Hematology Flashcards
DVT treatment
Anticoagulation
Several options
End-stage renal failure: Unfractionated heparin followed by warfarin is prefered
Vena cava filters when anticoagulation is contraindicated
Contraindications for anticoagulation
Intracraneal hemorrhage
Active bleeding
Malignant hypertension
Warfarin
interrupts synthesis Vit K related coagulation factors
Goal: INR 2-3
Bleeding: fresh frozen plasma / less severe vit k IV
Plummer vinson syndrome
Iron deficiency anemia, esophageal webs, dysphagia
How to differentiate iron deficiency anemia vs Thalassemia ?
Same: ⬇️HB MCV
Clues: RBW, RBC normal in thalassemia ⬆️ in iron deficiency
Target cells
B thalassemia have HA2in electrophoresis
What to do to prevent non hemolytic blood transfusion reactions ?
Leukoreduction
Osteosarcoma
Boys 13-16 YO are in higher risk
RX: sunburst pattern & periosteal elevation (codman triangle)
Erythropoietin adverse effects
––Worsening HTN
––headaches
––Flu like symptoms
––Red cell aplasia (rare)
Decreased haptoglobin [ ] ?
It binds free hb —> if intravascular hemolysis —> Decreased level
Necrotic skin lesions 5 days after heparin injection ?
Hep induced thrombocytopenia»_space; Exposition of neoantigen and production of antibodies
>50% reduction platelets
arterial or venous thrombosis
DX: serotonin release assay
Hemolysis + cytopenias + Venous thrombosis (abdominal)
Paroxysmal nocturnal hemoglobinuria
dx: confirmed by absence of CD55 CD59
tx: fe and folate
Eculizumab (monoclonal antibd that inhibits complement activation)
Patient underwent bone marrow transplantation, donated by his brother, after some days he develops–Maculopapular rash involving palms, soles and face, blood positive diarrhea, and abnormal liver function test
Acute graft vs host disease
50% if matching siblings
Skin-liver-intestine
Due to recognition of host major and minor HLA antigens by donor T cells
Graft rejection (bone marrow transplant)
⬇️ Myelopoiesis
T lymphos rejecting the graft
Smudge cells & severe lymphocytosis
Chronic lymphocytic leukemia
Elderly
high carboxyhemoglobin levels
Carbon monoxide poisoning»_space; Carboxyhb has ⬆️ affinity to O2 –> tissue hypoxia —> ⬆️ EPO
Multiple myeloma
Monoclonal plasma cell proliferation
Dx clues:
- PAIN!!! 😖»_space; Osteolytic lesions
- Anemia
- Renal insufficiency > Bence jones protein in uroana
- Hypercalcemia>Fatigue, constipacion
- Monoclonal paraproteinemia
Fanconi anemia
Autosomal recessive or X linked disorder
–Aplastic anemia
–Short stature, abnormal thumbs, microcephaly
–Hypopygmented/hyperpigmented areas, café au lait spots, large freckles
Prostate cancer history + orchidectomy + pain from metastasis
Radiation
If not castrated –> Flutamide + LHRH agonist is an option
TTP
⬇️Platelets Microangiopathic hemolytic anemia Neurologic symptoms Renal failure Fever
HUS
⬇️Platelets
Microangiopathic hemolytic anemia
Renal failure
CHILD WITH HISTORY OF RECENT DIARRHEA
Chronic disease anemia
⬇️ Fe, /// TIBC, transferritin > decreased in fe deficiency
⬆️ Ferritin (elevated in fe deficiency)
Normal serum tranferritin receptors
Porphirias
Due to porphyrins accumulation
Precipitated by drugs ! Alcohol!!
Photodermatitis (Cutanea tarda: blisters) Neuro psych symptoms Abdominal pain seizures Pink urine
CML
BCR ABEL translocation > Philadelphia chromosome
Non specific symptoms, splenomegaly, very high WBC
Tx: Imatinib > 🚫 BCR ABL tyrosine kinase
Non Hodgkin lymphoma
B cell malignancy (30 or 60 yo males)
Multiple lymph nodes involved
Pel ebstein fevers (fevers for 1 week>then normal)
pruritus
