Hematology Flashcards
What is a thrombophilia? broadly
Thrombophilias can be defined as a group of inherited or acquired disorders that increase a person’s risk of developing thrombosis (abnormal “blood clotting”)
Gold standard to diagnose lymphoma?
What technique shouldn’t you do?
Excisional biopsy is the gold standard for lymphoma diagnosis
- imaging-guided core biopsy can be acceptable
- dont do an FNA
Risks of RBC transfusion? … why you shouldn’t do them willy nilly
allergy, fever, infections, volume overload and hemolysis
3 big complications of acute leukemias
- Tumor lysis syndrome
- the blasts run out of resources and start to massively lyse, releasing contents and causing inflammation - hyper K, hypo Ca, AKI - DIC - disseminated intravascular coagulation, balance between coag and fibrinolysis gets disrupted, INR/PTT too long, low platelets, maybe schiztocytes
- leukostasis - big fat blasts are sticky and cause infarcts in various systems
Definitive criteria for acute leukemia? (2)
Blasts in peripheral blood smear AND
>20% blasts in bone marrow
How to assess lineage (ie AML vs ALL, myeloid vs lymphoid)
flow cytometry
Heme history you might not think to ask
Exposure to cytotoxic things..
- chemo, radiation
- work - ionizing radiation, pesticides, solvents
PMHx - cancer, autoimmune disorders, blood product transfusions
Meds - immunosuppressive medications
Heme important to look for on physical exam
conjunctival pallor (signs of anemia) petechia, purpura (thrombocytopenia) lymphadenopathy (suggests ALL) splenomegaly (suggests CML) mouth - poor dentition, candida, risk of infection
Labs to assess for tumor lysis syndrome (5)
Uric acid (urate)
potassium, calcium, phosphate
lactate dehydrogenase
Labs to assess for DIC
CBC (platelets)
INR/PTT
fibrinogen
?d-dimer
AML vs ALL, which is more likely to occur in which age group (adults vs children)
AML acute myeloid leukemia - 80% adults
ALL acute lymphoid leukemia - 80% children
Goal and broad method for treatment of leukemia
goal is remission
chemo to induce this
then consider post-remission things such as stem cell transplants
what defines remission in leukemia? (4)
bone marrow with less than 5% blasts
peripheral blood with no detectable blasts
normalization of peripheral blood cell counts
and absence of extramedullary disease (for at least four weeks).
What is myelodysplastic syndrome, MDS?
Persistent, progressive, and otherwise unexplained cytopenias (eg. macrocytic anemia refractory to replacement of vitamin B12 and folate)
myelo - think lineage
dysplastic - think “misformed/shaped”
What is a high reticulocyte count?
> 2%
ask yourself whether this is appropriate or not..
if low, think substrate..
if high, think loss..
What can MDS progress to?
AML!
MDS = ineffective hematopoeisis, function or form AML = arrested hematopoeisis, non-functional, stop at the blast stage
Most common cause of anemia in children?
ddx (3)
Iron deficiency anemia
- remember how we harp on parents to feed their kids iron rich cereals and not too too much milk…
ddx: malabsorption (celiac), blood loss (bleeding disorder, GI), anemia of inflammation (ask and infectious sx, order ferritin and CRP)
Labs for ?hemolytic anemia (6)
LDH (lactate dehydrogenase) - will be high
Haptoglobin - will be low if there is hemolysis
Bilirubin
Reticulocyte count
DAT (direct antiglobulin test)
Blood film
What four tests should you order when you suspect multiple myeloma?
Serum protein electrophoresis
Urine protein electrophoresis
Light chains
Immunoglobulins
When should you order a blood smear?
All the time.
Anemia NYD Any cell line is down or up Pancytopenia Concern for hemolysis (TTP, DIC, HELLP) Concern for leukaemia or lymphoma
ddx to child with anemia
iron deficiency (by far most common cause)
- malabsorption
bleeding (ask about GI, GU)
inflammation (viral illness, fever, malaise, sick contacts)
hemolytic anemia (jaundice, dark urine, bruising)
malabsorption (celiac)
bleeding disorder (family history)
hemoglobinopathy (sickle cell, thalassemia)
What percentage of the time is a lymphoma hodgkins? Is hodgkins the better or worse prognosis of the lymphomas?
15%, more curable!
What two tests do you need to diagnose TTP?
CBC - anemia, low platelets
Smear - schistocytes
What’s the “mainstay” of lymphoma treatment?
Steroids
