Fatigue headaches fever exertional dyspnea
all anemias
Acute blood loss anemia PP
accident or internal hemorrhage
Acute blood loss anemia Blood test
normochromicmacrocytosispoikilosytosisnucleated rbireticulocytesincreases WBCs (neutrophils)anisocytosisdecreased platelets”norma makes peter nut really intense all day”
Chronic blood loss anemia PP
slow internal bleeding (not noticed until iron depleted)
Chronic blood loss anemia blood test
MicrocyticHypochromicincreased plateletsleukopenia
Iron deficient anemia PP
currently pregnant, young child growing fastPICAassociated with ulcers and gastrectomy
Iron deficient S&S
PICAParesthesiaBurning tongueAngular stomatitis (cracking mouth in corners)GastritisDysphagiaSpooning nails”Peter’s penis burns all day, got syphilis”
Iron deficient Anemia BT
Decrease MCV Decrease MCHC Decrease HCT (hematocrit)microcyticnormal WBCHypochromicAnisocytosis Poikilocytes
Iron depletion
loss exceeds intakemobilized iron storage
Iron deficient erythropoeisis
decreased serum ferrite’ssaturated transfurens
megaloblastic anemia
pernicious anemiafolate deficient anemia
pernicious anemia PP
numbness or tingling in distal extremitydifficulty walkingepisodic abdominal paingastroectomyA vegantapworm
Pernicious anemia S&S
atrophic glossitis (sore, raw pale)episodic abdominal painPallesthesia loss of vibratory sensationsUMNL (paresthesia)post column-pins/needles in distal extremitylat column- weakness, spastic
Pernicious anemia blood test
increased MCVdecreased hematocritnormochromicmacrocyticPoikilocytesovalcytesphlimsy RBC
normal iron problem with dna synth.
pernicious anemia
only vitamin exclusive to microorganismsstored in liverdepleted in people with gastroectomy or vegan
B12
Treatment of pernicious anemia
intraMuscular injection of B12
FOLATE DEFICIENCYPP
formeruser of alcoholpregnantw/ fatiguenormalB12Heatfood or use powder milkvegans
FOLATE DEFICIENCY BT
↓ Serum FolateB12 normalPlatletsnormalWBCnormal
STOREDin LIVERformedby intestinal bacteria
folate
deficiency in folate
Heat foodsPowdered MilkGoats Milk
APLASTIC ANEMIAPP
bloodtest with pancytopenia (decrease in all blood cells)nose/ gum bleedingInfection
APLASTIC ANEMIA SS
bleedingfrom the gumsnosebleeds frequent↑susceptibility to infection
Aplastic Anemia BT
NormocytesThrombocytopeniaLeucocytopenia↑serum feritanNormochromicB12 & Folic acid normal
BoneMarrow production problem2 WAYS:
1) Direct Destruction of Hematocrit[Drugs (chlorophenical), radiation, virus, hepatitis, Epsteinbarr]2) ImmuneComplexMediated Destruction of Marrow Cells
Aplastic Anemia
BoneMarrow Transplant
Hemolytic Anemias
Intrinsic and extrinsic formsoften leasts to Gallstones
Hemolytic intrinsic
IntrinsicFormproblemw/ membrane, metabolic, or hemoglobin disorder
Hemolytic extrinsic
ExtrinsicForm factorsoutside the RBC (aquired)***MC cause: malaria
Renal Insufficiency Anemia
↓ ErythropoietinBUNpresent↑ Hemolysis↑ Urobilinogen levels
Liver Disease Anemia
↓ production & survival of RBC↑ Blood volume.↑ ReticulocytesPlateletsnormalLeucocytesnormalNormo&Macrocytic
spur cells are associated with
cirrhosis
cirrhosis anemia
↑ CholesterolPhospholids normal (trapped in spleen & destroyed)
Hypothyroidism [Endocrine]
NOReticulocytestestosteronedeficientcy (low RBC production)Normo–cyte & chromic↓cortisol
Bone Marrow Infiltration
Leukemia,Lymphoma, Mets, MM, Red marrow replaced
Hereditary Spherocytosis PP
youngchild w/ jaundicesplenomegalyIncreaseurobilinogenbrownstool
Hereditary Spherocytosis S&S
↑ Urobilinogen in urineJaundiceBrownStoolspleenomegalyMacrocyticcells (lyses when going through capillary)
Hereditary Spherocytosis BT
increased Neutrophils w/ shift to left↑ Reticulocytes↑ MCHCNORMALMCVThrombocytesNormo/Giant PlateletsMacrocytic
Hereditary Spherocytosis treatment
Spleenectomy
*** Occurs from a SUBSTITUTION of VALINE for Glutamine at the 6 th Postion on Beta ChainIRREVERSABLE↓O 2
Sickle Cell Disease
Problem w/ Bone Marrow Hyperplasia(ulcer in leg)
Sickle cell disease
sickle cell disease PP
AfricanAmerican decentswellingin dorsum of hand & footDecreasedO2Periostitis
sickle cell disease S&S
Normo–cytic & chromicPeriostitis(before age 4) &hand& feet syndrome (swelling on dorsal side)Spleen Triad1) blood pooling2) spleenomegaly & hypovolemic shoke3) Functional Asplenia ( blocked RE filters)
Sickle cell Blood test
Howard Jolly Bodies (remnants of chromatin of RBC)TargetCellsSickleCellsTripanocytes
Problemnot making on polypeptide chain at the same rate as the other***MC are Alpha & Beta chainsDestabilizesthe RBC
Thalassemiaaka [Medditeranean, Cooley’s Anemia]
Thalassemia PP
European decentDelayed pubertyprominent jawmongoloid appearance
Thalassemia Blood Test
Extreme PoikilocytesHoward Jolly Bodies↓ MCVMicrocyticHypochromicOvalcytesTarget Cells
**Beta Major thalassemia
Iron overloadJaundiceLeg ulcerationSplenomegaly
thalassemia treatments
Minor(none needed)Major(blood transfusion, splenoectomy)
Metabolic Hemolysis
deficit in enzyme activity of RBCInherited
Metabolic Hemolysis lack of
Lacking:pyruvate kinaseglycolytic enzymesmitochondriaG6P DehydrogenasePyramidine 5 Nucleotidase
(group of diseases that cuase cancer in Lymphnodes)(usually B &T cells)
NonHodgkin’sLymphoma
NonHodgkin’sLymphoma S&S
-Slow progressive-Painless Lymphoadenopathy (pathological lymphnodes)-one or widespread-Night Sweats-Located retroperitoneal, pelvic, abdominal areas-seen on Xray (dense white masses)-further tested by CT & Xrays-Mediastinal (behind sternum)-Edemain the Face-ureteralblockages (oliguria)-anemia (bone marrow infiltration)
NonHodgkin’sLymphoma lab study
Normal
diagnosis for non hodgkin’s
chest X-ray
Greatest Age risk (15-35yrs)painless mass in neck
Hodgkin’s Lymphoma
ReedSternbergCells in lab tests
Hodgkin’s Lymphoma
Hodgkin’s Lymphoma PP
painless mass in neck (made painful by alcohol consumption)Intense itching over the bodydifficulty swallowing
Hodgkin’s S&S
Ivory VertebraSpinal Cord Compression***Horner’s syndromeleg edematracheal blockagearises in one node, then metastasis
leukemia Chronic vs acute
chronic- normocytic normochomicacute- pancytopenia, circulating leukoblasts
CLL
90% >50 years oldincidental discoveryisolated lymphocytesmalignancy of B lymphocytes
CML
young middle aged adults
ALL
80% of all childhood leukemia3-7 y/oquick onsetlymph swelling
AML
few months old or 60+ yearsBone marrow swelling