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Internal Medicine > Hematology > Flashcards

Hematology Flashcards

1
Q

Iron Deficiency Anemia cause

A

blood loss (GI bleed, surgery); pregnancy, diet, alcohol, malabsorption

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2
Q

Iron Deficiency Anemia s/s

A

glossitis (sore tongue), brittle nails, vague GI symptoms; plummer-vinson syndrome (dysphagia, esophageal webs); fatigue, pallor, SOB, tachycardia

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3
Q

Iron Deficiency Anemia dx

A

Fe <150; CBC (microcytic, low MCV/MCHC (hypochromic), platelets high); peripheral blood smear (anisocytosis, poikilocytosis); serum Fe (low), ferritin (low), TIBC (elevated)

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4
Q

Iron Deficiency Anemia tx

A

ferrous sulfate 325mg

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5
Q

Thalassemia cause

A

hemoglobinopathy; hereditary

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6
Q

Thalassemia s/s

A

fatigue, pallor, tachycardia, SOB
■ Alpha thalassemia minor: mild to no symptoms; stillbirths/hydrops fetalis
■ Alpha thalassemia H: pallor, splenomegaly
■ Beta thalassemia minor: modest anemia, mild to no symptoms
■ Beta thalassemia major: severe anemia; growth failure, pathologic fractures, jaundice, bronze colorization

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7
Q

Thalassemia dx

A

Hgb electrophoresis (r/o sickle cell); CBC (microcytic; Hgb close to 10, MCV <70; MCV/RBC<13; normal RBC count); retic count (normal))

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8
Q

Thalassemia tx

A

treat type
■ Alpha thalassemia minor: no treatment, folate
■ Alpha thalassemia H: transfused frequently; folate
■ Beta thalassemia minor: no treatment; folate
■ Beta thalassemia major: transfused frequently; folate

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9
Q

Aplastic Anemia cause

A

bone marrow failure; congenital/familial; idiopathic, infectious (EBV, HIV, parvo), liver transplant, pregnancy, MDS, ALL, drugs/toxins

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10
Q

Aplastic Anemia s/s

A

insidious onset; pallor, headache, palpitations, dyspnea, fatigue, foot swelling, gingival bleeding, petechial rashes, recurrent infections, oropharyngeal ulcerations

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11
Q

Aplastic Anemia dx

A

CBC (normocytic, pancytopenia; small # of platelets, RBCs, granulocytes, monocytes, reticulocytes); peripheral blood smear (teardrop poikilocytes, leukoerythroblastic changes -> infiltrative); bone marrow biopsy (hypocellular/hypoplasia)

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12
Q

Aplastic Anemia tx

A

supportive therapy, immunosuppressive therapy, hematopoietic cell transplant

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13
Q

B12 Deficiency Anemia cause

A

lack of intrinsic factor; gastric bypass, diet (vegans, alcoholics), metformin/PPI use, IBD, pancreatic insufficiency

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14
Q

B12 Deficiency Anemia s/s

A

smooth tongue, glossitis, cheilosis, neurologic findings (paresthesias, balance problems, cerebral dysfunction), vague GI complaints; fatigue, pallor, tachycardia, SOB

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15
Q

B12 Deficiency Anemia dx

A

CBC (megaloblastic, macrocytic; leukopenia, thrombocytopenia, increased MCV/MCH); peripheral blood smear (hypersegmented neutrophils, anisopoikilocytosis); low B12, anti-intrinsic factor antibodies (shillings); antiparietal cell antibodies; increased homocysteine levels

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16
Q

B12 Deficiency Anemia tx

A

B12 IM monthly; daily cobalamin; (neurologic s/s reversible <6months)

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17
Q

Hemolytic Anemia cause

A

hereditary (intrinsic) vs extrinsic; immune attack; trauma

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18
Q

Hemolytic Anemia s/s

A

fatigue, pallor, tachycardia, SOB, jaundice, bilirubin gallstones, bone marrow expansion, hepatosplenomegaly, petechiae/purpura

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19
Q

Hemolytic Anemia dx

A

CBC (HCT falling >3%/wk); peripheral smear (immature RBCs, nucleated RBCs); retic count (elevated); haptoglobin (low); LDH (high); Coombs (DAT) positive (autoimmune); Heinz body, osmotic fragility, d-dimer, PT, apt, pregnancy

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20
Q

Hemolytic Anemia tx

A

treat underlying disorder

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21
Q

G6PD Deficiency Anemia (hemolytic) cause

A

x-linked disorder; oxidant exposure to antibiotics/medications (sulfa, quinine, nitrofurantoin), chemicals, infections, or ketoacidosis (intrinsic hemolytic anemia)

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22
Q

G6PD Deficiency Anemia (hemolytic) s/s

A

malaise, fatigue, irritability, weakness, jaundice, tachycardia, tea-colored urine; jaundice, pallor, splenomegaly, RUQ pain (on PE)

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23
Q

G6PD Deficiency Anemia (hemolytic) dx

A

CBC (macrocytic, hemolytic anemia); reticulocyte count (increased); peripheral smear (“bite” cells, Heinz bodies); elevated G6PD; increase bilirubin and LDH

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24
Q

G6PD Deficiency Anemia (hemolytic) tx

A

no treatment required; avoid stressors (abx)

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25
Q

Sickle Cell Anemia (hemolytic) cause

A

autosomal recessive, African American

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26
Q

Sickle Cell Anemia (hemolytic) s/s

A

delayed puberty growth, vascular occlusions, AVN, pain crisis, splenic sequestration, stroke; increased by dehydration, acidosis, hypoxemia, stress

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27
Q

Sickle Cell Anemia (hemolytic) dx

A

CBC (thrombocytosis); elevated retic count; Hgb electrophoresis (>50%); peripheral smear (sickle cells); elevated indirect bilirubin

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28
Q

Sickle Cell Anemia (hemolytic) tx

A

analgesics, fluid, rest, low dose PCN, pneumococcal vaccine, oral hydroxyruea therapy

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29
Q

Factor VIII Coagulation Disorder (Hemophilia A) cause

A

hereditary/x-linked recessive; deficiency Factor VIII (intrinsic)

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30
Q

Factor VIII Coagulation Disorder (Hemophilia A) s/s

A

bleeding in joints/muscles, spontaneous hemarthrosis

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31
Q

Factor VIII Coagulation Disorder (Hemophilia A) dx

A

spontaneous hemarthroses; PTT (prolonged), bleeding time (normal), PT (normal), fibrinogen (normal)

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32
Q

Factor VIII Coagulation Disorder (Hemophilia A) tx

A

Factor VIII concentrate, DDAVP (AVOID ASA)

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33
Q

Factor IX Coagulation Disorder (Hemophilia B) cause

A

hereditary/x-linked recessive; deficiency Factor IX (extrinsic); Christmas disease

34
Q

Factor IX Coagulation Disorder (Hemophilia B s/s

A

bleeding into joints/muscles, spontaneous hemarthrosis

35
Q

Factor IX Coagulation Disorder (Hemophilia B) dx

A

spontaneous hemarthroses; PT (prolonged); bleeding time (normal), PTT (normal), fibrinogen (normal)

36
Q

Factor IX Coagulation Disorder (Hemophilia B) tx

A

factor IX concentrate; (NO DDAVP, AVOID ASA)

37
Q

Factor XI Coagulation Disorder (Hemophilia C) cause

A

hereditary; deficiency Factor XI (extrinsic)

38
Q

Factor XI Coagulation Disorder (Hemophilia C) s/s

A

unpredictable bleeding pattern; following dental extraction, trauma, surgery; bruising, petechiae

39
Q

Factor XI Coagulation Disorder (Hemophilia C) dx

A

PT (prolonged), lupus anticoagulant

40
Q

Factor XI Coagulation Disorder (Hemophilia C) tx

A

plasma, antifibrinolytic agents (aminocaproic acid, tranexamic acid)

41
Q

Idiopathic Thrombocytopenia Purpura (hemolytic) cause

A

IgG antibodies on platelets attack glycoprotein complexes in spleen; viral infections (childhood), chronic disease (adult); heparin use

42
Q

Idiopathic Thrombocytopenia Purpura (hemolytic) s/s

A

mucosal bleeding, No splenomegaly

43
Q

Idiopathic Thrombocytopenia Purpura (hemolytic) dx

A

platelet count (low); positive platelet antibody; bone marrow biopsy (increased megakaryocytes; resistant to treatment, >40); PT/INR and PTT (normal)

44
Q

Idiopathic Thrombocytopenia Purpura (hemolytic) tx

A

Prednisone 1-2mg/kg; splenectomy, IVIG

45
Q

Thrombotic Thrombocytopenic Purpura (hemolytic) cause

A

drugs (estrogen, quinine, plavix), infection (HIV); idiopathic

46
Q

Thrombotic Thrombocytopenic Purpura (hemolytic) s/s

A

fevers, fluctuating LOC, renal failure, focal neurologic deficits

47
Q

Thrombotic Thrombocytopenic Purpura (hemolytic) dx

A

CBC (thrombocytopenia, microangiopathic hemolytic anemia, increased LDH); peripheral smear (schistocytes, fragmented cells); retic count (elevated); PT/PTT normal; renal insufficiency

48
Q

Thrombotic Thrombocytopenic Purpura (hemolytic) tx

A

plasmapheresis; NO transfusion

49
Q

Von Willebrand’s Disease cause

A

autosomal dominant disorder of platelets (platelet adhesion, factor VIII)

50
Q

Von Willebrand’s Disease s/s

A

minor to severe bleeding; Hx of childhood bleeding after trauma/surgery; mucosal bleeding (epistaxis, gingival, menorrhagia, GI); worse with ASA, better with pregnancy/estrogen use

51
Q

Von Willebrand’s Disease dx

A

CBC (normal platelet count); bleeding time/PTT (prolonged); Ristocetin Cofactor activity (vWF activity); factor VIII activity; vWF antigen level quant

52
Q

Von Willebrand’s Disease tx

A

nothing unless surgery; DDAVP nasal inhibitor, Humate P

53
Q

Acute Myeloblastic Leukemia (AML) cause

A

replacement of bone marrow w/ abnormal WBCs; chromosomes 5&7; radiation

54
Q

Acute Myeloblastic Leukemia (AML) s/s

A

gingival bleeding, epistaxis, menorrhagia, petechiae, purpura; infections w/ gram negative and fungi, fatigue, lethargy, fever, bone/joint pain, rashes, LAD; impaired circulation, HA, confusion (emergent leukapheresis)

55
Q

Acute Myeloblastic Leukemia (AML) dx

A

CBC (pancytopenia w/ circulating blasts, WBC >200K, thrombocytopenia); hyperuricemia; Auer rods; bone marrow biopsy (hypercellular); peripheral smear (>90% blasts)

56
Q

Acute Myeloblastic Leukemia (AML) tx

A

bone marrow transplant, chemo; consolidation therapy, allopurinol

57
Q

Acute Lymphocytic Leukemia (ALL) cause

A

replacement of bone marrow w/ abnormal WBCs; chromosomes 5&7

58
Q

Acute Lymphocytic Leukemia (ALL) s/s

A

gingival bleeding, epistaxis, menorrhagia, petechiae, purpura; infections w/ gram negative and fungi, fatigue, lethargy, fever, bone/joint pain, rashes, cranial nerve palsies, LAD; impaired circulation, HA, confusion (emergent leukapheresis)

59
Q

Acute Lymphocytic Leukemia (ALL) dx

A

surface markers on flow cytometry; CBC (pancytopenia w/ circulating blasts, WBC >200K, thrombocytopenia); hyperuricemia; terminal deoxynucleotidyl transferase; bone marrow biopsy (hypercellular); peripheral smear (>90% blasts)

60
Q

Acute Lymphocytic Leukemia (ALL) tx

A

chemo; bone marrow transplant; consolidation therapy, allopurinol

61
Q

Chronic Myelocytic Leukemia (CML) cause

A

myeloproliferative disorder; young-middle age adults

62
Q

Chronic Myelocytic Leukemia (CML) s/s

A

fatigue, anorexia, weight loss, fever, night sweats, splenomegaly, blurred vision, respiratory distress, priapism (chronic, accelerated, acute); blast crisis (accelerated disease w/ short survival)

63
Q

Chronic Myelocytic Leukemia (CML) dx

A

CBC (neutrophils, leukocytosis 100-200K) peripheral smear (anemia, thrombocytosis); PCR/bcr/abl (Philadelphia chromosome; translocation 9&22)

64
Q

Chronic Myelocytic Leukemia (CML) tx

A

Gleevec (imatimib mesylate); bone marrow transplant

65
Q

Chronic Lymphocytic Leukemia (CLL) cleaning the smudges cause

A

clonal malignancy of B cells; MC leukemia; men <65

66
Q

Chronic Lymphocytic Leukemia (CLL) cleaning the smudges s/s

A

peripheral lymphocytosis and lymphocytic invasion of bone marrow, liver, spleen, lymph nodes; recurrent infection, splenomegaly, LAD

67
Q

Chronic Lymphocytic Leukemia (CLL) cleaning the smudges dx

A

CBC (isolated lymphocytosis w/ leukocytosis >20K); peripheral smear (smudge cells)

68
Q

Chronic Lymphocytic Leukemia (CLL) cleaning the smudges tx

A

palliative for advanced disease (median survival 6 years) -> second malignant tumor common

69
Q

Hodgkin’s Lymphoma cause

A

EBV; 15-45yo

70
Q

Hodgkin’s Lymphoma s/s

A

painless LAD, generalized pruritus, fever, night sweats, weight loss

71
Q

Hodgkin’s Lymphoma dx

A

peripheral smear (Reed-sternberg cells); CBC (abnormal), EBV titer; CT

72
Q

Hodgkin’s Lymphoma tx

A

chemotherapy, radiation

73
Q

Non-Hodgkin’s Lymphoma cause

A

B lymphocytes

74
Q

Non-Hodgkin’s Lymphoma s/s

A

painless bulky LAD, fever, night sweats, weight loss, change in bowel habits; patches on skin (cutaneous Tcell lymphoma); abdominal pain/fullness (Burkitt’s lymphoma)

75
Q

Non-Hodgkin’s Lymphoma dx

A

lymph node biopsy; CBC (abnormal); LDH (elevated); uric acid level (elevated!!!); CT/ PET; bone marrow biopsy

76
Q

Non-Hodgkin’s Lymphoma tx

A

watchful; chemotherapy (rituxan), radiation; autologous stem cell transplant

77
Q

Multiple Myeloma cause

A

plasma cell disorder, osteoclast activity; 6th decade

78
Q

Multiple Myeloma s/s

A

anemia, bone pain (back), NO bony tenderness, retinal vein engorgement, hypercalcemia syndrome (bones, stones, abdominal groans, psychic moans, fatigue overtones); hyperviscosity (mucosal bleeding, AMS)

79
Q

Multiple Myeloma dx

A

CBC (anemia); CMP (renal disease, hyperproteinemia, hypercalcemia); peripheral smear (Rouleau formation); SPE (M spike); 24hr urine immunoelectrophoresis (Bence Jones proteins); plain films (lytic lesions); bone marrow biopsy

80
Q

Multiple Myeloma tx

A

chemo, autologous stem cell transplant; bisphosphonate, dialysis

Internal Medicine (9 decks)

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