Hematology Flashcards
What conditions will you see basophilic stippling with?
- Lead poisoning
- Thallasemia
- EtOH abuse
Treatment of lead poisoning?
- Adults: EDTA or succimer
- Kids: Dimercaprol (iron chelation)
If a peripheral blood smear shows microcytic, hypo chromic anemia with basophilic stippling, what should you suspect?
Lead poisoning
What medication can be given to sickle cell patients to decrease vasoocclusive crises?
hydroxyurea (increases the hemoglobin F production)
What medication are children with sickle cell given until the age of 5?
Penicillin (as prophylaxis for pneumococcal infection)
What vaccines are important for kids with Sickle Cell?
“Please Hit My Infection”
- pneumococcal
- HiB
- Meningococcal
- Influenza
What drugs can cause hemolysis in G6PD patients?
“Spleen Purges Nasty Inclusions From Damaged Cells”
- Sulfonamides
- Primaquine
- Nitrofurantoin
- Isoniazid
- Fava Beans
- Dapsone
- Chloroquine
Howell-jolly bodies are seen in what condition?
Hereditary spherocytosis
Bite cells and Heinz bodies?
G6PD deficiency
Heinz bodies (oxidative stress --> clumps of hemoglobin) -bite cells (from splenic removal heinz bodies)
Transfusion reaction where IgE antibodies attack soluble antigens in donor plasma? Tx?
-Urticarial reaction
-Tx: diphenhydramine
(can continue reaction if urticaria resolves)
If a patient with IgA deficiency receives blood with IgA antigens, what reaction is likely to occur?
-Anaphylaxis (2/2 anti-IgA IgG antibodies in recipient)
What is the cause of non hemolytic febrile reaction? When is this seen?
-cytokines produced by stored donor cells cause fever, chills, malaise 1-6 hours after transfusion
What is the most common cause of acute hemolytic reaction? What are the symptoms?
- ABO incompatibility (2/2 clerical error)
- hemolysis, fever, chills, tachycardia, tachypnea, hypotension
What is the cause of fever, hemolysis or elevated indirect bilirubin 2-10 days after a blood transfusion?
- Anti-kidd or and-D(Rh) antibodies
- “delayed hemolytic reaction”
- No treatment needed
Findings in hemolytic anemia?
inc LDH, inc indirect bili, Dec haptoglobin, inc reticulocyte count
What can a parvovirus B19 infection lead to? What patients are more likely to experience this?
Aplastic anemia (pancytopenia) -sickle cell and hereditary spherocytosis
What is the diagnostic test for aplastic anemia? What will it show?
bone marrow biopsy–> hypocellularity and fatty infiltration
What labs are elevated in a B12 deficiency? How does this differ from folate deficiency?
Methylmalonic acid and homocysteine
-folate deficiency will have an elevated homocysteine and normal methymalonic acid
Microcytic anemia + neuro symptoms?
Lead poisoning
What is the cause of ITP?
anti-platelet IgG antibodies
treatment is normally glucocorticoids and IVIG or platelet transfusion if bleeding
What are the clinical features of HUS?
-hemolysis, uremia (renal failure) and thrombocytopenia
What are the clinical features of TTP?
Hemolysis, uremia (renal failure), thrombocytopenia, neurological sequelae (AMS, seizures, coma) and fever
What is the treatment for HUS and TTP?
Plasma exchange and glucocorticoids
What other 2 less critical disorders should be considered as differentials in a patient with thrombocytopenia?
Alcoholism and B12 deficiency
What are the causes of DIC?
"STOP Making Thrombi" Sepsis Trauma OB complications Pancreatitis Malignancy Transfusions
Treatment for von Willebrand Disease?
DDAVP (desmopressin)
How does hemophilia A affect PT and PTT?
Increase PTT
How does von willebrand affect PT, PTT, platelet count and bleeding time?
Normal platelet count, increases bleeding time, normal PT, increases PTT
How does DIC affect platelet count, PT, PTT and bleeding time? Fibrinogen?
Decreases platelet count. Increases bleeding time, PT and PT. Decreases fibrinogen
How does end stage liver disease affect PT and PTT?
Increases PT and PTT
What’s the most common mutation that predisposes people to venous thrombus?
Factor V Leiden
What autosomal dominant bleeding disorder often presents with easy bruising, mucosal bleeding, skin bleeding and menorrhagia?
von Willebrand disease
What lab is used to monitor Heparin anticoagulation?
PTT
What is the main use for the direct thrombin inhibitors (dabigatran, argatroban, bivalirudin, desirudin)?
anticoagulation in patients that develop HIT
What lab is used to monitor warfarin anti-coagulation?
PT
Treatment for a heparin overdose?
Protamine sulfate
Smear shows peripheral blasts that are PAS + and TdT +. What is it?
ALL
Smear shows peripheral blasts that are PAS-, myeloperoxidase + and have Auer rods. What is it?
AML
Which cancer is associated with a t(9;22)?
CML (Philadelphia chromosome, bcr-abl, tyrosine kinase)
What is the treatment for CML?
Tyrosine kinase inhibitors (Imatinib, Dasatinib, Nilotinib–> all end in “-ib” like inhIBitor)
What do smudge cells on a smear indicate?
CLL
What does a smear with pseudo Pelget-Huet anomaly (neutrophils with 2 nuclear lobes connected by a thin strand) indicate?
Myelodysplastic syndromes
Symptoms of Multiple Myeloma?
CRAB
- hyperCalcemia
- Renal failure
- Anemia
- Back pain (bone lytic lesions)
What are the diagnostic tests for Multiple Myeloma?
- SPEP and UPEP (serum and urine protein electrophoresis)
- skeletal survey (look for bone lytic lesions)
What is the characteristic cell type seen on lymph biopsy in Hodgkin lymphoma?
- Reed-sternberg cell
- looks like owl eyes –> large binucleate cells with prominent nucleoli and clearing around the cell
What is the most common type of Hodgkin Lymphoma? What are the features of this?
- Nodular sclerosis.
- Nodules of lymphocytes separated by sclerotic bands of collagen, few reed-sternberg cells
What translocation is associated with Burkitt lymphoma?
t(8;14)
What does the histology of Burkitt lymphoma look like?
- Starry sky
- background of dense dark lymphocytes with scattered macrophages.
What are the common findings in polycythemia vera?
- thrombosis
- pruritis
- erythromelalgia (burning pain in the hands and feet with erythema, pallor or cyanosis)
What is associated with a translocation t(14;18)?
Follicular lymphoma (non-hodgkin)
Most common lymphoma in the US?
Diffuse large B cell lymphoma
