CPC: Bone Marrow Transplant Flashcards

1
Q

what is going on here?

A

MAHA: DIC, TTP, HUS. there are obcious schistocytes.

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2
Q

outline the scheme for diarrhea

A
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3
Q
A

atrophied colon due to GVHD

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4
Q

how does severe GVHD impact ferritin levels?

A

can cause severe ferritin deposition and steatohepatitis.

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5
Q
A

normal liver with normal bile duct

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6
Q

what cell does GVHD first attack?

A

epithelial cells – which is why in the colon biopsy the crypts and mucosa are immediately affected.

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7
Q

a person just had a BMSCT. they then presented with elevated liver enzymes. what is going on in this liver?

A

iron deposits evident. indication of gvhd which causes severe iron deposits.

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8
Q

prevention and treatment of graft vs host disease

A

prophylaxis: cyclosporin, methotrexate (immune suppression), anti-thymocyte globulin
treatment: steroids, rexolitinim Jak2 inhibitor, ECP (extracorporal photopheresis), ATG antithrmocyte globulin. IL2 receptor blockers( antibodies)

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9
Q

what virus could’ve caused this?

A

CMV. CMV can cause CMV colitis.

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10
Q

what do you expect to see on a tissue biopsy of CMV-colitis.

A

small bubbles of enlarged cells. Viral cytopathic effect.

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11
Q

CMV symptoms

A

can be primary or secondary (due to stress)

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12
Q

summary: after BMT, you gotta balance GVHD and CMV.

A
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13
Q
A

hypocellular marrow

  • no malignant cells and no normal cells
  • aplastic anemia–cause of pancytopenia
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14
Q

a person presents with low platelets, wbc, and is anemic. he has these physical features:

what congenital disease could be responsible for this?

A

this is dyskeratosis congenita: causes pancyopenia via aplastic anemia. Due to a telomere issue.

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15
Q

Case: a 38 yo woman is short of breath and tired. She had a normal delivery of a healthy baby girl 4 months prior. She is finding it more difficult to run long distances. She experiences heavy bruising. PBS shows this:

what is going on?

A

auer rods present. huge cell is a blast. this is AML.

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16
Q

which marrow is normal and which is malignant?

A

right is malignant. the patient has hypercellular marrow.

seen in a patient with pancytopenia due to acute leukemia.

17
Q

a 58yo woman presents to ER sent in by walk-in clinic with abnomrla blood work after presenting wiht fatigue.

Hb 45, MCV 120, WBC 1.2 with neutrophils 0.8, platelets 60.

interpret her PBS and labs

A

Hb= very anemic.

Macrocytic anemia

WbC= low, but neutrophils probably are still wihtin proportion.

she’s pancytopenic for sure. platelets also low.

everything is affected- Aplastic anemia? What accounts for MCV? nutritional deficiency?

also, PBS shows hypersegmentation in neutrophil– characteristic of B12 deficiency

CASE ANSWER: B12 folate was low. showcases hematopoietic ineffectiveness.

18
Q

what’s going on in the PBS

A

packed PBS; abnormal cells in BM. Aren’t released in BS so it’s stuck in the marrow.

probably due to B12 or folate deficinecy– if you see the yellow arrow, there is a cell that is skipping mitosis.

19
Q
A

seen in pbs with metastatic marrow infiltration (this patient had prostate cancer)

20
Q

what cell is this and what is it characteristic of?

A

hypersegmented neutrophil– indicative of B12/folate deficinecy.

21
Q
A

A