Hematology Flashcards
Aside from the lab values, what else plays a factor in regards to the symptoms and treatment of anemia?
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.
B12 deficiency is suspected, but the B12 level is normal. What is the next best test to confirm the diagnosis?
Order a methylmelonic acid level. It will be elevated in B12 deficiency.
What two antibodies are present in pernicious anemia?
- Anti-intrinsic factor
2. Anti-parietal cell antibody
What is the most common neurological symptom associated with B12 deficiency?
Most commonly the patient will present with peripheral neuropathy. Be aware that the patient can present with any neurological complaint.
How are patients with thalassemia diagnosed?
Patients are diagnosed with electropharesis.
What will the serum iron level demonstrate in sideroblastic anemia?
There will be an increased serum iron.
What will the CBC and reticulocyte count demonstrate in aplastic anemia?
Aplastic anemia will show pancytopenia with an elevated reticulocyte count.
What is the most common cause precipitating a G6PD attack?
Infection is the most common cause, not fava beans.
What does the peripheral smear show us with G6PD deficiency?
Look for bite cells and heinz bodies.
Name 5 things that will lead to vaso-occlusion in sickle cell.
- Cold
- Hypoxia
- Dehydation
- Infection
- Alcohol
What does the peripheral smear show us with sickle cell disease?
- Sickled cells
2. Howell-Jolly Bodies
What is the only approved therapy to treat vaso-occlusive episodes?
Hydroxyurea.
What is the function for von willebrand factor?
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.
What will the platelet level be? What about PT/PTT?
Platelet levels are normal. The PT is normal. The PTT will be prolonged (may be normal).
What is the most common cause of inherited thrombophilias?
Factor V leiden.
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?
Low molecular weight heparin should be given for DVT prophylaxis. Warfarin is contraindicated during pregnancy.
How long does it take to develop heparin induced thrombocytopenia?
On average it takes 4 or more days to develop this.
Treatment for immune thrombocytopenia is started when platelets are at what level?
Severe bleeding usually does not occur until the platelet level is
Patients deficient in what enzyme are at risk for thrombotic thrombocytopenic purpura?
ADAMTS13 deficiency increases the patients risk.
What two lab findings are required to diagnose hemolytic uremic syndrome?
- Thrombocytopenia
2. Microangiopathic hemolytic anemia
At what age are most diagnosed with ALL?
Peak incidence is 5 years of age.
How many blasts must be present to diagnose ALL and AML?
> 20% blasts on bone marrow biopsy are required for both diagnosis.
Auer rods are seen in what condition?
Auer rods are are pathognomonic for AML.
The M3 subtype of AML is a result of what translocation?
There is a translocation of T(15:17).
Who gets all-trans-retinoic acid for the treatment of leukemia?
Those with AML and the M3 subtype will get all-trans-retinoic acid as part of the treatment.
CML is a result of proliferation of what?
Proliferation of maturing granulocytes, most notably neutrophils.
The philadelphia chromosome is present in what disease process? What translocation is responsible for this?
This is seen in CML. There is a translocation of t(9:22).
What is the average age of CLL diagnosis?
The average age of diagnosis is 70 years.
How is CLL diagnosed?
Diagnosed with flow cytometry expressing CD5 and CD20. Bone marrow biopsy is not needed.
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?
Classic for Hodgkin Lymphoma. Also, look for reed steinberg cells from the lymph node biopsy.
SPEP and UPEP are done in the evaluation of what cancer?
This is part of the workup for multiple myeloma.
Peripheral smear will show rouleax formation in what disease?
This will be present in multiple myeloma.
