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PANCE > Hematology > Flashcards

Hematology Flashcards

1
Q

In patients with reduced Fe, use up _____ first which will show a decreased serum_______ level?

A

Ferritin

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2
Q

Decreased Serum Iron, Decreased Ferritin, Inc. TIBC

A

Fe deficiency anemia

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3
Q

Decreased Serum iron, Increased ferritin and TIBC

A

Anemia of chronic disease

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4
Q

Microcytic Anemias include?

A 
Fe deficiency                    (FLATS)
Lead poison
Anemia of chronic Dz
Thalassemia
Sideroblastic anemia
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5
Q

Macrocytic Anemias include?

A
  • Folate *Alcohol (FATRBC)
  • Thyroid (Hypo) *Rx (meds)
  • B12 *Cirrhosis
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6
Q

Blood smear Rouleaux formation “Stack of coins”

A

Multiple Myeloma

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7
Q

Blood smear “Howell-Jolly bodies” (Dot on RBC)

A

Sickle Cell

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8
Q

Blood smear Heinz body “Bite Cells”

A

G6PD deficiency

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9
Q

Blood smear Basophilic stippling

A

Lead Poisoning or Sideroblastic anemia (Heavy metal)

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10
Q

Blood smear Codocytes “Target cells”

A

Thalassemia

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11
Q

Blood smear hypersegmented or >5 lobes in WBC neutrophil?

A

B12 and Folate deficiency

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12
Q

Blood smear Auer Rods

A

Acute Myelogenous Leukemia

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13
Q

Blood smear Reed-Sternberg Leukemia “Owl eyes”

A

Hodgkin Lymphoma

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14
Q

Approach to anemia step 1-2?

A 
#1. Reticulocyte (High or Low)
#2. LOW= MCV (<80 or >120)?
       High= Blood loss or RBC destruction G6, SC, Sphe?
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15
Q

Deficiency –> Abnormal synthesis of DNA
Almost exclusively MCV >115

Pernicious Anemia, strict Vegans, ETOH malabsorption

A

B12 (Cobalamin) Deficiency

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16
Q

What vitamin increases Fe iron absorption?

A

Vitamin C

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17
Q

Inhibits multiple enzymes for heme synthesis and shortens RBC life span.

Abdominal pain with constipation + Neurological Sx. Ataxia, fatigue, learning disability, shock or coma

A

Lead poisoning Anemia (Plumbism)

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18
Q

Decreased production of alpha globin chain with 3 abnormal alleles:

A

Alpha Thalassemia Intermedia (Hgb H Disease)

“Symptomatic”

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19
Q

Decreased production of alpha globin chain with 2 abnormal alleles:

A

Alpha Thalassemia Minor

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20
Q

Decreased production of alpha globin chain with 4 abnormal alleles:

A

Hydrops Fatalis “Bart’s” (Tetramer)

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21
Q

Decreased production of alpha globin chain with 1 abnormal allele:

A

Alpha Thalassemia Silent carrier

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22
Q

Decreased production of Beta globin chain w 1 normal and 1 deletion or mutation of alleles: B/ B+ (or B0)
X1 Mutated and X1 mutated or deleted)

A

Beta Thalassemia Trait (Minor)

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23
Q

Decreased production of Beta globin chain with both Alleles mutated

A

Beta Thalassemia Major (Cooley’s anemia) severe

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24
Q

Decreased production of Beta globin chain with 1 deletion and 1 mutation of alleles: B+/B 0
X1 Mutated and X1 mutated or deleted)

A

Beta Thalassemia Intermedia (Mild symptoms)

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25
Q

Treatment for Alpha Thalassemia Moderate and Severe?

A

Moderate: Folate (Avoid Iron supplementation)

Severe: IV deferoxamine (Fe Chelating Agents)
Splenectomy: Bone marrow transplant definitive

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26
Q

Treatment for Betta Thalassemia Moderate and Severe?

A

Moderate-Severe: Folate, Vitamin C, IV Deferoxamine

Splenectomy : Bone marrow transplant Definitive

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27
Q

At what age is adult Hgb predominant and what type of Hgb is adults and which is fetal?

A

Predominant after 6 months (95% = 2 alphas/2 Betas)

Adult Hgb= Hgb A Fetal Hgb= Hgb F

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28
Q

Anemia caused by infection, inflammation or malignancy: Normocytic Anemia

A

Anemia of chronic Disease

29
Q

caused by oxidative stresses causing the RBC to rupture. infection is the MCC

also fava beans, sulfa drugs or antimalarial drugs: Tx:?

A

Glucose-Phosphate Dehydrogenase deficiency

Tx: Iron + Folate (Transfusion if severe)

30
Q

Stress, infection or hypoxia –> Dactylitis (MC Sx), microthrombosis, hemolytic anemia, pain, hematuria

infections (salmonella), H shaped vertebrae, skin ulcers.
Tx:

A

Sickle Cell Anemia

Tx: #1. Pain control, IV Hydration, O2
#2. Hydroxyurea (reduces sickling "inc. Hgb F")
#3. Transfusion
31
Q

Sickle cell anemia trait Hgb

A

autosomal recessive disorder “HgbS Heterozygous”

32
Q

Parvo B19 in Sickle cell disease can cause what?

A

Aplastic crisis

33
Q

RBC membrane and cytoskeleton defect–> cell fragility and hemolysis: Lacks central pallor (donut)

–> aplastic crisis with Parvo B19

A

Hereditary Spherocytosis

34
Q

Hemolysis + thrombosis: Dar Coca-Cola urine during night or early a.m:

A

Paroxysmal Nocturnal Hemoglobinuria

35
Q

Secondary hemostasis pathway with Normal PTT requires factors VIII, IX, XI, XII

A

Intrinsic Pathway

36
Q

Extrinsic Pathway secondary hemostasis with normal ____ requires factors?

A

Normal PT

Factors: VII and X

37
Q

PTT and INR are affected mostly by what drug? what is the reversal/antidote?

A

Heparin, LMWH, UFH

Protamine Sulfate

38
Q

PT is affected mostly by what drug? what is the reversal/antidote?

A

Warfarin and Vitamin K deficiency

Reversal-Vitamin K

39
Q

Thrombocytopenia MC acquired by children post-infection: Autoimmune Ab against platelets:

, epistaxis, menorrhagia, bruises teeth and gums bleeding: normal Coags/ (-) splenomegaly Tx:

A

Idiopathic Thrombocytopenic Purpura (ITP)

Tx: Child IV Ig Adult: IV Ig + CS

40
Q

Autoimmune Ab against ADAMTS 13: 2T SLE, HIV, Prego , malignancy: Thrombocytopenia (+) Splenomegaly

Tx:

A

Thrombotic Thrombocytopenic Purpura (TTP)

Tx: Plasmapheresis + CS

41
Q

Thrombocytopenia, anemia, and kidney failure: preceded by E. Coli 0157:H7, shigella, salmonella:

Antibiotic use may worsen condition Tx:

A

Hemolytic Uremic Syndrome

Tx: Plasmapheresis

42
Q

MC caused by Gram negative endotoxins: –> wide spread microthrombi consuming coagulation factors–>

severe thrombocytopenia–> bleeding)

A

Disseminated Intravascular coagulation

43
Q

Systemic Inflammatory Response Syndrome

A

Temperature (Hypo/Hyperthermia)
Heart Rate > 90
Respiration >20
WBC < 4K or > 12K

44
Q

MC hemophilia–> almost only in males: Hemarthrosis and excessive hemorrhage:

Less common present with petechia/purpura:
Tx:

A

Hemophilia A (Factor VIII deficiency)

Tx: Desmopressin and Factor VIII

45
Q

Hemophilia B AKA ______ disease will have deficiency of what factors?

Tx?

A

“Christmas disease”

Deficiency: Factor IX (prolonged PTT)

Tx: Factor IX (Desmopressin not effective)

46
Q

Study that differentiates Hemophilia A/ B from ?

A 
Mixing study
 (Blood mixed w normal plasma->corrects=Factor Def.)
47
Q

ineffective platelet adhesion autosomal dominant disorder: MC Hereditary bleeding disorder

Mucocutaneus bleeding and Petechiae is common: Prolonged PTT Dx: Tx:

A

Von Willebrand Disease (Type II-Deficient III- Absent)

Dx: Ristocetin decreased Tx: Mod (II) Desmopressin Severe (III) vWF and Factor VIII

48
Q

Lymphocyte Neoplasm EBV associated: mediastinal LAD (clavicular cervical), weight loss, fever, peaks @ 20

Contiguous spread to local lymphnodes “Reed Sternberg” cell Owl-eye: highly curable

A

Hodgkin Disease (Lymphoma)

49
Q

Non-Hodgkin lymphoma

A
  • Peripheral painless lymphocyte
  • Non- contiguous spread to local lymphnodes
  • Extra nodal GI (Burkitt “Starry Sky”), Skin (pruritus), CNS
  • Aggressive/unpredictable (Especially Large B cell)
50
Q

What are the 4 main types of Leukemia?

A
  • Acute Lymphocytic Leukemia
  • Chronic Lymphocytic Leukemia
  • Acute Myelogenous Leukemia
  • Chronic Myelogenous Leukemia
51
Q

MC in children peaks 3-7 yo (Trisomy 21 <5yo): B/T cell mediated: CNS sx: Fever MC Sx:

anemia and >20% Blasts (Immature WBCs): CNS and testes MC site for METS

A

Acute Lymphocytic Leukemia

52
Q

MC Leukemia in Adults: B cell clonal Malignancy:

Blood Smear= “Smudge Cells” ZAP-70= poor prognosis

A

Chronic Lymphocytic Leukemia

53
Q

MC in older males: “WBC> 100K” Philadelphia chromosome: Asymptomatic until plastic crisis

A

Chronic Myelogenous Leukemia

54
Q

MC acute Leukemia >50: Anemia, thrombocytopenia, Neutropenia: gingival hyperplasia: WBC >100K

Bone Marrow “Auer Rods”

A

Acute Myelogenous Anemia

55
Q

monoclonal Ab (IgA and IgG) accumulate in bone marrow disrupting normal cell production: AA >65 yo

Punched out Lytic bone lesions (Skull) UA: Bence-Jones proteins: Blood smear “Rouleaux formation” Stack coins

A

Multiple Myeloma

56
Q

Multiple Myeloma patient presentation?

A

K-CRAB

  • Kidney failure
  • Calcinosis
  • Recurrent infections
  • Anemia
  • Bone lesions (Lytic)/Pain
57
Q

Pruritus after a hot bath, headaches, blurred vision, facial flushing, engorged retinal veins

High hematocrit without hypoxia: hyper-viscosity and thrombosis: Tx

A

Polycythemia Vera

Tx: Phlebotomy (Myelosuppression-Hydroxyurea)

58
Q

Excess iron deposition due to increased Fe storage /absorption: Genotype HFE C282Y:

Cirrhosis, Cardiomyopathy, Pancreatic Insufficiency: Bronze Diabetes: Bronze skin Dx: Tx:

A

Hereditary Hemochromatosis

Dx: Liver Bx Tx: Phlebotomy (Chelating agents)

59
Q

MC inherited cause of hypercoagulability: aProtein C “resistance”: DVTs, PEs

Dx: Tx:

A

Factor V Leiden

Dx: Actiated Protein C resistance assay
Tx: Indefinite Anticoagulation

60
Q

Hypercoagulable disorder: deficiency of a vitamin-k dependent anticoagulant protein:

recurrent DVTs/PEs Tx:

A

Protein C Deficiency

Tx: PO Anti-coagulant for life

61
Q

Child with a cobb angle of 10-19 degrees treatment?

A

Observation F/U every 6-9 months

62
Q

Metronidazole should mixed with _______–> ______

A

Alcohol: Disulfiram reaction

63
Q

Antidote for TCAs amitriptyline?

A

Sodium Bicarb

64
Q

What can worsen the condition of aspirin overdose ?

A

Endotracheal intubation

65
Q

Cipro treats almost all abdominal issues except____ which is treated with azithromycin.

A

Shigellosis

66
Q

Air in orbit after trauma to the eye = what?

A

Ethmoid (Medial orbital wall) Fracture

67
Q

Difference between a chronic and acute subdural hematoma?

A

Chronic is hypodense

Acute is within 3 days f trauma and hyperdense (white)

68
Q

When you see lymphopenia suspect what viral illness?

A

West Nile Virus

69
Q

Latent Tuberculosis treatment for patient with liver disease?

A

Rifampin (Not Isoniazid)

PANCE (13 decks)

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