Hematology Flashcards
71-year-old male with known hypertension consults for routine annual laboratory examination. He is asymptomatic with normal physical examination findings. Lab results showed elevated white cell count with lymphocytic predominance. After ruling out an infectious process, what is the next step in the workup for this patient? (HPIM C103 P766)
a. Bone marrow aspiration with biopsy
b. RT PCR of peripheral blood for Philadelphia chromosome
c. Fluorescence in situ hybridization for BCR-ABL
d. Flow cytometry of peripheral blood
d. Flow cytometry of peripheral blood
Flow cytometry
• next step when noting either an elevated total white blood cell (WBC) count with lymphocytic predominance or a normal WBC with a differential showing a lymphocytosis
• Typical immunophenotype:
• typical B-cell markers CD19, CD20, CD22, CD23
• T-cell marker CD5 (CD5 is also expressed on the B1 subset of B cells that typically has unmutated immunoglobulin and responds to antigens independent of cognate T-cell help), and dim surface immunoglobulin of either kappa or lambda type
72-year-old male diagnosed with asymptomatic chronic lymphocytic leukemia suddenly develops cervical lymphadenopathies, anorexia, body malaise, fever, night sweats and weight loss. Initial workup showed high LDH. A suspicion for lymphoma transformation was made. What is the appropriate first step to guide biopsy for this patient? (HPIM C103 P767)
a. FDG-PET CT
b. HIDA scan
c. Nuclear scintigraphy technetium
d. Radioactive iodine uptake
a. FDG-PET CT
Richter’s transformation,
• One of the most devastating complications
• transformation of CLL to an aggressive lymphoma, most commonly DLBCL
• Clinical signs: rapid progression in adenopathy, often in a specific area, and constitutional symptoms including fatigue, night sweats, fever, and weight loss. LDH is usually high.
• In suspected cases, the first step is 18FDG-PET/CT to localize an area for biopsy
= SUV ≥ 10
• Excisional biopsy is diagnostic. Needle biopsy should be discouraged.
Therapy – usually involves combination chemoimmunotherap
Which of the following immune-mediated transfusion reactions is correctly paired with its mechanism? (PIM C109 P812-813)
a. Acute hemolytic reactions : preformed cytokines
b. Allergic reactions : RBC alloantigens
c. Delayed hemolytic reactions : plasma proteins
d. Febrile nonhemolytic transfusion reaction : antiHLA antibodies
d. Febrile nonhemolytic transfusion reaction : antiHLA antibodies
24-year-old female consults for a 3-month duration of heavy menstrual bleeding and easy bruisability. She has no known comorbid illnesses and does not take maintenance medications nor herbals. Her CBC shows hemoglobin 109, WBC 7, platelet count of 12. Which of the following are important laboratory tests to rule out secondary causes of immune thrombocytopenic purpura (ITP) in her condition? (HPIM C111 P825-826)
a. Bone marrow examination
b. H. pylori testing
c. Karyotyping
d. Serological testing for antibodies to platelet
H. pylori
IMMUNE MEDIATED THROMBOCYTOPENIA
LABORATORY TESTING
• Peripheral Blood Smear – large platelets, otherwise normal morphology
• Coomb’s Test: if with anemia to rule out AIH with ITP (Evan’s syndrome)
• Bone marrow examination
• for older adults >60 years old
• who have other signs or laboratory abnormalities not explained by ITP
• who do not respond to initial therapy
• Evaluate for secondary causes: HIV, Hepatitis C, serologic testing for SLE, SPEP, immunoglobulin levels, monoclonal gammopathy, IgA deficiency,H. pylori.
The phenomenon of enhanced O2 delivery through changes in the O2–hemoglobin dissociation curve via decreased pH is called:
a. Bohr Effect
b. Bernoulli’s Phenomenon
c. Fick’s Principle
d. Le Châtelier’s Principle
a. Bohr Effect
Which of the following parameters can distinguish liver cirrhosis from disseminated intravascular coagulation? (HPIM C112 P836)
a. Thrombocytopenia
b. Increased fibrin degradation products
c. Deranged PT INR
d. Rapidity of laboratory changes
d. Rapidity of laboratory changes
patient was admitted to the ER after a vehicular crash. He complained of abdominal pain while being assessed at the ER. PE showed BP 110/60 (90/50 on standing), HR 100, RR 22, O2saturation 99%, with abdominal hematoma. How much intravascular blood volume would be expected to be lost in this case?
a. 10%
b. 20%
c. 30%
d. 40%
30%
For Questions 2-4: An 80/M presented for workup of fatigue at the OPD. He had no history of bleeding. Tests showed Hb 90, Hct 25%, MCV 110 fL, MCH 32 pg, MCHC 33 g/dL, reticulocyte count 6.7%, platelet 140, WBC 6.0. What is the patient’s reticulocyte production index?
a. 1.5
b. 2.0
c. 2.5
d. 3.0
b. 2.0
RCI = (reticulocyte % / HCT%) / 2
Which among the following is the most likely diagnosis?
a. Iron-deficiency anemia
b. Sideroblastic anemia
c. Thalassemia
d. Vitamin B12 deficiency
d. Vitamin B12 deficiency
Which of the following conditions would present with an elevated reticulocyte production index?
a. Acute blood loss
b. Cardiopulmonary bypass
c. Hypothyroidism
d. Myelodysplasia
Cardiopulmonary bypass
What is the most important predictor of bleeding risk?
a. Aspirin use
b. History of bleeding
c. Liver disease
d. Platelet count <150
b. History of bleeding
Questions 9 and 10: An 18/M presented at the OPD for a 3-day history of a painful and swollen right knee after accidentally hitting it hard against the kitchen counter. He recalls that this happened 4 years ago, after a fall on the same knee. It was resolved after one week so work-up was not done. Laboratory results showed normal CBC and isolated prolonged aPTT. Which of the following diagnostics will confirm the diagnosis?
a. Factor VIII assay
b. Factor VII assay
c. Prothrombin assay
d Bethesda assay
a. Factor VIII assay
Which of the following is least appropriate for treatment of this condition?
a. Cryoprecipitate
b. Factor replacement therapy
c. Prothrombin complex concentrate
d. Tranexamic acid
c. Prothrombin complex concentrate
Hemophilia Treatment
- factor replacement therapy
** Cryoprecipitate: factor 8, 13, vWF
** Tranexamic acid- antifibrinolytic
30/F presented with recurrent episodes of gum bleeding and heavy menstrual flow. Blood count showed isolated thrombocytopenia of 3. Which of the following is appropriate to include in the succeeding work-up?
a. Antibody testing
b. Bone marrow biopsy
c. Bleeding time
d. Peripheral blood smear
d. Peripheral blood smear
Which of the following is consistent with thrombotic thrombocytopenic purpura (TTP)?
a. Decreased haptoglobin
b. Decreased lactate dehydrogenase
c. Decreased reticulocyte count
d. Decreased unconjugated bilirubin
DIAGNOSIS: need to rule out DIC
☆ Creatinine– Renal failure
☆ Increased levels of
1. Lactate dehydrogenase
2. indirect bilirubin
3. reticulocyte count
☆ decreased haptoglobin
☆ negative direct antiglobulin test
☆ PBS
• schistocytes
• Polychromasia is usually also present (due young RBCs)
• Nucleated RBCs (due to infarction in the microcirculatory system of the bone marrow)
☆ NORMAL PT and aPTT
• differentiates it from DIC
