Hematology Flashcards
Causes of Sideroblastic Anemia
Alcoholism (#1)
Lead poisoning
Isoniazid / Vit B6 def
Labs in iron deficiency anemia
Low ferritin
High TIBC
Inc RDW
What test do you order when there is macrocytic anemia on CBC?
Blood smear
Will show if there are hyper-segmented neutrophils which is specific to folate or B12 deficiency
V. other factors that raise MCV
Complications of B12 or Folate Replacement
Hypokalemia (inc cell production)
Reticulocyte count in Macrocytic Anemia
LOW - RBCs destroyed as they leave marrow
What 2 drugs lower mortality in sickle cell?
ABX with fever or elevated WBC (do not wait for testing - ceftriaxone, moxifloxicin or levofloxicin)
Hydroxyurea
4 Indications for Exchange Transfusion in Sickle Cell
1 - acute chest syndrome
2 - priapism
3 - stroke
4 - visual disturbance from retinal infarct
Aplastic Crisis in Sickle Cell
Parvovirus B19
Check reticulocyte count first - will suddenly decrease
Tx - IVIG
Causes of Aplastic Anemia
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
What is the most accurate test for hereditary spherocytosis?
eosin-5-maleimide flow cytometry
Indications for Tx of Essential Thrombocytosis
age > 60 + symptoms
OR platelets > 1.5 million
Why do you get pruritus in CML?
Inc # basophils which release extra histamine (esp after hot shower)
Pelger-Huet Cells
Seen on smear in myelodysplastic syndrome
Cells w/ bi-lobe nucleus
Which genetic abnormality is associated w/ myelodysplastic syndrome?
5q deletion
Has better prognosis than those w/o deletion
Responds well to lenalidomide
What are the indications for treatment of multiple myeloma? What is the treatment?
Plasma cells in BM > 60%
OR free light chain ratio > 100
Tx = dexamethasone + lenalidomide + bortezumib
What is the most accurate test for multiple myeloma?
BM biopsy
Must quantify % of plasma cells (> 10%)
What disorders can be cured w/ splenectomy?
Spherocytosis
Warm Autoimmune IgG Hemolysis (hemolysis occurs in spleen - warm)
Recurrent ITP
What heme disorders are treated w/ steroids as first-line?
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
Eculizumab
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)
Indications for Plasmaphoresis
Cold IgM AI Hemolysis
Severe TTP-HUS
Waldenstrom Macroglobinemia
Tx of PV and Essential Thrombocytosis
Hydroxyurea !
Can also use phlebotomy and ASA for PV
If hydroxyurea fails … ruxolitinib (JAK2 inhibitor)
How do you treat myelofibrosis?
Thalidomide andlenalidomide (TNF alpha inhibitors)
ruxolitinib (JAK2 inhibitor)
Tx of ALL and AML
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
Tx of CML
Imatinib (TK inhibitor) = first treatment
BM transplant = later / most effective treatment
Tx of CLL
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
Tx of Hairy Cell Leukemia
Cladribine + pentostatin
NHL v. HL Tx
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)
How do you diagnose HIT? How do you treat it?
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
