Hematologic System Flashcards
0
Q
Lymphoma and staging
A
- RFs: EBV, H. pylori, HIV, organ/stem cell transplant, autoimmune disease
- Imaging/tests: CT, PET, bone marrow bx
- Dx: cervical or axillary node excisional bx
- *Burkitt lymphoma**
- translocation of c-myc on chrom 8 to chrom 14 which leads to overexpression of c-myc and excess B cell proliferation
- *Follicular lymphoma**
- 14:18 translocation which leads to over expression of bcl-2 which prevents apoptosis
- *CLL**
- B-cell lineage
- Sx: fatigue, frequent infections, lymphadenopathy, splenomegaly, thrombocytopenia, increase in circulating mature lymphpcytes
- Tx: chemo, stem cell transplant
- *Hairy cell leukemia**
- B cell lymphoma in middle aged men
- Sx: pancytopenia, massive splenomegaly
- Hairy cells detected by TRAP stain (hairy monster in a trap)
- Flow cytometry
- *Non-Hodgkin Lymphoma**
- Sx: painless lymphadenopathy
- Dx: NEED TISSUE BX, flow cytometry, FNA bx
- Labs: CBC, LFTs, uric acid, Ca, serum protein electrophoresis, CXR, CT, bone marrow bx, LP, PET scan
- Tx: rituximab, chemo
- GI lymphoma: most commonly seen in stomach
- RF= H. pylori
- Sx: abdominal pain, obstruction, GI hemorrhage, GI tract perforation, fatigue
- Tx: surgical resection with removal of draining LNs, chemo
- *Hodgkin Lymphoma**
- 20-30yo and >50yo
- Sx: nontender lymphadenopathy, fever, night sweats, wt loss
- Dx: LN bx (will see Reed-Sternberg cells)
- Tx: Low stage= radiotherapy. Advanced stage= chemotherapy.
- Good prognosis
- *Ann Arbor Staging**
- Stage 1: single LN region
- Stage 2: 2 or more LN regions on the same side of the diaphragm
- Stage 3: Both sides of the diaphragm are involved
- Stage 4: Involvement of extra-nodal sites (liver, bone marrow)
- A: asymtomatic
- B: Symptoms (wt loss, fever, night sweats)
- E: extralymphatic involvmement
1
Q
Anemia
A
- All women of childbearing age should have CBC done before any surgical procedure
- IDA in an elderly pt is colorectal carcinoma until proven otherwise
- anisocytosis=variation in size of RBCs
- poikilocytosis= variation in shape of RBCs
- Target cells: Thalassemia
- Howell Jolly bodies: sickle cell, hemolytic anemia
- Iron def is the most common cause of anemia
- Microcytic: iron def, anemia of chronic disease, sideroblastic anemia, thalassemia
- Macrocytic: Vit B12 def, Folate def
- Normocytic: hemolysis, acute blood loss
- Sx:HA, dyspnea, palpitations, dizziness, fatigue, dark urine, pallor, icterus, glossitis, koilonychia, angular cheilitis, tachypnea, tachycardia, pica (with IDA)
- Dx: gold standard is bone marrow bx, but this is rarely done.
- Labs: CBC, peripheral blood smear, reticulocyte count, UA, stool for occult blood, serum Fe(decreased in IDA), TIBC(increased in IDA), serum ferritin(decreased in IDA)
- Tx IDA: oral iron (ferrous sulfate), parenteral iron, blood transfusion if Hgb <6g/dL (generally if 6-7, possible if 7-8),