Hematology Flashcards
Iron deficiency anemia iron studies
Microcytic anemia
Iron: low
TIBC: high
Ferritin: low
Anemia of chronic disease iron studied
Microcytic anemia
Iron: low
TIBC: low
Ferritin: high
Hodgkin lymphoma Path: Pt: Dx: Tx:
Path: Malignant proliferation of cells in the lymphoreticular system
Pt: Bimodal: 20 y/o; 65 y/o
Lymphadenopathy (often cervical and painless), pruritus, fever, night sweats, unintentional weight loss, frequent infections
Dx: Lymph node biopsy-> Reed-Sternberg cells
Tx: Chemo, radiation, surgery, stem cell transplantation
Remission:
-Annual mammography in women >40 or younger women 5-8 yrs post radiation
-Cardiac stress testing, echo, and carotid U/S: 10 years post-treatment
Non-hodgkin lymphoma Path: Pt: Dx: Tx:
Path: HIV and autoimmune association
Pt: Persistent, painless, peripheral lymphadenopathy
fever, weight loss, night sweats
Dx:
Stages
Stage 1: single nodule or single tumor outside of abdomen or mediastinum
Stage 2: singular tumor w/ extension to regional lymph nodes or 2 single nodules on the same side of diaphragm
Stage 3: nodules on both sides of the diaphragm, paraspinal or epidural tumor, primary intrathoracic disease or extensive primary intra-abdominal disease
Stage 4: any of above with bone marrow involvement or CNS involvement
Tx:
Combination chemo without radiation
Polycythemia Path: Pt: Dx: Tx:
Path: JAK2 mutation-> causes bone marrow to make too many blood cells
Pt: Pruritus following warm showers (2/2 histamine release from increased basophils)
HA, dizziness, tinnitus, blurred vision, fatigue,
PE: plethora, engorged retinal veins, splenomegaly, HTN
Dx: all 3 major criteria or 2 major + 1 minor
Major criteria
-Hemoglobin >16.5 male; >16 females
-Bone marrow bx-> hypercellularity for age w/ trilineage growth (panmyelosis)
-Presence of JAK2
Minor criteria
-Serum erythropoietin level below reference range for normal
Tx:
Serial phlebotomy
hydroxyurea, aspirin, allopurinol
Other causes than polycythemia for increase hemoglobin
hypoxia, smoking, COPD, high altitude, sleep apnea, renal/liver disease
Clozapine
indications:
black box warnings:
indications: schizophrenia, bipolar, psychosis in Parkinson disease
black box warnings: severe neutropenia
orthostatic hypotension, bradycardia, syncope
seizures
myocarditis, cardiomyopathy, mitral valve incompetence
Thalassemia Path: Pt: Dx: Tx:
Microcytic anemia
Path: Genetic
Pt: Asx (1 alpha deleted) Minor ( 2 alpha deleted 1 beta deleted) Major (3 alpha deleted, 2 beta deleted) Dead (4 alpha)
Dx: Iron: normal Ferritin: normal TIBC: normal Hbg electrophoresis
Tx:
minor: nothing
Major: transfusion, deferoxamine
Microcytic anemia path
dx
tx
iron deficiency anemia Iron: low TIBC: high Ferritin: low tx: po iron
anemia of chronic disease Iron: low TIBC: low Ferritin: high Tx: chronic dz control, EPO
thalassemia Iron: normal Ferritin: normal TIBC: normal Hbg electrophoresis Tx: Major: transfusion, deferoxamine
sideroblastic
Iron: high
TIBC: normal
Ferritin: normal
best: bone marrow bx-> ringed sideroblasts
tx: remove exposure (copper, lead, ETOH), give back B6, treat cancer
Macrocytic anemia path
pt
dx
tx
folate deficiency pt: tea + toast diet, pregnancy, ETOH dx: low folic acid normal methylmalonic acid tx: folate
B12 deficiency pt: vegan, crohn's dz, s/p gastric bypass Dx: low B12 levels high methylmalonic acid tx: B12
Pernicious anemia
pt: ab against parietal cells, no intrinsic factor, no b12 absorption
dx: ab-intrinsic factor or anti-parietal
tx: IM b12
Non-megaloblastic anemia
Pt: liver dz, ETOH, meds-> AZT, HAART, 5-FU
Normocytic anemia
path:
dx:
tx:
Sickle Cell
dx: smear-> sickled cells
hgb electrophoresis-> SC,SS
tx: hydroxyurea, IVF, O2, Pain control, exchange transfusion (emergency)
G6PD- african american males, dapsone, TMP-SMX, nitrofurantoin
dx: smear-> bite cells, heinz bodies
best: G6PD levels 6-8 weeks
tx: supportive, avoid stress
Hereditary spherocytosis
dx: smear-> spherocytes
best-> osmotic fragility
tx: folate + fe, splenectomy
Autoimmune hemolytic anemia Warm: dx: + coombs test IgG tx: steroids, splenectomy, severe-> IVIg Cold: dx: negative coombs tx: avoid cold, refractory: rituximab
Clotting disorders
path
pt
dx:
Von Willebrand disease: MC inherited bleeding disorder; dec VWF, dec factor III
Pt: Easy bruising, skin bleeding, prolonged bleeding from mucosal surfaces-> gingival, vagina, skin
Labs:
Normal Plt
Normal PT/PTT
Normal aPTT
Dx: VWF assay
Tx: Desmopressin (DDAVP); give factor if severe hemorrhage
Hemophilia A Pt: hemarthrosis, hematoma Labs: Normal Plt Normal PT/PTT Elevated aPTT Decreased factor VIII level
Hemophilia B Pt: hemarthrosis, hematoma Labs: Normal Plt Normal PT/PTT Elevated aPTT Normal factor VIII level Decreased factor XI level
Leukemia Path: Pt: Dx: Tx:
AML Path: acute= blasts, myelogenous= neutrophils Pt: acute, age 67 Exposure: benzene radiation Dx: smear: blasts BM bx: >20% blasts \+myeloperoxidase Tx: M3: vitamin A (Auer Rods on bx) Not M3: chemo
ALL Path: Acute= blasts, Lymphocytic= lymphocytes Pt: acute, age 7 Dx: smear: blasts BM bx: >20% blasts \+cALLa and +TdT Tx: Chemo PPx CNS, +/- radiation
CML Path: Chronic=mature cells, myelogenous= neutrophils Pt: chronic, age 47 Dx: Diff (way more cells then should be) BM bx: philadelphia +t(9,22), +BCR-ABL Tx: Imatinib (tyrosine kinase)
CLL Path: chronic=mature cells, lymphocytic=lymphocytes Pt: chronic, age 87 Dx: Diff (way more cells then should be) BM bx Tx: >65 + asx = nothing >65 + sx= chemo <65 + donor= stem cell transplant
TTP Path: Pt: Dx: Tx:
thrombotic thrombocytopenic purpura
Path:
Hyaline clots
Adam TS-13
Pt: FAT-RN (Don’t have to be an RN to be FAT
-Fever
-Anemia (microangiopathic hemolytic anemia)
-Thrombocytopenia
-Renal failure
=Neuro sxs
Dx: CBC: dec plt Smear: schistocytes PT/PTT: normal Fibrinogen: normal D-Dimer: Normal
Tx: exchange transfusion; NEVER give plts
ITP Path: Pt: Dx: Tx:
Primary Immune Thrombocytopenia
Path:
Antiplatelet antibodies
splenic destruction
Pt: 2-6y/o w/ hx recent viral infection women w/ autoimmune dz Red spots on skin/easy bruising PE: petechiae, purpura, gingival bleeding
Dx:
labs: plts <100k
DOE
Tx:
observation
steroids
IVIG
