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Hemato-onco Flashcards

1
Q

Very large nucleated cells (blasts) with purple-red inclusions (Auer rots) is a hallmark of
It’s most common in

A

Acute myeloid leukemia
65 year old patients

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2
Q

Hallmarks of Hodgkin lymphoma

A

-Reed-stenberg cells
-B sts + presents with mass

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3
Q

Hypersegmented neutrophils with6 or more lobules should always make you suspect

A

Megaloblastic anemia

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4
Q

Hallmarks of B12 deficiency

A

Neurological disfx: usually start affecting proprioception (recurrent falls) and vibration
-MVC > 110 (also in Folic acid def)
-Hypersegmented neutros (“ “)

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5
Q

How and why does an Acute hemolytic transfusion rx present?

A

Fever, chills, dyspnea, chest or back pain and hemoglobinuria within min to hours of transfusion.
Usually due to ABO incompatibility (Type ll hypersensitivity rx - mainly IgM)

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6
Q

Possible triggers of DIC

A

Sepsis
Malignancy
Trauma
Obstetric complications

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7
Q

Pancytopenia in the settings of sepsis most likely indicates

A

DIC

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8
Q

What’s the mec of DIC due to sepsis ?

A

Endotoxins activate coagulation cascade which leads to widespread fibrin deposition, shearing of RBC = schistocytes

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9
Q

Atypical lymphocytes are usually seen in

A

Infections, specially Mononucleosis

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10
Q

Howell-Jolly bodies are round, dark, purple-red inclusions in RBC seen in

A

Splenectomy, spleen disfx, sickle cell disease.

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11
Q

Howell-Jolly bodies are round, dark, purple-red inclusions in RBC seen in

A

Splenectomy, spleen disfx, sickle cell disease.

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12
Q

Which type of donor is most appropriate for Congenital diseases that require bone marrow transplants?

A

Matched unrelated donor (can have near perfect HLA matching)

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13
Q

Why aren’t Autologous and syngenetic donor a good option for congenital genetic disorders?

A

Autologous = Cells harvested from patients (eg umbilical cord) will have the same problem.
Syngenetic = cells from identical twin will have exact HLA match and not be rejected but will have same congenital mutation

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14
Q

Pathophysiology Chronic myeloid leukemia ?

A

Translocation of genes between chromosomes 9 and 22 with the resulting fusion of genes BCR-ABL

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15
Q

Sickle cell disease hallmarks

A

-hemolysis
-vasoocclusion
-Infections
*small and firm spleen

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16
Q

Pathophisiology of sickle cell disease

A

Beta globin Mut (Glu for Val) Polymerization of HbS lead to sickle shaped RBCs which cause small vessel occlusion and hemolysis

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17
Q

Numerous plasma cells (>10%) in BM aspirate is characteristic of

A

Multiple myeloma

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18
Q

Features of multiple myeloma

A

-Monoclonal ig spike
-Normo-normo anemia
-hypercalcemia and bone lesions
-Light-chain cast nephropathy/renal insuf
-Amyloidosis

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19
Q

Main difference between sickle cell anemia and sickle cell disease

A

No HbC present in SC anemia

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20
Q

Pathophysiology of Homozygous sickle cell anemia

A

Mut in both beta globin genes (change of glutamate for valine) = forms beta sickle globins = unable of producing HbA (has beta globin) but can produce HbF and HbA2 (don’t have beta globin)

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21
Q

Acute intermittent porphyria presents as

A

Recurrent abdominal pain
Neurological symptoms
Port-wine colored urine

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22
Q

Pathophysiology of Acute intermittent porphyria and tto

A

Failure to produce heme. Accumulation of perphyrin precursors in blood and urine due to enzyme deficiency (porphobilinogen deaminase.
tto is hemin infusion (downreg aminolevilinate synthase)

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23
Q

A mutation in beta globin gene (beta thalassemia) affects which cellular process?

A

Initiation of translation bc mutation occurs before methionine start codon (AUG) needed for the Kozak consensus seq to initiate protein translation

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24
Q

Blood smear Findings in Beta thalassemia:

A

-microcytosis
-increased central pallor (hypochromia)
-target cells
-anisopoikilocytosis (different shape,sizes)
-basopholic stippling

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25
Hereditary spherocytosis is caused and characterized by
RBC membrane cytoskeleton defect. Hyperchromia. Defects in spectrin, ankyrin.
26
Difference between iron deficiency anemia and thalassemia’s anemia
There’s usually iron overload in thalassemia
27
Sickle cell anemia occurs due to
A to T Mutations in beta globin gene that make glutamate be replaced by valine
28
Which anticoagulant is most appropriate during pregnancy
Heparins bc they do not cross the placenta
29
Difference in use between LMWH and Unfractioned ?
LMWH: long-term life. Does not req lab monitoring. Renal clearance (can’t use if GFR<30). It’s usually preferred. (Ex enoxaparin, dalteparin) Unfractioned: used in severe renal insufficiency and at term pregnancy (37 weeks)
30
Difference in use between LMWH and Unfractioned ?
LMWH: long-term life. Does not req lab monitoring. Renal clearance (can’t use if GFR<30). It’s usually preferred. (Ex enoxaparin, dalteparin) Unfractioned: used in severe renal insufficiency and at term pregnancy (37 weeks)
31
Direct thrombin inhibitors (factor IIa)
-batran -gatran -troban
32
Which factors are targeted by heparins
Xa IIa (thrombin)
33
Which factors are targeted by heparins
Xa IIa (thrombin)
34
Werfarin must-knows
-Vit k antagonist: inhibits factors Vll, IX, X, ll -Monitored with PT and INR -Can cause skin necrosis (Prot C reduction befor affection of other factors) -> Req Heparin bridge (before Werfarin) -Teratogenic toxicity
35
PT, PTT and BT are used to monitor
-Werfarin and extrinsic pathway disease -LMWH and intrinsic “ -Platelets function
36
Which drugs are most commonly rel to drug induced immune mediated hemolysis?
Anti-inflam, penicillins and cephalosporins. The last two cause extravasc hemolysis by IgG binding to surface of RBC
37
Which drugs are most commonly rel to drug induced immune mediated hemolysis?
Anti-inflam, penicillins and cephalosporins. The last two cause extravasc hemolysis by IgG binding to surface of RBC
38
Hemolysis is characterized by
Symptomatic anemia Indirect hyperbilirubinemia Retycolocytosis Low haptoglobin (binds to Hb) Confirmed by direct Coombs test
39
Anemia of chronic disease is caused by
Cytokine mediated iron desreg
40
Iron deficiency anemia is characterized by:
-Microcytosis -Hypochromia -Poikilocytosis (several shapes) if severe -common in young women (menstruation) - high EPO but reduced RBC and reticulocytes -high transferrin (increased iron scavage) but low saturated transferrin -hepcidin is low (no inflam related)
41
Chronic disease anemia
Normo-normo Mediated by hepcidin Inflam: High hepcidin, High serum cytokins, PCR Low serum iron Transferrin normal or decreased and transferrin sat low EPO is variable High bone marrow iron (due to sequestration by macrophages)
42
Severe chronic hemolysis is associated with
Presence of erythroid precursors in liver and spleen (increased size). Extramedullary hematopoiesis (driven by increased EPO) Causes can be beta thalassemia or sickle cell disease
43
Burr and helmet cells are associated to
Traumatic hemolysis
44
Paroxysmal nocturnal hemoglobiuria
Complement mediated Pancytopenia
45
Hallmarks of B-lymphoblastic Leukemia
Expression of TdT markers CD > or same as 10 Lack of MPO
46
Target cells are seen in
Def hemoglobin level synthesis = thalassemia, iron deficiency Obstructive liver disease, splenectomy
47
The following are associated to: 1.Pappenheimer bodies 2.Howell-jolly bodies 3.Heinz babies 4.Sphirocytosis 5. Basophilic stippling
1.sideroblastys anemia (dark blue) 2.hyposplenia asplenia (dark purple, blue inclusions 3.G6PD def, thalassemia 4. Hemolysis and hereditary spherocytosis 5. Thalassemia, heavy OH use, lead/metal poisoning
48
Which heparin is most effective inactivating Thrombin?
-Unfractioned H: Thrombin = Xa -LMWH: Xa > thrombin (less antithrombin activity)
49
Rasburicase is given prior or during chemo to
Protect organs by converting Uric acid into soluble metabolites
50
Tumor lysis sd causes
HyperK HyperPHO4 Hyperuricemia -> AKI
51
How do you treat Tumor lysis sd after chemo Adm
Aggressive intravenous to flush phosphorus and uric acid out of kidneys Rasburicase: adds urate oxidase to increase allontin (more soluble) Allopurinol: competitive inhibition of xanthine oxidase to produce less uric acid
52
Mesna is used to prevent
Hemorrhagic cystitis’s by Cyclophosphamide or ifosfamide
53
Leucorovin prevents
Methrotrexate adverse side effects
54
Hepcidin’s mec in chronic anemia
Binds to ferroportin on enterocytes and reduces iron absorption in gut
55
Heparin’s mec
Binds to antithrombin lll which neutralizes clotting factors Xa and lla (indirect effect)
56
Vincristine’s mec and effect
Microtubule formarion inhibitor by binding to beta tubulin and inhibiting proliferation. Microtubules are critical for axonal transport ~> peripheral neuropathy
57
Vincristine’s mec and effect
Microtubule formarion inhibitor by binding to beta tubulin and inhibiting proliferation. Microtubules are critical for axonal transport ~> peripheral neuropathy
58
Anthracycline’s main adverse effect
Cardiotoxicoty
59
What’s aspirin’s mec? And lifespan?
Blocks Cox1 primarily and it’s *irreversible* Cox1 can’t produce Troboxane A2 -> no increase glucoprot llb, lllA -> no platelet aggregation/activation Lifespan: 3-7 days
60
How many days prior to sx should aspirin be suspended?
Minimum 5 days prior to
61
Principal site of uric acid precipitation
Distal tubules and collection ducks (where pH is lowest, key for its precipitation)
62
Tumor lysis management
Alkalinization and Hydration Allopurinol (xanthine oxidase inhibitor) reduces uric acid production
63
What can Exclusive breastfeeding cause ? Why?
Iron deficiency anemia due to loss through shedding of epithelium which depletes the low reserves of babies
64
Iron deficiency stages
1.Reduced storage: low ferritin level only 2.Iron limited erythropoiesis: transferrin increases and transferrin sat decreases 3. Iron deficiency anemia: low MVC and MCHC. Reduce reticulocytes
65
Iron deficiency stages
1.Reduced storage: low ferritin level only 2.Iron limited erythropoiesis: transferrin increases and transferrin sat decreases 3. Iron deficiency anemia: low MVC and MCHC. Reduce reticulocytes
66
Francisella tularensis causes ___ and risk factor
Single papiloulcerative lesion Contact with wild animals

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