CPC: Bone Marrow Transplant Flashcards
what is going on here?
MAHA: DIC, TTP, HUS. there are obcious schistocytes.
outline the scheme for diarrhea
atrophied colon due to GVHD
how does severe GVHD impact ferritin levels?
can cause severe ferritin deposition and steatohepatitis.
normal liver with normal bile duct
what cell does GVHD first attack?
epithelial cells – which is why in the colon biopsy the crypts and mucosa are immediately affected.
a person just had a BMSCT. they then presented with elevated liver enzymes. what is going on in this liver?
iron deposits evident. indication of gvhd which causes severe iron deposits.
prevention and treatment of graft vs host disease
prophylaxis: cyclosporin, methotrexate (immune suppression), anti-thymocyte globulin
treatment: steroids, rexolitinim Jak2 inhibitor, ECP (extracorporal photopheresis), ATG antithrmocyte globulin. IL2 receptor blockers( antibodies)
what virus could’ve caused this?
CMV. CMV can cause CMV colitis.
what do you expect to see on a tissue biopsy of CMV-colitis.
small bubbles of enlarged cells. Viral cytopathic effect.
CMV symptoms
can be primary or secondary (due to stress)
summary: after BMT, you gotta balance GVHD and CMV.
hypocellular marrow
- no malignant cells and no normal cells
- aplastic anemia–cause of pancytopenia
a person presents with low platelets, wbc, and is anemic. he has these physical features:
what congenital disease could be responsible for this?
this is dyskeratosis congenita: causes pancyopenia via aplastic anemia. Due to a telomere issue.
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?
auer rods present. huge cell is a blast. this is AML.
which marrow is normal and which is malignant?
right is malignant. the patient has hypercellular marrow.
seen in a patient with pancytopenia due to acute leukemia.
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
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.
what’s going on in the PBS
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.
seen in pbs with metastatic marrow infiltration (this patient had prostate cancer)
what cell is this and what is it characteristic of?
hypersegmented neutrophil– indicative of B12/folate deficinecy.
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