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Step 2 CK > Hematology > Flashcards

Hematology Flashcards

1
Q

Causes of Sideroblastic Anemia

A

Alcoholism (#1)

Lead poisoning

Isoniazid / Vit B6 def

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2
Q

Labs in iron deficiency anemia

A

Low ferritin

High TIBC

Inc RDW

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3
Q

What test do you order when there is macrocytic anemia on CBC?

A

Blood smear

Will show if there are hyper-segmented neutrophils which is specific to folate or B12 deficiency

V. other factors that raise MCV

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4
Q

Complications of B12 or Folate Replacement

A

Hypokalemia (inc cell production)

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5
Q

Reticulocyte count in Macrocytic Anemia

A

LOW - RBCs destroyed as they leave marrow

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6
Q

What 2 drugs lower mortality in sickle cell?

A

ABX with fever or elevated WBC (do not wait for testing - ceftriaxone, moxifloxicin or levofloxicin)

Hydroxyurea

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7
Q

4 Indications for Exchange Transfusion in Sickle Cell

A

1 - acute chest syndrome

2 - priapism

3 - stroke

4 - visual disturbance from retinal infarct

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8
Q

Aplastic Crisis in Sickle Cell

A

Parvovirus B19

Check reticulocyte count first - will suddenly decrease

Tx - IVIG

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9
Q

Causes of Aplastic Anemia

A

BM infection

BM cancer

Radiation

Toxins (benzene)

SLE

PNH

HIV, hepatitis, CMV, EBV

B12 or folate def

PTU or methimazole

Other drugs: sulfa, phenytoin, carbamazepine, chloramphenicol

Alcohol

Chemo

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10
Q

What is the most accurate test for hereditary spherocytosis?

A

eosin-5-maleimide flow cytometry

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11
Q

Indications for Tx of Essential Thrombocytosis

A

age > 60 + symptoms

OR platelets > 1.5 million

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12
Q

Why do you get pruritus in CML?

A

Inc # basophils which release extra histamine (esp after hot shower)

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13
Q

Pelger-Huet Cells

A

Seen on smear in myelodysplastic syndrome

Cells w/ bi-lobe nucleus

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14
Q

Which genetic abnormality is associated w/ myelodysplastic syndrome?

A

5q deletion

Has better prognosis than those w/o deletion

Responds well to lenalidomide

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15
Q

What are the indications for treatment of multiple myeloma? What is the treatment?

A

Plasma cells in BM > 60%
OR free light chain ratio > 100

Tx = dexamethasone + lenalidomide + bortezumib

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16
Q

What is the most accurate test for multiple myeloma?

A

BM biopsy

Must quantify % of plasma cells (> 10%)

17
Q

What disorders can be cured w/ splenectomy?

A

Spherocytosis

Warm Autoimmune IgG Hemolysis (hemolysis occurs in spleen - warm)

Recurrent ITP

18
Q

What heme disorders are treated w/ steroids as first-line?

A

Warm Autoimmune IgG Hemolysis (NOT cold)

TTP-HUS that is not related to drugs or diarrhea

Hyper-eosinophilic syndrome

Mild ITP

Paroxysmal Nocturnal Hemoglobinuria

Multiple myeloma (dexamethasone) along with other meds

19
Q

Eculizumab

A

MAO: inactivates C5 in complement pathway

Can be used in HUS not associated w/ infection

Can also be used in paroxysmal nocturnal hemoglobinuria

Must vaccinate against meningitis (encapsulated)

20
Q

Indications for Plasmaphoresis

A

Cold IgM AI Hemolysis

Severe TTP-HUS

Waldenstrom Macroglobinemia

21
Q

Tx of PV and Essential Thrombocytosis

A

Hydroxyurea !

Can also use phlebotomy and ASA for PV

If hydroxyurea fails … ruxolitinib (JAK2 inhibitor)

22
Q

How do you treat myelofibrosis?

A

Thalidomide andlenalidomide (TNF alpha inhibitors)

ruxolitinib (JAK2 inhibitor)

23
Q

Tx of ALL and AML

A

1) initial induction chemo
2) if good prognosis then more chemo, if poor prognosis then right to BM transplant
3) ALL = intrathecal and AML = add al-trans-retinoic acid

24
Q

Tx of CML

A

Imatinib (TK inhibitor) = first treatment

BM transplant = later / most effective treatment

25
Q

Tx of CLL

A

PCP prophylaxis

Stage 0-2: no treatment

Stage 3 or 4 (anemia and thrombocytopenia): fludarabine + cyclophosphamide + rituximab

If come in w/ severe infection … give IVIG

26
Q

Tx of Hairy Cell Leukemia

A

Cladribine + pentostatin

27
Q

NHL v. HL Tx

A

Both - local radiation and chemo if local disease (NEVER RADIATION ALONE)

NHL - CHOP for advanced (cyclophosphamide, hydroxydaunorubicin, oncovin/ vincristine, prednisone)

HL - ABVD for advanced (adriamycin, bleomycin, vinblastine, dacarbazine)

28
Q

How do you diagnose HIT? How do you treat it?

A

Drop in platelets 5-10 days after starting heparin

Confirm w/ ELISA for platelet factor 4 (PF4)

Tx = stop heparin, use direct thrombin inhibitor (argatroban, fondaparinaux, bivalirudin)

Can eventually switch to warfarin

Step 2 CK (28 decks)

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