Hematology Flashcards
How does anemia kill?
Myocardial ischemia
Additional tests for anemia include
retic count haptoglobin LDH total/direct bilirubin] TSH and T4 B12/folate levels iron studies
also order urinalysis with microscopic analysis
Anemia of chronic disease shows what on Iron studies?
High/Normal ferritin
Low total iron binding content (TIBC)
Low iron
Normal or low Fe sat
Iron deficiency anemia shows what on Iron studies?
Low ferritin High TIBC Low Iron Low Fe sat ELEVATED RDW!!!
Elevated RDW? Think
iron deficiency
Iron levels will be high in
Alcoholic
Isoniazid
Lead exposure
Unexplained microcytic anemia in patient >50 is probably
Colon cancer
The only Anemia of chronic disease that responds to EPO is that caused by
end stage renal disease
What drug blocks B12 absorption?
Metformin! Fun fact!
Drugs that block GI absorption of folate are
alcohol
nitrofurantoin
estrogens
phenytoin
In B12 deficiency, the reticulocyte count is __ because of ineffective erythropoiesis
LOW; B12 deficiency destroys red cells early as they come out of the bone marrow
___ levels go up in both B12 and folate deficiency, but __ levels only go up in B12 deficiency
Homocysteine; methylmalonic acid
To discover the cause of B12 deficiency, check __ and __ levels
antiparietal cell antibodies and anti intrinsic factor antibodies!
What are four tests indicative of hemolysis?
LDH Indirect bilirubin Haptoglobin Reticulocyte level Also order a peripheral smear!
Watch for low __ after treating B12 deficiency!
Potassium
Fever in a patient with Sickle Cell Disease is an emergency because
the patient has no spleen!
If a fever is present in SCD patient, give
ceftriaxone
levofloxacin or moxifloxacin
When is the answer exchange transfusion for SCD?
Retinal infarction
pulmonary infarction leading to pleuritic pain and abnml xray
priapism
stroke
The only findings of sickle cell trait are
Renal manifestations (hematuria)
Syphilis causes __ with IVIG
cold agglutinins
Heinz bodies and bite cells can appear in patients with
G6PD Deficiency
__ deficiency presents the same way as G6PD deficiency except it’s unclear what provokes the hemolysis
Pyruvate kinase deficiency
The most accurate test for hereditary spherocytosis is
eosin-5-maleimide
The treatment for hereditary spherocytosis is
splenectomy
Genetic loss of ankyrin and spectrin =
hereditary spherocytosis
Autoimmune hemolysis + Renal failure + Thrombocytopenia =
Hemolytic Uremic Syndrome
TTP is HUS +
fever + neurologic issues
What level is down in TTP?
ADAMTS-13
Do NOT give ___ in HUS or TTP!
platelets!
The purpose of plasmapheresis in the treatment of severe TTP is to
replace ADAMTS-13, a metalloproteinase that breaks down VWF
Treat severe paroxysmal nocturnal hemoglobinuria with
Eculizumab, an inhibitor of C-5 that prevents complement activation
Treat mild dz with steroids
PNH can transform into
aplastic anemia
Acute myelogenous leukemia
HELLP syndrome stands for
hemolysis
elevated liver function tests
low platelets
Deliver that baybay
Shortness of breath, clear lungs, brown blood =
methemoglobinemia
treat with methylene blue
M3 acute promyelocytic leukemia is associated with
DIC
Treat M3 APL with
all trans retinoic acid
A special neutrophil in myelodysplasia with 2 lobes is called a
Pelger-Huet cell
The most common cause of death in myelodysplasia is
infection or bleeding
Best treatment for CML is
imatinib initially
Bone marrow transplant is the only cure but not initial
Smudge cells =
CLL
Best initial therapy for hairy cell leukemia is
cladribine (2-CDA)
Both hairy cell leukemia and myelofibrosis present with __ and __
pancytopenia and splenomegaly
EPO level is ___ in polycythemia vera
low
JAK2 mutation is found in__, __, and __
Myelofibrosis, polycythemia vera, and essential thrombocythemia
Daily aspirin should be given to patients with
polycythemia vera and essential thrombocythemia
The key feature of essential thrombocythemia is
markedly elevated PLATELET count
-Treat with hydroxyurea to lower the platelet count
The most frequent presentation of ___ is bone pain caused by fracture occurring under normal use
multiple myeloma
Treat multiple myeloma with
melphalan and steroids
Thalidomide, lenalidomide, or bortezomib may be added
The most effective therapy for multiple myeloma is
autologous stem cell bone marrow transplantation
Elevated protein level found in an elderly person =
monoclonal gammopathy of unknown significance
HIT is an ___ reaction characterized by a drop in platelets a few days AFTER the start of heparin
allergic
___ is safe in HIT
Fondaparinux
