Common presentation of hematological malignancies

Question 1

What are the microcytic anemias?

Answer 1

Fe deficiency
Thalassemia
Anemia of chronic disease
Hemoglobinopathies
Sideroblastic anemia

Question 2

What does ferritin measure?

Answer 2

Body Fe stores

Question 3

What does TIBC measure?

Answer 3

Number of open spots on transferritin

Question 4

What does retic count measure? What is normal?

Answer 4

Reticulocyte count (immature RBCs)

0.5-1.5%

Question 5

What does urea breath test check for?

Answer 5

H.pylori infection

Question 6

What are the three common causes of Fe deficiency anemia?

Answer 6

Inadequate absorption
Inadequate utilization
Excessive loss

Question 7

What is the treatment for a gastric ulcer?

Answer 7

PPIs

Question 8

What vitamin increases the absorption of Fe?

Answer 8

Vitamin C

Question 9

What mineral suppresses the absorption of Vitamin C?

Answer 9

Ca

Question 10

How long does it take for the retic count to rise in response to Fe therapy? Hb?

Answer 10

Fe = 1 week
Hb = 2 weeks

Question 11

How long should you continue fe therapy?

Answer 11

Until serum Fe normal

Question 12

What drug interferes with vit b12 absorption?

Answer 12

PPIs

Question 13

What are the causes of megaloblastic macrocytic anemia?

Answer 13

Vit B12 deficiency

Folate deficiency

Question 14

What are the causes of non-megaloblastic macrocytic anemia? (4)

Answer 14

myelodysplastic syndrome
Liver disease
Hypothyroidism
Alcoholism

Question 15

What condition are multilobed neutrophils found in? What are these called?

Answer 15

Macrocytic anemia

Hypersegmented neutrophils

Question 16

What happens to the reticulocyte count in pernicious anemia?

Answer 16

Goes down

Question 17

What disease has high methylmalonic acid and total homocysteine levels? Which has just high homocysteine levels?

Answer 17

Both high = B12

Just homocysteine = folate

Question 18

How long does it take retic count to increase with B12 administration?

Answer 18

End of first week

Question 19

How long does the megaloblastic anemia take to correct with B12 supplementation?

Answer 19

6-8 weeks

Question 20

What is the general ddx for normocytic anemia?

Answer 20

Hemolytic anemia

Question 21

What are the causes of intrinsic hemolytic anemia? (3)

Answer 21

Membrane defects
Enzyme deficiencies (G6PD)
Hemoglobinopathies

Question 22

What are the causes of extrinsic hemolytic anemia? (3)

Answer 22

Autoimmune
Alloimmune
Non-immune (trauma, infx)

Question 23

What is the test used to identify immune mediated hemolytic anemia?

Answer 23

Coombs test

Question 24

What is the reticulocyte count like in hemolytic anemia?

Answer 24

high

Question 25

What type of anemia is LDH high in?

Answer 25

extrinsic hemolytic anemia

Question 26

What does an elevated indirect bilirubin indicate? Direct?

Answer 26

Indirect = liver problem
Direct = obstruction

Question 27

BIte cells on PBS = ?

Answer 27

G6PD deficiency

Question 28

What are the triggers for G6PD deficiency?

Answer 28

Fava beans
Infections
Drugs (antimalarials and sulfa)

Question 29

What are the two types of drugs that pts with G6PD deficiency should avoid?

Answer 29

Sulfa drugs

Antimalarials

Question 30

What happens to BUN with GI bleeds?

Answer 30

Can increase, but not incredibly sensitive

Question 31

Itchy after showering = what disease?

Answer 31

Polycythemia vera

Question 32

What hematological diseases should you be concerned about with skin changes?

Answer 32

Hemochromatosis (gray)
Polycythemia vera
PCT

Question 33

What are the secondary causes of polycythemia vera? How can you differentiate this from primary polycythemia vera?

Answer 33

COPD, pulmonary HTN, CHF (lung issues where you need more oxygen carrying capacity)

EPO will be low in primary polycythemia vera

Question 34

What is the treatment for polycythemia vera?

Answer 34

Phlebotomy

ASA to prevent clots