Hematology

Question 1

Aside from the lab values, what else plays a factor in regards to the symptoms and treatment of anemia?

Answer 1

The rate at which the patient arrived at those levels is crucial. The faster it occurred the sicker the patient will be, which will influence treatment.

Question 2

B12 deficiency is suspected, but the B12 level is normal. What is the next best test to confirm the diagnosis?

Answer 2

Order a methylmelonic acid level. It will be elevated in B12 deficiency.

Question 3

What two antibodies are present in pernicious anemia?

Answer 3

1. Anti-intrinsic factor


2. Anti-parietal cell antibody

Question 4

What is the most common neurological symptom associated with B12 deficiency?

Answer 4

Most commonly the patient will present with peripheral neuropathy. Be aware that the patient can present with any neurological complaint.

Question 5

How are patients with thalassemia diagnosed?

Answer 5

Patients are diagnosed with electropharesis.

Question 6

What will the serum iron level demonstrate in sideroblastic anemia?

Answer 6

There will be an increased serum iron.

Question 7

What will the CBC and reticulocyte count demonstrate in aplastic anemia?

Answer 7

Aplastic anemia will show pancytopenia with an elevated reticulocyte count.

Question 8

What is the most common cause precipitating a G6PD attack?

Answer 8

Infection is the most common cause, not fava beans.

Question 9

What does the peripheral smear show us with G6PD deficiency?

Answer 9

Look for bite cells and heinz bodies.

Question 10

Name 5 things that will lead to vaso-occlusion in sickle cell.

Answer 10

1. Cold

2. Hypoxia

3. Dehydation

4. Infection

5. Alcohol

Question 11

What does the peripheral smear show us with sickle cell disease?

Answer 11

1. Sickled cells


2. Howell-Jolly Bodies

Question 12

What is the only approved therapy to treat vaso-occlusive episodes?

Answer 12

Hydroxyurea.

Question 13

What is the function for von willebrand factor?

Answer 13

Von-willebrand factor helps platelets stick to endothelial injury. It does not affect platelet levels, therefore, platelets are normal. It is also used to transport factor VIII and increase its half life.

Question 14

What will the platelet level be? What about PT/PTT?

Answer 14

Platelet levels are normal. The PT is normal. The PTT will be prolonged (may be normal).

Question 15

What is the most common cause of inherited thrombophilias?

Answer 15

Factor V leiden.

Question 16

A 30 year old female patient is recently diagnosed with antiphospholipid syndrome. She recently found out she is pregnany; this is her first pregnancy. What medication should be given to this patient?

Answer 16

Low molecular weight heparin should be given for DVT prophylaxis. Warfarin is contraindicated during pregnancy.

Question 17

How long does it take to develop heparin induced thrombocytopenia?

Answer 17

On average it takes 4 or more days to develop this.

Question 18

Treatment for immune thrombocytopenia is started when platelets are at what level?

Answer 18

Severe bleeding usually does not occur until the platelet level is

Question 19

Patients deficient in what enzyme are at risk for thrombotic thrombocytopenic purpura?

Answer 19

ADAMTS13 deficiency increases the patients risk.

Question 20

What two lab findings are required to diagnose hemolytic uremic syndrome?

Answer 20

1. Thrombocytopenia


2. Microangiopathic hemolytic anemia

Question 21

At what age are most diagnosed with ALL?

Answer 21

Peak incidence is 5 years of age.

Question 22

How many blasts must be present to diagnose ALL and AML?

Answer 22

> 20% blasts on bone marrow biopsy are required for both diagnosis.

Question 23

Auer rods are seen in what condition?

Answer 23

Auer rods are are pathognomonic for AML.

Question 24

The M3 subtype of AML is a result of what translocation?

Answer 24

There is a translocation of T(15:17).

Question 25

Who gets all-trans-retinoic acid for the treatment of leukemia?

Answer 25

Those with AML and the M3 subtype will get all-trans-retinoic acid as part of the treatment.

Question 26

CML is a result of proliferation of what?

Answer 26

Proliferation of maturing granulocytes, most notably neutrophils.

Question 27

The philadelphia chromosome is present in what disease process? What translocation is responsible for this?

Answer 27

This is seen in CML. There is a translocation of t(9:22).

Question 28

What is the average age of CLL diagnosis?

Answer 28

The average age of diagnosis is 70 years.

Question 29

How is CLL diagnosed?

Answer 29

Diagnosed with flow cytometry expressing CD5 and CD20. Bone marrow biopsy is not needed.

Question 30

A patient is presenting with night sweats, fever, and weight loss. Painless cervical lymphadenopathy is noted on exam. A mediastinal mass is noted on chest x-ray. What is the most likely diagnosis?

Answer 30

Classic for Hodgkin Lymphoma. Also, look for reed steinberg cells from the lymph node biopsy.

Question 31

SPEP and UPEP are done in the evaluation of what cancer?

Answer 31

This is part of the workup for multiple myeloma.

Question 32

Peripheral smear will show rouleax formation in what disease?

Answer 32

This will be present in multiple myeloma.