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Step 2 Study > Hematology > Flashcards

Hematology Flashcards

1
Q

MCV>100

A

Macrocytic

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2
Q

MCV

A

Microcystic

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3
Q

Causes of Low MCV

3 have low reticulocyte count

A

Iron Def
Thalassemia
Sideroblastic anemia
Anemia of Chronic disease

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4
Q

Causes of Macrocytic Anemia

A 
B12 &Folate
Alcholism
Sideroblastic Anemia
Liver disease/hypothyroidism
Meds &Antimetabolite meds
MDS
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5
Q

Normocytic Anemia

A

Acute blood loss and hemolysis

will increase the reticulocyte count.

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6
Q

Anemia Tx?

A

Packed RBC if severe

Symptomatic Transfuse

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7
Q

Symptomatic Anemia

A

SOB
Light headed, confused, syncope
Hypotension and tachycardia
Chest pain

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8
Q

Packed RBC raises Hct

A

by 3 points/unit

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9
Q

FFP replaces

A

Clotting factors

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10
Q

Microcytic Anemia- Iron Def

A 
GI bleeds/Menstruation
Low ferritin
Increased TIBC
Low serum iron
RDW is increased
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11
Q

Microcytic Anemia- Chronic Disease

A

Cancer/infection/rheumatoid arthritis
High Ferritin- iron trapped
Low TIBC
Low serum iron- all that is floating around is bound

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12
Q

Microcytic Anemia- Sideroblastic

A

Alcoholic
High serum Iron
Prussian blue staining for ringed sideroblasts

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13
Q

Microcytic Anemia-Thalassemia

A 
typically asymptomatic
Target cells
Normal iron studies
Best test: Hb electrophoresis
Normal RDW
High reticulocyte
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14
Q

Megaloblastic=Hypersegmented

Seen in ??

A

Folate and B12 def

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15
Q

Vitamin B12 Def caused by

A

Pernicious anemia
Pancreatic Insufficiency
Crohn’s
Diphyllobothrium latum

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16
Q

Folate Def. causes

A

Diet
Psoriasis
Drugs: Phenytoin, sulfa

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17
Q

Alcohol

A

Macrocytosis and neuro problems

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18
Q

B12 def

A

Neuro probs- particularly peripherlal neuropathy. Posterior column damage most common
look for ataxia
Labs: Increase methylmalonic acid levels

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19
Q

Pernicious Anemia confirmed with

A

antiintrinsic factor and anti-parietal cell antibodies

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20
Q

Sickle cell mechanism

A

Glutamic at 6 position is replaced with valine

Point mutation

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21
Q

Vaso-occlusive crisis caused by

A

hypoxia
dehydration
infection
cold temperatures

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22
Q

African america
severe chest pain, butt/thigh pain
Fever (?)

A

Think sickle cell

Tx: with empiric antibiotics if there is a fever.

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23
Q

Sickle Cell Manifestations

A 
Bilirubin gallstones
Increased infections--why?
Osteomyelitis--common bug?
Retinopathy
Stroke
Skin ulcers
Avascular necrosis of femoral head
Enlarged hear with hyperdynamic features and systolic murmur
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24
Q

Sickle Cell

  1. ) Best initial test?
  2. ) Most accurate test?
A
  1. ) Peripheral smear-Howell Jolly Bodies

2. ) Hb electrophoresis

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25
Q

Tx. Sickle Cell

A 
Oxygen/hydration/analgesia
Antibiotics if fever
Folic acid for all
Pneumococall vaccine
Hydroxyurea.
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26
Q

Sickle Cell Trait

A

inability to concentrate urine

No treatment

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27
Q

Hereditary Spherocytosis

A

Cytoskeleton of RBC mutation
Low MCV
Increased MCHC
best test osmotic Fragility

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28
Q 
Young child/newborn with hemolysis
Intermittent jaundice
Splenomegaly
FHx: anemia/hemolysis
Bilirubin gallstones
A

Hereditary Spherocytosis

Tx: folic acid & splenectomy–will stop hemolysis

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29
Q

Autoimmune Hemolysis
aka?
diagnostic test?
Tx:

A 
Warm IgG
Coombs test
Glucocorticoid therapy
Splenectomy
IVIG
Rituximab
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30
Q

Cold Agglutinin Disease

A

IgM antibodies against RBC
Direct coombs test
Tx: stay warm, administer rituximab, cyclophosphamide, cyclosporine, plasmapheresis

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31
Q

G6PD

x-linked recessive

A

inability to generate glutathione reductase
Look for AA/Mediterranea males with sudden anemia/jaundice
Normal spleen

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32
Q

Heinz bodies + bite cells

A

G6PD

Tx: avoid oxidant stress

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33
Q

HUS/TTP

A

E. Coli for HUS
Neuro +Fever with TTP
Both have schistocytes, Thromobocytopenia, renal insufficiency

34
Q

Tx HUS/TTP

A

Plasmapheresis or plasma exchange

35
Q

Paroxysmal Noturnal Hemoglobinuria

MCC of death? Thrombosis

A 
def in CD55 and CD59 (best test measures it)
causes increased sensitivity to acidosis/hypoxia which occurs at night time.
Tx: Prednisone, bone marrow transplant, eculizumab, folic acid and transfusions as needed.
36
Q

Aplastic Anemia

A

invasion of bone marrow causing decreased production or hypoplasia
acts as an autoimmune disorder. T-cells attack patients own marrow.

37
Q

Tx: for Aplastic Anemia

A

Treat underlying cause
Blood transfusion, antibiotics for infection and platelets for bleeding
BMT if young
Anti-thymocyte globulin and cyclosporine in older.

38
Q

Polycythemia Vera

A 
JAK2 mutation
Hct>60%
hypoxia excluded
Vit B12 levels are elevated.
Iron levels dec.
Platelets and WBC count increase
Erythropoietin decrease
39
Q

Essential Throbocytosis

A

Platelet count>1 million
Tx if older than 60 with plt count>1.5 million
Tx hydroxyurea, aspirin

40
Q

Myelofibrosis

A

Fibrosis of the bone marrow
look for teardrop shaped cells
Tx: thalidomide and lenalidomide

41
Q

Acute Leukemia

A

ALL M3->DIC
Best test? blood smear
Accurate test? Flow cytometry
Myeloperoxidase–> characteristic for AML

42
Q

Tx: ALL and AML

A

Chemo to remove blasts
Remission relapse +poor prognosis= BMT
Remission relapse + good prognosis= chemo

43
Q

best indicator for acute leukemia

A

Cytogenetics
good genetics: chemo
bad genetics: BMT

44
Q

Tx with M3

45
Q

Tx with ALL

A

Intrathecal chemotherapy prevents relapse of all in CNS

46
Q

CML what to look for

A

high WBC: all neutrophils
vague symptoms
Splenectomy
Pruritius

47
Q

Tests with CML

A

first test: LAP. Will be low in CML

accurate: BCR-ABL the philly chromosome test

48
Q

CML Tx:

A

Imatinidb, dasatinib, niotinib best 1st therapy

BMT cures it

49
Q

Acute Leukostasis reaction

A

elevated WBC emergency tx with leukapheresis

50
Q

Myelodysplastic syndrome

A

Pancytopenia despite hypercellular bone marrow.

51
Q

MDS labs

A

anemia with increased MCV, nucleated red cells, small #of blasts
Ringed sideroblasts
Pelger-Huet cells–bilobed nucleus

52
Q

MDS Tx:

A

Transfuse
Erythropoietin
Lenalidomide

53
Q

CLL

A 
WBC elevated with all lymphocytes
Lymphadenopathy
Spleen/liver enlargement
Infection
Tx: stage 2+ give fludarabine (+rituximab)
PCP prophylaxis
refractory: cyclophosphamide
mild: chlorambucil
severe infection: IVIG
54
Q

Hairy Cell Leukemia

A

TRAP positive

Cladribine

55
Q

Painless Lymphadenopathy

Best test

A

Excisional biopsy

56
Q

Nonhodgkin tx

A

stage 1+2: Local radiation
Adv. stage: chemotherapy (CHOP and rituximab)
Burkitt and immunoblastic bad.

57
Q

Hodgkin

A 
Reedsternberg cells
Lymphocyte predominant best prog.
around cervical area
Tx: radiation 
ABVD
58
Q

Multiple Myeloma
bone pain lytic lesions
don’t light up on bone scan

A 
Plasma cell proliferation 
IgA and IgG proliferation
M spike
Bence jones protein
Rouleaux
59
Q

Multiple Myeloma Best test

A

Bone marrow biopsy >10% plasma cells

60
Q

Multiple Myeloma Tx

A

Steriods with lenalidomide, bortezomib, melphalan

61
Q

MGUS

A

small number of plasma cells

must get bone marrow biopsy to rule out MM

62
Q

Waldentrom Macroglobinemia

A

Overproduction of IgM
Viscosity is a problem
Tx: plasmapheresis best initial therapy
Long term treatment is chlorambucil/fludrabine/prednisone

63
Q

Platelet Bleeding

A

Superficial

64
Q

Factor Bleeding

65
Q

Brain bleeds

A

platelets or factor

66
Q

Normal HCT, WBC, spleen

A

ITP
Diagnosis of exclusion
Tx: Prednisone if count

67
Q

Neisseria
hemophilus
pneumococcus

A

Vaccinate before splenectomy

68
Q

Most common inherited bleeding disorder

A 
Von Willebrand Disease
autosomal dominant
platelet type bleeding with a Normal platelet count
worse after aspirin
PTT can go up
69
Q

VWD-tests?

Tx: DDAVP

A

Bleeding time- increased duration
VWF level will be discreased
Ristocetin cofactor assay

70
Q

PT normal

Delayed joint of muscle bleeding

A

Most accurate test: Factor 8 or 9 assay

first study: Mixing study: correct to normal

71
Q

Hemophila Tx

72
Q

Factor 11 def.

Tx: FFP if bleeding

A

With trauma or surgery there is increased bleeding.
Normal PT and prolonged aPTT
Mixing will correct it to normal

73
Q

DIC RF

A 
sepsis
burns
snake bites
cancer
tissue factor release
amniotic fluid emboli
consumptim coagulopathy
74
Q

DIC

Tx: FFP

A

elevated PT and aPTT
elevated D-dimer and fibrin split products
decreased fibrinogen level
low platelet count

75
Q

2,7,9,10

A

Vit K factors when def. increase PT and aPTT

76
Q

Factor V leiden mutation

A

MCC hypercoaguable state/thrombophilia

77
Q

HIT

clotting disorder

A

common with unfractionated heparin
drop in platelet count by 30%
confirmed with ELISA platelet factor 4 or serotonin release assay
Tx: stop heparin switch to Direct thrombin inhibitors (agatroban, lepiruidin, bivalirudin) and then warfarin

78
Q

Lupus anticoagulant

anti-cardiolipin antibodies

A

Antiphospholipid syndromes
clotting and increased aPTT

Tx: heparin/warfarin
APL gets lifelong anticoagulation

79
Q

anti-cardiolipin antibodies

A

recurrent spontaneous abortions

80
Q

Antiphospholipid Syndrome with Inc. aPTT

Order what test?

A

mixing study still elevated

81
Q

lupus anticoagulant test

A

russell viper venom test

82
Q

Tumor Lysis Syndrome

A

Cell contents leak out

Hyperkalema, hyperphosphotemia, hypocalcemia, hyperuricemia

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