7 Heme Onc Flashcards by Marcus Wong

B12 deficiency:

think what 4 causes for the test

pernicious anemia–no IF
crohn’s–attacks TI (absorption)
pancreatic insuff (need proteases to release from salivary R-binder)
Fish tapeworm

How well did you know this?

Not at all

Perfectly

B12 vs Folate equivocal, get what?

Get MMA. If elevated, then B12 deficiency

How well did you know this?

Not at all

Perfectly

Schilling’s test for B12

give IM nonradioactive B12, saturate liver binding sites.
give oral radioactive B12, then check if radioactive excreted in urine. If radioactive is present in urine, then it can be absorbed in gut.
If not, then add other things to aid absorption: IF, abx if bacterial overgrowth, and pancreatic enzymes

How well did you know this?

Not at all

Perfectly

Fe deficiency anemia.
-what is normal Fe daily requirement and max?

how long to replace serum Fe, and how long to replace Fe stores?
How much Fe in 1 PRBC unit?

1 mg/day, max 3 mg/day

serum Fe: 6 weeks
stores: 6 mo

350g Fe in 1 PRBC unit. So, 1 year’s supply.

How well did you know this?

Not at all

Perfectly

anemia of chronic dz

-tx and decision making

Tx underlying dz. (eg SLE, RA). If can’t, can give EPO. helps body utilize Fe stores.

If Hgb>10, f/u labs in 3 mo
If <10, give EPO

How well did you know this?

Not at all

Perfectly

Pt with microcytic anemia on blood test, but normal Fe studies. Think what. then do what/look for what

Thalassemia.

To dx, get Hgb electrophoresis. Can show B-Thal positive. But if neg, then A-thal is dx of exclusion

Also, LDH normal, but retic count low.

How well did you know this?

Not at all

Perfectly

Thalassemia: how to think about it.

Classic vignettes

Pt either presents:

MILD: Asx–no tx.
-Asian person with isolated anemia and low retic count, LDH normal. Told couldn’t donate blood. (if Hgb electrophoresis negative, must be A-thal)

SEVERE: severe anemia–transfusion required, + deferoxamine
-16yoM comes with Hgb 3.2

How well did you know this?

Not at all

Perfectly

Pt with microcytic anemia. Fe studies show elevated serum Fe.
do what

Sideroblastic anemia

Get pt away from lead, give B6, Confirm dx with bone marrow bx. (ringed sideroblasts)

How well did you know this?

Not at all

Perfectly

Sideroblastic anemia:

causes to know (5)

Lead
ETOH
INH
B6 def
AML/myelodysplastic

How well did you know this?

Not at all

Perfectly

Normocytic hemolytic anemias: (4)

name each, smear, confirm test, tx

Spherocytosis
- smear +
- osmotic fragility test
- Folate and Fe if mild, splenectomy if severe
PNH
- smear -
- flow cytometry
- steroids, eculizumab
G6PD
- Smear: Heinz bodies and Bite cells
- G6PD levels 6-8 wks after attack
- avoid triggers
Autoimmune hemolytic anemia
- Smear: spherocytes
- Coombs test (IgG)
- steroids, IVIG, splenectomy

How well did you know this?

Not at all

Perfectly

Blood smear: you see spherocytes. think what

Either spherocytosis, or AIHA.

Do Coombs. If positive AIHA. negative, spherocytosis.

How well did you know this?

Not at all

Perfectly

PNH: what to remember

can have venous thrombosis in intra-abdominal veins, causing abd pain.

How well did you know this?

Not at all

Perfectly

Sickle cell:

what test for avascular necrosis of hip/femur to know

DEXA scan screening

How well did you know this?

Not at all

Perfectly

Leukemias, ages?

7, 47, 67, 87

ALL, CML, AML (must be older than CML for blast crisis), CLL

How well did you know this?

Not at all

Perfectly

You suspect AML or ALL. What dx tests to do and not do

CBC not helpful, could be up or down

Blood smear, look for blasts.
Confirm with BM bx, >20% blsts

How well did you know this?

Not at all

Perfectly

Auer rods

-what associations?

M3 subtype of AML.
Can go into DIC
Tx with ATRA (vit A)

Leukemias: what special thing to remember about each?

ALL: CNS PPx with intrathecal Ara-C. Also scrotum

AML: Auer rods, DIC

CML: Blast crisis to AML. imatinib to delay.

CLL: do no harm if old.

Lymphoma staging

-how affects tx?

1: 1 group lymph nodes
2: >1 group nodes on same side of diaphragm
3: >1 group nodes, opposite side of diaphragm
4. diffuse dz (blood, bone marrow)

2a or less: radiation (can add chemo IRL)
2b or more: chemo

B means B-sxs present

Lymphoma:
-common classic sxs (3)

-uncommon sxs to know (2)

fevers, night sweats, weight loss.

Pel-Epstein fevers: cyclical over weeks
ETOH tender LAD

chemo tox man (5)

cisplatin: oto and nephrotox
bleomycin: lung fibrosis

doxorubicin, adriamycin: cardiomyopathy

Cyclophosphamide: hemorrhagic cystitis (mesna)

Vincristine, vinblastine–
peripheral neuropathy

Multiple Myeloma

-sxs mnemonic

CRAB

Ca, hyper
renal insuff (myeloma kidney)
anemia
bone lesions/pain

multiplel myeloma

-3 mechs to know, their sxs, and diagnostic findings

Bad plasma cells make these:

bad monoclonal Ab.
- infections
- Protein gap, with M-spike on SPEP
Bence Jones proteins (bad Ig’s)
- renal failure
- protein gap, UPEP
Osteoclast activating factor
- hyperCa, bone lesions
- imaging shows

you suspect multiple myeloma. do what tests:

SPEP: m spike
UPEP: bence jones proteins
skeletal survey

-BM Bx to confirm. >10% plasma cells

MGUS

definition
conversion rate to MM, how often check labs

SPEP+ but no other MM findings

- Conversion to MM 2%/year. check labs q6mo.

Waldenstrom's macroglobulinemia - classic vignette - dx finding - tx

-hyperviscosity syndrome (HA, AMS, blurry vision, mucosal bleeding)+peripheral neuropathy. 62yo male with gum bleeding when brushing teeth, sleeping more. Trouble driving with blurry vision. Feet tingling - >10% lymphs on BM bx - plasmapheresis to prevent stroke. also chemo.

von willebrand's disease - dx - tx - tx in severe acute bleeding

low vWF, also low F8 -vWF assay or platelet fxn test - desmopressin (vWF) - acute severe: can give Cryo (F8)

general platelet transfusion rules

Transfuse for: <20k <50k and bleeding

when in thrombocytopenia to NOT give platelets

TTP/HUS. just eats more of it. do plasmapheresis

TTP, HIT, DIC, ITP: | -tx

TTP: plasmapheresis, no plt HIT: stop Hep, do argatroban DIC: give cryo, FFP, plt, blood ITP: IVIG, steroids. refractory splenectomy

TTP sxs

FAT RN fever, anemia, thrombocytopenia renal, neuro sxs Also think HUS with diarrhea

Pt with bleeding because low VitK. causes to know other than warfarin (3)

- cirrhosis - Abx. killed intestinal K-producing bacteria - Low PO intake (think ICU pt)

always think: If microcytic anemia, then what test?

Iron studies, specifically Ferritin. high--ACD low--Fe def normal--thalassemia

Chemo for lymphoma:

Any lymphoma 2b. (ABC) Hodgkin's, not severe: ABVD Hodgkin's severe: BEACOPP Non-H: Rituximab or CHOP-R, with CNS ppx with MTX

NOACs: brand names, indications and contraindications ``` Lepirudin Argatroban Dabigatran Rivaroxiban Apixaban ``` which can be reversed, with what?

Both: HIT, transition to Coumadin. - HIT, cannot use in renal dz (renally cleared) - HIT, ok in renal fail. (hepatic) All 3: nonvalv Afib, DVT - Pradaxa - Xarelto - Eliquis Pradaxa can be reversed with Praxbind (Idarucixumab)