Hematology/Oncology Flashcards
Physiologic anemia nadir
6-9 weeks
Diamond-Blackfan anemia BM findings
paucity of erythroid precursors
Diamond-Blackfan anemia age
< 1 year
Diamond-Blackfan anemia findings
triphalangeal thumb, cataracts/glaucoma, cleft lip, CHD
TEC triggers
viral - parvovirus, echovirus, HHV-6
TEC age
1-4 years
Fanconi anemia lab findings
macrocytic pancytopenia
Fanconi anemia PE findings
short stature, skin pigment changes, thumb/radius abnormalities
Fanconi anemia genetics
AR
Dyskeratosis congenita
reticulated hyperpigmentation, nail dystrophy, mucosal leukoplakia, BM failure
Dyskeratosis congentia age range
5-15 years
Evans syndrome
autoimmune hemolytic anemia and ITP
Normal adult hemoglobin
alpha2, beta2
Fetal hemoglobin
alpha2, gamma2
NBS findings: FAS
HgbS trait
NBS findings: FS
SCD or HbS trait with other variant
NBS findings: FSC, FSD
sickling disorder
NBS findings: FAE
HbE trait
Anemia: adolescent
Female < 12, Male < 13.5
Cow milk intake associated with iron deficiency
> 900 cc/day
G6PD genetics
x-linked
Elevated MCHC
hereditary spherocytosis
Elevated RDW
iron-defieicency anemia (normal in thalassemia)
Findings in iron-deficiency anemia
low Fe, low ferritin, high TIBC
Alpha thalassemia syndromes
silent carrier, thal trait, HgH disease, hydrops fetalis
Cooley’s anemia
beta thalassemia major
Findings in beta thalassemia
“hair-on-end” skull x-ray, chipmunk facies
Peak incidence of death in SCD
6 mo to 3 years
Second most common hemoglobin variant
HgbE
Measurement of extrinsic pathway
PT/INR (VII, X, V, II, fibrinogen)
Measurement of intrinsic pathway
PTT (XII, XI, IX)
Peak incidence of ITP
2-5 years
Alloimmune thrombocytopenia pathophysiology
maternal IgG against paternal Pla1 Ag (may arise with 1st pregnancy but increased with subsequent pregnancies)
Hemophilia genetics
XLR (33% = new mutations)
Hemophilia A
factor IIX
Hemophilia B
factor IX
Hemophilia labs
prolonged PTT
vWD genetics
AD (incomplete penetrance)
Standard risk ALL
1-10 yo, WBC < 50K, pre-B, hyperdiploid, minimal residual disease
Survival in AML
30%
Most common presentation for Hodgkin lymphoma
painless LAN (B symptoms = worse prognosis)
Infratentorial tumors
Most common (70%) Cerebellar astrocytoma, medulloblastoma, ependymoma, brainstem glioma
MRI findings in medulloblastoma
Contrast enhancing midline tumor (exclusively in the cerebellum)
Medulloblastoma treatment
resection, XRT (not in < 3 yo), chemo
Most common malignancy in infancy
neuroblastoma
Neuroblastoma features associated with poor prognosis
stage III or IV (except IVS), age > 1, high N-myc amplification
IVS neuroblastoma
infant (< 1 year), resectable primary and only mets to liver, skin or BM
Most common site of rhabdomyosarcoma
head/neck/orbits
Retinoblastoma features associated with good prognosis
< 2 years, unilateral, no extension
Management of bilateral retinoblastoma
MRI to rule out PNET of pineal gland
Hepatoblastoma associations
Beckwith-Wiedeman, FAP
Tumors associated with von Hippel Lindau
CNS - retinal hemangioblastoma
Visceral - renal cell carcinoma, pheochromocytoma, pancreatic tumor
Pearson syndrome findings
pallor, pancreatic dysfunction, lactic acidemia, FTT
RBC indice that differentiates TEC and DBA
MVC - normal in TEC, increased in DBA
SCD: common age for dactylitis
< 2 years
SCD: rate of stroke
15%
SCD: screening for stroke
TCD every 6-12 months, MRA/V if velocity > 200 cm/sec
SCD: chelation therapy
deferoxamine
SCD: non-infectious etiology of ACS
fat-emboli
SCD: age range for sequestration
6 mo - 2 years
SCD: recurrence rate for sequestration
50%
SCD: chronic complications
gallstones, restrictive pulmonary dz, LVH, retinal detachment, delayed puberty, infertility in female patients
Hgb Bart’s
tetramer of gamma-globin that forms with decrease in alpha-globin synthesis
Diagnosis of beta thalassemia
increase in HgA2
HbH
beta-globin tetramers that occur in alpha thalassemia
Peak age of Hodgkin lymphoma
adolescence
Primary location of Hodgkin lymphoma
above the diaphragm
Most common presentation of NHL
lymphadenopathy without fever or weight loss
3rd most common childhood cancer
NHL
Wilms tumor prognosis
90% 4 year survival
Desmopressin is contraindicated in which type of vWD
type 2 B
Prognosis of stage IV Hodgkin disease
> 80%
Hemolysis triggers (G6PD vs. HS)
G6PD - drugs, HS - viral infection
HS genetics
AD (high rate of new mutations)
Malignancy most closely associated with TLS
Burkitt lymphoma (HL)
Findings in TLS
elevated K, PO4, uric acid; decreased Ca
WAGR
wilms tumor, aniridia, genital anomalies, MR
Target cells
hemoglobinopathy
Howell-Jolly bodies
splenic dysfunction (SCD)
Evaluation of Wilms tumor
CT chest/abd/pelvis, echo (r/o extension), CXR
Chemo SE: hearing loss
cisplatin
Chemo SE: neurotoxicity
vincristine/vinblastine
Shwachman-Diamond syndrome
pancreatic insufficiency (2nd MCC), BM dysfunction, skeletal anomalies, increased risk of leukemia
Treatment of autoimmune hemolytic anemia (AIHA)
corticosteroids