Hematology/oncology Flashcards
When does Monoclonal gammopathy of undetermined significance (MGUS) become multiple myeloma?
When there is evidence end organ damage due to protein deposition. There is only a 1% annual risk of MGUS progressing to MM.
How is hypercalcemia of malignancy managed?
First give IV normal saline to get the patient euvolemic. This corrects the patient’s volume depletion and helps with the renal excretion of calcium. Then the patient can receive a bisphosphonate or another calcium lowering agent.
What is the threshold for prophylactic platelet transfusion?
The threshold for prophylactic platelet transfusion is 10,000/μL. Platelet transfusion decreases the risk of spontaneous bleeding in such patients. A count below 50,000/μL is an indication for platelet transfusion in patients undergoing an invasive procedure.
What is the criteria for a diagnosis of polycythemia vera?
Specific criteria for the diagnosis of polycythemia vera include an elevated red cell mass, a normal arterial oxygen saturation (>92%), and the presence of splenomegaly. In addition, patients usually exhibit thrombocytosis (platelet count >400,000/mm3 ), leukocytosis (WBC>12,000/mm3 ), a low serum erythropoietin level, and an elevated leukocyte alkaline phosphatase score. Patients often demonstrate puritis, especially after showering.
What is the most common presenting symptom of Hodgkin Lymphoma?
Painless lymphadenopathy. Also, about 1/3 of patients will have B symptoms.
What are the criteria for diagnosis of polycythemia vera?
Major criteria include an increased red cell mass, a normal O2 saturation, and the presence of splenomegaly. Minor criteria include elevated vitamin B 12 levels, elevated leukocyte alkaline phosphatase, a platelet count >400,000/mm3 and a WBC count >12,000/mm3 .
Who are candidates for thromboembolism prophylaxis (e.g. Levenox)?
Prophylaxis is generally recommended for patients over the age of 40 who have limited mobility for 3 days or more and have at least one of the following risk factors: acute infectious disease, New York Heart Association class III or IV heart failure, acute myocardial infarction, acute respiratory disease, stroke, rheumatic disease, inflammatory bowel disease, previous venous thromboembolism, older age (especially >75 years), recent surgery or trauma, immobility or paresis, obesity (BMI >30 kg/m2), central venouscatheterization, inherited or acquired thrombophilic disorders, varicose veins, or estrogen therapy.
What are the treatment guidelines for multiple myeloma?
Early treatment of asymptomatic patients does not improve mortality (SOR A) and may increase the likelihood of developing acute leukemia. The standard treatment for symptomatic patients under age 65 is autologous stem cell transplantation. Patients over 65 who are healthy enough to undergo transplantation would also be appropriate candidates. Patients who are not candidates for autologous stem cell transplantation generally receive melphalan and prednisolone with or without thalidomide. Radiotherapy can be used to relieve metastatic bone pain or spinal cord compression.
What is Waldenström’s macroglobulinemia?
The average age at the time of diagnosis is 65 years. Weakness, fatigue, weight loss, bleeding, and recurrent infections are common presenting symptoms. Physical findings include pallor, hepatosplenomegaly, and lymphadenopathy. Typical laboratory findings include moderate anemia and monoclonal IgM peaks on serum electrophoresis. Bence-Jones protein is seen in 80% of cases. Unlike in multiple myeloma, lytic bone lesions are not seen, and marrow biopsy reveals mostly lymphocytes.
What is the recommendation for switching from dabigatran to warfarin?
Start warfarin now and stop dabigatran in 3 days
What type of anemia is typically seen with myelodysplastic syndrome?
Macrocytic anemia
What are the recommendations around ambulation in a patient with a known DVT on anticoagulation?
Early mobility as tolerated (bed rest not recommended)
