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Med Surg: Hem/Onc PPT 2 - Other Blood Cell Disorders
Fall Semester - 2010 (Hem/Onc Test 1)
41
Medical
Graduate
12/02/2010

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Term
What condition is described as excessive iron overloading of tissues?
Definition
Hemochromatosis
Term
What type of trait is hereditary hemochromatosis? Which gene controls the level of iron absorption? On which chromosome is this gene located?
Definition
Autosomal Recessive Trait (in caucasians)
HFE1 Gene
Chromosome 6
Term
What can be used as an indicator of total body stores of iron? Why? What is the normal level for males and females?
Definition
Serum Ferritin
B/C it is maintained in equilibrium with iron stores
Males = 20 - 250; Females = 10 - 120
Term
If a patient presents with c/o asthenia (unexplained chronic fatigue), darkening of the skin, arthralgias, loss of libido or impotence as well as a serum iron level >150 and a transferrin saturation > 50%, what condition should you suspect?
Definition
Hemochromatosis
Term
If a patient as hemochromatosis what infectious agents are they susceptible to?
Definition
Listeria
Yersenia
Vibrio
E. Coli
S. Aureus
Term
What conditions should hemochromatosis be considered in?
Definition
Arthropathy (Early arthritis)
Gonadal Failure (Caused by iron build-up in the anterior pituitary)
Pts with MI and CAD at a young age
Cirrhosis
Skin pigmentation disorder
Term
What condition is described as a stem cell disorder that results in an elevated Hgb or Hct an increased RBC mass and increased blood viscosity that can affect O2 delivery to tissues?
Definition
Polycythemia Vera
Term
What is the normal value for Hgb in males and females?
Definition
males = 14 - 18
females = 12 - 16
Term
What is the normal value for Hct in males and females?
Definition
males = 42 - 52%
females = 37 - 47%
Term
What are the causes of relative polycythemia?
Definition
Dehydration
Diuretics
Term
Which type of polycythemia is associated with neoplastic mutation of bone marrow stem cells?
Definition
Absolute Primary Polycythemia
Term
Which type of polycythemia is caused by high altitudes (for long periods), Cardiopulmonary diseases, chronic hypoxemia and hepatoma?
Definition
Absolute Secondary Polycythemia
Term
At what level of iron accumulation do sx of Hemochromatosis begin?
Definition
> 7 g of accumulation
Term
At what level of Hgb do symptoms of polycythemia vera occur?
Definition
Hgb > 18 - 20mg
Term
If a patient presents with symptoms including chronic HA, backache, pruritis after bathing, fatigue on exertion, plethora (redness or ruddiness of face), hepatosplenomegaly, and HTN, what condition do you suspect?
Definition
Polycythemia Vera
Term
What is the treatment for polycythemia vera?
Definition
There is no cure, only a means of reducing the symptoms.
Phlebotomy q 2 - 4 days
Term
What must be done to confirm a diagnosis of polycythemia vera?
Definition
bone marrow biopsy
Term
What is the most common cause of abnormal bleeding?
Definition
Thrombocytopenia
Term
What are the normal values for WBCs?
Definition
5,000 - 10,000
Term
What is the normal WBC differential?
Definition
Neutrophils = 50 -70%
Lymphocytes = 20 - 25%
Monocytes = 5 - 8%
Eosinophils = 2 - 4%
Bananas = .5 - 1%
"Never Let Monkeys Eat Bananas"
Term
What is the normal value for an adult platelet count?
Definition
150,000 - 350,000
Term
What initiates the first stage of the intrinsic pathway?
Definition
platlets (platlet plug)
Term
At what level of platelets does thrombocytopenia occur? What is a common symptom of this low amount of platelets?
Definition
Platelets < 50,000
Petechiae
Term
What labs will be indicative of thrombocytopenia?
Definition
On peripheral smear there will be no platelets and abnormally shaped RBCs
CBC - indicates thrombocytopenia when platelets are less than 50,000
PTT (Evaluates Intrinsic Pathway and will be slower >40sec)
BT (Will be prolonged which is >7min)
Term
Which bleeding lad evaluates the extrinsic system and the common pathway? What factors does it evaluate?
Definition
PT (Prothrombin Time)
Factor III, V, VII, X, XIII
Term
What is the normal value for PT?
Definition
PT Norm = 10 -14 sec
Term
What is the normal value for INR?
Definition
INR norm = 1
Term
What pathway does the PTT evaluate? What factors are being evaluated?
Definition
Intrinsic Pathway and Common Pathway
Factors V, VIII, IX, X, XI, XII, XIII
Term
What is the normal value for PTT?
Definition
PTT norm = 30 - 40 sec
Term
What is the normal value for bleeding time?
Definition
BT Norm = 3 - 7 min
Term
What does bleeding time evaluate?
Definition
Evaluates platelet function
Term
Which disorder is characterized by and Autoimmune IgG disorder that cause an anti-platelet antibody to form?
Definition
ITP -Idiopathic Thrombocytopenic Purpura
Term
What often proceeds a bout of ITP?
Definition
URI
Term
If a patient presents with petechiae, purpura, oral/gingival bleeding, menorrhagia, or epitaxis and on labs tests a finding of decreased platelets and anti-platelet antibodies, what condition do you suspect?
Definition
ITP - Idiopathic Thrombocytopenic Purpura
Term
How is ITP treated? What is chronic ITP?
Definition
May resolve spontaneously if acute
Corticosteroids
Platelet transfusion
Chronic ITP = > 6 months
Term
At what platelet count is Thrombocytosis dx?
Definition
Platelet count > 400,000
Term
When is transitory thrombocytosis seen?
Definition
After exercise or physical stress
Term
When is secondary thrombocytosis seen?
Definition
Seen in response to hemorrhage, infection, malignancy, hemolysis, etc
Term
When is primary thrombocytosis seen?
Definition
Seen with PCV (Polycythemia Vera) and chronic granulocytic leukemia
Term
How is thrombocytosis diagnosed?
Definition
Bone marrow biopsy is the definitive diagnosis
On peripheral blood smear and CBC an increased platelet count will be seen
Term
What is the treatment for thrombocytosis?
Definition
Transitory and Secondary will resolve on their own
Primary is treated with cytotoxic agent, and anti-platelet agents (ie ASA)
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