Hematology & Oncology Flashcards
Features of multiple endocrine neoplasia type 1?
- Pituitary adenomas
- Parathyroid adenomas
- Enteropancreatic tumors
Laboratory hallmarks of tumor lysis syndrome
- Hyperuricemia
- Hyperkalemia
- Hyperphosphatemia
Primary immune thrombocytopenia pathophysiology, presentation & management
(formerly known as idiopathic thrombocytopenia purpura)
- Pathophysiology: anti-platelet Ab attack platelets –> peripheral platelet destruction
- Presentation: petechiae, gingival bleeding, epistaxis, menorrhagia, GI bleed, ICH (in children, history of recent viral infection)
- Management: supportive (children), corticosteroids & IVIG/anti-D immunoglobulin (adults); platelets (severe bleeding/extremely low platelet count) splenectomy (refractory cases), rituximab, thrombopoietin receptor agonist, immunosuppressants
Thrombotic thrombocytopenia purpura pathophysiology, presentation & management
- Pathophysiology: severe ADAMTS13 deficiency 2/2 inhibitory auto-Abs
- Presentation: fever, MAHA, thrombocytopenia, AMS & renal failure
- Management: plasmapheresis
Tumor lysis syndrome pathophysiology, presentation & management
- pathophysiology: death of numerous neoplastic cells releasing large quantities of intracellular content & uric acid (typically 1-5 days after chemotherapy) –> hyperuricemia, hyperkalemia, hyperphosphatemia & hypocalcemia
- presentation: fatigue/lethargy, N/V, cloudy urine, muscle spasms & AMS
- management: aggressive IV hydration (kidneys excrete uric acid, potassium & phosphate), allopurinol (prevents conversion of hypoxanthine to uric acid) or rasburicase (converts uric acid to inactive & soluble metabolite)
Acute myeloid leukemia epidemiology, pathophysiology, presentation & prognosis
- epidemiology: most common leukemia in adults; 15-20% of childhood leukemias; median age of diagnosis 65 yr
- pathophysiology: clonal proliferation of myeloid precursor cells –> reduction in production of other cells (RBC’s, platelets, mature granulocytes)
- presentation: related to pancytopenia; pallor, fatigue, easy bruising, gingival bleeding, petechiae and infections; labs with normocytic normochromic anemia with Auer rods
- prognosis: 5-year survival rate 25%
Acute lymphoblastic leukemia epidemiology, pathophysiology & presentation
- epidemiology: most common cancer in children (age 3-7) with bimodal distribution (65 yo)
- pathophysiology: proliferation of blast cells
- presentation: bone pain, LAD, hepatosplenomegaly, CNS involvement
Chronic lymphocytic leukemia epidemiology, pathophysiology, presentation, management & prognosis
- epidemiology: male predominance; median age of diagnosis 70 yr; most common leukemia in adults of Western countries
- pathophysiology: monoclonal proliferation of incompetent mature B cells
- presentation: asymptomatic at diagnosis; B symptoms, LAD (painless), splenomegaly, anemia & thrombocytopenia; peripheral smear with isolated lymphocytosis & smudge cells (fragile lymphocytes)
- management: observation for early-stage or asymptomatic; purine analogs, antibodies, alkylating agents, IVIG (for hypogammaglobulinemia & frequent infection)
- prognosis: virtually incurable; median survival 4-20 years
Chronic myeloid leukemia epidemiology, pathophysiology, presentation & management
- epidemiology: least common leukemia
- pathophysiology: Philadelphia chromosome –> neutrophilic leukocytosis
- presentation: most asymptomatic; fatigue/weight loss, night sweats, LUQ pain, early satiety, bone pain, hepatosplenomegaly
- management: allogenic hematopoietic stem cell transplant (only curative treatment), tyrosine kinase inhibitor, dasatinib, inferferon-alpha + cytarabine (greater toxicity)
Neutropenic fever diagnostic criteria
Fever (single oral temp >38.3 C OR >38.0 C for >1 hr) + neutropenia (ANC <500 OR <1,000 w/ predicted nadir of <500 in 48 hr)
Preferred AC for VTE in cancer patients
LMWH (cancer patients have variable responses to traditional vitamin K antagonist therapy)
Preferred AC for VTE in cancer patients
LMWH (cancer patients have variable responses to traditional vitamin K antagonist therapy)
Waldenstrom macroglobulinemia
- plasma cell dyscrasia leading to abnormal synthesis of IgM paraproteins
- most common cause of hyperviscosity syndrome
Waldenstrom macroglobulinemia
- plasma cell dyscrasia leading to abnormal synthesis of IgM paraproteins
- most common cause of hyperviscosity syndrome
