Hematology/Oncology Flashcards
Causes of sideroblastic anemia?
ALICC: Anemia Loses its Clinical Color
Alcohol Lead poisoning INH Copper deficiency Chloramphenicol
What happens in Sideroblastic Anemia?
inherited or acquired defect in heme synthesis causing accumulation of iron in mitochondria = ring’d sideroblast w/basophilic stippling
*pt occationaly need iron chelation or therapeutic phlebotomy for iron overload
Once you start replacement with iron how long does it take for iron levels to return to normal? How long for hemoglobin levels to return to normal?
Two months for hemoglobin to return to normal. Six months for iron stores to be repeated.
If a patient has iron deficiency anemia and you start replacing their iron, how long will it take before you see reticulocyte count increase?
Ridiculous site counts should increase in 3 to 4 days after initiation a treatment and peak at about day 10
What should be your targeted level of elemental iron a day If you’re replacing do to iron deficiency anemia?
150 to 200 mg per day
Give EPO for anemia chronic disease in renal disease when hemoglobin reaches…..
less than 10
Bite cells and heinz bodies are associated with what type of hemolytic anemia?
G6PD deficiency. Heinz bodies are precipitate is formed by denatured, oxidize hemoglobin
Five important things to remember with chronic treatment of sickle cell disease
all individuals need pneumococcal vaccine, Annual screening for retinopathy, forecasted 1 mg PO daily, consider hydroxyurea to decrease frequency of crisis in patients with more than three hospitalizations per year, tree all fevers with antibiotics
Symptom and treatment of TTP
Sx: FAT RN - Fear, anemia, thrombocytopenia, renal insufficiency and neurologic abnormalities
Tx:  urgent transfusion of fresh frozen plasma(do not give blood or platelets as platelets will just increase clotting and anemia), splenectomy for recurrent cases, consider corticosteroids for inadequate response to plasmapheresis
** do not wait for results of ADAMTS13 to start treatment
Symptoms of HUS and treatment
ART: anemia renal failure and thrombocytopenia
Supportive care only
Heparin induced thrombocytopenia often will show up on day —- of heprin use
5-10
Common complication of hemophilia A&B
Spontaneous hemoarthrosis - stiffness, warmth, pain and swelling often in knees or ankles
Treatment due to bleeding in both von Willebrand disease and hemophilia a and hemophilia B
Desmopressin Dash increase the release of von Willebrand factor from endothelial storage
Most common inherited bleeding disorder
Von Willebrand disease
Most common inherited hypercoagulability
Factor five Leiden
When does An individual factor five Leiden need to be put on anticoagulants?
Anticoagulation after their first thrombotic event unless they are homozygotes in which they should be on anticoagulation no matter what
Cause and symptoms of febrile non-hemolytic blood transfusion reactions? What type of blood could you use to prevent this in the future?
Caused by antibodies against donor white blood cells and buildup of cytokines. Present says fever, chills, mild dyspnea usually within six hours of transfusion. in the future should use leukocyte depleted RBCs(removes WBC)
* Most common type of transfusion reaction
What is the cause of allergic transfusion reactions? Symptoms? What type of blood to use in the future?
Allergic reaction to plasma proteins such as IGA. This is usually seen in patients who are deficient in IGA. Presents is bronchospasms, angioedema, hypotension within minutes of transfusion. In the future patient will need washed RBCs (removes proteins and immunoglobin)
Delayed hemolytic transfusion reaction versus transfusion related acute lung injury(TRALI)
Delay hemolytic transfusion reaction occurs within 2-10 days of transfusion and is due to all antibodies against minor anagens.
Transfusion related acute lung injury occurs within six hours of transfusion and is due to donor antibodies to recipient white blood cells located in the pulmonary capillaries.
Those are treated with supportive care
Acute hemolytic transfusion reaction causes and symptoms?
Due to ABO incompatibility. Rare. Presents with fevers, chills, flank pain, hematuria, hypotension tachycardia within 24 hours of transfusion. Can also present as DIC if severe
What is polycythemia vera? Management?
Proliferation of myeloid cells distinguished by an increase in RBC mass due to a JAK2 mutation.  Treat with serial phlebotomy, low-dose daily ASA and all patients to prevent thrombosis. Consider hydroxyurea for those at increased risk of thrombosis and allopurinol for symptomatic gout
What is a essential thrombocythemia? Treatment?
Proliferation of megakaryocytes and bone marrow leading to a non-reactive increase in platelets, often presents between ages 50 to 60. Patients can be monitored or placed on low-dose ASA. Those with history of thrombosis may be placed on hydroxyurea.
Symptoms of multiple myeloma
Bone pain (most common in back or ribs), weakness, fatigue, weight loss, anemia, hypercalcemia, renal insufficiency and lytic bone lesions. This is distinguished from monoclonal gammopathy of undetermined significance(MGUS) due to the fact that it has evidence of secondary organ or tissue impairment such as bone lesions, renal insufficiency, anemia or hypercalcemia.
 which type of leukemia is associated with auer rods?
Acute myelogenous leukemia/AML
MCC of cancer in women?
breast cancer
2nd MCC of cancer related death in women?
breast cancer
MCC of cancer related death in women?
lung cancer
Pretreatment for tumor lysis syndrome?
allopurinol + fluids to maintain urine output of >2-3L/day
Dx of tumor lysis syndrome
at risk patients who develop ARF & 25% increase from baseline of P and/or K or decrease 25% of Ca
What is Superior Vena cava Syndrome? Sx? Common causes? tx?
compression of SVC by tumor(non small cell lung, small cell lung, lymphoma, metastatic lesions).
SX: facial/neck/arm swelling, plethora +/- edema & cyanosis, HA, dizziness, syncope. Worse when patient is supine or bends over.
TX: not an emergency unless obstructing airway. Tx w/stending or chemo/radiating
What is Lambert-Eatson Syndrome? associated cancers?
autoantibodies against presynaptic Ca channels @ NMJ
**seen w/thymoma, small cell lung cancer
Cancer associated with the paraneoplastic syndrome: Erythrocytosis
HCC, RCC
Cancer associated with the paraneoplastic syndrome: Cushing Syndrome
Small cell lung cancer, adrenal cancer, thymoma
Cancer associated with the paraneoplastic syndrome: SIADH
small cell lung cancer, intracranial neoplasms, pancreatic cancer
Cancer associated with the paraneoplastic syndrome: Hypercalcemia
breast cancer, non small cell lung cancer, solid tumors, bone tumors, SCC of the lung, Lymphoma, multiple myeloma
Do all pulmonary embolisms require anticoagulation?
No Subsegmental pulmonary embolisms do not require anticoagulation unless they meet certain criteria
How long does it take for iron stores to normalize?
About 4 to 6 months
How long does it take hematocrit and reticulocyte count to normalize?
Reticulocyte count to normalize within 5 to 7 days and hematocrit will take anywhere from 4 to 6 Weeks.
Dose and duration for ppx antibiotics for a kid with sickle cell disease?
PVK 125 mg bid for age 3m- 3 yrs
PVK 250 mg BID for age 3-5
Child with sickle cell disease what do you need to do to monitor for stroke?
Annual transcranial Doppler from age 2 to age 16
When would you start a pt with sickle cell disease on hydroxyurea therapy?
Three or more vaso-occlusive crisis is in one year
Patient was just diagnosed with multiple myeloma. What medication do you need to start them on?
Get them to an oncologist and start them on a biz phosphonate to decrease the risk of fractures
