CIS, cumulative Part I Flashcards
most common type anemia encountered clinically
diminished/decreased red cell production
4 y.o M with fever and dry cough petechial hemorrhages on chest and around eyes suspect thrombocytopenia and order CBC most likely Dx? -Bernard Soulier -ALL-B -DLBCL -Hereditary spheorocytosis -Acute ITP
dDx
ALL-B
Acute ITP
4 y.o M with fever and dry cough petechial hemorrhages on chest and around eyes suspect thrombocytopenia and order CBC shows lymphocytosis low platelets and mild splenomegaly most likely Dx? -Bernard Soulier -ALL-B -DLBCL -Hereditary spheorocytosis -Acute ITP
ALL-B
What is indicated for ALL-B
- platelet adhesion study
- serum ferritin
- Hb electrophoresis
- osmotic fragility testing- red cells
- Haptoglobin
- karyotyping
- bone marrow aspirate and biopsy
- flow cytometry
- myeloperoxidase study
- white cell differential
white cell differential karyotyping bone marrow aspirate and biopsy flow cytometry myeloperoxidase
myeloperoxidase study in peripheral blood is looking for what
AML
what are examples of flow cytometry
tdt, CD markers etc
45 y.o M dysphagia, focally cystic mass in L neck 7.5 cm mass extending midline of upper thorax reasonable on ddx? -thyroid carcinoma -thymoma -DLBCL -hodgkin lymphoma -germ cell tumor
All of those
45 y.o M dysphagia, focally cystic mass in L neck
7.5 cm mass extending midline of upper thorax
biopsies show unremarkable thymic cortical and medullary regions
best dx?
-thymoma
-malignant thymoma
-squamous cell carcinoma
-graves
-germ cell tumor
thymoma
thymoma has been associated with
- cushing
- myasthenia gravis
- pure red cell aplasia
- graves
- pernicious anemia
myasthenia gravis
all of them really
22 y.o M in MVA, 15 min later heli massive gliding abrasions down to bone near total amputation of distal third of R leg, semi conscious, tachy, pale low BP intubated and urinary bladder inserted no output observed CBC included most likley: -slightly dec Hct -increased MCV -Increased RDW -Leukocytosis -Reticulocytosis
slightly dec Hct
14 y.o female with low grade fever, anemia and splenomegaly juandice most likely -chronic blood loss -sickle cell disease -beta thalassemia -hereditoary spherocytosis -parvovirusB19
hereditary spherocytosis
14 y.o female with low grade fever, anemia and splenomegaly juandice absolute lymphocytosis suffer aplastic crisis transfused, weks later has colicky abdominal pain splenectomy and cholecytectomy caliculi from GB are most likley -calcium oxalate -triple ammonium phosphate -bilirubin/heme metabolites -uric acid -aggregates of Salmonella sp
bilirubin/heme
struvite stones, triple ammonium phosphate assoc with
infections
splenectomy more increased risk for infection with what
encapsulated bacteria
11 y.o F sore throat and fever, purulent cough
improves with antibiotics but 3 days later tired and listless
peripheral smear shows bite cell with heinz bodies
most likely Dx?
assoc with?
G6PD
oxidant stress
52 y.o M with low Hb RDW 19% high platelet
constipation abdominal pain, weakness, malaise
general pallor with pale conjunctiva
best characterized as?
chronic blood loss anemia
52 y.o M with low Hb RDW 19% high platelet
constipation abdominal pain, weakness, malaise
general pallor with pale conjunctiva
small liver peptide has significant role in terms iron absorption in this disorder
what is the peptide
-haptoglobin
-hepcidin
-ferritin
-transferrin
-intrinsic factor
hepcidin
52 y.o M with low Hb RDW 19% high platelet constipation abdominal pain, weakness, malaise general pallor with pale conjunctiva most likely? -low serum ferritin -high transferrin saturation -low TIBC depleted hepcidin levels -hemochromatosis
low serum ferritin
52 y.o M with low Hb RDW 19% high platelet constipation abdominal pain, weakness, malaise general pallor with pale conjunctiva which etiology is most likely -manopause -aplastic anemia -plasma cell dyscrasia -adenocarcinoma of colon -squamous cell carcinoma of lung
adenocarcinoma of colon
42 y.o japanese F
mother had RA. she has low fever with painful swollen joints especially at articulations
RF+ and erosive arthritis
several lung lesions with granulomatous inflammation
normocytic normochromic anemia
most likely?
-early iron deficiency anemia
-anemia of chronic disease
-hemolytic anemia precipitated by seropositive spondyloarthropathy
-superimposition of myelodysplastic syndrome
-chronic blood loss anemia
anemia of chronic disease
myelodysplasias are characterized by what generally
cytopenias
RA anemia of chronic disease most likely? - dec haptoglobin lebels -dec hepcidin levels -increased TIBC -high serum ferritin level -high serum iron/low storage iron (marrow)
high serum ferritin
RA anemia of chronic disease most likely pathogenesis? decreased hepcidin inflammatory mediator IL6 increase CRP hight EPO level high TIBC
inflammatory mediator IL6
42 y.o japanese F mother had RA. she has low fever with painful swollen joints especially at articulations RF+ and erosive arthritis several lung lesions with granulomatous inflammation what explains lung? -concomitant TB -sarcoidosis -syphilis -RA -bronchopulmonary aspergillosis -MAI in an immunocompromised patient
RA
22 y.o M with pancytopenia jaundiced and splenomegaly increased liver transaminases bone marrow aspirate shows hypercellularity and megakaryocytic hyperplasia what is most likely? -myeloproliferative syndrome -aplastic anemia -acute leukemia -acute lymphoma -beta thalassemia
myeloproliferative syndrome
What is needed to Dx AML
20% blasts in aspirate
44 y.o M with significatn normocytic normochromic anemia
PMH notable for radiation therapy for papillary carcinoma of the thyroid 10 yrs ago
had bone marrow transplant
PS shows leukoerythroblastosis
bone and whole body CT fails to reveal any mass lesions
most likely assoc with
-myeloproliferative syndrome
-chronic renal failure
-chronic liver failure
-metastatic papillary carcinoma; thyroid
-erythroblastic leukemia
myeloproliferative syndrome
17 y.o M chronic posterior HA L CVA tenderness
microscopic hematuria
large mass L kidney and cystic mass in posterior fossa
retinal lesion R eye
RCmass is increased MCV increase
most likekly
VhL syndrome
EPO causing erythroblastosis
52 y.o M with low Hb norm MCV and RDW 19 (elevated) high platelet constipation, abdominal pain, weakness malaise pallor pale conjunctiva due to? -celiac -chronic blood loss anemia - increased destruction red cells -due to marrow replacement -chronic inflammation
chronic blood loss
52 y.o M with low Hb norm MCV and RDW 19 (elevated) high platelet constipation, abdominal pain, weakness malaise pallor pale conjunctiva following etiologies is most likely? -ET -burkitt lymphoma -marginal zone carcinoma of colon -yersinia enterocolitica infection
-carcinoma of colon
52 y.o M with low Hb norm MCV and RDW 19 (elevated) high platelet constipation, abdominal pain, weakness malaise pallor pale conjunctiva most likely? -serum ferritin 10 (low) -high transferrin saturation -low TIBC - depleted hepcidin -hemochromatosis
low serum ferritin
47 y.o hispanic with malaise and weakness
muscle spasms of UE and cog wheel rigidity
been on omeprazole since teenager for GERD
suffers bouts of gastritis
tone is glazed and beefy with multifocal leukoplakia
MCV 110 and PS hypersegmented PMNs
increase homocystein and methymalonate
most likely?
-infestation with diphyllobothrium latum
pernicious anemia
-folate deficiency
-primary thymidine deficiency
-polymyositis
-pernicious anemia
Tx pernicious anemia?
parenteral B12
22 y.o F with microcytic hypochromic anemia PS shows target cells and nucleated red cells basophilic stippling in RBC serum ferrritin increased HbA2 increased small quantitiy of HbF most likely? - Fe deficiency -Beta thalassemia minor -alpha thalassemia trait -HbH disease -PNH
beta thalassemia minor
27 y.o SLEwith weakness and SOB Hct 12% RDW 25 PS fragmented forms mild spenomegaly direct coombs antiglobulin test + IgG best characterized as immunohemolytic anemia of what type -warm Ab -cold agglutinin -cold hemolysin -cryoglobulin -mycoplasmal
warm Ab
38 y.o M sharp intermittent left chest pain and SOB
dry cough, episodic low grade temp
EKG unremarkable but elevated CRP and LDL
mild lymphocytosis
5 cm lytic lesion in lateral portion L 7th rib
most likely in terms of rib lesion?
-solitary plasmacytoma
-histiocytosis X
-MGUS
-metastatic prostate carcinoma
-lymphoplasmacytic lymphoma
solitary plasmacytoma
38 y.o M sharp intermittent left chest pain and SOB
dry cough, episodic low grade temp
EKG unremarkable but elevated CRP and LDL
mild lymphocytosis
5 cm lytic lesion in lateral portion L 7th rib
biopsy rib shows macrophages and eos
scatter neutrophils binucleated plasma cell aggregates and mature lymphocytes identified
-histiocytosis X
-hodgkin lymohoma
-myeloproliferative syndrome
-solitary plasmacytoma
-granulocytic sarcoma
solitary plasmacytoma
24 y.o M complains chronic cough and GERD urine is tea colored PE shows pitting edema lower legs BUN cr elevated platelet count low platelet infusions prior to kidney biopsy glomerular features consistent with FSGS most likely? -parvovirus B19 -HUS -vWb disease -HIV -Chronic ITP
HIV
72 y.o M with fatigue and weakness. 15 Lb loss in recent weeks
diffuse painless lymphadenopathy and HSM mildly jaundice
Hct 32% and RDW 19
BM aspirate shows plasma cell proliferation in paratrabecular distribution
Molecular profiling of BM shows mutations in MYD88 and flow cytometry CD19 20 +
Peripheral studies on blood are consistent with cold agglutinin Ab
most likely?
-multiple myeloma
-mycoplasma infection syndrome
-parvovirus B19
-lymphoplasmacytic lymphoma
-immunohemolytic anemia, NOS
lymphoplasmacytic lymphoma
47 y.o M obese and indicates his service is to entertain VIPs
drinks alot
dull L upper quadrant pain for some time and episodically bleeding hemorrhoids
CBC unremarkable
imaging shows splenomegaly
mild pitting edema ankles
most likely cause of organomegaly?
congestive
57 y.o M weakness and lethargy n/n anemia with significant splenomegaly t 9;22 most likley -CMML -anemia of chronic disease -primary myelofibrosis -richter syndrome -CML
CML
67 y.o M with fatigue/ethargy and L foot pain night sweaths and weight loss. n/n anemia with increased RDW splenomegaly L shift WBC with eos/basophils blast count 8% with hgih platelets BM has 12% blasts and BCR ABL fusion big toe swollen and painful at joint most likley? -myelodysplastic syndrome -myeloproliferative syndrome -CML in lymphoid blast crisis -hairy cell leukemia -AML
myeloproliferative syndrome
54 y.o F with fatigue lethargy night sweats and weight loss n/n aemia with increased RDW HSM liver shows EMH left shift low WBC count no blasts in PS high platelet 7% blasts in BM with alrge dysplastic megakaryocytes in clusters osteosclerosis BM reticulin increased pancytopenia develops and PS shows nucleated RBC with dacryocytic configurations numerous acute infections from pyogenic bacteria and fungi bleeding episodes -CML -APL -TTP -PV -PM
Primary Myelofibrosis
37 y.o G7P5 F has history HUS successfully Tx with supportive care
borderline kidney function with microcytic hypochroimc anemia
splenectomy 6 mo ago with rise in paltelet count
while getting platelet infusion, became hypotensive and SOB
cardiac arrest and was DOA at hostpial
most likely?
-immunohemolytic crisis
-primary cardiac disease
-DIC
-transfusion related complication
-fatal allergic reaction
transfusion related complication
