FNP III Hematologic and Immune Problems

  1. 1.  What are fevers in excess of 104°F associated with?

    2.  What are fevers between 101.3°F and
    104°F associated with?

    3.  What are fevers less than 101.3°F associated with?
    1.  Dealers in excess of 104°F tend to be associated with pancreatitis, UTIs, and intracranial pathology.

    2.  Fevers between 101.3°F and 104°F are associated with URI's in some acute viral syndromes.

    3.  Fevers less than 101.3°F are characteristic of hepatitis some acute viral infections, and TB.
  2. 1.  What is microcytic anemia?

    2.  What is microcytic anemia linked to?

    3.  What are the causes of microcytic anemia?
    1.  Microcytic anemia is a category of anemia based on the small size of the RBC.

    2.  Microcytic anemia is linked to nutritional deficiencies, particularly a deficiency in dietary intake of iron.

    • 3.  The causes of microcytic anemia include:
    •    1.  Inadequate dietary intake of iron
    •    2.  Anemia of chronic disease (ACD)
    •    3.  Thalassemia
    •    4.  Sideroblastic anemias
  3. 1.  What is the most common cause of microcytic anemia?
    1.  Iron deficiency is the most common cause of microcytic anemia.
  4. 1.  Iron deficiency anemia may be linked to?
    Iron deficiency resulting from acute or chronic blood loss is perhaps the most prevalent cause of microcytic anemia.

    Underlying G.I. problems such as celiac sprue, surgical resection was involving the stomach, duodenum, or jejunum or inflammatory bowel disease such as Crohn's.
  5. 1.  Describe anemia of chronic disease (ACD)?
    • 1.  ACD:
    • May be microcytic or normocytic

    ACD as the cause of microcytic anemia results from mechanisms that involve inflammation, infection, and/or underlying malignancy.
  6. 1.  Describe thalassemia?
    1.  Thalassemia is related either to depletion or mutation in the genes that code for the protein component of adult hemoglobin.

    2 chains of globin (2alpaha and 2 Beta)composed 95% of hemoglobin in the adult.

    • Alpha thalassemia -- Asian descent far more widespread
    • if
    • Beta thalassemia -Mediterranean descent
  7. 1.  Describe sideroblastic anemia?
    1.  Sideroblastosis and its resulting microcytic anemia are caused by a host of molecular defects that affect the biosynthesis of the heme moiety of hemoglobin.  May be congenital or acquired.

    There is a reversible form responsive to pyridoxine therapy.  

    The most common cause of acquired sideroblastic anemia is chronic alcoholism
  8. 1.  While laboratory findings would you expect to see in iron deficiency anemia?
    1.  A serum protein level of less than 30 mg per liter.

    2.  Elevated TIBC (total iron binding capacity)

    3.  Findings such as variable shape, size, or pale colored rbc's.
  9. 1.  Distinguish the laboratory findings of a iron deficiency anemia and the anemia of chronic disease?
    2. Diagnostic tests for ACD focus on distinguishing ACD from iron deficiency anemia.  Unlike iron deficiency anemia, ACD presents with low serum iron along with low a TIBC.
  10. 1.  What to diagnostic tests are necessary to diagnose a particular thalassemia?
    1.  The thalassemia is, both Alpha and Beta thalassemia, require a CBC and a hemoglobin electrophoresis for diagnosis.
  11. 1.  Describe how sideroblastic anemia is diagnosed?
    1.  A diagnosis of sideroblastic anemia is confirmed that Prussian blue stain of a bone marrow aspirate.

    The Prussian blue stain reveals tinged sideroblastic which help iron deposits located in the mitochondria.
  12. 1.  How is iron deficiency anemia treated?
    1.  Iron deficiency anemia is treated 1st with an increase in dietary iron and therefore with supplemental iron.

    Supplemental oral iron is best given as ferrous sulfate 325 mg TID on an empty stomach.  Recheck values in 2 to 4 weeks after starting regimen.
  13. 1. How is a CD treated?
    1.  ACD is treated symptomatically.  

    Chronic a CD might require treatment with drugs that stimulate erythropoiesis given sub Q.
  14. 1.  What is the treatment for thalassemia related anemias?
    1.  The thalassemia is often require no treatment other than vigilance by the commission concerning hematological markers.

    Patients with severe anemia, such as as is associated with beta thalassemia major in hemoglobin H. disease require regular blood transfusions.
  15. 1.  What are the treatment options for sideroblastic anemia?
    1.  There are few options for treatment of sideroblastic anemia.  Depending on the severity, blood transfusions may be required.

    Large doses of vitamins B6 Pyridoxine have benefited some patients
  16. 1.  What is normocytic anemia?
    1.  Normocytic anemia is defined as an anemia associated with normally sized red blood cells.

    Most commonly this type of anemia results from chronic disease states.

    Acute blood loss, hemolysis and volume overload our other etiologies of normocytic anemia.
  17. 1.  What is the clinical presentation of normocytic anemia?
    1.  Because normocytic anemia rarely presents with a moderate to severe anemia ( less than 30% Hct)  many patients with a diagnosis do not report subjective findings.
  18. 1.  What would one expect the RBC indices for normocytic anemia to be?
    The clinician should expect the finding of anemia not to be accompanied by an alteration in RBC indices.
  19. 1.  How is macrocytic anemia defined?

    2.  What are the causes of macrocytic anemia?
    1.  Macrocytic anemia is defined as having an MCV equal or greater than 100 femtoliters, but normal MCHC.

    • 2.  The causes of macrocytic anemia include:
    •    1.  Vitamin B12 deficiency
    •    2.  Folate deficiency
    •    3.  Drug induced (anti-metabolite drugs) ex. methotrexate.
    •    4.  Miscellaneous etiologies

    The most common cause of megaloblastic anemia is a hereditary autoimmune disorder called pernicious anemia, which results in B12 deficiency a critical component to RBC maturation.
  20. 1.  What is pernicious anemia?
    1.  Pernicious anemia is a macrocytic anemia caused by a hereditary autoimmune disorder that disrupts metabolism of dietary vitamin B 12.  May also be caused by vegans who avoid animal and dairy or patients with malabsorption issues such as Crohn's.
  21. 1.  What is the clinical presentation for a patient with macrocytic anemia?
    1.  Patients with macrocytic anemia typically complained of stomatitis, glossitis, nausea, anorexia, diarrhea, peripheral neuropathies, and malaise.

    The clinician should note pale mucosa, dry and cracked oropharynx thick and smooth tongue, tachycardia, systolic ejection murmur, peripheral neuropathy, increased or decreased deep tendon reflexes, positive Rhomberg's were Babinski sign.
  22. 1.  What is the treatment for non-pernicious macrocytic anemia due to B12 deficiency?

    2.  What is the treatment for folic acid deficiency anemia?
    1.  If the cause of vitamin B12 anemia is not pernicious anemia, and the clinician prescribes 1000 mcg per day of oral B12 until normal serum levels of B12 are achieved usually in 6 to 12 weeks.

    If pernicious anemia is present or neurological symptoms are present more aggressive IM administration is warranted.

    2. Folic acid deficiency anemias should be prescribed 1 mg per day of supplemental folic acid.  The effects of therapy should be reassessed in 2 to 3 months.
  23. 1.  Describe sickle cell anemia?

    2.  Describe the clinical presentation of sickle cell crisis?

    3.  What will a blood smear typically look like and sickle cell anemia?
    1.  Sickle cell anemia is an autosomal -- recessive disorder.  Initial symptoms appear within. the 1st year of life for those born with sickle cell anemia.

    2.  The vardinal subjective symptom of sickle cell crisis is pain.  Pain appear suddenly in fact chest abdomen or extremities.

    3.  Sickle cells constitute 5 to 10% of blood smear.  Howell - Jolly bodies which are remnants of nuclear material are present.
  24. 1.  Describe the management of sickle cell anemia?
    1.  Folic acid supplementation of 1 mg per day by mouth as indicated along with the diet is rich in complex B. vitamins and vitamin C.

    Significant rehydration is needed as a part of management and is a key to reversing sickle cell crisis.
  25. 1.  Describe polycythemia?
    1.  Polycythemia involves an increase in erythrocyte volume, which results in an increase in blood viscosity.
  26. 1.  Differentiate between relative polycythemia and absolute polycythemia?
    1.  Relative polycythemia is a condition in which there is a decrease in plasma volume while the total number of circulating urethra sites remains the same.

    Relative polycythemia is associated with dehydration; therefore, the clinicians objective is to rehydrate the patient

    Absolute polycythemia is a condition in which the actual number of circulating urethra sites are increased with a corresponding increase in measured RBC mass.

    Absolute polycythemia management begins with progressive phlebotomy's hematocrit is greater than 55 to 60%.  The goal of weekly phlebotomy's is a hematocrit of less than 45%.
  27. 1.  What is polycythemia of vera?
    1.  Polycythemia vera is an absolute polycythemia where there is a proliferation of stem cells independent of erythropoietin.
  28. Described the clinical presentation of polycythemia?
    Most subjective complaints do not arise until the hematocrit is greater than 60%

    Common complaints include headache, blurred vision, weakness, fatigue, durability, dizziness, and on occasion tinnitus.  Epitaxis is due to mucosal engorgement in the nares and irregularities in clotting.
  29. 1.  Describe the clinical lab profile of polycythemia vera or other absolute polycythemia's?
    1.  If the patient has polycythemia vera or one of the other absolute polycythemias the hematocrit should be greater than 60% for men and 55% for women.
  30. 1.  Describe leukemia?
    1.  Leukemia is a neoplastic disease of malignant hemopoietic stem cells that differentiate and proliferate according to classified trajectories that distinguished the types of leukemia is either a cute or chronic.

    The etiology of leukemia remains unknown.  Researchers have linked leukemia to environmental toxins such as chemical solvents, petroleum products, and insecticides.
  31. 1.  What type of leukemia are most adults afflicted with?

    2.  When does ALL typically appear?
    1.  By far the largest number of adults with acute leukemia suffer from acute non-lymphocytic leukemia ( ANLL).

    2.  Acute lymphoblastic leukemia ALL can appear among persons of all ages and is clearly a disease of early childhood.
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FNP III Hematologic and Immune Problems
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