hematology case

Question 1

signs and symptoms of anemia

Answer 1

-asymptomatic, tired, SOB, fatigue, malaise, chest pain, tachycardia/tachypnea, exertional dyspnea
Hemolysis: pallor, scleral icterus, jaundice, dark urine, splenomegaly/hepatomegaly

Question 2

causes of microcytic anemia

Answer 2

Iron deficiency
Anemia of Chronic disease
Copper deficiency
Lead Poisoning
Thallasemic states (or other hemoglobinopathies)
Sideroblastic anemia

Question 3

causes of normocytic anemia

Answer 3

Extravascular Hemolysis
Hereditory Spherocytosis
Sickle Cell Anemia
Hemoglobin C

Intravascular Hemolysis
PNH (Paroxysmal Nocturnal Hemoglobinuria)
G6PD deficiencies
Immune Hemolytic Anemia
Microangiopathic Hemolytic Anemia
Malaria

Pregnancy
Drugs
Systemic Illness
Hepatitis
Sepsis
Renal Failure

Question 4

causes of macrocytic anemia

Answer 4

Reticulocytosis
Folate, B12
Drugs (eg. hydroxyurea)
Abnormal RBC maturation
Acute Leukemia
Myelodysplastic Syndrome
Acute Leukemia
Alcohol Disease
Liver Disease
Hypothyroidism

Question 5

MGUS

Answer 5

• a precursor lesion – presence of M protein WITHOUT evidence of MM
• usually asymptomatic, discovered on incidental bloodwork
• reflects an expanding clone of Ig secreting cells
• most people do not development MM
• prevalence increases w/ age & may exist for many yrs before advancing to MM; 1%/yr
• no lytic bone lesions, end organ damage, or myeloma Sx
• M protein present but less than myeloma levels (<10%

Question 6

multiple myeloma

Answer 6

• neoplasm of plasma cells in the bone marrow
• multifocal, presents w/ M protein (paraprotein) in the serum/urine
• usually not curable
• malignant cells in bone → bone destruction, anemia, hypercalcemia
• large amounts of immunoglobin → renal failure/end organ damage
• infections due to depressed production of normal Igs
• 2nd most common hematological cancer (15%) after Non-Hodgkins; 1% of all cancer

Dx: by M protein in serum/urine, BM clonal plasma cells, plasmacytoma (serum protein electrophoresis, urine protein electrophoresis)

Tx: supportive care; chemo maintenance therapy, allogenic SCT may be curative

Question 7

plasmacytoma

Answer 7

• localized tumor of neoplastic plasma cells, grows in soft tissue/bone, can progress to MM
• can be solitary or representative of systemic plasma cell myeloma

Question 8

why should doctors apologize?

Answer 8

-right thing to do, legally obligated to disclose medical errors, dec. likelihood of the scenario happening again, better future relationship w/ pt, reduce neg. emotions

Question 9

what are the elements of an effective apology?

Answer 9

-recognition of error, admit fault, take responsibility, communicate sincerity, promise to refrain from future mistakes, compensation

Question 10

what are the barrier and benefits to apologizing?

Answer 10

Barriers to apology
-potential litigation, culture of medicine, accepting you made a mistake

Benefit of apology to patient
-restores trust, reduces patient guilt, motivate patient to follow-up