HEM&ONC Flashcards
Shift oxy-hemoglobin curve to left
Metabolic alkalosis Decreased body temp Increased Hgb F
Shift oxy0hemoglobin curve to the right
Metabolic acidosis Increased body temp High altitude Exercise
5 causes of microcytic anemia
Iron deficiency Lead poisoning Anemia of chronic disease Sideroblastic anemia Thalassemias
3 causes of normocytic anemia
Hemolytic anemia Anemia of chronic disease Hypovolemia
Normal MCV Increased retake count Increased indirect bill Increased LDH Decreased serum haptoglobin
Hemolytic anemia
Pathology of G6PD deficiency
Deficiency of G6PD (enzyme required to repair oxidative damage to RBCs) Ingestio nof an oxidant causes excessive hemoylsis
Heinz bodies
Small densities of Hgb in RBC seen in GG6PD deficiency
Oxidants that exacerbate G6PD deficiency
Fava beans High dose ASA Sulfa Dapsone Quinine/quinidine Primaquine Nitrofurantoin
Serum iron and ferritin in sideroblastic anemia
Increased
Which thalassemia shows basophilic stippling
Beta
Gingival lead lines, peripheral neuropathy, decreased MCV
Lead poisoning anemia (acquired sideroblastic anemia)
Treamtnet for lead poisoning
EDTA or Dimercaptosuccinic acid
Drugs that can cause aplastic anemia
Chloramphenicol, sulfonamides, phenytoin, chemotherapeutics
H/P of aplastic anemia
Persistent infections Poor clotting Easy brusiing
Defective heme synthesis
Sideroblastic anemia
Causes of sideroblastic anemia (3) - acquired
Alcohol Isoniazid Lead poisoning
Tx of hereditary sideroblastic anemia
Vitamin B6. Significant iron overload requires therapeutic phlebotomy or chelation with deferoxamine.
Complication in 10% of sideroblastic anemia patients
Acute leukemia
SORE tongue points to what kind of anemia
folate deficiency
How many abnormal genes do pts with alpha thalassemia minor have
Two
What kind of Hb increases in pts with B-thalassemia minor
HbA2
What kind of Hb is increased in pts with B-thalassemia major
HbA2 and F
Complications of thalassemias
Chronic iron overload from repeat transfusions causes damage to heart and liver.
Diff between sickle cell anemia and beta thalassemia
SCD causes production of DEFECTIVE beta chains. In B-thalassemia, decreased production of NORMAL beta chains.
“fish mouth vertebrae”
sickle cell disease
Encapsulated organisms
S pneumo H influenzae N. meningitidis Klebsiella
What type of hypersensitivity is drug-induced hemolytic anemia
Type II
Increased PT/INR indicates decreased function of which factors
Factors II, VII, IX, X
Increased PTT indicates decreased function of which factors
IIa, IXa, Xa, XIa, XIIa
Monitoring required in LMWH
None :)
Only factors not synthesized by the liver
VWF and VIII therefore they remain normal in liver failure
vWD labs
Increased PTT Increased bleeding time decreased ristocetin cofactor assay
Name 3 GPIIb/IIIa inhibitors
Abciximab Tirofiban Eptifibatide
Name 2 drugs you can use for HIT patients
lepirudin Argatroban Direct thrombin inhibitors
MOA of dipyridamole
Inhibit activity of adenosine deaminase and phosphodiesterase to inhibit platelet aggregation
4 things increased in DIC
increased PT Increased PTT Increased fibrin split products Increased D-dimer

Plasmodium infection. Ntote enlarged size, intracellular ring and eosinophilic Schuffners granules
Prophylactic regimen for HIV in needle stick injury
Lamivudine + zidovudine for 4 weeks.
At what CD4 count is Kaposi sarcoma seen
<500
Tx of toxoplasmosis
Pyrimethamine
Sulfadiazene
Clindamycin
Chronic tx may be needed.
3 infections seen at CD4<50
MAC
CMV
Cryptococcal meningitis
Complication of polycythemia vera
Leukemia
Most common form of Hodgkin lymphoma
Nodular sclerosing
“Starry sky pattern”
Burkitt lymphoma
t14:18
Follicular lymphoma
t8;14
Burkitt lymphoma
Staining with myeloperoxidase
AML
Smudge cells
CLL
Philadelphia chromosome (t9;22 BCR-ABL)
CML. Also associated with 15% of adult ALL cases.
massive splenomegaly and NO lymphadenopathy is what leukemia?
Hairy cell
Features of Fanconi anemia
Short stature
ABnormal skin pigmentation
Horsehoe kidney
Thumb abnormalities
Its bone marrow failure + pancytopenia + increased risk of leukemia
Congenital pure RBC anemia
Diamond-Blackfan
Elevated megakaryocytes
ITP
Giant platelets, abnormal ristocetin assay, thrombocytopenia
Bernard-Soulier
Labs in hereditary spherocytosis
Anemia with reticulocytosis and increased MCHC
Higher incidence of PSEUDO HYPERKALEMIA as RBCs lyse after blood draw and intracellular potassium leaks.
Tx of hereditary spherocytosis
Folic acid, 1 mg daily.
RBC transfusion if extreme anemia.
Splenectomy in moderate to severe disease.
What lab markers suggest anemia due to hemolysis
Low H & H
Normal MCV
High reticulocyte count
Indirect bilirubinemia
High LDH
LOW haptoglobin.
Name 4 things that cause schistocytes
DIC
HUS
TTP
Hemolytic anemia
What disease do you see acanthocytes in?
Abetalipoproteinemia
3 times you’d see basophilic stippling of RBCs
Lead poisoning
Thalassemia
Alcohol use
Heinz bodies
G6PD
Ddx for serum eosinophilia
D NAAACP
Drugs (NSAIDs, pcn/cephs)
Neoplasms
Allergies, Arthma (Churg Strauss), Allergic bronchopulonary aspergillosis
AIN
Collagen vasc disease (PAN, dermatomyosities)
Parasites (Such as strongyloides, ascaris lofflers eosinophilic pneumonitis)
What drugs are known for causing thrombocytopenia
Heparin, abciximab
Carbamazepine, phenytoin, valproate
Cimetidine
Acyclovir, rifampin
Sulfonamides
Procainamide
Quinine, gold compounds
You gave a von willebrand pt DDAVP but theyre still bleeding. Now what.
Cryo or Factor VIII concentrates.
MOA of clopidogrel
ADP blocker
MOA of eptifibatide
GPIIb/IIIa
MOA of ticlopidine
ADP blocker
MOA of tirofiban
GPIIb/IIIa
Labs in HUS or TTP
Decreased platelets
Increased bleeding time
Nml PT, nml PTT
Labs in Hemophilia A or B
Isolated elevation in PTT
Labs in Von Willebrand
Normal platelets
Increased bleeding time
Normal PT
Increased PTT (Due to factor VIII)
Labs in end stage liver disease
Platelet count: decreased or normal
Bleeding time : increased or normal
PT: Increased
PTT: increased
Labs in ASA use
Increased bleeding time ONLY!
Erythromelalgia – what is it and what dz is it classically seen in
Burning pain in hands/feet with erythema, pallor or cyanosis that is relieved by ASA. Seen in polycythemia vera
Treatment of polycythemia vera
PHlebotomy to keep hct below 45% in men, 42% in women
What can you add to therapy for a polycythemia vera patient if at high risk for thrombosis
Hydroxyurea. Can also take ASA daily to help prevent thrombosis
What can you add to therapy if a patient has refractory pruritis or refractory erythrocytosis in polycythemia vera
IFN alpha
What medication is associated with remission in 95% of patients with CML
Imatinib
Peripheral blasts are PAS + and TdT+
ALL
21 y/p/ with recent weight loss, pruritis and night sweats. PE reveals hepatosplenomegaly and nontender cervical lymphadenopathy. What do you immediately suspect
Hodgkins
Which anti retroviral causes lactic acidosis
NRTI
4 anti retrovirals that cause pancreatitis
Didanosine!!!
Zalcitabine
Stavudine
Ritonavir
Which anti retroviral causes megaloblastic anemia and bone marrow suppression
zidovudine
Regimen for HIV exposure ppx
AZT plus lamivudine
At CD4 <200, add what meds prophylactically? for waht organisms?
TMP-SMX or dapsone for PCP and toxoplasmosis
At CD4 <100, add what meds prophylactically and for what organism
Erythro or clarithromycin for MAC