Hematology

Question 1

How does anemia kill?

Answer 1

Myocardial ischemia

Question 2

Additional tests for anemia include

Answer 2

retic count
haptoglobin
LDH
total/direct bilirubin]
TSH and T4
B12/folate levels
iron studies

also order urinalysis with microscopic analysis

Question 3

Anemia of chronic disease shows what on Iron studies?

Answer 3

High/Normal ferritin
Low total iron binding content (TIBC)
Low iron
Normal or low Fe sat

Question 4

Iron deficiency anemia shows what on Iron studies?

Answer 4

Low ferritin
High TIBC
Low Iron
Low Fe sat
ELEVATED RDW!!!

Question 5

Elevated RDW? Think

Answer 5

iron deficiency

Question 6

Iron levels will be high in

Answer 6

Alcoholic
Isoniazid
Lead exposure

Question 7

Unexplained microcytic anemia in patient >50 is probably

Answer 7

Colon cancer

Question 8

The only Anemia of chronic disease that responds to EPO is that caused by

Answer 8

end stage renal disease

Question 9

What drug blocks B12 absorption?

Answer 9

Metformin! Fun fact!

Question 10

Drugs that block GI absorption of folate are

Answer 10

alcohol
nitrofurantoin
estrogens
phenytoin

Question 11

In B12 deficiency, the reticulocyte count is __ because of ineffective erythropoiesis

Answer 11

LOW; B12 deficiency destroys red cells early as they come out of the bone marrow

Question 12

___ levels go up in both B12 and folate deficiency, but __ levels only go up in B12 deficiency

Answer 12

Homocysteine; methylmalonic acid

Question 13

To discover the cause of B12 deficiency, check __ and __ levels

Answer 13

antiparietal cell antibodies and anti intrinsic factor antibodies!

Question 14

What are four tests indicative of hemolysis?

Answer 14

LDH
Indirect bilirubin
Haptoglobin
Reticulocyte level
Also order a peripheral smear!

Question 15

Watch for low __ after treating B12 deficiency!

Answer 15

Potassium

Question 16

Fever in a patient with Sickle Cell Disease is an emergency because

Answer 16

the patient has no spleen!

Question 17

If a fever is present in SCD patient, give

Answer 17

ceftriaxone

levofloxacin or moxifloxacin

Question 18

When is the answer exchange transfusion for SCD?

Answer 18

Retinal infarction
pulmonary infarction leading to pleuritic pain and abnml xray
priapism
stroke

Question 19

The only findings of sickle cell trait are

Answer 19

Renal manifestations (hematuria)

Question 20

Syphilis causes __ with IVIG

Answer 20

cold agglutinins

Question 21

Heinz bodies and bite cells can appear in patients with

Answer 21

G6PD Deficiency

Question 22

__ deficiency presents the same way as G6PD deficiency except it’s unclear what provokes the hemolysis

Answer 22

Pyruvate kinase deficiency

Question 23

The most accurate test for hereditary spherocytosis is

Answer 23

eosin-5-maleimide

Question 24

The treatment for hereditary spherocytosis is

Answer 24

splenectomy

Question 25

Genetic loss of ankyrin and spectrin =

Answer 25

hereditary spherocytosis

Question 26

Autoimmune hemolysis + Renal failure + Thrombocytopenia =

Answer 26

Hemolytic Uremic Syndrome

Question 27

TTP is HUS +

Answer 27

fever + neurologic issues

Question 28

What level is down in TTP?

Answer 28

ADAMTS-13

Question 29

Do NOT give ___ in HUS or TTP!

Answer 29

platelets!

Question 30

The purpose of plasmapheresis in the treatment of severe TTP is to

Answer 30

replace ADAMTS-13, a metalloproteinase that breaks down VWF

Question 31

Treat severe paroxysmal nocturnal hemoglobinuria with

Answer 31

Eculizumab, an inhibitor of C-5 that prevents complement activation Treat mild dz with steroids

Question 32

PNH can transform into

Answer 32

aplastic anemia | Acute myelogenous leukemia

Question 33

HELLP syndrome stands for

Answer 33

hemolysis elevated liver function tests low platelets Deliver that baybay

Question 34

Shortness of breath, clear lungs, brown blood =

Answer 34

methemoglobinemia treat with methylene blue

Question 35

M3 acute promyelocytic leukemia is associated with

Answer 35

DIC

Question 36

Treat M3 APL with

Answer 36

all trans retinoic acid

Question 37

A special neutrophil in myelodysplasia with 2 lobes is called a

Answer 37

Pelger-Huet cell

Question 38

The most common cause of death in myelodysplasia is

Answer 38

infection or bleeding

Question 39

Best treatment for CML is

Answer 39

imatinib initially | Bone marrow transplant is the only cure but not initial

Question 40

Smudge cells =

Answer 40

CLL

Question 41

Best initial therapy for hairy cell leukemia is

Answer 41

cladribine (2-CDA)

Question 42

Both hairy cell leukemia and myelofibrosis present with __ and __

Answer 42

pancytopenia and splenomegaly

Question 43

EPO level is ___ in polycythemia vera

Answer 43

low

Question 44

JAK2 mutation is found in__, __, and __

Answer 44

Myelofibrosis, polycythemia vera, and essential thrombocythemia

Question 45

Daily aspirin should be given to patients with

Answer 45

polycythemia vera and essential thrombocythemia

Question 46

The key feature of essential thrombocythemia is

Answer 46

markedly elevated PLATELET count | -Treat with hydroxyurea to lower the platelet count

Question 47

The most frequent presentation of ___ is bone pain caused by fracture occurring under normal use

Answer 47

multiple myeloma

Question 48

Treat multiple myeloma with

Answer 48

melphalan and steroids | Thalidomide, lenalidomide, or bortezomib may be added

Question 49

The most effective therapy for multiple myeloma is

Answer 49

autologous stem cell bone marrow transplantation

Question 50

Elevated protein level found in an elderly person =

Answer 50

monoclonal gammopathy of unknown significance

Question 51

HIT is an ___ reaction characterized by a drop in platelets a few days AFTER the start of heparin

Answer 51

allergic

Question 52

___ is safe in HIT

Answer 52

Fondaparinux