Awesome Review Flashcards
Difference btwn MCV and RDW?
MCV- measure of RBC size
RDW- measure of variation of red cell size
Note: if RDW is high, it’s a mixed anemia
Bite Cell
G6PD deficiency
Too much Erythropoietin can cause what 4 major problems?
Lymphoma, VTE, CVA, HTN
Most sensitive assay for IDA
Serum Transferrin receptor level/log ferritin which is
Transferrin receptor index
> 2.0 is IDA
IDA: Transferrin saturation Serum ferritin TIBC Transferrin receptor index
Transferrin saturation 2.0
Note: transferrin saturation is also low in AOCD
What would you see on hemoglobin electrophoresis for beta thalassemia?
Increased A2 levels
Increased fetal Hgb levels
Must have Both!
How to diagnose alpha thalassemia?
DNA PCR analysis
What will you see on XRAY of hip for Avascular necrosis of femur head
Diffuse articular sclerosis and patches of decalcification
Treatment algorithm for acute chest syndrome in sickle cell anemia patient?
Abx
Oxygen
PRBCs
Exchange transfusion if still hypoxic!!
Diagnose and Treat a schoolteacher with anemia and arthalgias- Parvovirus B19
IgM Antibodies or PCR assay
Treat with IVIg
MC cause of osteomyelitis in Sickle Cell Disease
Salmonella
If MCV is > 110, what are you thinking?
Vitamin B12 deficiency
Folate deficiency
Difference btwn B12 and folate deficiency?
B12 deficiency will have both increased MMA and Increased Homocysteine
Folate deficiency will only have increased homocysteine
Metformin and PPI can cause what macrocytic anemia?
B12 deficiency due to decreased absorption of Vitamin B12
5 causes of folic acid deficiency
Alcohol Folic acid antagonist (MTX) OCP Low dietary intake of folate Infection Celiac Sprue Dilantin/Phenytoin Relative Folate deficiency (chronic hemolysis or hereditary spherocytosis) Old Pregnancy
Treat Myelodysplastic Syndrome
If 55 yo, Azacitidine
If erythropoietin level > 500, antithymocyte globulin and cyclosporine
If 5q gene deletion or can’t tolerate antithymocyte globulin- Lenalidomide
Transferrin saturation is >45%
Hemochromatosis with HFE gene
Treat Aplastic Anemia
50 give antithymocyte globulin and cyclosporine
If can’t tolerate or doesn’t work, give
Alemtuzumab
Name 5 causes of Pancytopenia
MDS B12 deficiency Fanconi Syndrome Viral hepatitis HIV Hypersplenism Hairy cell Leukemia Bactrim Copper Deficiency
Name etiology of warm AIHA
SLE CLL Lymphoma Methyldopa PCN Procainamide
Etiology of Cold AIHA
Quinidine Lymphoma Infectious Mononucleosis Influenza Mycoplasma
Treatment of Warm AIHA
Steroids Danazol Rituximab Splenectomy Immunosuppressive drugs
Treatment of Cold AIHA
Cyclophosamide
Chlorambucil
Rituximab
NOT STEROIDS
Diagnose and Treat Hereditary Spherocytosis
Osmotic Fragility Test
Tx: folate supplement or splenectomy in severe cases
Screening and Specific Test for Hereditary Spherocytosis
Screening- fluorscent spot for G6PD activity in men
Specific- quantitative level of G6PD enzyme (but not during acute hemolysis)
Name 4 conditions you see schistocytes
DIC
HUS
HELLP
TTP
After massive blood transfusion, patient has seizure due to?
Citrate toxicity
What causes acute hemolytic transfusion reaction?
ABO incompatibility
What causes delayed Hemolytic transfusion reaction?
Rh incompatibility
2-10 days after transfusion
Prevent febrile nonhemolytic transfusion reaction, give what kind of PRBC
Leukoreduced (remove contaminating WBCs)
Give what kind of PRBC if IgA deficiency
Washed (removes protein)
Especially if urticaria and recurrent allergic reaction
Etiology for Transfusions Related Acute Lung Injury
Anti leukocyte antibody from donor
Stop donating!
Etiology and treatment of
Post transfusion Purpura
PLA-1 Antibodies
Tx: IVIg
What primary hemostasis disorder gas giant platelets?
Bernard Soulier disease
Normal PTT
Diagnose VonWilibrand Disease
Decreased Ristocetin factor assay
Increased bleeding time
Increased PTT
Treat VonWilibrand Disease
Mild- DDAVP
Severe- factor 7 concentrate contains vWD
Treatment for Idiopathic/Immune Thrombocytopenic Purpura
If bleeding or platelet
You need to anticoagulate someone with HIT
Argatoban or Bilavirudin
Direct thrombin inhibitor
How to determine factor 13 deficiency?
Clot Retraction Test
What are the Factor Xa inhibitors?
Rivaroxaban
Apixaban
Fondaparinux
Edoxaban
What are Low Molecular Weight Heparin?
Dalteparin
Enoxaparin
Tinzaparin
(Inhibit thrombin and Xa)
What are direct thrombin Inhibitors?
Hirudin, bivalirudin, lepirudin, desirudin
Argatroban
Dabigratan
Russel Viper Venom Time Test for..?
Lupus anticoagulant syndrome
How long do you treat provoked cause of DVT or post surgically?
How long do you treat Leiden factor V defect or protein C deficiency DVT?
3 months
6 months
Cause of Warfarin Skin Necrosis
How to treat?
Protein C deficiency
FFP
Treat Polycythemia Vera
Low dose Aspirin with phlebotomy to get Hct 60, give hydroxyurea
Or consider Ruxolitinib (JAK2 inhibitor)
In Essential Thrombocytosis,
What are the 2 associated mutations?
JAK2
CALR
Diagnose CML
FISH for t(9:22)
Or
PCR analysis for abl/bcr fusion gene
3 diseases you see decreased leukocyte alkaline phosphatase
CML
PNH
Wilson’s disease
Long standing history of PV
Blood smear is tear drop cells, uncleared RBC, giant platelets
Myelofibrosis
Translocation and treatment of
Acute Promyelocytic leukemia
T(15:17)
Auer rods!
Tx: All trans retinoic acid and arsenic trioxide
Signs/Symptoms and Treatment of ATRA differentiation syndrome
ATRA- all trans retinoic acid
Dyspnea, pulmonary infiltrate, fever, weight gain, hypotension
Give Dexamethasone
Mutation for Hairy Cell Leukemia
BRAF V600E
What ethnicity is common in alpha thalassemia?
SE Asia like Vietnam, Cambodia, Laos
What ethnicity is common in beta thalassemia?
Mediterranean/Asian like Italian, Greek, Indian
Spurr cell OR acanthocyte
Liver Disease
Burr Cell OR Echinocyte
Anemia of Uremia
Smear shows Tear Drop, nucleated RBC and giant platelets
Myelofibrosis
Side Effect of Lenalidomide
VTE/PE
