Juan Shared "Boards: HEME/ONC" - 103 Picmonics
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Boards: HEME/ONC
Coagulation Cascade
- Secondary Hemostasis
- Intrinsic Pathway
- Partial Thromboplastin Time (PTT)
- Heparin
- Extrinsic Pathway
- Prothrombin Time (PT)
- Warfarin
- Common Pathway
- Thrombin
- Convert Fibrinogen to Fibrin
- Stabilizes the Platelet Plug
2 mins
Vitamin K
- Sources
- Dark Green Leafy Vegetables
- Synthesized by Intestinal Flora
- Mechanism
- Activated by Epoxide Reductase
- Gamma Carboxylation of Glutamate
- Activation of Clotting Factors II, VII, IX, X, Protein C and S
- Considerations
- Deficiency with Broad Spectrum Antibiotics
- Neonatal Hemorrhage with Increased PT and aPTT
- Warfarin is a Vitamin K Antagonist
4 mins
Folate Deficiency
- Clinical Features
- Macrocytic Anemia
- Megaloblastic Anemia
- Etiologies
- Malabsorption
- Dietary
- Tea and Toast
- Alcoholics
- Medication-induced
- Methotrexate
- Trimethoprim
- Increased Requirement
- Hemolytic Anemia
- Pregnancy
2 mins
Orotic Aciduria
- Pathophysiology
- Autosomal Recessive
- Defect in UMP Synthase
- De Novo Pyrimidine Synthesis Pathway
- Symptoms
- Increased Orotic Acid in Urine
- Megaloblastic Anemia
- No Response to B12 or Folate
- Non-Hyperammonemic
- Failure to Thrive
- Treatment
- Oral Uridine Monophosphate
2 mins
Vitamin B12 (Cobalamin) Mechanism and Deficiency
- Mechanism
- Cobalamin
- Large reserve pool in the liver
- Homocysteine to methionine
- Methylmalonyl CoA to succinyl CoA
- Deficiency Signs and Symptoms
- Macrocytic Megaloblastic Anemia
- Hypersegmented Neutrophils
- Neurologic defects
- Posterior column
- Lateral corticospinal tract
- Spinocerebellar tract
5 mins
Vitamin B12 (Cobalamin) Deficiency Causes
- Causes
- Vegans
- Pernicious Anemia
- Gastric Bypass Surgery
- Malabsorption
- Sprue
- Enteritis
- Crohn's Disease
- Diphyllobothrium latum
4 mins
Anemia Lab Values
- Iron Deficiency Anemia
- Serum Iron Decreased
- Transferrin Increased
- Ferritin Decreased
- % Transferrin Saturation Decreased
- Pregnancy and OCP Use
- Serum Iron Normal
- Transferrin Increased
- Ferritin Normal
- % Transferrin Saturation Decreased
- Anemia of Chronic Disease
- Serum Iron Decreased
- Transferrin Decreased
- Ferritin Increased
- % Transferrin Saturation Decreased or Normal
- Hemochromatosis
- Serum Iron Increased
- Transferrin Decreased
- Ferritin Increased
- % Transferrin Saturation Increased
3 mins
Normocytic Nonhemolytic Anemia Causes
- MCV 80-100
- Nonhemolytic
- Anemia of Chronic Disease/Inflammation
- Aplastic Anemia
- Chronic Kidney Disease
- Early Iron Deficiency
1 min
Microcytic Anemia Causes
- MCV < 80
- Causes
- Thalassemias
- Chronic Disease or Illness
- Lead Toxicity
- Late Iron Deficiency
- Sideroblastic Anemia
1 min
Iron Deficiency Anemia
- Causes
- Malnutrition/Malabsorption
- Hemorrhage
- Signs
- Microcytic, Hypochromic Anemia
- Decreased Heme Synthesis
- Labs
- Decreased Reticulocytes
- Decreased Ferritin
- Increased Red Cell Distribution Width (RDW)
- Poikilocytosis
- Anisocytosis
- Increased Central Pallor
2 mins
Plummer-Vinson Syndrome
- Triad of Symptoms
- Dysphagia
- Esophageal Webs
- Glossitis
- Iron Deficiency Anemia
- Association
- Squamous Cell Cancer of Esophagus
1 min
Transfusion Reactions
- Acute Hemolytic
- Febrile, Non-Hemolytic
- Mild Allergic
- Anaphylactic
- Circulatory Overload
- Sepsis Reaction
- Transfusion-Related Acute Lung Injury (TRALI)
- Massive Blood Transfusion
2 mins
Blood Transfusion Administration
- Proper Patient Identification
- Large Bore Needle
- Y Tubing
- Baseline Vital Signs
- Slow IV Infusion
- Monitor During First 15 Minutes or 50 mL of Blood
- Monitor for Reactions
- Considerations
- Do Not Add Anything To Same IV Line
- No Dextrose or Lactated Ringers
- Jehovah's Witnesses, No Transfusions
3 mins
Normocytic Hemolytic Anemia Causes
- Intrinsic Hemolytic
- Hereditary Spherocytosis
- RBC Enzyme Deficiency
- Hemoglobin C Defect
- Paroxysmal Nocturnal Hemoglobinuria (PNH)
- Sickle Cell Anemia
- Extrinsic Hemolytic
- Autoimmune
- Microangiopathic
- Mechanical Destruction
- Prosthetic Cardiac Valves
- Infection
- Snake Venom
2 mins
Warm Agglutinin Autoimmune Hemolytic Anemia (W-AIHA)
- Pathophysiology
- Most Common Autoimmune Hemolytic Anemia
- IgG Coats RBCs at Warm Temperatures
- Fc Portion of IgG Recognized By Macrophages
- Extravascular Hemolysis
- Medications
- Alpha Methyldopa
- Chronic Lymphocytic Leukemia (CLL)
- Systemic Lupus Erythematosus (SLE)
- Diagnosis
- Positive Coombs Test
- Treatment
- Corticosteroids
- Splenectomy
- Intravenous Immunoglobulin (IVIG)
- Rituximab
3 mins
Cold Agglutinin Autoimmune Hemolytic Anemia (C-AIHA)
- Pathophysiology
- IgM Binds to RBCs at Cold Temperatures (28-31C)
- Extravascular Hemolysis
- Waldenstrom's Macroglobulinemia
- Mycoplasma Pneumoniae
- Infectious Mononucleosis
- Lymphomas and CLL
- Symptoms
- Acrocyanosis with Cold Exposure
- Blue Fingers and Toes
- Diagnosis
- Positive Coombs Test
- Treatment
- Avoid Cold
- Rituximab
- +/- Fludarabine
4 mins
Heme synthesis Part 1
- Mitochondria
- glycine + succinyl-CoA
- with B6
- E: aminolevulinate synthase
- rate limiting step
- cytoplasm
- aminolevulinic acid
- E: aminolevulinate dehydratase
- Porphobilinogen
- E: porphobilinogen deaminase
- hydroxymethylbilane
- Uroporphyrinogen III synthase
- Uroporphyrinogen
- Note: aminolevulinate = ALA
- Note: glucose and heme inhibit ALA synthase
Heme synthesis Part 2
- cytoplasm
- Uroprophrinogen
- E: uroporphyrinogen decarboxylase
- coproporphyrinogen III
- Mitochondria
- protoporphyrin
- with iron (Fe2+)
- E: ferrochelatase
- Heme synthesis
Lead Antidotes
- Antidotes
- Dimercaprol
- CaEDTA
- Succimer
39 secs
Acute Intermittent Porphyria (AIP)
- Pathophysiology
- Autosomal Dominant
- Inhibited Porphobilinogen Deaminase
- Increased Serum Porphobilinogen
- Increased Serum Delta-ALA
- Increased Urinary Porphyrin Precursors
- Signs & Symptoms
- Precipitated By P450 Inducers
- Painful Abdomen
- Polyneuropathy
- Psychological Disturbances
- Port Wine-Colored Urine
- Treatment
- Glucose and Hemin
- Considerations
- Avoid Triggers
3 mins
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