Hematology

Question 1

What are the lab changes in hemolytic anemia?

Answer 1

reticulocytosis
increased LDH
decreased haptoglobin (binding free iron)
spherocytes
increased bilirubin (uncong)

Question 2

What is the difference between a b12 and folate deficiency?

Answer 2

time: b12 takes longer

neuro symptoms: b12 has neuro symptoms

Question 3

What do you watch for with injections of b12?

Answer 3

hypokalemia (k goes into new cells being made)

Question 4

How do you tx alpha thalassemia?

Answer 4

heme (fe + protoporphyrin) + globin
bad globin chains (alpha chains in all types)

mild: no tx
moderate: folate, avoid oxidative stress, no extra fe
severe: blood transfusions and fe chelation (IV deferoxamine)

Question 5

Pt presents with back pain, anemia symptoms, jaundice, and splenomegaly. Just took antibiotic for a sinus infection. Schistocytes are seen on a peripheral smear. What do you suspect?

Answer 5

G6PD deficiency
(bactrim = trimethoprim-sulfamethoxazole which is a sulfa drug)  Sulfa drugs can trigger oxidative stress

Question 6

How do you treat a sickle cell crisis?

Answer 6

(beta chain mutated from substitution of valine for glutamate)

IV hydration
oxygen

RBC transfusion if needed

(maybe morphine?)

Question 7

How do you dx hereditary spherocytosis?

Answer 7

osmotic fragility test

Question 8

What is tx for hereditary spherocytosis?

Answer 8

splenectomy

Question 9

What is the best screening test for paroxysmal nocturnal hemoglobinuria?

Answer 9

flow cytometry

Question 10

IgG ab are associated with which hemolytic anemia? What autoimmune disorder is it associated with?

Answer 10

autoimmune hemolytic anemia
warm agglutinins
extravascular destruction after being tagged

SLE

Question 11

What is the triad of hemolytic anemia? What is the pentad of ttp?

Answer 11

thrombocytopenia
microangiopathic hemolytic anemia
kidney failure

add: fever, neurologic symptoms

Question 12

Do you give antibiotic in HUS?

Answer 12

no, might worsen by releasing more toxin

Question 13

what is a common cause of HUS?

Answer 13

enterohemorrhagic e coli 0157:H7

Question 14

Heparin is what side of the coag cascade?

Answer 14

12, 11, 9,8

intrinsic

Question 15

Warfarin affects what side?

Answer 15

7, extrinsic

Question 16

Hemophilia A affects which coag test?

Answer 16

factor 8
intrinsic
PTT

Question 17

What is given for hemo A that increases release of Factor 8 and vWF?

Answer 17

desmopressin (DDAVP)

not useful in 9

Question 18

What is the MC hereditary bleeding disorder?

Answer 18

vWF

Question 19

What disease are associated with a hypercoagulable state?

Answer 19

oral contraceptives (estrogen increases coag factors)
factor V leiden (lacks cleavage site)
Protein C/S deficiency (they normal deactivate V/VIII)
Prothrombin 20210A (thrombin over expressed)
ATIII deficiency (heparin like molecules reduced)

Question 20

What are the “B” symptoms?

Answer 20

fever
night sweats
WL
anemia
pruritis

Question 21

What is hodgkin’s lymphoma associated with?

Answer 21

reed-sternberg cells
owl eyes
epstein-barr virus (also burkitt lymphoma, a nhl)

Question 22

Which is more curable: hodgkin’s or nonhodgkins?

Answer 22

hodgkins is highly curable

Question 23

What is the MC childhood malignancy?

Answer 23

ALL

Question 24

What is the MC form of leukemia in adults?

Answer 24

AML

Question 25

What do you find in the bone marrow of AML?

Answer 25

auer rods

Question 26

How do you tx polycythemia vera?

Answer 26

phlebotomy

hydroxyurea causes myelosuppression

Question 27

What differentiates polycythemia vera from secondary erythrocytosis?

Answer 27

in secondary only RBCs are increased

in vera all myeloid lines are increased (RBCs, WBCs, platelets)

Question 28

what disorders would make you bleed?

Answer 28

advanced liver disease (decreased coag factors)
hemophilia A/B
vWF

Question 29

What is aplastic anemia?

Answer 29

hematopoeitic stem cell damage resulting in pancytopenia

Question 30

What causes aplastic anemia?

Answer 30

chemicals
viral infections
autoimmune