Hematology (Alice) (3%) Flashcards
microcytic anemias (4)
IDA
sideroblastic
thalassemias
anemia of chronic dz
lead poisoning
normocytic anemias are divided into (2)
hemolytic
non hemolytic
intrinsic hemolytic anemias (5)
hereditary spherocytosis
g6pd
puruvate kinase deficiency
ssa
hbc dz
extrinsic hemolytic anemia
autoimmune hemolytic anemia
macrocytic anemias are divided in to
megaloblastic
non megaloblastic
megaloblastic macrocytic anemias (4)
folate deficiency
b12 deficiency
copper deficiency
drugs
non megaloblastic macrocytic anemias
etoh
liver dz
work up for microcytic anemia (3)
ferritin
iron
TIBC
work up for normocytic anemias (3)
coombs
iron
bilirubin
work up for macrocytic anemias (2)
RBC folate
B12
only anemia with elevated TIBC
IDA
what does “basophilic stippling” make you think of
lead poisoning
4 infxns associated w. anemia
4 infxns associated w. extrinsic hemolysis
osteolmyelitis
HIV
mycoplasma
EBV
type of anemia associated w. bone marrow malignancy
normocytic
lab findings associated w. intrinsic hemolytic anemia (4)
increased reticulocytes
positive coombs
spherocytosis
decreased haptoglobin
labs associated w. extrinsic hemolytic anemias (3)
cold agglutinins
increased: LDH, K+, bilirubin
decreased haptoglobin
what does spherocytosis make you think of
g6pd deficiency
3 causes of extrinsic hemolysis
cold agglutinins
autoimmune
mechanical destruction
3 causes of mechanical destruction extrinsic hemolytic anemia (microangiopathic hemolysis)
TTP
HUS
DIC
hemostatic problems are divided into (2)
primary
seconday
describe primary hemostatic problems
weak platelet plug -> mucocutaneous bleeding
describe secondary hemostatic problems
problems w. coagulation factors -> deep tissue bleeding
sx of primary hemostatic problems (4)
-petechiae
-anterior epistaxis
-immediate post op bleeding (ex tooth extraction)
-mucosal, gingival, GI, vaginal bleeding
sx of secondary hemostasis (5)
-large bruises
-deep tissue hematomas
-hemarthrosis
-posterior epistaxis
-persistant bleedig post op (ex ICH)
problems w. hemostasis are caused by decreased (3)
PLT number
PLT fxn
clotting factors
primary hemostasis disorders (5)
von willebrand
bernard-soulier
glanzmann thrombasthenia
uremic PLT dysfxn (CKD)
meds: NSAIDs, clopidogrel
secondary hemostasis disorders (5)
anticoagulant use
hemophilia
cirrhosis
vit K deficiency
DIC
labs associated w. primary hemostatic problems
prolonged PT
prolonged PTT
_ is elevated in bleeding from warfarin
_ is elevated in bleeding from heparin
warfarin: PT
heparin: PTT
what factors are decreased in von willebrand dz
von willebrand
VIII
hemophilia is classified in to
A: VII
B: IX (christmas)
lab findings associated w. hemophilia
prolonged aPTT
normal PTT
normal PLT
three presentations of hemophilia in peds
-excessive bleeding from circumcision
-cephalohematoma during delivery
-hemearthrosis when walking starts
3 conditions where you see prolonged PT and PTT
liver cirrhosis
vitamin K deficiency
DIC
lab findings of DIC
everything out of whack:
-elevated PT, PTT
-decreased PLT
-(+) schistocytes
-smear: microangiopathic hemolytic anemia
pediatric brain tumors to know mc -> lc (4)
astrocytoma
medulloblastoma
ependymoma
retinoblastoma
5 yo w. occipital HA, ataxic gait, nystagmus, papilledema
astrocytoma
mc primary childhood CNS tumor
astrocytoma
sx of brain tumors are mc related to
increased ICP:
morning HA
vomiting
lethargy
t/f astrocytomas are often benign
t!
sx of astrocytoma based on location
cerebellum: weakness, tremor, ataxia
visual pathway: vision loss, proptosis, nystagmus
spinal cord: pain, weakness, gait disturbance
dx for brain tumors
MRI
bx
which type of astrocytoma has the best prognosis
posterior fossa
5 yo w. 1 month of AM HA, nausea, vomiting, mild f/c - PE shows wide based gait, impaired heel to toe walking, bilat papilledema
medulloblastoma
MRI findings of medulloblastoma
heterogenous midline lesion w. hydrocephalus
mc malignant posterior fossa tumor in peds
posterior fossa tumor
4 mc sx of medulloblastoma
n.v
HA
visual changes
unsteady walking/clumsy
pediatric brain tumor that is sometimes associated w. sz, balance/gait disturbance, or sx of spinal cord compression
ependymoma
tx for ependymoma
surgery
+/- chemo
3 yo w. strabismus - in pics, one eye is white, other is red
retinoblastoma
mc age for retinoblastoma
< 3 yo
medical term for absent red reflex
leukocoria
tx for retinoblastoma
surgical enucleation of the eye
chemo
hemophilia is _ linked
X, recessive
presentation of hemophilia (both types)
bleeding
bruising
hemarthrosis
grading of hemophilia
mild (5-25% nl): bleeding after surgery/dental extractions/injury, usually non fatal
moderate (1-5% of nl): little unprovoked bleeding, bleeding after surgery/injury may be fatal
severe (< 1% nl): unprovoked bleeding,
when is severe hemophilia often diagnosed
bleeding immediately after delivery -> ex cephalohematoma
mod/severe hemophilia is commonly diagnosed at what age
< 18 mo
lab findings of hemophilia
increased: PTT
normal: PT, bleeding time
decreased: factor VIII vs IX
hallmark lab findings of hemophilia (2)
increased PTT
normal PLT
most specific test for hemophilia
functional assay for factor VIII vs IX
tx for hemophilia
replace deficient factor
4 yo M presents w. abd pain, constipation x 2 days - has also been lethargic, irritable x 2 weeks and has stopped talking - PMH includes failing to meet developmental milestones x 1 year
lead poisoning
mc environmental illness of children in the US
lead poisoning
most significant source of lead for peds
environmental: lead-based paint, food, water, soil
big HPI clue for lead poisoning
old house w. paint chips
sx of lead poisoning (lots!)
anemia
behavior changes
temperamental lability
irritability
hyper/hypoactivity
developmental delays
abd pain
vomiting
constipation
lethargy
HA
ataxia
sz
what blood level of lead is considered positive
> /= 10
lab findings of lead poisoning
-basophilic stippling
-low vs nl MCV
-low MCH
-hemolysis: elevated indirect bili, LDH; low haptoglobin
tx for lead poisoning
> 45: chelation
80: hospitalization
-diet
when do you have to contact health department w. lead poisoning (2)
> 20
elevation > 3 mos
3 chelation meds used in lead poisoning
dimercaprol
CaNaEDTA
pencill
pediatric leukemias to know (2)
ALL
AML
mc childhood malignancy
leukemia
2 mc childhood leukemia
ALL
AML
child + LAD + bone pain + bleeding + fever
ALL
hallmark finding of ALL (2)
20% blasts in bone marrow
ANC < 1,000
mc childood malignancy
ALL
tx for ALL
chemo
t/f: AML is much more common in males
t!
pt’s w. AML may develop a greenish soft tissue tumor called a _
which is located in the _ (2)
chloroma
spinal cord, skin
hallmark finding of AML
auer rods on smear
+/- blast cells
sx of AML (5)
pallor
ecchymoses
petechiae
fever
bone pain
_ are present at dx w. 90% of AML cases (2)
-anemia (normochromic, normocytic)
-thrombocytopenia
low reticulocytes also common
tx for ALL vs AML
ALL: chemo
AML: combo chemo/bone marrow transplant
lethal s.e of chemo
tumor lysis syndrome
tx for tumor lysis syndrome
allopurinol
pediatric lymphomas to know (2)
hodgkin
non-hodgkin
hodgkin lymphoma is derived from _ cells in lymph nodes
B
LAD associated w. hodgkin lymphoma
painless LAD: cervical vs supraclavicular vs upper body
what are B symptoms associated w. lymphoma (3)
wt loss > 10%
T > 38
night sweats
hodgkin lymphoma is assocated w. what virus
EBV
t/f: hodgkin lymphoma rarely has extranodal spread
t!
2 types of hodgkin lymphoma
classical
nodular
4 types of classical hodgkin lymphoma
nodular sclerosis
mixed cellularity
lymphocyte-rich
lymphocyte depleted
if you suspect hodgkin lymphoma, order a _
CXR -> look for mediastinal LAD
hallmark finding of hodgkin lymphoma
reed-sternberg cells: B cells fused together to form “owl eye”
tx for hodgkin lymphoma
chemo/xrt: highly effective
non hodgkin lymphoma is derived from _ cells (2)
B
T
sx of non hodgkin lymphoma (5)
constitutional
painless LAD
bowel obstruction
fatigue/bruising/infxns
loss of sensation
2 types of non hodgkin lymphoma
B cell
T cell
types of non hodgkins B cell lymphoma
diffuse large B cell -> mc/aggressive
follicular
burkitt
mantle cell
marginal zone
nodal marginal
splenic marginal
lymphoplasmacytic
starry sky appearance
burkitt lymphoma
2 types of non hodgkin T cell lymphoma
adult t-cell -> leukemia
mycosis fungoides -> skin
typical presentation of T cell hodgkin lymphoma (3)
immunocompromised
painless peripheral LAD
extranodal spread (skin/GI/brain)
t/f: non hodgkin lymphoma has a worse prognosis than hodgkin
t!
neutropenia definition
ANC < 1,000
earliest sign of neutropenia
fever
tx for neutropenia
outpt/low risk: cipro PLUS augmentin, +/- moxifloxacin
monotherapy/pseudomonas: cefepime vs imipenem vs augmentin
dual therapy/unstable: monotherapy + vanc vs flagyl
