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Hematology PA
Clinical presentation
| Question | Answer |
|---|---|
| Reticulocyte count will be low (<2%) | Hypoproliferative Anemia |
| Reticulocyte count will be high (>3%) | Hyperproliferative Anemia |
| seen primarily in southeast Asian, Mediterranean or African descent | Alpha Thalassemia |
| seen primarily in Mediterranean (Italian, Greek) and less often in Asians and Africans | Beta Thalassemia |
| fatigue, dyspnea on exertion, tachycardia, nail changes, dysphagia, pica ; microcytic/hypochromic as iron stores depleted | Iron Deficiency Anemia |
| mild to moderate anemia; initially normocytic and moves to mild microcytic hypochromic due to defect in moving iron into rbcs | Anemia of Chronic Disease |
| may have enlarged spleen or liver; mild to moderate anemia | Sideroblastic Anemia |
| glossitis, anorexia, diarrhea, peripheral neuropathy | B12 Deficiency |
| malnourished appearing, diarrhea, cheilosis, glossitis, NO neurological symptoms; alcohol is most common precipitator due to impaired hepatic function | Folate Deficiency |
| severe anemic symptoms | Pure Red Cell Aplasia |
| any age; pancytopenia; fatigue, weakness, excess bleeding/bruising, petechiae, purpura, pallor | Aplastic Anemia |
| anemia may not be apparent until rbc life span becomes shortened to approx 20 days | Hemolytic Anemias |
| anemia, splenomegaly, jaundice; pogment type gallstones may be present; maybe chronic leg ulcers | Hereditary Spherocytosis |
| episodic hemolytic anemia will cause Fe deficiency as well; venous thrombosis; deficient hematopoiesis causing pancytopenia; reddish-brown urine | Paroxysmal Nocturnal Hemoglobinuria |
| episodic hemolysis often triggered by oxidative stress (infections, toxins or drugs); no splenomegaly; no chronic hemolytic anemia | Glucose 6 Phosphate Dehydrogenase Deficiency |
| pallor, jaundice, splenomegaly, leg ulcers, pigment gallstones, priapism; vascular occlusion leading to infarction | Sickle Cell Disorders |
| anemia can be rapid onset and severe | Autoimmune Hemolytic Anemia |
| mottled or numb fingers/toes; anemia is rarely severe | Cold Agglutinin Disease |
| stomatitis (ulcers in mouth); fever sometimes; severe infections such as septicemia, pneumonia and cellulitis may occur | Neutropenia |
| dyspnea, headaches, visual disturbances, tinnitus, pruritis, thromboses; PE shows retinal-vein occlusion, ruddy cyanosis and splenomegaly | Polycythemia Vera (PCV) |
| rare in children, slight female predominance; approx 1/3 or pts asymptomatic at diagnosis; 2/3 of pts report vasomotor symptoms or complications from thrombosis or bleeding | Thrombocytosis |
| early stages asymptomatic; later stages: general malaise, weight loss, splenomegaly or splenic infarction (LUQ pain); hepatomegaly in 50% of pts | Myelofibrosis |
| asymptomatic; abnormal blood counts during routine screening; if symptomatic: fatigue, bleeding, recurrent infections, fever, splenomegaly, pallor | Myelodysplastic Syndrome |
| fatigue/anemia, recurrent infections, lytic lesions predisposing pts to bone pain, pathologic fractures and hypercalcemia, kidney failure, hyperviscosity of blood; | Multiple Myeloma |
| probable precursor to multiple myeloma | Monoclonal Gammopathy of Unknown Significance (MGUS) |
| fatigue, hyperviscosity syndrome (nausea, vertigo, visual, mucosal or GI bleeding); weight loss, headache, cold hypersensitivity, peripheral neuropathy, hepatomegaly, splenomegaly, engorged retinal veins | Waldenstrom's Macroglobulinemia |
| male 2: female 1; 25% asymptomatic at diagnosis; fatgue, drenching night sweats, weight loss, frequent and/or persistent infections, lymphadenopathy (80%), skin infections/shingles less common | Chronic Lymphocytic Leukemia |
| young to middle age adults; phily chromosome present in over 95% of cases; bcr-abl is another way of diagnosing CML; fever with no infection, bone pain, LUQ pain due to enlarged spleen, fatigue, weakness, night sweats, bleeding and brushing, petechiae | Chronic Myelogenous Leukemia |
| pts acutely sick over days/weeks, not months; primarily children's disease; can affect T or B cells; malaise, fatigue, fever, bleeding gums, lympadenopathy, splenomegaly, petechiae, weight loss, meningitis, lethargy, anorexia, dyspnea | Acute Lymphoblastic Leukemia |
| similar to ALL; pancytopenia with circulating blasts, bone marrow with >20% blasts; peripheral smears showing wbc with Auer Rods; hepatomegaly, splenomegaly, elevated erythrocyte sedimentation rate | Acute Myelogenous Leukemia |
| median age of onset is mid 50s; male 5: female 1; fatique, abd discomfort from splenomegaly | Hairy Cell Leukemia |
| enlargement of lymphoid tissue, spleen, liver; painless cervical, supraclavicular, and mediastinal lymphadenopathy; constitutional/b symptoms (fever, drenching night sweats, weight loss); shortness of breath common with mediastinal mass | Hodgkin's Lymphoma |
| Three grades: indolent (slow growing); intermediate (aggressive, mix of small to large cells); high grade (very aggressive); lymphadenopathy persistent and painless, isolated or difuse; B symtpoms; occasional ab pain, vomiting, bleeding, edema | Non-Hodgkin's Lymphoma |
| usually in immunocompromised pts; organism in neutrophils and monocytes on Wright-Giemsa stained blood film; organism in macrophages on bone marrow smear | Histoplasmosis |
| nose bleeds, gum bleeds, bruising, menorrhagia, petechia | Acute Thrombocytopenia |
| same as acute (no systemic illness, spleen normal); common in childhood, starts with viral infection and have it intermittently throughout life; adult form is chronic | Idiopathic (Immune) Thrombocytopenic Purpura |
| heparin for 4-10 days (if plt count drops more by half or more than assume HIT); inflammation/necrosis at subcutaneous sites, limb asymmetry, cool/pulseless extremities; arterial or venous thrombosis | Heparin Induced Thrombocytopenia |
| mental status changes and symptoms correlating to end-organ damage (fever +/- mild renal insufficiency); associated with some meds; rare disease, but really sick; most prevelent in young women | Thrombotic Thrombocytopenic Purpura |
| renal failure; no mental status changes; most common in infants, children and pregnant women | Hemolytic Uremic Syndrome |
| hepatic coagulopathy | Liver Disease (prolonged PT) |
| bruises easily, increased bleeding after minor procedures (dental), menorrhagia* | von Willebrand Disease |
| can act in concert with smoking, birth control pills/hormone replacement | Prothrombin 20210A Mutation |
| anti-phospholipid (recurrent thromboses, 2nd trimester miscarriages, thrombocytopenia, valvular heart disease, migraines) | anticoagulation disorders |
| excessive thrombosis + bleeding (bc using up clotting products), organ dysfunction, shock, death; can get subacute DIC (Trousseau's syndrome) - see recurrent superficial cloting and DVTs | Disseminated Intravascular Coagulation |
| spontaneous hemarthroses | Hemophilia A |
Created by:
ac202
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