubbing
when will someone become cyanotic?
when 5g of Hb are FULLY desaturated
who's more likely to appear cyanotic - anemic or polycythemic?
polycythemic

why?
b/c the body can allow 5g of Hb to be desaturated since it has so much available
what causes a low reticulocyte count?
something wrong in the bone marrow - something missing or it's suppressed
what causes a high reticulocyte count?
hemolytic anemia - something wrong in the periphery
MCC of extravascular hemolysis
autoimmune

what test to run?
coombs
drugs that cuase extravascular hemolysis
penicillins
cephalosporins
sulfa drugs
dapsone
alpha methyl dopa
PTU
HIPPPE drugs
issue associated with HAMS test
Paroxysmal nocturnal hemoglobinuria

problem?
RBCs sensitive to hemolysis by acidosis
issue associated w/ osmotic fragility test?
hereditary spherocytosis

problem?
spectrin defect
only anemia that's microcytic hyperchromic
hereditary spherocytosis

test?
osmotic fragility
2 anemias that are autosomal dominant
hereditary elliptocytosis
hereditary spherocytosis
what does it mean if the reticulocyte count is >1%
BM is being revved up - problem in the periphery

what if it's low?
BM not working - problem is there
type of bld cell you'll see w/ a vasculitis
schistocyte
reasons for a tear drop cell
squeezed out by BM - can be due to hemolytic anemia or cancer of the bone marrow
issue with a heinz body?
G6PD deficiency

what causes heinz body?
protein precipitated on the side
issue w/ basophilic stippling
lead poisoning

what causes the stippling?
many proteins precipitated
what are acanthocytes?
RBCs coated w/ fat
what are howell jolly bodies?
nuclear remnants left in the RBC

reason for them?
BM isn't working or the spleen isn't working
what is anisocytosis or poikylocytosis?
aniso = diff cell sizes
poikylo = diff cell shapes

reasons for these?
2 anemias or 1 anemia that's been treated before and so is in diff stages
causes of microcytic hypochromic anemias (6 of em)
iron deficiency
late chronic dz
lead poisoning
thallessemia
hemoglobinopathies
sideroblastic anemias
MCC of iron deficiency anemia
poor intake

treatment?
ferrous sulfate
what will be the labs of iron deficiency anemia?
(total iron, ferritin, saturation, TIBC)
total iron decr
ferritin decr
saturation decr
TIBC inc
4 kinds of normocytic normochromic anemias
acute hemorrhage
early chronic dz
renal faiulre
hypothyroidism (early)
at what day do reticulocytes show up?
day 4

at what day do they peak?
day 7
7 causes of macrocytic anemias
B12 def
folate def
severe hypothyoidism
reticulocytosis
alcohol
chemo drugs
anticonvulsants
MCC B12 deficiency
pernicious anemia
MCC folate deficiency
overcooked veggies
MOA of phenytoin
blocks folate
MOA of ethosuximide
blocks Ca++ so blocks nuclear division
MOA of valproic acid
blocks Ca++ and folate
MOA of carbamezapine?
blocks Ca++

side effect?
agranulocytosis
by when does HbF disappear?
6 months
when can sickle cell crisis begin
6 months
when does erythropoiesis begin?
4 mo gestation

where?
yolk sac
what places does erythropoiesis occur?
yolk sac
liver, spleen, flat bones
long bones

at what ages?
yolk sac: 4 mo gestation
liver, spleen, flat bones: 6 mo gestation
long bones: 8 mo gestation
what does it mean if a child has MASSIVE splenomegaly
the bone marrow has stopped working and the spleen now has to take over

what else will you see?
teardrop cells because of myelofibrosis
what is methemoglobinemia?
Fe that is now 3+ instead of 2+

MCC causes?
virus
sulfa drugs (antimalarials, metronidazole, INH)
MCC iron deficiency anemia in ppl 20-40?
IBD

>40?
mucosal bleeding
female = endometrium
male = GI
which enz does lead inhibit?
delta ALA dehydratase

MCC ?
old buildings
MCC mental retardation?
Fetal alcohol syndrome
fragile X
Down's syndrome
normal lead levels?
<10

What to do if >10, >30, >50?
>10: notify health dept - Rx w/ succimer
>30: notify health dept - hospitalize - do CaEDTA challenge - Rx w/ penicillamine and dimercaprol
>50: same, but w/o EDTA challenge
MC porphyria
acute intermittent porphyria
recurrent severe abdominal pain and neuropathy (anything neurological)
acute intermittent porphyria
every time pt goes outside they get burned - problem?
prophyria cutanea tarda

MCC death?
skin infection
MC reason for attack of acute intermittent porphyria?
stress
amino acid change in sickle cell
glutamate to valine - goes from charged to uncharged
4 things involved in vaso occlusive crises of SCD
CVA
pulmonary infection
splenic sequestration
priapism

RX?
O2
exchange transfusion
MCC aplastic crisis in SCD
parvo B19
by when is a pt's spleen removed when have SCD
6 y/o

consequence of that?
susceptible to infections from encapsulated organisms
MCC crisis in SCD
infection

MC organism?
S. pneumonia
usually healthy patient comes in b/c of painless hematuria after being on a plane - sometimes it happens when it's smoky - dx?
sickle cell trait
substituting lysine for glutamate - dx?
Hb C dz

sickling?
no - both are charged
when will a person become symptomatic if has alpha minor thalessemia?
when has at least 2 genes missing and is active or has 3 genes missing
baby dies in utero due to heart failure - huge bag of water - problem?
hydrop fetalis - couldn't make any hemoglobin at all = alpha thalassemia major
inc HbA2 and HbF - dx?
beta thalessemia minor

problem? when will symptoms appear?
problem: ineffective EPO
symptoms when active
previously healthy baby comes in at 6 mo b/c face is starting to look extra fat - see spikes on skull on x-ray - dx?
beta thalassemia major

rx?
transfusions!
big forehead, wide sternum, painful bones - dx?
cooley's anemia
when do you do bld transfusions?
when patient is symptomatic, no matter the level of anemia

6 types?
whoe bld
packed RBC
FFP
cryoprecipitate
DDAVP
IgG
albumin
pt comes in after severe car accident and needs bld - what kind of transfusion?
whole RBC
SCD pt comes in needing transfusion - what kind?
packed RBC
pt on warfarin comes in bleeding all over the floor - what kind of transfusion to stop bleeding immediately?
FFP
types of pts to give cryoprecipiate
hemophilia A (as factor 8)
vWF dz (has vWF)
DIC (has fibrinogen)
mild bleeding hemophilia A or vWF dz - what can you give?
DDAVP

what else is this used for?
severe bedwetting
see slight color on the skin - liver has spots on biopsy - heart is having problems beating - pt also has painful joints - dx?
hemochromatosis
type of hemochromatosis due to genetics?
primary

what's the genetic issue and the consequence?
genetic = HLA A3
consequence = inc iron absorption in the duodenum
MCC death in first 10 yrs of 2ry hemochromatosis
transfusion related infections

after 10 yrs?
CHF
pt has flushing and wheezing after transfusion - dx?
anaphylaxis

cause?
Rx?
selective IgA deficiency

Rx: stop transfusion, then give epi
pt has inc fever after transfusion that lasts a few hrs and then goes away - dx?
febrile rxn

cause?
Rx?
WBC Ags

Rx: acetaminopehen and washed packed RBCs
fever and sudden back pain after transfusion - dc?
ABO incompatibility

rx?
stop transfusion - retype and cross
10 transfusion related infections
HIV
Hep B
Hep C
Hep D
EBV
CMV
hemorrhagic viruses
malaria
babesiosis
syphilis