Hematology Flashcards
Jak2 V617F mutation that have essential thrombocytopenia, what is the best treatment regimen?
Aspirin and Hydroxyurea
What heme/onc medication can reduce neutrophils?
Methotrexate
IgG monoclonal antibody spike, everything else is normal, what else should be done?
Nothing, observation, MGUS, no follow up testing required.
Sickle cell patient needs gallbladder removal, what should be the hemoglobin goal?
Pre-surgery, hemoglobin above 10
A patient has parvo-virus s/p chemo, and she is a Kindergarten teacher. What is the next best treatment if reticulocyte count is low?
IV immunoglobulin
Parvovirus can lead to red cell aplasia
If a patient has CAD and a GI bleed, they take Plavix and aspirin on a routine basis. Hemoglobin 10, platelets are wnl. What should be next best step?
Hold plavix, give ASA, call cardiology
If a patient has a normal hemoglobin electrophoresis, a thalassemia is suspected, what is the most likely concern?
Alpha Thalassemia
C282Y, H63D, and 65C mutations are the most common mutations with what liver pathology?
Hemochromatosis
If all three cell lines are low, no blast cells are seen, what is the most likely heme pathology?
Myelodysplastic Syndrome
What is a very common cause of neutrophilia?
Chronic Smoking
Superficial vein thrombosis usually has AC treatment for how long?
Superficial vein thrombosis greater than 5cm should have treatment for how long?
6 weeks
3 months
If a patient has an elevated INR less than 10 and they are asymptommatic, what should be done?
Watch and wait
If a patient has an elevated INR greater than 10 and no bleeding, what should be given?
Vitamin K
If a patient has an elevated INR greater than 10 and bleeding, what should be given?
Vitamin K and Kcentra (4-factor prothrombin complex concentrate)
If a patient has unexplained ITP, what are the first things to test for?
Hep C and HIV
Pediatric Leukemia patients that have had treatment are at an increased risk of what?
Diabetes Mellitus and HLD
If a patient is starting chemotherapy, what should be given to them to maintain neutrophil count?
Granulocyte-CSF, helps preserve WBC count
Warm autoimmune hemolytic anemia obscures detection of what?
Alloantibodies, complicating identification of compatible donors
Warm autoimmune hemolytic anemia, how does one eliminate antibody production?
Glucocorticoids and Rituximab
A patient has hereditary spherocytosis, mild symptoms, what should be done?
Severe Symptoms, what should be done?
Folate
Splenectomy
If a patient has a central venous catheter placed, clot forms, and the central venous catheter is still functioning, what should be done?
Keep the central venous catheter in place, and AC for three months
If a patient is low risk and he has multiple subsegmental PE, what should be done?
D/C home with Rivaroxaban
A patient has G6PD deficiency, no acute symptoms, what is the best treatment course?
Symptom management
Are steroids used in DIC treatment?
What is the treatment?
No
Treat the underlying cause
A patient has platelets less than 50, what should be done?
If a patient requires a platelet transfusion, how much should the platelet count go up?
Transfusion
Should go up 20,000 to 30,000
A bone marrow biopsy shows marked hypocellularity, increased fat content without dysplastic cells, hepatitis is negative, what is this?
What is the treatment?
Aplastic anemia
If an HLA match is available and less than 50, should have a stem cell transplant
What is the aplastic anemia treatment for older than 50, no suitable stem cell donor?
Immunosuppression with antithymocyte globulin, cyclosporine, and prednisone
What is the drug Azacytidine or other hypomethylating agents are used to treat what?
Treat symptomatic
Antiphospholipid syndrome has what unique clotting pattern?
Arterial and Venous embolism
What is the drug of choice for antiphospholipid syndrome??
Warfarin, should start with heparin first
Particularly triple positive lupus patients
A patient takes a macrolide and has hemolytic anemia. What is the best test to run?
Cold agglutin Titer
Thrombocytopenia and microangiopathic hemolytic anemia, easy bruising, what is the best initial treatment?
Plasma Exchange, Glucocorticoids, and Rituximab
What enzyme is missing in the TTP?
ADAMS13
If a patient has a PESI score of 1 with a pulmonary embolism, what is the best treatment?
Apixaban or Elliquis
In a patient with an unprovoked DVT, how long should the treatment course be?
3-6 months, can be reduced after a discussion
Does pregnancy naturally have an elevated D-dimer?
What scoring criteria is used to evaluate if a pregnant woman should undergo radiological testing?
Yes
YEARS algorithm
Transfusion-associated circulatory overload occurs when?
What is it?
6 hours
Respiratory Distress, positive fluid balance, pulmonary edema
How is the difference between Gestational Thrombocytopenia and ITP found?
Gestational Thrombocytopenia: later in pregnancy, platelets around 100,000
ITP: Early in pregnancy, platelets around 70,000
A sickle cell patient with fever, hypoxia, chest pain, and pulmonary edema, would benefit from what treatment?
Erythrocyte Exchange Transfusion
Platelet Transfusion does not normally occur in thrombocytopenia unless the patient is bleeding and below what number?
10-20k
If a patient has platelets less than 30k and no active bleeding, what treatment is indicated?
Steroids
Hemophilia A has what inheritance pattern?
Who will be affected?
X-linked recessive
men only are affected, women are asymptomatic
If a patient is undergoing Multiple Myeloma Treatment with proteasome inhibitors, what other medications should be given?
Valacyclovir, helps any viral/varicella reactivation occurrence
Patients with unexplained splanchnic vein thrombosis, what should be tested?
JAK2 mutation
Normocytic anemia, what are the next best tests to order?
Reticulocyte Count and peripheral blood smear
The first step in evaluating thrombocytopenia is what?
Peripheral Blood Smear
Immune Mediated hemolysis is detected by what?
Positive Direct antiglobulin test
If a patient has a chemoradiation due to breast cancer, and they have myelodysplastic syndrome. What is the next best test?
Bone Biopsy
Hydroxyurea treatment can inadvertently cause what?
Macrocytic Anemia
AML in a 79 year old woman, she responds well to induction therapy, what is the next best consolidation therapy step?
Allogenic Hematopoietic Stem Cell Transplantation
Patient most likely has Heparin Induced Thrombocytopenia, what is the next best treatment step? Assuming she needs to be anticoagulated
Start Rivaroxaban
Polycythemia Vera, patient under 60, and low risk, what should be done?
Polycythemia Vera, patients over 60, and high risk, what should be done?
Low Risk patient: Low Dose Aspirin and phlebotomy
High Risk patient: Hydroxyurea or IFN-alpha, and phlebotomy
Before starting chemotherapy and managing VTE, what should be done to assess the need for DVT prophylaxis?
Khorana Score
Dabigatran causes a large hemorrhagic bleed, what is the reversal agent?
Idarucizumab
A whole-body low-dose CT scan is negative for smoldering myeloma, what is the next best step?
Whole Body MRI
Elevated IgM, hyperviscosity, difficulty with vision, fever, night sweats, weight loss, what is the next treatment step?
Plasmapharesis
B-thalassemia patients should be heavily monitored for what?
iron overload
All multiple myeloma patients should have what treatment done?
Pneumococcal Vaccination
Anemia of chronic disease, what is the best treatment course?
Reverse the original cause and give steroids
In liver disease vs. DIC, what clotting factor should be measured?
Factor VIII
Amyloidosis can be confirmed by a biopsy located where?
Abdominal Fat Pad
Elevated aPTT, what is the best step to evaluate the cause?
Mixing Study
Warm autoimmune hemolytic anemia is best detected how?
Positive Direct antiglobulin test that detects IgG and C3
A patient receives chimeric T cell therapy, patients with a high disease burden may develop what?
Cytokine Release Syndrome
Proximal Deep venous clot treatment with ESRD on dialysis, is what?
Apixaban (Eliquis), lowest renal elimination
Rivaroxaban is eliminated through the kidneys
What is this?
Iron Deficiency Anemia
What is this?
Normal Heme Path Slide
What is this?
Normal packed RBCs
What is the black arrow pointing at?
Iron deficiency anemia
What two pathologies are on this slide?
Target Cell and Thalassemia
What is this?
Warm IHA
Autoimmune, lymphoproliferative disorders, B-cell non-Hodgkin lymphoma, and drug induced problems can cause what type of anemia?
Warm Autoimmune Hemolytic anemia
Here/Onc: Autoimmune, what process is typically infectious?
Cold Autoimmune Hemolytic Anemia
Cold agglutinin disease can be treated how?
Rituximab
CLL, what feature (Path slide) will be there for a diagnosis?
Smudge Cell
What is this?
CLL
What is this? What is the distinguishing feature?
CLL, smudge cell
What is this?
ALL, note, no myeloid or granules in the picture
What is this?
Multiple Myeloma
What is this?
AML, look at the auer rods
What is this?
CML
What cell shows up in a CML smear slide?
Basophils are heavy, slide will show multiple different myelocyte phases
What is this?
TTP, low platelet with AIHA
What is this?
What are the black arrows pointing at?
Schistocytes
What is this? What can be see on the pathology slide?
ITP, no platelets around
What is this?
Essential Thrombocytosis
Increased reticulocyte count (RI > 2%), increased LDH, decreased haptoglobin, increased indirect bilirubin, what is this?
Hemolytic Anemia
Extravascular hemolytic anemia has what issue?
Splenomegaly
What syndrome has acquired clonal stem cell disorder, inactivating somatic mutation of PIG-A gene deficiency of GPI-anchor fo CD55 and CD59, pooor complement inhibition?
Paroxysmal nocturnal hemoglobinuria (PNH)
What is one of the treatments for paroxysmal nocturnal hemoglobinuria?
Eculizumab
Paroxysmal nocturnal hemoglobinuria is what type of hemoglobin disorder?
Myelodysplastic Syndromes
G6PD has what issue?
X-linked defect of metabolism, susceptibility to oxidative damage
Sulfonamides
Dapsone
Nitrofurantoin
Rasburicase
Primaquine
Doxorubicin
Methylene Blue
INFX, DKA, fava beans can cause what?
G6PD Deficiency
Bite Cells show up in what problem?
G6PD Deficiency
Sickle Cell, what can be given to prevent a pain crisis?
L-glutamine
Sickle Cell, pain, and vaso-occlusive crises, what is the =mab?
Crizanlizumab
What type of infections are particularly scary with sickle cell?
Osteomyelitis, encapsulated organisms
Hereditary Spherocytosis has a defect in what?
Ankyrin, alpa and beta spectrin, band 3
Osmotic Fragility Test and low Eosin-5-maleimide binding is code for what hematology problem?
Hereditary Spherocytosis
Warm Autoimmune Hemolytic Anemia is caused by what?
Idiopathic, CLL, NHL (Non-hodgkin lymphoma), autoimmune (SLE), HIV, Babesiosis, and drugs
Cold Autoimmune Hemolytic Anemia is caused by what?
Intravascular hemolysis and acrocyanosis, Lymphoprolif. disorders (Waldenstroom’s monoclonal), Mycoplasma Pneumoniae and EBV
Warm AIHA treatment is what?
Corticosteroids, splenectomy, IVIG, Cytotoxic agents, rituximab
Cold AIHA treatment is what?
Corticosteroids and rituximab
Low ADAMTS13 is code for what disease?
Thrombotic Thrombocytopenic Purpura (TTP)
Burr cell (Echinocytes) is seen in what disease?
Uremia and MAHA
Acanththocytes (Spur cells) are seen in what disease?
Severe Liver Disease
Target cells are seen in what 3 diseases?
Liver Disease, Thalassemia, HbC disease
Tear Drop RBCs with nucleated RBCs and immature WBCs, a dry tap is seen most times, time course is a few months?
Primary Myelofibrosis