Hematology Flashcards
Iron deficiency
Low Fe Low ferritin High TIBC High RDW** Low Fe sat
AOCD
Low Fe
high ferritin
Low TIBC
Low to high Fe sat
Iron deficiency
Most accurate
Bone marrow biopsy
Don’t do on ccs though
Anemia blue box about HgH
HgH has beta 4 tetrads with 3 gene deleted alpha thal
What’s the only mictocytic anemia with high retic count?
HgH
B12 deficiency
MC: Peripheral neuropathy
Least common: dementia
High LDH High indirect bilirubin Low retic ct Oval cells Hypersegmented neutrophils
PE for sickle cell
*** very important
Neurological Heent Chest Cv Abdominal Extremities
When you answer exchange transfusion in sickle cell
Eye: retinal infarction
Lung: pulmonary infarction
Penis: priapism
Brain: stroke
Goal: decrease HbS to 30-40%
Sudden drops in Hct in sickle cell patients is due to what
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
Parvovirus b19 Tx
Transfusions and immunologlobulin
The mcc death in PNH
Large vessel venous thrombosis … like portal vein thrombosis
Aplastic anemia
Main feature
Tx
Pancytopenia
Tx
Young patients bm tx
Older patients :
antithymocyteglobulin
Cyclosporine
Ccs pcv
Order: CBC Abg heme consultation Nuclear rbc mass test Epo B12 and lap elevated!!!
MM
Tx
Most effective therapy
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
VWD
Tx
Desmopressin
Or…
VIII replacement
Thrombopoietin analogs
Romiplostim
Eltrombopag
They treat chronic ITP
They stimulate megakaryocytes
No response to splenectomy
Mixing study
Correct ptt to normal—> clotting factor deficiency
Does not correct to normal —> factor inhibitor antibody
APL syndrome
Presents
Dx
Tx
Venous thrombosis
Spontaneous abortion
Increased ptt, normal pt
Fp VDRL
Dx
Mixing study first
Then Russell viper venom test
Tx
Heparin then warfarin
Anemia Dx testing
On top of all the others you know also do UA with microscopic analysis.
PNH can transform into
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
Acute intermittent porphyria
Motor and sensory neuropathy
Recurrent abdominal pain
Red colored urine with a negative dipstick
Brought on by fasting, alcohol, and phenobarbital
Myelofibrosis
Features
Tx
Normal TRAP
Smear shows teardrops
Marrow shows fibrosis
JAK2 mutation
Tx
Best initial therapy lenalidomide or thalidomide
ruxolitinib inhibits jam 2
CLL Tx
Fludarabine + rituxomab And cyclophosphamide m
Alemtuzumab (anti cd 52)when fludarabine fails
CML Tx
Imatinib (gleevec), dasatanib, nilotinib
Bone marrow transplant is curative but rarely needed
MM Dx tests
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
Hereditary spherocytosis
Recurrent hemolysis
Splenomegaly
Elevated MCHC
Bilirubin gallstones
Dx
Osmotic fragility test
Tx
Splenectomy
PNH. Can transform into …
Dx
Tx
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!
Waldenstroms macroglobulinrmia
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
HD and NHL.
Best initial test
Excisional lymph node Bx
HD And NHL staging tests
Tx
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!
ITP
Dx
Tx
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
HIT therapy
Stop heparin and switch to a direct thrombin inhibitor like fondaparinoux, lepirudin, argatroban
