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PANCE > Hematology > Flashcards

Hematology Flashcards

1
Q

List three ways to describe the genetic abnormality in CML?

A

922 - BCR-ABL gene - Philadelphia chromosome

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2
Q

What leukemia would lymphoblast be associated with?

A

ALL (Blasts = Acute)

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3
Q

What leukemia would myeloblasts be associated with?

A

AML (Blasts = Acute)

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4
Q

What gene mutation is associated with polycythemia vera?

A

JAK2 mutation

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5
Q

TTP symptom Mnemonic: FAT-RN. What dose FAT-RN stand for?

A

Fever - Anemia - Thrombocytopenia - Renal failure - Neurologic involvement

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6
Q

List two conditions which predispose a patient to antiphospholipid syndrome.

A

Systemic Lupus Erythematosus - Women with recurrent abortions

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7
Q

What disorder is a hemoglobin electrophoresis result of “SA” indicative of?

A

Sickle cell trait

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8
Q

What disorder is a hemoglobin electrophoresis result of “SS” indicative of?

A

Sickle cell disease

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9
Q

What type of anemia are cephalosporins PCN NSAIDS methyldopa associated with?

A

Autoimmune hemolytic anemia

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10
Q

Erythropoietin analogs should be suspended once the hemoglobin is >_____?

A

11 mg/dl

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11
Q

Erythropoietin analogs should only be initiated if the hemoglobin is < ____?

A

10 mg/dl

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12
Q

What two types of anemia have macroovalocytes?

A

B12 and folate deficiency

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13
Q

Which anemia has a decreased MCV, decreased MCH (hypochromic) yet normal TIBC and ferritin?

A

Thalassemia

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14
Q

Acute chest syndrome occurs during the acute phase of which anemia?

A

Hemolytic sickle cell crisis

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15
Q

What are some common oxidative events which may trigger hemolysis in G6PD deficiency?

A

Antimalarials - Sulfa drugs - Aspirin - Febrile Illness - Acidosis - Fava beans

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16
Q

What type of anemia does a + osmotic fragility test indicate?

A

Hereditary Spherocytosis

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17
Q

What do an increased LDH, decreased Haptoglobin and an increased indirect Bilirubin represent?

A

Hemolysis

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18
Q

What type of anemia does a + direct coombs indicate?

A

Autoimmune hemolytic anemia

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19
Q

What does a > 50% reduction in platelet count within 7-10 days of exposure to heparin define?

A

Heparin Induced Thrombocytopenia (HIT) syndrome

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20
Q

Which type of anemia is most likely with associated leukopenia and thrombocytopenia?

A

Aplastic anemia

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21
Q

How would you expect TIBC and ferritin to present in anemia of chronic disease?

A

Decreased TIBC - Normal/increased Ferritin

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22
Q

Anemia of renal failure is defined by decreased levels of which hormone?

A

Erythropoietin

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23
Q

Can oral B12 be used as an initial treatment in a B12 deficient patient?

A

Yes - Oral B12 is considered initial therapy - Other routes if oral fails or pernicious anemia is diagnosed

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24
Q

Which route is best for administering B12 to a deficient patient?

A

Sublingual IM or deep subcutaneous

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25
Q

What tests other than a Schilling test are used to diagnose pernicious anemia?

A

Increased Methylmalonic acid levels - + Intrinsic factor and parietal cell antibodies

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26
Q

Increased MCV with smooth tongue, loss of proprioception and vibratory sense is likely which type of anemia?

A

B12 deficiency

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27
Q

List 5 common causes of folate deficiency.

A

EtOH abuse - Advancing age - Gastric bypass - Pregnancy - Methotrexate

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28
Q

What symptom differentiates B12 from folate deficiency ?

A

Neuropathy occurs with B12 deficiency but not with folate deficiency

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29
Q

Slowly decreasing MCV in an elderly patient?

A

Occult GI blood loss

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30
Q

Pica is a specific symptom of which type of anemia?

A

Iron deficiency anemia

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31
Q

Decreased Ferritin and Increased TIBC?

A

Iron deficiency anemia

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32
Q

What surgery can induce B12 deficiency?

A

Gastric bypass

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33
Q

Heavy menstrual cycle gum bleeding with teeth brushing?

A

Von Willebrand deficiency

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34
Q

What tests will confirm your diagnosis of multiple myeloma?

A

Serum: Protein electrophoresis may show monoclonal proteins - Urine: Bence Jones proteins

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35
Q

Autoimmune bleeding disorder in which patients develop antibodies against their own platelets?

A

Idiopathic Thrombocytopenia Purpura (ITP)

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36
Q

Deficient factor in hemophilia B?

A

Factor IX

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37
Q

Deficient factor in hemophilia A?

A

Factor VIII

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38
Q

What type of leukemia is most commonly seen in older men?

A

Chronic lymphocytic leukemia (CLL)

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39
Q

What is the most common type of kids leukemia?

A

Acute lymphocytic leukemia (ALL)

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40
Q

What does the presence of Heinz bodies indicate?

A

G6PD deficiency (May also be found in thalassemia)

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41
Q

Anemia due to renal failure may be confirmed by which test?

A

Decreased Serum erythropoietin levels

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42
Q

What type of megaloblastic anemia causes neurologic deficits?

A

Vitamin B12 deficiency

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43
Q

What type of anemia can occur in hypothyroidism?

A

Macrocytic non-megaloblastic anemia

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44
Q

What factor is produced in the stomach and required for Vitamin B12 absorption?

A

Intrinsic factor

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45
Q

What test confirms the diagnosis of pernicious anemia?

A

Schilling test or + antibodies to intrinsic factor and parietal cells

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46
Q

Which anemia is associated with bilirubin cholelithiasis?

A

Hereditary spherocytosis

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47
Q

What is the best test to determine whether a patient as a hemolytic anemia?

A

Reticulocyte count and haptoglobin

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48
Q

Which anemia has all 3 cells lines affected: Anemia leukopenia and thrombocytopenia?

A

Aplastic anemia

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49
Q

What is the Dx? Very low MCV, normal/high RBC, normal RDW and high/normal serum iron normal TIBC.

A

Thalassemia

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50
Q

What is the Dx? Low MCV, low RBC, high RDW, low serum iron, high TIBC.

A

Iron Deficiency Anemia

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51
Q

What is the Dx? Microcytic hypochromic anemia, low serum iron and low TIBC. Unresponsive to iron therapy.

A

Anemia of chronic disease

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52
Q

What is the result of homozygous alpha thalassemia (Alpha major) genetics?

A

Fetal death

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53
Q

Basophilic stippling of RBCs?

A

Lead poisoning (May also occur in thalassemia and chronic EtOH abuse)

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54
Q

Type of anemia in which serum iron is decreased and TIBC is increased?

A

Iron deficiency anemia

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55
Q

What is the Dx? Teenage African American with severe bone and joint pain severe anemia.

A

Sickle cell disease

56
Q

What is the etiology of pernicious anemia?

A

Antibodies to gastric parietal cells and intrinsic factor

57
Q

Increased serum protein with a decreased albumin/globulin ratio?

A

Multiple myeloma

58
Q

Reed Sternberg cells?

A

Hodgkins lymphoma

59
Q

Philadelphia (Ph) chromosome?

A

Chronic myeloid leukemia (CML)

60
Q

Auer rods?

A

Acute myeloblastic leukemia (AML)

61
Q

What hematological malignancy has a bimodal incidence by age of 15-45 years old or >60 years old?

A

Hodgkin lymphoma

62
Q

Which malignancy has a peak incidence of 20-40 years old and can be associated with HIV?

A

Non-Hodgkin Lymphoma

63
Q

Painless lymphadenopathy indicative of which malignant disorder?

A

Hodgkin lymphoma

64
Q

What are the organ systems which may be involved in Thrombotic thrombocytopenia purpura (TTP)?

A

Renal - Neuro - Cardiac

65
Q

List the four lab findings which support a diagnosis of DIC.

A

Decreased Fibrinogen - Thrombocytopenia - Increased D-Dimer - Increased PT and PTT

66
Q

What disorder should be considered for a patient on warfarin who develops diffuse necrotic skin lesions?

A

Protein C deficiency

67
Q

How is factor V Leiden disorder confirmed?

A

Activated protein C resistance assay - Genetic testing definitive

68
Q

What is the most common genetic hypercoagulable state?

A

Factor V Leiden

69
Q

List the three tests to confirm an DX of antiphospholipid syndrome in a hypercoagulable patient?

A

Lupus anticoagulant - Anticardiolipin antibody ELISA - Anti-beta2-glycoprotein-I ELISA

70
Q

List the four direct thrombin inhibitors which may be used in HIT.

A

Lepirudin - Bivalirudin - Argatroban - Fondaparinux

71
Q

Which antibody is positive in HIT syndrome?

A

+ platelet factor 4 (PF4) antibody

72
Q

Which food is known to trigger hemolysis in a patient with G6PD deficiency?

A

Fava beans

73
Q

List three medications which may trigger hemolysis in a patient with G6PD deficiency.

A

Antimalarials - Sulfa drugs - Aspirin

74
Q

Which groups are most likely to be affected by G6PD deficiency?

A

Black or Mediterranean males

75
Q

List three medications which may trigger autoimmune anemia.

A

Cephalosporins - Penicillins - NSAIDs

76
Q

What is the most common autoimmune disorder associated with hemolytic anemia?

A

Systemic lupus erythematosus (SLE)

77
Q

Which anemia is most commonly associated with EtOH abuse?

A

Folate deficiency

78
Q

Priapism may occur in which acute anemia?

A

Sickle cell crisis

79
Q

What test is diagnostic for sickle cell disease?

A

Hemoglobin electrophoresis

80
Q

Which test is more sensitive than B12 levels for B12 deficiency in early disease?

A

Increased Methylmalonic acid levels occur in early B12 loss and may precede decreased serum B12 levels

81
Q

What is the chronic treatment of Von Willebrand disease?

A

Chronic treatment: Factor VIII replacement

82
Q

What is the acute treatment of Von Willebrand disease?

A

Acute/initial treatment: DDAVP

83
Q

What assay is definitive for Von Willebrand disease?

A

Ristocetin cofactor assay

84
Q

What factors are affected in Von Willebrand disease?

A

Von Willebrand factor and factor VIII are both decreased

85
Q

What is first line treatment for Idiopathic thrombocytopenia purpura?

A

Steroids

86
Q

Christmas disease is another name for deficiency of which clotting factor?

A

Decreased Factor IX (AKA Hemophilia B)

87
Q

What disorder is usually diagnosed early in childhood and has hemarthrosis bruising and bleeding?

A

Hemophilia

88
Q

How is hemophilia inherited?

A

X-linked recessive

89
Q

What is the Dx? 75 year old male with adenopathy WBC 150K (90% lymphocytes).

A

CLL

90
Q

What is the Dx? Child with fever bleeding bone pain and adenopathy?

A

ALL

91
Q

What are the two medications available for treatment of anemia due to renal failure?

A

epoetin alfa and darbepoetin alfa

92
Q

Increased reticulocyte count likely represents which two anemia etiologies?

A

Hemolysis or blood loss

93
Q

Which test is most specific for hemolysis?

A

Haptoglobin is decreased in both extra and intravascular hemolysis

94
Q

List three medications which may cause aplastic anemia.

A

ACE inhibitors - Sulfonamides - Phenytoin

95
Q

What heritage is associated with an increased chance of thalassemia?

A

Mediterranean descent

96
Q

What medication is commonly used for CML?

A

Imatinib

97
Q

Translocation of chromosomes 9 and 22 or 922 suggests which disorder?

A

CML (This describes the Philadelphia chromosome)

98
Q

WBC > 100000 and hyperuricemia are most likely associated with which disorder?

A

CML

99
Q

Does AML primarily occur in adults or children?

A

Adults

100
Q

The complications of multiple myeloma can be described by CRABI. List these 5 complications.

A

C: hyperCalcemia - R: Renal failure - A: Anemia - B: lytic Bone lesions - I: Infections

101
Q

What tests are used to confirm monoclonal gammaglobulinopathy?

A

Protein electrophoresis + immunofixation (Monoclonal spike IgG or IgA - multiple myeloma)

102
Q

Monoclonal proteinuria (Bence Jones proteins) are found in which disorder?

A

Multiple myeloma

103
Q

A 73 year old male presents with back pain and high protein with an increased albumin/globulin ratio. Which laboratory tests would be appropriate to order next?

A

Serum protein electrophoresis + immunofixation and urine for Bence Jones protein in patient with suspected multiple myeloma

104
Q

What is the most likely lymphoma to occur in a 31 year old male with HIV who presented to the ER after suffering focal neurological deficit?

A

Non-Hodgkin Lymphoma

105
Q

Which is the only lymphoma that is bimodal in age of onset, painless lymphadenopathy and has Reed-Sternberg cells on pathology?

A

Hodgkin Lymphoma

106
Q

An 82 year old male has recurrent infections, lymphadenopathy and lymphocytosis. What is the most likely type of leukemia the patient suffers from?

A

Chronic lymphocytic leukemia (CLL)

107
Q

A patient has a leukemia with high uric acid levels and a WBC of 109,000. What chromosome abnormality would you expect to find upon further testing?

A

Philadelphia chromosome in patient with chronic myeloid leukemia (CML)

108
Q

An acute leukemia causing lymphadenopathy, bone pain, bleeding and fever in a child is most likely which type of leukemia?

A

Acute Lymphoblastic Leukemia (ALL)

109
Q

Which leukemia is more common in adults and on laboratory review has Auer rods with increased myeloblasts?

A

Acute Myeloid Leukemia (AML)

110
Q

What organism associated with ground meat is often responsible for hemolytic uremic syndrome?

A

E. Coli 0157

111
Q

What organ systems can be affected in thrombotic thrombocytopenia purpura (TTP)?

A

Renal, neuro and cardiac

112
Q

An adult patient presents with acute thrombocytopenia, fever, multi-organ thrombosis, and hemolytic anemia. What is the best treatment for this patient?

A

Plasmapheresis for thrombotic thrombocytopenia purpura (TTP)

113
Q

Is the onset of idiopathic thrombocytopenia purpura (ITP) usually faster or slower than TTP?

A

ITP has a slow onset whereas TTP is usually an acute onset

114
Q

Chronic thrombocytopenia with an otherwise negative work up is most likely what disorder?

A

Idiopathic thrombocytopenia purpura (ITP)

115
Q

What conditions other than trauma can lead to disseminated intravascular coagulation (DIC)?

A

Sepsis and malignancy

116
Q

A patient presents 2 months after initiating warfarin with necrotic skin lesions. What underlying hypercoagulable state is most likely?

A

Protein C deficiency

117
Q

What is the most common hypercoagulable state?

A

Factor V Leiden Mutation

118
Q

A patient with SLE is admitted with a with new onset DVT. What antibodies should be ordered to aid in the diagnosis of the patients hypercoagulable state?

A

Anti-phospholipid antibodies

119
Q

A 76 year old female develops a post op DVT after an ORIF if her hip. She has a platelet count of 72,000. What medication is the likely cause of her condition?

A

Heparin or low molecular weight heparin in patient with Heparin Induced Thrombocytopenia (HIT)

120
Q

What is the difference between Von Willebrand disease and hemophilia in regards to platelet function?

A

Platelet function is normal in hemophilia and impaired in Von Willebrand disease

121
Q

In addition to Factor VIII replacement, what medication may be used in the treatment of Von Willebrand disease?

A

DDAVP (desmopressin) = increased release of vWF

122
Q

A 25 year old white female had prolonged bleeding after a dental procedure, bruises easily and has heavy periods. What is the most likely bleeding disorder?

A

Von Willebrand Disease

123
Q

What anemia should be suspected in a 3 year old black male with anemia and priapism?

A

Sickle cell anemia

124
Q

A 31 year old Mediterranean female has a hemoglobin of 10.3 gm/dl, MCV of 54, TIBC and Ferritin are normal. What is the most likely etiology of her anemia?

A

Thalassemia minor

125
Q

Measurement of which laboratory value is the best indicator of whether or not a sickle cell crisis is resolving?

A

Reticulocyte count - Decreasing reticulocyte counts are the best indicator that a crisis is resolving

126
Q

What medications related to travel can be an oxidative trigger for a patient with G6PD?

A

Anti-malarial medications

127
Q

What is the most common malignancy associated with autoimmune hemolytic anemia?

A

CLL

128
Q

A 42 year-old black female with SLE has an increased bilirubin and a mild anemia. Which test is most definitive to evaluate this patient’s anemia?

A

Direct coombs in patient with autoimmune anemia

129
Q

Name 2 things which can cause aplastic anemia other than medications.

A

Chemotherapy and radiation

130
Q

A patient who recently started lisinopril has a hemoglobin 7.4, WBC 1.1, platelets 55. What is the most likely disorder?

A

Aplastic Anemia

131
Q

A dialysis patient has been on darbepoetin alfa for 3 months. His most recent hemoglobin is 11.3 gm/dl. Should he continue to use this medication?

A

No. erythropoetin analogs must be stopped when the hemoglobin is greater than 11 gm/dL

132
Q

A 36 year old black male s/p gastric bypass surgery has peripheral neuropathy. Oral B12 has not improved his symptoms. What is the next step?

A

Sublingual or IM B12

133
Q

What antibody test would confirm a diagnosis of pernicious anemia?

A

Intrinsic factor and parietal cell antibodies

134
Q

A 74 year old white male with a history of chronic ETOH abuse has an MCV of 102. Physical exam finds no neurological deficit. What is the most likely diagnosis?

A

Folate deficiency

135
Q

A 23 year old white female has weakness, fatigue and has developed a habit of chewing ice. What are the expected findings in regard to TIBC and Ferritin?

A

Increased TIBC and decreased Ferritin in patient with iron deficiency anemia

136
Q

What organism is likely responsible for Renal failure microangiopathic hemolytic anemia and thrombocytopenia?

A

E. Coli 0157

PANCE (9 decks)

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