Hem/Onc Flashcards
Ferritin, iron, and TIBC levels in iron deficiency anemia?
Ferritin: low ferritin (if this is low it’s Iron def anemia no matter what!)
Iron: low
TIBC: high
Ferritin, iron, and TIBC levels in anemia of chronic dz?
Ferritin: high
Iron: low
TIBC: low
Ferritin, iron, and TIBC levels in hemochromatosis? (hepcidin deficiency)
Ferritin: high
Iron: high
TIBC: low
Ferritin, iron, and TIBC levels in thalassemia?
NORMAL
the only microcytic anemia with elevated Fe on iron studies
sideroblastic anemia. caused by lead poisoning, EtOH, Isoniazid or other cause of B6 deficiency, and Myelodysplasia/AML
on CBC, person has microcytic anemia. what is next step in workup?
iron studies
CBC shows normocytic anemia. what is next step in workup?
hemolysis studies: reticulocyte count, LDH, Bili, Haptoglobin.
if this confirms hemolysis, do a blood smear.
on CBC, person has macrocytic anemia. what is next step in workup?
go straight to blood smear
what are causes of NONmegaloblastic macrocytic anemia?
liver dz
drugs (AZT, 5-FU, ARA-C/cytarabine)
metabolic syndromes (Lesch-Nyhan, Oritic Aciduria)
EtOH use
homocysteine levels are elevated in both folate and b12 deficiency, but which one has elevated methylmalonic acid?
B12 defic
what part of small bowel absorbs b12?
parietal cells secrete intrinsic factor -> absorbed in terminal ileum
3 drugs that trigger hemolysis in G6PD
trimethoprim sulfate
dapsone (be careful in patients with HIV before u start treating them with this!)
nitrofurantoin
spherocytosis is from defective what? (general and specific)
cytoskeleton scaffolding proteins: spectrin, ankrin, palllidin
besides hereditary spherocytosis, autoimmune hemolytic anemia can also show spherocytes on blood smear. how do you confirm dx for each?
hereditary - osmotic fragility test
autoimmune - coombs test (direct and/or indirect +, either igG for hot or igM for cold)
what is pathyophys of anemia caused by hereditary spherocytosis? what is treatment?
spheres cant get thru spleen -> sequestered and destroyed by spleen macrophages -> hemolytic anemia
tx: splenectomy. doesnt fix the spheres! but will fix the anemia
causes/associations of warm autoimmune hemolytic anemia (spherocytes, positive coombs test, positive igG NOT igM) (3)
rheumatological dz
drugs (PCN, Sulfa, Rifampin)
Cancer causing Anti RBC IgG Ab to be made
what is cold autoimmune hemolytic anemia (positive coombs test, IgM) caused by (2)
Mycoplasma
Mono
treatment for paroxysmal nocturnal hematuria (it’s a specific immunotherapy drug)
eculizumab
what does flow cytometry show in PNH? to dx
absence of CD55 and CD59
paraneoplastic syndrome: migratory thrombophlebitis (Trousseau’s syndrome) and nonbacterial/sterile thrombotic endocarditis
what cancer is this associated with
pancreatic adenocarcinoma
paraneoplastic syndrome: dermatomyositis
what cancer is this associated with
adenocarcinomas, especially ovarian
paraneoplastic syndrome: Leser Trelat = suddenly brown spots everywhere on skin
what cancer is this related to? what are those brown spots?
brown spots are multiple seborrheic keratoses
GI adenocarcinomas and other visceral cancers
(note that acathosis nigricans can also these cancers! even tho mostly for insulin resistance)
paraneoplastic syndrome: hypertrophic osteoarthropathy
what cancer is this associated with
adenocarcinoma of lung
hypercalcemia and weight loss. PTH is normal. what next?? why?
order PTHrp levels (doesnt get picked up on regular PTH test). this is paraneoplastic syndrome from malignancy.
paraneoplastic syndrome: SIADH and Cushings, Lambert Eaton (anti resynaptic (P/Q-type) Ca2+ at NMJ antibodies), cerebellar degeneration (from antibodies against Purkinje cells), encephalomyelitis (ab against neurons)
what cancer is this associated with. how to treat this cancer specifically?
small cell/oat cell lung cancer
DO NOT RESECT. it’s VERY responsive to chemo!
the cerebellar degeneration one can also be from gyn/breast cancers, or Hodgkin lymphoma
in tumor lysis syndrome, you have high uric acid, K+, and phosphate in blood, but calcium is low. why is that?
phosphate binds w/ and precipitates Ca which reduces intravascular levels (the precipitate can also deposit in kidneys along with uric acid, which facilitates the AKI in TLS)
how to tell between leukemoid reaction and CLL if person has profound leukocytosis?
leukocyte alkaline phosphatase is also elevated in leukemoid reaction (infection). it’s not in the abnormal neutrophils of CLL so it’s low to normal.
also absolute basophils are present on peripheral smear in CLL.
