Hematology Flashcards
leukemias to know
ALL
AML
CLL
CML
child
LAD
bone pain
fever, bleeding
ALL
if the vignette is leukemia in a kid it’s
ALL
hallmark bx finding of ALL
> 20% blasts
tx for ALL
chemo
middle aged pt w. fatigue, LAD. splenomegaly
CLL
mc leukemia in adults
CLL
hallmark findings of CLL
smudge cells on peripheral smear (mature lymphocytes)
management of CLL
lymphycytes > 10,000: obs
symptomatic: chemo
2 hallmark findings of AML
blasts
auer rods
3 sx of AML
splenomegaly
gingival hyperplasia
WBC > 100,000
hallmark finding of AML
auer rods
>20% blasts
2 sx of CML
WBC > 100,000
hyperuricemia
splenomegaly
hallmark finding of CML
philadelphia chromosome (translocation of chromosomes 9 and 22)
lab findings of anemia of chronic dz
normal vs decreased MCV
decreased TIBC
increased ferritin
mcc causes of anemia of chronic dz
CKD
connective tissue d.o
RA
SLE
HIV
ca
cirrhosis
chronic infxn
hallmark finding of anemia of renal failure
decreased serum erythropoietin
pharm for anemia of chronic dz if Hgb < 10
EPO analog (epogen, procrit)
2 bleeding disorders to know
VWD
hemophilias A and B
clotting factor deficiencies associated w. hemophilias a and b
a: VIII
b: IX
moa for von willebrand factor
found on plasma, platelets, and walls of BV -> helps PLTs adhere to vessel wall at the site of injury
mc genetic bleeding d.o
VWD
common presentation for VWD
excessive bleeding after a cut or menstrual bleeding
how is VWD differentiated form hemophilia
w. hemophilia:
hemarthrosis
small amt of superficial bleeding
common w. minor injury
petechiae
tx for VWD
DDAVP
severe: transfusion containing VW factor
how is hemophilia passed on
x-linked recessive
hallmark presentation of hemophilas
hemarthrosis
lab findings of hemophilias
increased PTT
normal PT/PLT
tx for hemophilias
replace factor VIII or IX
anemia post infxn or medication
G6PD
G6PD is a _ anemia
hemolytic
what 3 populations are mc affected by g6pd
african
middle eastern
asian
3 triggers for g6pd
fava beans
antimalarials
sulfonamides
2 hallmark dx findings of g6pd
on smear:
heinz bodies
bite cells
4 genetic causes of hypercoagulable state
protein C def.
protein S def.
antithrombin III def.
factor V leiden
6 acquired heme causes of hypercoagulable states
polycythemia vera
DIC
antiphospholipid syndrome
TTP
HUS
HIT
what acquired clotting disorder is often associated w. SLE
antiphospholipid abs syndrome
AI rxn to PLT’s usually after viral illness
ITP
4 conditions associated w. ITP
HIV
HCV
SLE
CLL
2 hallmark lab findings of ITP
CBC normal except for low PLT
(+) direct coombs
tx for ITP
kids: supportive vs IVIG
adults: prednisone
5 s/sx of IDA
target cells
pica
nail spooning
angular cheilitis
glossitis
mcc of IDA
blood loss
tx for IDA
FeSO4 325 mg TID
6 weeks to replete
recheck q 3 mos x 1 year
causes of microcytic anemia
IDA
sideroblastic
thalassemia
late anemia of chronic dz
lead poisoning -> basophilic stippling
lymphomas to know
hodgkin’s
non hodgkin’s
hallmark dx of hodgkin’s lymphoma
reed sternberg cells - owl eye appearance
s/sx of hodgkin’s lymphoma
painless upper body LAD:
neck
axilla
shoulder
mediastinum
what are 3 B sx associated w. hodgkin’s lymphoma
fever
wt loss
night sweats
what condition is highly associated w. hodgkin’s lymphoma
EBV
HIV pt + painless LAD + GI/skin sx
non hodgkin lymphoma
hodgkin lymphona affects _ cells
non hodgkin lymphoma affects _ cells (2)
hodgkin: B
non hodgkin: B and T
4 sx of non hodgkin lymphoma
SOB
intussusception
bowel obstruction
abdominal masses
cancer of monoclonal plasma cells
multiple myeloma
hallmark presentation of multiple myeloma
older pt
bone/back pain refractory to tx
what does CRAB stand for
multiple myeloma:
calcium elevation
renal failure
anemia
bone lesions
dx for multiple myeloma
UA: bence jones protein
smear: rouleaux formation (stacked RBC)
XR: lytic punched out bone lesions
electrophoresis: monoclonas M protein spike
bone marrow bx: >10% clonal plasma cells
definitive tx for multiple myeloma
bone marrow transplant
chronic hemolytic anemia that occurs almost exclusively in AA’s
SSA
s/sx of SSA
hemolysis
jaundice
splenomegaly
priaprism
poor healing
pain/swelling in hands/feet
acute chest syndrome
pigmented gallstones
what causes SSA crises
sickle-cell shaped RBCs clot capillaries -> end organ ischemia
what lab value can be used to monitor SSA crises
reticulocytes - decrease a pt improves
definitive dx for SSA
HgbS on Hgb electrophoresis
2 hallmark blood smear findings of SSA
sickled RBCs
howell-jolly bodies
also target cells
what type of anemia is SSA
normochromic
normocytic
Hb SS vs Hb SA
HbSS: disease
HbSA: trait
2 parents w. a sickle cell trait have a _ chance of having a child w. HbSS dz
25%
management of SSA crisis
high flow O2
pain control
Hgb < 6: transfusion
what med may reduce the frequency of SSA crises
hydroxyurea
what type of anemia is thalassemia
microcytic
hypochromic
3 types of thalassemia
beta major
beta trait
alpha
most severe form of thalassemia
beta major
electrophoresis findings associated with each form of thalassemia
beta major: Hgb A2 and F
beta trait: Hgb A2
alpha: Hgb H, Hgb Bart’s, Hgb A
Hgb _ is associated w. hydrops fetalis
bart’s
which thalassemia is minor and often misdiagnosed as IDA
beta trait
tx for beta thalassemia major
transfusion
deferoxamine (iron chelation)
acute febrile disease with multi-organ thrombosis
TTP
decreased PLT
anemia
schistocytes
TTP
3 precipitants of TTP
quinidine
cyclosporine
pregnancy
TTP is caused by inhibition of what gene
ADAMTS13
how to remember typical presentation of TTP
FAT RN:
fever
anemia
thrombocytopenia
renal failure
neuro sx
tx for TTP
steroids
plasmapheresis
3 causes of hemolytic uremic syndrome
e.coli 0157:h7
shigella
diarrheal illness in a child
common presentation of HUS
anemia
decreased PLT
renal failure
2 types of macrocytic anemia
vitamin B12
folic acide deficiency
hallmark finding of vit b12 deficiency
hypersegmented neutrophils
3 rf for b12 deficiency
pernicious anemia
gastrectomy
vegan
pernicious anemia is caused by abs to
intrinsic factor
2 sx of b12 deficiency
glossitis
poor balance/low proprioception
what is the schilling test for pernicious anemia
<10% radiolabeled b12 in urine -> administer intrinsic factor -> results normalize
presentation of folate deficiency
mimics b12 but no neuro sx
folate deficiency makes you think what pt pop
alcoholics
folate deficiency anemia is same same
megaloblastic anemia
what dx finding is pathognomonic for folate deficiency
hypersegmented PMNs
3 folic acid antagonists
bactrim
phenytoin
sulfasalazine