Hematology Flashcards
Lab test to help distinguish coagulopathy of liver disease from DIC
Factor VIII level
MKSAP 20
Hemoglobin transfusion threshold for most patients
<7 g/dL
MKSAP 20
Medication and dosing frequency for iron therapy
Once-daily or alternate-day ferrous sulfate
MKSAP 20
MDS gold standard diagnostic test
Bone marrow biopsy
MKSAP 20
Indications for a transfusion threshold >7 g/dL
ACS, acute stroke, hemodynamic instability, active bleeding
MKSAP 20
Treatment of CKD-related anemia
Erythropoietin
MKSAP 20
Optimal evaluation of lytic bone lesions in MM
MRI or PET
MKSAP 20
Erythrocyte index correlating with uniformity or variability in erythrocyte size
RDW
MKSAP 20
Decision support tool for suspected TTP management while ADAMTS13 level pending
PLASMIC score
MKSAP 20
Management of anemia of inflammation
Treat underlying cause
MKSAP 20
Transfusion therapy for ACS and ARDS in SCD
Exchange transfusion
MKSAP 20
Microcytosis, normal RDW, normal or increased erythrocyte count
Thalassemia
MKSAP 20
Dabigatran reversal agent
Idarucizumab
MKSAP 20
Initial decision support tool in evaluating low-risk PE
PERC
MKSAP 20
Treatment of SCD with frequent pain events, severe symptomatic anemia, previous ACS, or stroke
Hydroxyurea
MKSAP 20
Curative treatment for myelofibrosis
Allogeneic HSCT
MKSAP 20
Unprovoked VTE treatment duration
> 6 months
MKSAP 20
Vitamin K deficiency–related coagulation profile
Elevated PT, normal or mildly elevated aPTT
MKSAP 20
Hemochromatosis screening tests
Transferrin saturation, serum ferritin
MKSAP 20
Agglutinated erythrocytes, DAT showing C3
Cold agglutinin disease
MKSAP 20
Hemolytic anemia, bite cells, Heinz bodies
G6PD deficiency
MKSAP 20
Initial treatment of chronic-phase CML
TKI
MKSAP 20
Cold agglutinin disease treatment
Rituximab
MKSAP 20
Most common cause of classic HUS
Shiga toxin–producing E. coli
MKSAP 20
Outpatient therapy for acute low-risk PE
Apixaban, rivaroxaban
MKSAP 20
Pancytopenia, severe bone marrow hypocellularity
Aplastic anemia
MKSAP 20
Aplastic anemia is characterized by the failure of the bone marrow to produce sufficient blood cells.
Autoimmune gastritis and intrinsic factor deficiency causing vitamin B12 deficiency
Pernicious anemia
MKSAP 20
Pernicious anemia is an autoimmune condition that affects the absorption of vitamin B12.
Management of porphyria cutanea tarda
Phlebotomy
MKSAP 20
Phlebotomy is often used to reduce iron overload in patients with porphyria cutanea tarda.
Anticoagulation for distal DVT without symptoms or risk factors for extension
None
MKSAP 20
In cases of distal DVT without symptoms or risk factors, anticoagulation may not be necessary.
Duration of smoking-induced neutrophilia following smoking cessation
≥1 year
MKSAP 20
Neutrophil levels may remain elevated for at least one year after quitting smoking.
Oral therapy for HIT
DOAC (e.g., rivaroxaban)
MKSAP 20
Direct oral anticoagulants (DOACs) like rivaroxaban are used for treating heparin-induced thrombocytopenia (HIT).
Management of warfarin over-anticoagulation, INR >10, no bleeding
Stop warfarin, give oral vitamin K
MKSAP 20
This is the recommended approach for managing significant over-anticoagulation without bleeding.
Evaluation of PE in patients with contraindication to IV contrast
V/Q scan
MKSAP 20
A ventilation-perfusion (V/Q) scan is used to evaluate pulmonary embolism when IV contrast cannot be administered.
Symptomatic hyperviscosity treatment
Therapeutic apheresis
MKSAP 20
Therapeutic apheresis is used to reduce blood viscosity in symptomatic patients.
Duration of VTE prophylaxis in pregnant person with SCD
While hospitalized and 6 weeks postpartum
MKSAP 20
VTE prophylaxis is crucial for pregnant individuals with sickle cell disease during and after hospitalization.
Transfusion for warm autoimmune hemolytic anemia without crossmatch compatible blood
ABO- and Rh-matched transfusion
MKSAP 20
In cases of warm autoimmune hemolytic anemia, it is important to use ABO- and Rh-matched blood for transfusion.
Two main causes of kidney disease in MM
Hypercalcemia and cast nephropathy
MKSAP 20
Multiple myeloma can lead to kidney disease primarily due to hypercalcemia and cast nephropathy.
HIT therapy duration with documented thromboembolic event
At least 3 months
MKSAP 20
Patients with HIT and a thromboembolic event require at least three months of therapy.
Noncardiogenic pulmonary edema 6 hours after transfusion
TRALI
MKSAP 20
Transfusion-related acute lung injury (TRALI) can occur shortly after blood transfusion.
Preoperative management of patient with SCD for surgery requiring general anesthesia
Simple transfusion with target hemoglobin 10 g/dL
MKSAP 20
This approach helps reduce the risk of complications during surgery.
Confirms folate deficiency when serum folate level is normal
Elevated serum homocysteine level
MKSAP 20
Elevated homocysteine can indicate folate deficiency even when serum folate is within normal limits.
Treatment of DIC-related hypofibrinogenemia
Cryoprecipitate
MKSAP 20
Cryoprecipitate is used to manage low fibrinogen levels in disseminated intravascular coagulation (DIC).
MM preferred treatment
Autologous HSCT
MKSAP 20
Autologous hematopoietic stem cell transplantation is a preferred treatment for multiple myeloma.
Risk factors for upper extremity DVT
Central venous catheter, malignancy
MKSAP 20
These factors significantly increase the risk of developing upper extremity deep vein thrombosis.
IgM paraprotein, hyperviscosity
Waldenström macroglobulinemia
MKSAP 20
Waldenström macroglobulinemia is characterized by elevated IgM levels leading to hyperviscosity.
Safe ITP platelet count during pregnancy
> 30,000/µL (30 × 10^9/L)
MKSAP 20
A platelet count above this threshold is considered safe in pregnant patients with immune thrombocytopenic purpura (ITP).
Treatment of pre-eclampsia–related thrombocytopenia
Delivery
MKSAP 20
The definitive treatment for thrombocytopenia related to pre-eclampsia is delivery of the baby.
Increased infection risk in hereditary hemochromatosis
Vibrio vulnificus and Yersinia enterocolitica
MKSAP 20
Individuals with hereditary hemochromatosis are at increased risk for infections from these organisms.
Fever, tachypnea, hypoxia, cough, dyspnea, pulmonary infiltrates in patients with SCD
ACS
MKSAP 20
Acute chest syndrome (ACS) is a serious complication in sickle cell disease characterized by these symptoms.
Isolated mild asymptomatic neutropenia in a patient of African descent
Duffy-null associated neutrophil count
MKSAP 20
This condition can be a benign variant seen in some individuals of African descent.
Confirms vitamin B12 deficiency when cobalamin level is borderline
Elevated serum methylmalonic acid level
MKSAP 20
Methylmalonic acid (MMA) is a marker that helps in the diagnosis of vitamin B12 deficiency.
Treatment to shorten recovery time in drug-induced neutropenia with active infection
G-CSF
MKSAP 20
G-CSF stands for granulocyte colony-stimulating factor, which stimulates the production of white blood cells.
Treatment of MM-related hypogammaglobulinemia and recurrent infections
IVIG
MKSAP 20
IVIG stands for intravenous immunoglobulin, which provides antibodies to help fight infections.
Microcytic anemia, increased hemoglobin A2 and F
β-Thalassemia minor
MKSAP 20
β-Thalassemia minor is a genetic blood disorder that affects hemoglobin production.
Prolonged aPTT, low factor VIII, no correction with mixing study
Acquired hemophilia
MKSAP 20
Acquired hemophilia is often associated with autoimmune disorders and can lead to significant bleeding.
MGUS with unexplained kidney disease
Monoclonal gammopathy of renal significance
MKSAP 20
MGUS stands for monoclonal gammopathy of undetermined significance, which can lead to renal complications.
Mucocutaneous bleeding, normal platelet count and coagulation tests
Qualitative platelet disorder
MKSAP 20
This condition indicates a dysfunction in platelet function rather than quantity.
DOAC for patients receiving dialysis
Apixaban
MKSAP 20
Direct oral anticoagulants (DOACs) like apixaban are often preferred for their safety profile in renal impairment.
Macrocytic anemia, malnutrition, alcohol use disorder
Folate deficiency
MKSAP 20
Folate deficiency is a common cause of macrocytic anemia and can be exacerbated by alcohol use.
Post-DVT pain, edema, stasis dermatitis
Postthrombotic syndrome
MKSAP 20
Postthrombotic syndrome can occur after deep vein thrombosis and lead to chronic pain and swelling.
Hemolytic anemia, spherocytes, positive DAT
Warm autoimmune hemolytic anemia
MKSAP 20
Warm autoimmune hemolytic anemia is characterized by spherocytes in the blood and a positive direct antiglobulin test (DAT).
Most common indications for autologous HSCT
Multiple myeloma, relapsed aggressive lymphoma
MKSAP 20
Autologous hematopoietic stem cell transplantation (HSCT) is often used in these hematologic malignancies.
Lab test to diagnose PNH
Flow cytometry (demonstrates loss of CD55 and CD59)
MKSAP 20
PNH stands for paroxysmal nocturnal hemoglobinuria, and flow cytometry helps identify affected cells.
Concomitant anticoagulant duration with warfarin for acute VTE
At least 5 days and therapeutic INR at least 24 hours
MKSAP 20
Venous thromboembolism (VTE) treatment often requires bridging with anticoagulants before achieving therapeutic INR.
Erythrocytosis, positive JAK2
Polycythemia vera
MKSAP 20
Polycythemia vera is a myeloproliferative disorder characterized by increased red blood cell mass.
SCD-related pulmonary vascular complication of pregnancy
Pulmonary hypertension
MKSAP 20
Sickle cell disease (SCD) can lead to various complications, including pulmonary hypertension, especially during pregnancy.
Aminotransferase elevation, arthritis of the 2nd and 3rd metacarpophalangeal joints
Hereditary hemochromatosis
MKSAP 20
Hereditary hemochromatosis can cause liver damage and joint issues due to iron overload.
Mild, asymptomatic thrombocytopenia late in pregnancy
Gestational thrombocytopenia
MKSAP 20
Gestational thrombocytopenia is common and usually resolves after delivery.
Therapy for primary HES with PDGFR-α or -β variant
Imatinib
MKSAP 20
Imatinib is a targeted therapy used for certain hematologic malignancies and conditions like hypereosinophilia syndrome (HES).
Lab finding of citrate toxicity during massive transfusion
Hypocalcemia
MKSAP 20
Citrate, used as an anticoagulant in blood products, can bind calcium, leading to hypocalcemia.
Less invasive tissue biopsy site for systemic amyloidosis
Abdominal fat pad
MKSAP 20
An abdominal fat pad biopsy is a common and effective method for diagnosing systemic amyloidosis.
Prophylactic therapy for hemophilia A
Emicizumab
MKSAP 20
Emicizumab is a bispecific monoclonal antibody that mimics the function of factor VIII in hemophilia A patients.
PV therapy for patients intolerant of first-line agents
Ruxolitinib
MKSAP 20
Ruxolitinib is a JAK1/JAK2 inhibitor used in polycythemia vera for patients who cannot tolerate conventional therapies.
Genetic testing for abdominal thrombosis, splenomegaly, portal hypertension
JAK2
MKSAP 20
JAK2 mutations are commonly associated with myeloproliferative neoplasms, including conditions leading to thrombosis.
Testing indicated for moderate- to high-probability Wells score for DVT and PE
Duplex imaging for DVT; CT angiography for PE
MKSAP 20
The Wells score helps stratify the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE), guiding diagnostic imaging.
Inherited cause of mucosal bleeding; normal PT, aPTT, and platelets
vWD
MKSAP 20
von Willebrand Disease (vWD) is characterized by a deficiency in von Willebrand factor, which is crucial for platelet adhesion.
Cancer screening with unprovoked VTE
Age- and sex-appropriate screening
MKSAP 20
Unprovoked venous thromboembolism (VTE) may indicate an underlying malignancy that requires thorough screening.
Monoclonal protein <3 g/dL, clonal plasma cells <10% of marrow cellularity, no end-organ damage
MGUS
MKSAP 20
Monoclonal gammopathy of undetermined significance (MGUS) is a precursor condition to multiple myeloma.
Additional testing in most patients with thrombocytopenia and low 4T score
None
MKSAP 20
The 4T score helps assess the probability of heparin-induced thrombocytopenia (HIT).
Treatment of asymptomatic ET in older patients
Hydroxyurea and low-dose aspirin
MKSAP 20
Essential thrombocythemia (ET) management aims to reduce thrombotic risk.
AL amyloidosis preferred treatment
Autologous HSCT
MKSAP 20
Autologous hematopoietic stem cell transplantation (HSCT) is the preferred treatment for eligible patients.
Ineffective hematopoiesis, hypercellular marrow, peripheral cytopenia, normal vitamin B12 and folate
MDS
MKSAP 20
Myelodysplastic syndromes (MDS) are characterized by ineffective hematopoiesis leading to cytopenias.
PCD with monoclonal protein exceeding limit for MGUS, no other symptoms, no end-organ damage
Smoldering MM
MKSAP 20
Smoldering multiple myeloma (MM) indicates a higher risk of progression compared to MGUS.
Emergent reversal of unfractionated heparin
Protamine sulfate
MKSAP 20
Protamine sulfate is used to neutralize the anticoagulant effects of heparin.
Effect of known inherited thrombophilia on acute VTE management
None
MKSAP 20
Known inherited thrombophilias do not alter the immediate management of acute venous thromboembolism.
Optimal therapy for severe aplastic anemia in younger patients
Allogeneic HSCT
MKSAP 20
Allogeneic hematopoietic stem cell transplantation (HSCT) is preferred for younger patients due to better outcomes.
Management of hemophilia A, minor bleeding
Desmopressin
MKSAP 20
Desmopressin is used to increase factor VIII levels in patients with hemophilia A.
Eosinophilia and end-organ damage
HES
MKSAP 20
Hypereosinophilic syndrome (HES) is characterized by eosinophilia and damage to various organs.
Management of life-threatening bleeding in patients taking oral Xa inhibitors
Four-factor PCC or andexanet alfa
MKSAP 20
Prothrombin complex concentrate (PCC) and andexanet alfa are used for reversal of anticoagulation.
Initial evaluation of suspected platelet dysfunction
Platelet function analyzer
MKSAP 20
Platelet function analyzers assess the functional capacity of platelets.
Posttransfusion dyspnea, elevated CVP, elevated BNP
TACO
MKSAP 20
Transfusion-associated circulatory overload (TACO) can occur after blood transfusions, leading to respiratory distress.
Management of ITP with severe thrombocytopenia and bleeding
Glucocorticoids with or without IVIG
MKSAP 20
Immune thrombocytopenic purpura (ITP) treatment may include glucocorticoids and intravenous immunoglobulin (IVIG) for severe cases.
Normochromic, normocytic anemia; elevated ferritin; low iron and TIBC
Anemia of inflammation
MKSAP 20
Anemia of inflammation occurs due to chronic disease and is characterized by normal iron stores but impaired utilization.
Target hemoglobin level for ESA treatment in ESKD
10-11 g/dL
MKSAP 20
Erythropoiesis-stimulating agents (ESAs) are used to manage anemia in end-stage kidney disease (ESKD).
Management of type I HIT
No further testing or therapy
MKSAP 20
Type I HIT is generally mild and resolves without intervention.
TTP treatment
Plasma exchange, glucocorticoids, rituximab
MKSAP 20
Thrombotic thrombocytopenic purpura (TTP) requires urgent treatment to prevent complications.
Treatment of complement-mediated HUS
Eculizumab
MKSAP 20
Eculizumab is a complement inhibitor used in atypical hemolytic uremic syndrome (HUS).
Iron overload, cutaneous blisters, hypertrichosis
Porphyria cutanea tarda
MKSAP 20
Porphyria cutanea tarda is associated with hepatic iron overload and skin manifestations.
Thrombocytopenia, prolonged aPTT and PT, elevated INR, hypofibrinogenemia, and elevated D-dimer level
DIC
MKSAP 20
Disseminated intravascular coagulation (DIC) is a complex disorder often secondary to severe conditions.
Most common cause of iron deficiency in men and postmenopausal women
GI blood loss
MKSAP 20
Gastrointestinal bleeding is the leading cause of iron deficiency anemia in these populations.
Treatment of acute proximal DVT or PE when anticoagulation is contraindicated
Retrievable or temporary IVC filter
MKSAP 20
IVC stands for inferior vena cava, and filters are used to prevent blood clots from reaching the lungs.
VTE prevention in high-risk APLAS
Warfarin
MKSAP 20
APLAS refers to antiphospholipid syndrome, a condition that increases the risk of blood clots.
Management of hemophilia A, active bleeding, high titer inhibitor
Activated factor VII
MKSAP 20
This treatment is used because traditional factor VIII replacement is ineffective in the presence of inhibitors.
Skin, GI, and liver injury following allogeneic HSCT
Graft-versus-host disease
MKSAP 20
Allogeneic HSCT refers to allogeneic hematopoietic stem cell transplantation, where donor cells attack the recipient’s tissues.
Management of asymptomatic ITP and platelet count 35,000/μL (30 × 10^9/L)
Observation
MKSAP 20
ITP stands for immune thrombocytopenic purpura, a condition characterized by low platelet counts.
MDS therapy that reduces transfusion requirements and AML conversion risk
Hypomethylating agent (azacytidine or decitabine)
MKSAP 20
MDS refers to myelodysplastic syndromes, which can progress to acute myeloid leukemia (AML).
Secondary iron overload treatment
Iron chelation
MKSAP 20
This treatment helps remove excess iron from the body, often necessary in patients with repeated blood transfusions.
Episodic hemolysis, marrow aplasia, unusual site of thrombosis, erythrocytes lacking CD55 and CD59
PNH
MKSAP 20
PNH stands for paroxysmal nocturnal hemoglobinuria, a rare blood disorder.
Pancytopenia, promyelocytes, and DIC
Acute promyelocytic leukemia
MKSAP 20
DIC stands for disseminated intravascular coagulation, a serious condition associated with this type of leukemia.
Common causes of vitamin K deficiency
Malnutrition, prolonged antibiotics
MKSAP 20
Vitamin K is crucial for blood clotting, and its deficiency can lead to bleeding problems.
Treatment of factor VIII inhibitor–related bleeding
Activated factor VII, activated PCC, or recombinant porcine factor VIII
MKSAP 20
PCC stands for prothrombin complex concentrate, used in the management of bleeding in hemophilia.
Monoclonal B lymphocytes, no other clinical features to suggest CLL
Monoclonal B-cell lymphocytosis
MKSAP 20
CLL stands for chronic lymphocytic leukemia, but this condition represents an early stage or benign form.
Infectious cause of aplastic anemia
Parvovirus B19
MKSAP 20
This virus can suppress bone marrow function, leading to decreased blood cell production.
Supplement to increase iron absorption
Vitamin C
MKSAP 20
Vitamin C enhances the absorption of non-heme iron from plant sources.
Warfarin-related life-threatening bleeding treatment
Four-factor PCC
MKSAP 20
This treatment provides the necessary clotting factors to reverse the effects of warfarin.
Management of liver disease, hypofibrinogenemia, active bleeding
Cryoprecipitate
MKSAP 20
Cryoprecipitate is rich in clotting factors, especially fibrinogen, which is crucial in bleeding scenarios.
Deficiency causing heparin resistance and VTE
Antithrombin deficiency
MKSAP 20
Antithrombin is a protein that helps regulate blood clotting, and its deficiency can lead to thrombotic events.
Malabsorption-related iron deficiency treatment
Parenteral iron
MKSAP 20
Parenteral iron is administered via injection or infusion, bypassing the gastrointestinal tract.
Cause of pseudothrombocytopenia
Platelet clumping
MKSAP 20
This phenomenon can lead to falsely low platelet counts in laboratory tests.
Microcytic anemia, normal hemoglobin electrophoresis, normal iron level
α-Thalassemia trait
MKSAP 20
This genetic condition affects the production of hemoglobin and is often asymptomatic.
Mechanical causes of acquired vWD
Prosthetic heart valves, native valvular disease, LVAD
MKSAP 20
vWD stands for von Willebrand disease, which can be exacerbated by mechanical factors.
Low hemoglobin level with indirect hyperbilirubinemia, elevated lactate dehydrogenase, low haptoglobin
Hemolytic anemia
MKSAP 20
These lab findings are indicative of increased destruction of red blood cells.
Lab testing diagnostic of inherited hemophilia A or B
Prolonged aPTT (corrects with mixing study), normal PT and CBC
MKSAP 20
aPTT stands for activated partial thromboplastin time, a test used to assess blood coagulation.
Treatment of massive PE with shock
Thrombolytic therapy
MKSAP 20
Thrombolytic therapy is used to dissolve blood clots quickly in emergency situations.
Hemolysis, thrombocytopenia, ADAMTS13 deficiency
TTP
MKSAP 20
TTP stands for thrombotic thrombocytopenic purpura, a serious condition characterized by microangiopathic hemolytic anemia and thrombocytopenia.
Acute promyelocytic leukemia treatment
All-trans retinoic acid
MKSAP 20
Chronic hemolytic anemia, spherocytes, negative DAT
Hereditary spherocytosis
MKSAP 20
Hypercalcemia, kidney failure, anemia, bone lesions, rouleaux formation
MM
MKSAP 20
Common deficiency causing thrombocythemia
Iron
MKSAP 20
Antibiotic management of HUS
Not indicated
MKSAP 20
Infectious causes of ITP
HIV, hepatitis C virus, H. pylori
MKSAP 20
Type 1 vWD treatment
Desmopressin
MKSAP 20
Nephrotic syndrome, cardiomegaly, macroglossia
Systemic amyloidosis
MKSAP 20
Confirmatory test for HIT when EIA is positive
Serotonin release or heparin-induced platelet aggregation assay
MKSAP 20
Factor inhibitor evaluation in patients with prolonged aPTT
Mixing study
MKSAP 20
5q− MDS treatment
Lenalidomide
MKSAP 20
Predisposing condition for warfarin-related skin necrosis
Protein C deficiency
MKSAP 20
Settings in which warfarin preferred to DOAC for acute VTE therapy
Prosthetic heart valve, high-risk APLAS
MKSAP 20
Hematologic complication of testosterone supplementation
Erythrocytosis
MKSAP 20
Lenalidomide unique toxicity
VTE
MKSAP 20
Hereditary hemochromatosis treatment
Phlebotomy
MKSAP 20
Adjunct to autologous HSCT and chemotherapy to prolong survival in MM
Bisphosphonate
MKSAP 20
Treatment of superficial vein thrombosis with significant risk for progression
Low-dose fondaparinux
MKSAP 20