Hematology Flashcards
Iron deficiency is the only anemia with elevated______
RDW
Only microcytic anemia with high reticulocyte count _____
HgH (hemoglobin H, variant of alpha thalassemia)
B12 deficiency can be tested with a b12 level, and ____
methylmalonic acid, homocysteine (both elevated)
B12 deficiency can also look hemolytic (LDH, haptoglobin)
___ electrolyte deficiency can occur after treating B12 deficiency
Low potassium
Treatment for severe sickle cell disease______
Exchange transfusion
- Pulm infarction
- priapism (try aspirating first)
- Stroke
- Retinal Infarction
*start fluids, O2, possibly Abx, hydroxyurea, maybe IVIG
Target sickle cell percent = 15%
Sickle cell patient with sudden drop hemoglobin ______, _____
Folate deficiency, parvovirus B12
- Reticulocyte count will be abnormally low-normal
Only signs of sickle cell trait ____, ____
Dilute urine, hematuria/renal defect
Autoimmune hemolytic anemia (warm antibody) associated with lymphoma, other auto-immune (SLE, RA), drugs (quinine, sulfa, penicillin), will show ______ on the peripheral smear
Spherocytes
Tx: Steroids, rituximab—> IVIG —> Splenectomy
Cold antibody hemolytic anemia.
Coombs ____
Complement ____
Only responds to Tx______
negative
positive
Tx: Rituximab
Heinz body, bite cells is a sign of ______
Drug most correlated
G6PD deficiency
Dx: G6PD level 2 months after episode
Dapsone, rasburicase
Only condition causing elevated MCHC____
Caused by defect in _____
Diagnosed with ____ assay
Hereditary spherocytosis
- splenomegaly, hemolysis, bilirubin gallstones
Ankrin/spectrin cytoskeletal proteins
EMA (eosin-5′-maleimide (EMA) binding test) , or osmotic fragility
Treatment of severe HUS or TTP______
Plasmapharesis , not steroids
Eculizumab only used for non-infectious HUS
ADAMS TS 13 breaks down Vwf, to break down platelet strands, plasmapheresis replenishes VwF
_____ characterized by pancytopenia, dark urine episodes early morning, diagnosed with ____
PNH
CD55, 59
Tx: Eculizumab, vaccinate with menningococal vaccine before
Cx: AML
_____ during pregnancy results in hemolysis, liver injury, distinguished from DIC since no change to PT/PTT
HELLP syndrome
Anaphylaxis from blood transfusion caused by ______
IgA deficiency
Type of leukemia most associated with DIC_____
Promyelocytic leukemia, treated with all trans retinoid acid or arsenic trioxide
_____ smoldering, pancytopenia disease with pelger huet cells on smear, treated with linalidomide
MDS
Another treatment: azacitidine
How to distinguish reactive vs CML neutrophil count____. CML cytogenetic hallmark_____
LAP score (Low score)
Philadelphia chromosome (BCR/Abl)
____ characterized by elevated lympocytes, and smudge cells on smear
CLL
Tx: Rituximab, fludarabine, –> Venetoclax
Massive splenomegaly, age = 50, panctopenia ______
Hairy cell leukemia
Tx: Cladribine
Dx: Smear + Flow Cytometry
Pancytopenia, splenomegaly with tear drop cells_____ treated with _____
Myelofibrosis, Ruxolitnib (Anti Jak2)
Treatment of polycythemia vera_____
aspirin, phlebotomy, hydroxyurea, —> ruxolitnib/anagrelid
Dx: LAP, B12 level
Tx: Hydroxyurea
Treatment of polycythemia vera_____
aspirin, phlebotomy, hydroxyurea, —> ruxolitnib/anagrelid
Dx: LAP, B12 level (elevated)
Tx: Hydroxyurea
Multiple myeloma workup
1) Skeletal Survey
2) SPEP: IgG monoclonal
3) UPEP: Bence jones proteins
4) Free light chain : Kappa/lambda
Most effective therapy:
Rouleux formations
Autologous bone marrow transplant, others: lenalidomide/thalidomide/bortezomib
Treatment of Waldenstrom_____
Plasmapheresis
Rituximab/Fludarabine
Reed stern burg, owl eyes cells associated with ____
Hodgkins Lymphoma
Best diagnostic step for Hodgkins and Non-Hodgkins_____
Excisions lymph node biopsy
Tx: CHOP, R-CHOP, ABVD
______ caused by lack of platelet stabilization and function, diagnosed with ____
Von willibrand, ristocetein assay or Vwf assay
Hack: elevated PTT, Plt levels are normal
Tx: ddAVP, Factor 8 replacement
disease characterized by low Plt, no splenomegaly, megakaryocytes in bone marrow with large platelet chunks on peripheral smear____
ITP
Treatment of ITP_____
Only treat if Plt<50,000
Acute: Steroids, IVIG (Plt<20,000 + bleeding)
Chronic: Romiplostim, Splenectomy
How to tell if clotting factor deficiency and inhibitor_______
Mixing study
- If deficiency, mixing will correct
glanzman and bernard soulier act like VwF, ristocetein assay will show no binding, ddAVP can be used to release sub endothelial stores , will show giant platelets on smear
Glanzman (low glycoprotein IIb, IIIa) for fibrinogen bridging, like being on abxiximab
Bernard soulier caused by deficiency in a VwF receptor (Giant platelets)
Tx: ddAVP, also only works for hemophilia A (Factor 8)
How is a factor 8 inhibitor treated______
Factor 7, bypasses to Factor 10
HIT
1) Diagnosis:
2) Treatment:
Plt Factor 4 Antibody
Fondaparinaux, Argatroban, Bivalirudin
Test for antiphospholipid antibody syndrome____
Russel viper venom
