Hematology

Question 1

Iron deficiency

Answer 1

Low Fe
Low ferritin
High TIBC
High RDW**
Low Fe sat

Question 2

AOCD

Answer 2

Low Fe
high ferritin
Low TIBC
Low to high Fe sat

Question 3

Iron deficiency

Most accurate

Answer 3

Bone marrow biopsy

Don’t do on ccs though

Question 4

Anemia blue box about HgH

Answer 4

HgH has beta 4 tetrads with 3 gene deleted alpha thal

Question 5

What’s the only mictocytic anemia with high retic count?

Answer 5

HgH

Question 6

B12 deficiency

Answer 6

MC: Peripheral neuropathy
Least common: dementia

High LDH
High indirect bilirubin 
Low retic ct
Oval cells
Hypersegmented neutrophils

Question 7

PE for sickle cell

*** very important

Answer 7

Neurological 
Heent
Chest
Cv
Abdominal 
Extremities

Question 8

When you answer exchange transfusion in sickle cell

Answer 8

Eye: retinal infarction
Lung: pulmonary infarction
Penis: priapism
Brain: stroke

Goal: decrease HbS to 30-40%

Question 9

Sudden drops in Hct in sickle cell patients is due to what

Answer 9

Parvovirus B19

 - Best initial : 
 - most accurate; pcr for dna of parvovirus 

Also parvovirus gives low retic ct and aplasia in bm

Folate deficiency
- All sickle cell pts need to be on folate replacement

Question 10

Parvovirus b19 Tx

Answer 10

Transfusions and immunologlobulin

Question 11

The mcc death in PNH

Answer 11

Large vessel venous thrombosis … like portal vein thrombosis

Question 12

Aplastic anemia

Main feature
Tx

Answer 12

Pancytopenia

Tx
Young patients bm tx

Older patients :
antithymocyteglobulin
Cyclosporine

Question 13

Ccs pcv

Answer 13

Order:
 CBC
Abg 
heme consultation
Nuclear rbc mass test
Epo
B12 and lap elevated!!!

Question 14

MM

Tx
Most effective therapy

Answer 14

Melphalan and steroids

Add lanilodimide, thalidomide
Bortezomib ( revèrses renal dysfunction)

Most effective: autologous stem cell transplant … but have to be <70

(-) AG is due to paraproteinemia because proteins are cationic (+) aCl- and Hco3- increase to compensate … same with albumin does the same thing. Every 1 point decrease in albumin; 2 point decrease in AG

Question 15

VWD

Tx

Answer 15

Desmopressin

Or…
VIII replacement

Question 16

Thrombopoietin analogs

Answer 16

Romiplostim
Eltrombopag

They treat chronic ITP
They stimulate megakaryocytes

No response to splenectomy

Question 17

Mixing study

Answer 17

Correct ptt to normal—> clotting factor deficiency

Does not correct to normal —> factor inhibitor antibody

Question 18

APL syndrome

Presents

Dx
Tx

Answer 18

Venous thrombosis
Spontaneous abortion
Increased ptt, normal pt
Fp VDRL

Dx
Mixing study first
Then Russell viper venom test

Tx
Heparin then warfarin

Question 19

Anemia Dx testing

Answer 19

On top of all the others you know also do UA with microscopic analysis.

Question 20

PNH can transform into

Answer 20

Aplastic anemia
Best initial
Most accurate tx: bone marrow transplant
Tx: antithymocyte globulins and cyclosporine

AML
Best initial : smear
   Most accurate 
   Tx: idarubicin
Cytosine arabinoside

Question 21

Acute intermittent porphyria

Answer 21

Motor and sensory neuropathy
Recurrent abdominal pain

Red colored urine with a negative dipstick

Brought on by fasting, alcohol, and phenobarbital

Question 22

Myelofibrosis

Features
Tx

Answer 22

Normal TRAP

Smear shows teardrops
Marrow shows fibrosis
JAK2 mutation

Tx
Best initial therapy lenalidomide or thalidomide
ruxolitinib inhibits jam 2

Question 23

CLL Tx

Answer 23

Fludarabine + rituxomab And cyclophosphamide m

Alemtuzumab (anti cd 52)when fludarabine fails

Question 24

CML Tx

Answer 24

Imatinib (gleevec), dasatanib, nilotinib

Bone marrow transplant is curative but rarely needed

Question 25

MM Dx tests

Answer 25

SPEP- MONOclonal hypergammaglibenemia usually IgG

UPEP

BUN and creatinine qq_ renal failure
Hypercalcemia

Bone scan

Peripheral smear - rouleax, inc MPV

B2 microglobulim- prognostic indicator!!!

… neg alk phosp and neg bone scan

Question 26

Hereditary spherocytosis

Answer 26

Recurrent hemolysis
Splenomegaly
Elevated MCHC
Bilirubin gallstones

Dx
Osmotic fragility test

Tx
Splenectomy

Question 27

PNH. Can transform into …
Dx

Tx

Answer 27

Aplastic anemia
AML ( auer rods, idarubicin or daunorubicin and cytosine arabinoside)

Most accurate test cd55 and cd59

Tx glucocorticoids tx dependent with severe disease —> eculizumab!

Question 28

Waldenstroms macroglobulinrmia

Answer 28

Hyperviscosity from IgM overproduction

Best initial test is serum viscosity level and SPEP

Tx
Best initial therapy plasmapharesis
Furtherther treatment add the same agents used in CLL like fludarabine ands rituximab Or chloramvucil

Question 29

HD and NHL.

Best initial test

Answer 29

Excisional lymph node Bx

Question 30

HD And NHL staging tests

Tx

Answer 30

Cxr
Ct with contrast
Bm biopsy

Stage 1 and 2 without B symptoms are treated with radiation and low dose chemo

Advanced stage, 3 and 4 are treated just with chemo

HD: ABVD ( adriamycin, bleomyocin, vinblastine, dacarbazine

NHL: CHOP
Cyclophosphamide, hydroxyadriamycin, oncovin. ( vincristine, prednisone add rituximab!

Question 31

ITP

Dx
Tx

Answer 31

The preriphersl smear shows LARGE platelets

U/S to look for a normal spleen

You need a BM Biopsy

Antibodies to gp 2b/3a receptor

Tx: first steroids then IvIg when platelet < 20000

Question 32

HIT therapy

Answer 32

Stop heparin and switch to a direct thrombin inhibitor like fondaparinoux, lepirudin, argatroban