Hematology Flashcards
What are the lab changes in hemolytic anemia?
reticulocytosis increased LDH decreased haptoglobin (binding free iron) spherocytes increased bilirubin (uncong)
What is the difference between a b12 and folate deficiency?
time: b12 takes longer
neuro symptoms: b12 has neuro symptoms
What do you watch for with injections of b12?
hypokalemia (k goes into new cells being made)
How do you tx alpha thalassemia?
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)
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?
G6PD deficiency (bactrim = trimethoprim-sulfamethoxazole which is a sulfa drug) Sulfa drugs can trigger oxidative stress
How do you treat a sickle cell crisis?
(beta chain mutated from substitution of valine for glutamate)
IV hydration
oxygen
RBC transfusion if needed
(maybe morphine?)
How do you dx hereditary spherocytosis?
osmotic fragility test
What is tx for hereditary spherocytosis?
splenectomy
What is the best screening test for paroxysmal nocturnal hemoglobinuria?
flow cytometry
IgG ab are associated with which hemolytic anemia? What autoimmune disorder is it associated with?
autoimmune hemolytic anemia
warm agglutinins
extravascular destruction after being tagged
SLE
What is the triad of hemolytic anemia? What is the pentad of ttp?
thrombocytopenia
microangiopathic hemolytic anemia
kidney failure
add: fever, neurologic symptoms
Do you give antibiotic in HUS?
no, might worsen by releasing more toxin
what is a common cause of HUS?
enterohemorrhagic e coli 0157:H7
Heparin is what side of the coag cascade?
12, 11, 9,8
intrinsic
Warfarin affects what side?
7, extrinsic
Hemophilia A affects which coag test?
factor 8
intrinsic
PTT
What is given for hemo A that increases release of Factor 8 and vWF?
desmopressin (DDAVP)
not useful in 9
What is the MC hereditary bleeding disorder?
vWF
What disease are associated with a hypercoagulable state?
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)
What are the “B” symptoms?
fever night sweats WL anemia pruritis
What is hodgkin’s lymphoma associated with?
reed-sternberg cells
owl eyes
epstein-barr virus (also burkitt lymphoma, a nhl)
Which is more curable: hodgkin’s or nonhodgkins?
hodgkins is highly curable
What is the MC childhood malignancy?
ALL
What is the MC form of leukemia in adults?
AML
What do you find in the bone marrow of AML?
auer rods
How do you tx polycythemia vera?
phlebotomy
hydroxyurea causes myelosuppression
What differentiates polycythemia vera from secondary erythrocytosis?
in secondary only RBCs are increased
in vera all myeloid lines are increased (RBCs, WBCs, platelets)
what disorders would make you bleed?
advanced liver disease (decreased coag factors)
hemophilia A/B
vWF
What is aplastic anemia?
hematopoeitic stem cell damage resulting in pancytopenia
What causes aplastic anemia?
chemicals
viral infections
autoimmune
