Hematology/Oncology Flashcards
What is the MCV for thalassemia?
Low (microcytosis)
What is the cause of chronic anemia in elderly without any known precipitating cause?
B12 deficiency –> give parenterally
What does tumor lysis syndrome cause?
Occurs during chemo for high grade lymphomas, leukemias etc. Large numer of destroyed tumor cells cause leakage of ions leading to hypocalcemia, hyperphosphatemia, hyperuremia (can cause gout), hyperkalemia (can cause arrhythmia)
What is the inheritance pattern of G6PD deficiency?
XR
What is deep bleeding associated with?
Factor deficiencies
What is mucosal bleeding associated with?
Platelet defect (like vWD disease)
How do you distinguish vWD from ITP on just a clinical presentation?
vWD will have more chronic bleeding vs ITP is more insidious onset
What is cilostazole?
Phosphodiesterase inhibitor that inhibits platelet aggregation and causes vasodilation
What causes the green color in bruises?
Heme oxygenase which converts heme to green biliverdin
How does HbF bind oxygen better?
It has decreased affinity for 2,3 BPG (left shift)
Why do you see skin necrosis with warfarin?
Can exacerbate already existing protein C deficiency which prevents clotting
What is mycosis fungoides?
Proliferation of CD4 cells; red patches/plaques; cereberiform nuclei, powdery chromatin
When in the blood it is sezary
What causes megaloblastic anemia and increased orotic acid (crystals in urine)?
Orotic Aciduria from deficiency in UMP synthase
If you have orotic aciduria what can’t you make?
Pyrimidines
Diagnosis: koilonychias (spoon nails), dysphagia?
Iron deficiency anemia
What is heme generated in the liver used for?
CYP450
What causes circumoral pallor?
Fifth’s disease
What has EML4-ALK gene fusion that causes constitutive TK activity?
Non small cell lung cancer
Why do people with whole blood transfusion develop hypocalcemia?
Contains citrate which causes hypocalcemia
What does normal urinary excretion of radiolabeled B12 mean?
B12 defciency
What does impaired urinary excretion of radiolabeled B12 mean?
Malabsorption or pernicious anemia. 2nd dose of radiolabeled b12 but w/ IF: normal urinary excretion than diagnosis is pernicious anemia, if not then it is malabsorption
What are the cells that are seen with EBV blood smear?
Atypical CTL (even though it infects B cells)
What is the bluishness in cells on peripheral blood smear with giemsa stain?
rRNA
What can the mediastinal mass in T-ALL cause?
SVC syndrome, dysphagia, respiratory sx
What is a side effect of Ticlodipine?
Neutropenia (pw/ mouth ulcers and fever)
Where are Weibel palade bodies made?
Endothelial cells
How does Desmopressin effect endothelial cells?
Activates endothelial cells to make more vWF and factor VIII
What do you use for heparin toxicity?
Protamine sulfate
What do you use for tpa toxicity?
Aminocaproic acid and tranexamic acid
What values of SaO2 and PO2 do you need to have for hypoxic erythrocytosis?
SaO2
What is relative erythrocytosis?
No increase in RBC mass itself and is due to dehydration and diuresis that makes it seem like erythrocytosis
What do you think if you see iron deficiency anemia in post menopausal woman or if male?
Think occult blood (or chronic blood loss)
What is pure red cell aplasia associated with?
Pure red cell aplasia is hypoplasia of BM erythroid precursors. Associated with thymoma, lymphocytic leukemia, parvovirus
With what do you see painless waxing and waning lymphadenopathy?
Follicular lymphoma
What are sickle cell patients predisposed to?
Folic acid deficiency and macrocytic change due to high erythrocyte turnover
What do you have increased sensitivity to in polycythemia vera?
Mutation PV causes hematopoeitic cells to be more sensitive to growth factors like GM-CSF and erythropoetin
What type of receptor is JAK2 mutation associated with?
Cytoplasmic tyrosine kinase
What produces arylsulfatase?
Eosinophil
What does cromolyn sodium do?
Prevents mast cell degranulation
What type of mutation do you have in beta thalassemia?
Point mutations in splices sites and promoter sequences
What is fanconi syndrome?
Decreased reabsorption of amino acids, uric acid, glucose, phosphate, bicarb. All passed into urine
What do you use to screen for hereditary spherocytosis?
Eosin maleimide binding test
What do you see burr cells with?
Pyruvate kinase deficiency
What do you see rigid RBCs with?
Pyruvate Kinase deficiency
What is eculizumab?
Used for PNH
What do you use to treat acute intermittent porophyria
Heme and glucose (downregulate ALAS)
What triggers acute intermittent porphyria?
Sulfonamides, barbiturates, progesterone, alcohol, starvation
What is the inheritance pattern of vWD?
AD
What causes rapid fibrosis of BM in primary myelofibrosis?
Increased PDGF
Which of the lymphoma/leukemia had DIC?
AML - APL
Which one had hypecalcemia?
Multiple myeloma, ATLL
What is waldenstorm?
Like multiple myeloma but have IgM spike, no lytic bone lesions, and hyperviscosity
Which one is CD5+
Mantle cell lymphoma
Who do you give cryoprecipitate to?
Those with coagulation deficiencies involving fibrinogen and factor VIII
What is pseduo-pelger-huet anomaly?
Neutrophils bilobed nuclei (two nuclear masses with a thin filament of chromatin) typically seen after chemo
What cancers cause polycythemia via ectopic EPO production?
Hepatocellular carcinoma and renal cell carcinoma
What are the side effects of heparin?
Osteoporosis, HIT, bleeding
Which of the ADP receptor inhibitors is reversible?
Ticagrelor
What is a major side effect of ADP receptor inhibitors?
TTP/HUS
What does PNH increase risk for?
Acute leukemias
What do you see on liver histology due to MTX?
Macrovesicular fatty change
What activates 6-MP/Azathioprine?
HGPRT
What drug do you use for childhood tumors?
Dactinomycin
How does bleomycin work?
Causes free radical formation inducing breaks in DNA
Which drug was used for brain tumors?
Nitrosureas (carmustine, lomustine etc) because they cross BBB
How does Ironotecan/Topotecan work?
Inhibits toposisomerase I so it inhibits DNA unwinding
What is etoposide used for?
Testicular and small cell lung cancer
What is topotecan used for?
Ovarian and small cell lung cancers
How does hydroxyurea work?
Inhibits ribonucleotide reductase
What is a side effect of Trastuzmuab?
Cardiotoxicity
Which drugs increase risk for PML
Natalizumab and Ritxumab
What does the spleen look like in sickle cell patients?
Fibrosis and atrophy because of repeated infarctions
Why is there macrocytosis in sickle cell patients?
High turnover of RBC causes folate deficiency
Why is heparin a safer choice than warfarin in pregnant women?
Heparin is a large charged water soluble molecule that does not cross the placenta. Wafarin is lipophilic and does (it also binds albumin)
What are the lab findings in DIC?
Low fibrinogen, prolongated PT & PTT, thrombocytopenia, increased D-dimer
What medication is an analog of the carboxyl terminal of the delta chain of fibrinogen?
Apiciximab, eptafibatide (GpII/IIIa inhibitor)
The carboxyl terminal is the part that binds the GpII/III receptor
What is the MCC of heritable hypercoagulability?
Factor V leiden
What do you think when LUQ pain in sickle cell patient?
Splenic pathology!
