Hematology Flashcards

Question

Transfusion reaction occurring during transfusion, mild

Answer 1

urtricarial reaction: -during transfusion Cause: IgE antibodies against soluble antigens in donor plasma Findings - urticaria Treatment - diphenhydramine - if resolves continue transfusion

Answer 2

Anaphylactic reaction: Occurs seconds to minutes after starting transfusion Cause: possibly anti-IgA IgG antibodies in patients with IgA deficiency Findings: shock/hypertension, angioedema, respiratory failure Treatment - epinephrine, IVF, O2, +/- intubation

Answer 3

Nonhemolytic febrile reaction occurs one to six hours after transfusion Cause: cytokines produced by store donor cells Findings: fever, chills, malaise Treatment: acetaminophen

Answer 4

Acute hemolytic reaction Occurs during transfusion Cause: ABO incompatibility - clerical error Findings: severe hemolysis, fever, chills, tachycardia, tachypnea, hypotension Treatment: aggressive supportive care

Answer 5

Delayed hemolytic reaction Occurs 2 to 10 days after transfusion Cause:: anti-Kidd or anti-D (Rh) antibodies Findings: mild fever, hemolysis, increased indirect bilirubin Treatment: no therapy needed

Answer 6

Etiology: singing chronic inflammatory states, disorder of iron mobilization and utilization Presentation: signs and symptoms of anemia (fatigue, pallor, dyspnea) -often asymptomatic Diagnostic testing: Mild normocytic or microcytic anemia Iron studies: low serum iron, elevated/normal ferritin, low normal transferrin, normal % transferrin saturation Management: Treatment of the underlying disorder +/- erythropoietin supplements

Answer 7

pancytopenia resulting from bone marrow failure Etiologies: - radiation - drugs (chemo, chloramphenicol, sulfonamides, phenytoin) - viral infections - Parvovirus B19, HIV, hepatitis viruses - toxins - industrial chemicals, insecticides - congenital Presentation: - anemia (weakness, pallor, fatigue) - leukopenia (persistent infections) - thrombocytopenia (easy bruising, petechiae) Diagnostic testing: - anemia, leukopenia, thrombocytopenia - bone marrow biopsy - hypocellularity and fatty infiltration, r/o leukemia or metastatic cancer infiltrating marrow Management: - Address the underlying cause - BM transplant - patients with no suitable match (or mild anemia) maybe treated with immunosuppressants

Answer 8

pernicious anemia - autoantibodies against gastric parental cells or intrinsic factor chronic gastritis -> impaired intrinsic factor production and gastric acid excretion Malabsorption - Crohn's, pancreatic disease Gastrointestinal bypass/resection -> bacterial overgrowth in blind loop of jejunum Resection of terminal ileum - Side of absorption of IF-B12 complex Diphyllobothrium latum infection - Fish tapeworm - Japan Inadequate B12 intake - strict vegans

Answer 9

S/S of anemia - fatigue, pallor, dyspnea Neurological problems -subacute combined degeneration - loss of vibration sense and proprioception, weakness/paresthesias/ataxia in the lower extremities -dementia Atrophic glossitis - inflammation the tongue, loss of papillae -> smooth (also in folate/iron def) Diagnostic testing: Megaloblastic anemia - macroovalocytes + hyper segmented neutrophils Low serum B12 level Elevated METHYLMALONIC ACID (MMA) and homocystine Schilling test Anti-IF antibodies - pernicious anemia Management - IM B12 - high dose oral B12 supplements - B12 nasal spray B9 (folate) Will improve anemia but not neurologic symptoms

Answer 10

Inadequate folate intake - alcoholism, elderly, poor nutrition S/S of anemia - fatigue, pallor, dyspnea Atrophic glossitis No neurologic defects Diagnostic testing: Megaloblastic anemia -macroovalocytes + hyper segmented neutrophils Low serum folate level and RBC folate level Normal methylmalonic acid Elevated homocysteine Management: Oral folate supplements Be sure to evaluate for concomitant B12 deficiency

Answer 11

Micro hemorrhages: - epistaxis - mucosal bleeding - bruising - petechia - Purpura Labs -platelet count less than 150,000 Prolonged bleeding time (platelet plug) PT and PTT normal (fibrin clot)

Answer 12

AD deficiency of vWF +/- factor VIII vWF: released by an injured vascular endothelial cells, enables platelet adhesion and aggregation -stabilizes factor VIII Presentation: Easy bruising, mucosal bleeding, skin bleeding, menorrhagia ``` Diagnostic testing Elevated PTT - Factor VIII Elevated bleeding time Normal platelet count vWF antigen low Plasma vWF activity (ristocetin cofactor activity) low Factor VIII activity low or normal ``` Management: Desmopressin (DDAVP) - increases vWF release - first line for acute bleeding -vWF concentrate for severe/refractory bleeding or before surgery -oCP's for menorrhagia -avoid aspirin and other platelet inhibitors

Answer 13

X linked R - A: factor VIII - B: factor IX ``` Presentation: Hemarthrosis Hematuria G.I. bleeding Intracranial hemorrhage is a rare Mucosal bleeding, epistaxis Bleeding following minor trauma or procedures ``` ``` Diagnostic testing: Elevated PTT Normal PT Normal bleeding time and platelet count Factor VIII and factor IX activity levels Genetic testing ``` Management: A: give factor VIII B: give factor IX DDAVP Will increase factor VIII levels - A

Answer 14

Required for factors X, IX, VII, II, protein C, S -protein C and S inactivate factors V and VIII Causes of efficiency - neonates - antibiotic use eradicate flora - malabsorption - pancreatic insufficiency, celiac disease, IBD Presentation: Easy bruising, mucosal bleeding, melena, hematuria Hemorrhagic disease of newborn -> intracranial hemorrhages Diagnostic testing: Elevated PT and INR Normal or elevated PTT Management - vitamin K oral or IM - acute bleeding - FFP

Answer 15

Widespread pathologic intravascular coagulation -> consumption of platelets and coagulation factors-> hypocoagulability ``` Causes: Sepsis Trauma and extensive surgery OB complications - amniotic fluid embolism or placental abruption Pancreatitis Malignancy Transfusions ``` ``` Presentation: Bleeding from wounds/surgical sites hemoptysis Venus or arterial thrombosis -> organ ischemia Hypotension Jaundice Cyanosis a distal extremities ``` Diagnostic testing Low platelets Elevated bleeding time Elevated PT and PTT Low fibrinogen Elevated fiber and split products and the and D dimer Hemolysis-> schistocytes, anemia, elevated bilirubin, low haptoglobin, elevated LDH Management: Treat underlying problem Aggressive supportive care Treat acute bleeding with platelet transfusions, FFP, +/- RBC transfusion

Answer 16

``` Factor V Leiden mutation - MC Prothormbin 20210 gene mutation - stays around longer Antithrombin deficiency Protein C deficiency Protein S deficiency ```

Answer 17

dysregulated inflammatory response without infectious causes ``` Seen in: Pancreatitis acute adrenal insufficiency Autoimmune disease Vasculitis PE Severe trauma Severe burns Fat embolic syndrome ```

Answer 18

Life-threatening organ dysfunction - dysregulated Post response to infection Increase in Sequential Organ Failure Assessment (SOFA) of two or more points: - CNS (Glasgow coma score) - CV (amount of vasoactive meds required to maintain MAP) - renal (serum creatinine or urine output) - coagulation (platelet count) - hepatic (serum bilirubin level) - Respiratory (PaO2:FiO2 ratio)

Answer 19

``` Sinusitis Pneumonia Peritonitis Endocarditis cholangitis Pancreatic infection Septic arthritis UTI Catheter related bacteremia ``` ``` Most common organisms: Staph spp, esp MRSA Strep spp. N. Meningitidis E. coli Klebsiella pneumoniae Pseudomonas aeruginosa Candida spp. (treat with ampotericin B) ```

Answer 20

Airway and breathing: O2, monitor pulse ox, secure airway ``` Circulation: -indicators of adequate perfusion: BP Temperature of the extremities Urine output and renal function Serum lactate level ``` Treatment of hypertension: IVF - NS or LR Vasopressor - norepi IV glucocorticoids - adrenal insufficiency Identify and treat underlying infection: - blood/urine/sputum cultures - CXR - Cx surgical incision - Cx catheters - Broad spectrum IV antibiotics Insulin to maintain glucose 140-180

Answer 21

Plasmodium vivax | Pasmodium falciparum

Answer 22

Plasmodium falciparum (CNS problems)

Answer 23

``` Periodic fever at 1-3 day intervals Diaphoresis Headache Arthralgias Myalgias abdominal pain Vomiting Diarrhea Encephalopathy - P. falciparum Reliance efficiency Pulmonary edema ``` Dx: Peripheral smear - Banana shaped gametocyte Antigen testing PCR

Answer 24

Sub-Saharan Africa Central and South America Asia - india, Indonesia, Laos, cambodia, china, Korea, Vietnam

Answer 25

Proliferation myeloid cells - precursors of rbc's, platelets, granulocytes

Answer 26

Proliferation of lymphoid cells - precursors of lymphocytes

Answer 27

Proliferation of immature "blast" cells in and the bone marrow and peripheral blood

Answer 28

Proliferation of mature cells

Answer 29

Children ages 2-5 Whites and Latinos > blacks Down Sn "ALL fall DOWN" ``` Presentation: Bone pain Fever Lymphadenopathy Fatigue Recurrent infections ``` Dx: lymphoblasts - PAS+, TdT+ Anemia Thrombocytopenia Tx: Chemo: vincristine + steroids

Answer 30

Adults median age 65 M>F M0-M7 M3- acute promyelocytic AML (auer rods) Presentation: Fatigue Easy bruising Recurrent infections ``` Dx: Pancytopenia Myeloblasts: - myeloperoxidase (MPO)+ -Auer rods (thin red/pink rods in cytoplasm) - M3 ``` Tx: chemo

Answer 31

Adult median age 50 Exposure to radiation Philadelphia chromosome t(9;22), bcr-abl (tyrosine kinase) "Philadelphia CreaML cheese" ``` Presentation: Indolent course -fatigue, splenomegaly, bleeding Blast crisis - >20% blasts in BM and peripheral blood -rapidly fatal ``` Dx: Anemia Thrombocytosis - 500-700K Leukocytosis - 100K ``` Tx: Hematopoietic cell transplant Tyrosine kinase inhibitor -imantinib -dasatinib -Nilotinib ```

Answer 32

Elderly adults 70-80s ``` Presentation: Most asx Fever Night sweats Fatigue Lymphadenopathy Hepatosplenomegaly ``` Dx: Severe leukocytosis >70 "Smudge cells" on smear Tx: Periodic monitoring Chemo/rad prn

Answer 33

Dysplasia of myeloid cells, may progress to leukemia -> AML Risk factors: Age >65 Associated with exposure to chemo, radiation, or benzene ``` Presentation: Often asx Anemia -> fatigue Neutropenia -> bacterial infections Thrombocytopenia -> petechiae and purpura ``` Dx: CBC: macrocytic anemia, neutropenia (hypogranular granulocytes), thormbocytopenia Peripheral smear: pseudo Pelger-Huet anomaly - neutrophils with 2 nuclear lobs connected by thin strand BM bx: dysplasia and disordered hematopoiesis Tx: Monitored for progression Transfusions and growth factors as needed Hematopoietic cell transplant