Hematology/Oncology Flashcards
What is the most common clinical presentation of a lymphoid malignancy in adults?
painless enlargement of lymph nodes with no explanation or lymphadenopathy
What type of cancer is caused by the Epstein-Barr virus?
Burkitt’s lymphoma
What type of cancer is caused by Helicobacter pylori?
gastric MALT lymphoma
What are the B-symptoms?
Signs of lymphoma
- unexplained fevers
- drenching night sweats
- weight loss of 10% of body weight in 6 months
What is the significance of the following in the Ann Arbor Staging System?
- Stage I
- Stage II
- Stage III
- Stage IV
- Stage I
- 1 node involved
- Stage II
- >1 node, above diaphragm
- Stage III
- >1 node, below diaphragm
- Stage IV
- Diffuse involvement
What are the cell markers for Follicular lymphomas?
- CD19
- CD20
- CD21
- Negative for CD5
Do B cell or T cell lymphomas have a worse prognosis?
T cell lymphomas
Which are the most aggressive non-Hodgkin’s lymphomas?
Burkitt’s lymphoma
Lymphoblastic lymphoma
Mantle Cell Lymphoma
- Cell markers
- Chromosomal abnormality
- Markers
- CD19, 20, 5 positive
- CD23-negative (distinguishes from CLL)
- Chromosome
- t(11;14)
Lymphoblastic Lymphoma
- What nodes are affected?
- Where can it spread?
- Nodes:
- mediastinal
- Spread:
- bone marrow
- leptomeninges (brain)
Burkitt’s Lymphoma
- Organ involvement
- Characteristic cell pattern
- Translocation
- Tumor lysis syndrome at start of therapy
- Organ involvement
- bone marrow
- CNS
- Characteristic cell pattern
- Starry sky pattern
- Translocation
- t(8;14)
What is the pathology and cytology of Nodular Sclerosing Hodgkin’s Disease?
- Path
- fibrous bands separate nodes into nodules
- affects mediastinal and supradiaphragmatic nodes
- Cytology
- lacunar type Reed-Sternberg cells
Nodular-Lymphocyte-predominant Hodgkin’s Disease
- Cytology
Popcorn cells
(No reed-sternberg cells)
What are the cell markers of Reed-Sternberg cells? What disease is signaled by the presence of these cells?
- Markers: CD30, CD15
- Diagnosis: Hodgkin’s Disease
What is the disease?
Patient presents with a generalized pruritis and B symptoms with shortness of breath. There is painless enlargement of the lymph nodes of the neck. Chest radiography shows mediastinal and hilar adenopathy. RS cells were found.
Hodgkin Disease
What are some factors associated with a bad prognosis in Hodgkin’s Disease?
High erythrocyte sedimentation rate
Bulky disease (mediastinal widening by >1/3 or nodal mass >10cm)
Chronic Lymphocytic Leukemia
- Markers
- Cytology
- Symptoms
- Markers:
- CD19, 20, 21 positive (B cells)
- CD 5 and 23 positive (differentiates from Mantel Cell)
- Cytology
- Smudge cells
- Symptoms: Blood-related
- thrombocytopenia
- Hemolytic anemia
- Hypogammaglobulinemia
What is the RAI staging system for CLL?
- 0
- I
- II
- III
- IV
- 0
- only increased white count
- I
- 1 w/ lymphadenopathy
- II
- 1 & 2 w/ splenomegaly
- III
- 1-3 w/ anemia
- IV
- 1-4 w/ thrombocytopenia
What is the disease?
What is the disease?
- Cell Markers
- CD19, 20, 5 positive
- CD23-negative
Mantle Cell Lymphoma
What is the disease?
What is the disease?
- Tumor lysis syndrome at start of therapy
- Organ involvement
- bone marrow
- CNS
- Characteristic cell pattern
- Starry sky pattern
Burkitt’s Lymphoma
What is the disease?
What is the disease? Be specific.
- Path
- fibrous bands separate nodes into nodules
- affects mediastinal and supradiaphragmatic nodes
- Cytology
- lacunar type Reed-Sternberg cells
Nodular Sclerosing Hodgkin’s Disease
What is the disease?
What is the disease? Be specific.
Cytology reveals only Popcorn cells
Nodular-Lymphocyte-predominant Hodgkin’s Disease
What is the disease?
What is the disease?
- Markers:
- CD19, 20, 21 positive
- CD 5 and 23 positive
- Cytology
- Smudge cells
- Symptoms: Blood-related
- thrombocytopenia
- Hemolytic anemia
- Hypogammaglobulinemia
Chronic Lymphocytic Leukemia
What is the disease?
Patient presents with bone lesions, splenomegaly, and pancytopenia. A bone marrow biopsy was attempted but the aspiration was dry due to fibrosis. Cells are TRAP-positive and CD5 negative.
Hairy Cell Leukemia
What is the disease?
Patient has no symptoms, but blood tests show less than 10% bone marrow plasma cells and M proteins. Lytic bone lesions are also present.
Monoclonal gammopathy of unknown significance (MGUS)
What is the disease?
Patient has no symptoms, but blood tests show M protein and marrow plasma cells 10-30%.
Smoldering Myeloma
What is the disease?
Patient presents with lytic bone lesions, hypercalcemia, plasma cytosis and Bence Jones Protein. Blood smear shows rouleaux formation.
Multiple Myeloma
Staging System for Multiple Myeloma
- Stage I
- B2M < 3.5, albumin > 3.5
- Stage II
- B2M < 3.5, albumin < 3.5
- Stage III
- B2M > 3.5, albumin < 3.5
Albumin should be high, B2M should be low (Normal)
What is the effect of Waldenstrom’s Macroglobulinemia on the blood?
- Hyperviscosity syndrome
- epistaxis
- retinal hemorrhages, CHF
28 yo old male presents with 6 month history of pruritis. On exam he was found to have bilateral cervical lymphadenopathy and also splenomegaly. What is the possible diagnosis and what is the clinical stage.
Hodgkin’s Disease
Stage III
64 y old female presents with fatigue , tiredness and bone pains. On exam she was found to be anemic, skeletal survey showed punched out lesions. Her possible diagnosis.
Multiple Myeloma
75 y old male on routine CBC was found to have increased WBC of 17,000 with 85%lymphocytes. He is completely asymptomatic, and has no lymphadenopathy or organomegaly. Hemoglobin and platelets are normal.
Stage 0 CLL
What are the indications and complications of granulocyte transfusion?
- IND:
- sepsis
- Complications:
- must be ABO compatible
- Allergy
- CMV
- Graft vs Host Disease
By how much does a unit of packed RBCs increase amount in blood?
1 gram
By how much does one unit of platelets increase amount in blood?
8,000
What are the indications for platelet infusion?
- Plts < 10,000
- Plts < 20,000 w/ bleeding
What are the components of fresh frozen plasma? What are some indications?
- Components:
- coagulation factors (proteins C and S)
- Plasma proteins (fibrinogen)
- Indications:
- Coag factor deficiency
- Overdose of coumadin
- coagulopathy (ex: liver disease)
What are the components of Cryoprecipitate? What are its indications?
- Components:
- Factors VIII, XIII
- vWF
- Fibrinogen
- IND:
- DIC
- Hemophilia A
- Afibrinogemia
- vWD
What Ab is responsible for acute intravascular transfusion reactions associated with ABO incompatibility?
IgM
Hemolytic Transfusion Rxn
- Mediated by which Ab
- Prevention
- Treatment
ABO incompatibility
- IgM
- Prevention:
- pretransfusion compatibility test
- Treatment:
- stop transfusion immediately
- Infuse fluids with diuretic use
- protect kidneys
Febrile Nonhemolytic Reactions
- Mediated by which Ab
- Cause
- Symptoms
- Prevention
- Treatment
- Mediated by IgG?
- Cause
- HLA or leukocyte Ag on donor WBCs that react w/ recipient Ab
- Symptoms
- fever, chills
- Prevention
- Leukopore
- Treatment
- Antipyretic (Tylenol)
Allergic Transfusion Reactions
- Mediated by which Ab
- Cause
- Symptoms
- Prevention
- Treatment
- Mediated by IgG?
- Cause
- Ab to plasma proteins of donor
- Symptoms
- Urticaria
- Erythema
- Dyspnea
- Prevention/ Treatment
- Antihistamine
Anaphylactic Reactions
- Mediated by which Ab
- Cause
- Symptoms
- Prevention
- Treatment
- Mediated by IgA
- Cause
- AgA antibodies in IgA deficient patients
- Symptoms
- No fever
- flushing
- Hypotension
- Cardiac arrythmia
- Laryngeal edema
- Prevention
- Give IgA deficient blood
- Treatment
- Epinephrine