Hematology / Oncology Flashcards
True or false: you should order antiplatelet antibody testing to evaluate ITP.
False
While there is such a test, it has low sensitivity and is not available at many hospitals. As such, ITP is still a diagnosis of exclusion. You must exclude the following things:
- Infections: HIV, HCV, HBV, H. pylori
- Autoimmune: SLE, vasculitides
- Nutrient deficiencies: B12, folate
- Malignancy: MDS, leukemia
If a patient has a thrombocytopenia-like bleeding pattern (e.g., epistaxis, gum bleeding, and petechiae) but there platelet levels are normal, you should consider ordering a ___________________.
platelet function analyzer 100
This test passes anticoagulated platelets through a collagen network and measures the speed at which the filter clogs up. Prolonged closure time indicates platelet dysfunction.
What is paraprotein?
A type of protein that inhibits clotting factors
True or false: all DOACs can be started without heparin bridging.
False
Apixaban and rivaroxaban can be started without bridging.
Dabigatran and edoxaban require heparin bridging.
Describe the utility of the pulmonary embolism severity index.
PESI is a score that predicts the 30-day mortality of pulmonary emboli using several criteria (age, sex, cancer status, CHF status, AMS, and vitals among other things). Those with PESI < 65 have a near 0% risk of 30-day mortality and can be managed outpatient. Those 65-85 have a near 1% risk and can go either way for disposition. Greater than 85 is considered higher risk and should be managed inpatient initially.
What is the mechanism behind inflammatory anemia?
IL-6 leads to proteolysis of the membrane protein ferroportin which is the protein that absorbs iron from the gut, thus lowering the serum iron without affecting iron stores already within cells.
Inflammatory anemia usually has what iron panel profile?
High ferritin
Low TIBC
Low serum iron
Discuss the different treatment options for MDS based on risk status.
In patients with high risk disease (which is determined by genetic analysis), allogenic stem cell transplantation is pursued if the patient is young and healthy enough to tolerate it. In patients with low-risk disease, therapy is aimed at limiting the need for transfusions. Specifically, lenalidomide can help delay progression and limit transfusion need.
Lenalidomide works by _______________.
affecting both the humoral and cellular immune system
Describe hypereosinophilic syndromes.
High levels of eosinophils (>1.5) can cause organ damage regardless of why they are elevated. The most common organs involved are the skin (eczema, erythroderma, urticaria, and angioedema), lungs (parenchymal infiltrates, pleural effusion, lymphadenopathy, and pulmonary emboli), gastrointestinal tract (eosinophilic gastritis, enteritis, colitis, chronic active hepatitis, focal hepatic lesions, eosinophilic cholangitis, Budd-Chiari syndrome), and heart (mitral or tricuspid regurgitation, cardiomegaly, restrictive cardiomyopathy).
Describe the management of anemia in people with hereditary spherocytosis.
Those with HS usually just have a mild anemia that warrants no intervention. There are some instances where they do need interventions, though:
- Chronic severe hemolytic anemia: rarely, those with HS will have more severe anemia and require splenectomy to limit hemolysis.
- Aplastic anemia: those with HS are at increased risk of virally induced aplastic anemia and can require transfusion.
Prednisone treats what kind of anemia?
AHA
D-dimer is only useful in _____________________.
evaluating those with a low probability of PE
It isn’t perfectly sensitive, so if someone has a high probability of PE then you would need to do additional imaging regardless of what the D-dimer is.
How should you diagnose PE in pregnant women?
- First, do PVLs. If they have DVTs you can presume their pulmonary symptoms are from PE.
- Second, if PVLs are negative do a V/Q scan.
- Third, only do a CTA if the V/Q is equivocal.
Why is it important to deal with anemia preoperatively?
Preoperative anemia has been associated with increased perioperative mortality, particularly when it is IDA. Addressing iron deficiency before a surgery can boost survival and limit intervention.
True or false: the preferred agent (per the boards) to reverse warfarin toxicity urgently is FFP.
False
It is Kcentra (4-factor prothrombin complex concentrate). This is preferred because it is quicker to give than FFP and saves volume for those in whom volume is a concern. Of note, Kcentra costs $5k per dose.
It used to be that guidelines recommended searching for _____________ in those with unprovoked DVT.
malignancy
Studies have shown mixed results in looking for occult malignancy, so currently guidelines recommend only being up to date on standard cancer screens like Pap smears, mammograms, and colonoscopies.
B2 microglobulin is used to risk stratify ______________.
MM
Patients with multiple myeloma will sometimes get ppx ______________.
IVIG (because of hypogammaglobulinemia)
A patient who has evidence of hemolysis (e.g., elevated indirect bilirubin and low hgb) as well as low-grade fever a few days after receiving a blood transfusion may have _______________.
delayed hemolytic transfusion reaction
In this syndrome, a person has low-level antibodies to a non-ABO antigen on RBCs (say, from a past transfusion or pregnancy). When they get blood that may have that antigen, they won’t hemolyze as aggressively as frank ABO mismatch, but slowly the will lyze the cells and may present days later like the stem described.
__________________ should be supplemented in DIC to limit bleeding.
Cryoprecipitate
True or false: most adult Parvovirus infections entail arthralgias and rash.
False
Most are actually asymptomatic, which is why you need to have a high index of suspicion in a person presenting in aplastic crisis.
True or false: aplastic anemia most commonly presents with pure red cell aplasia.
False
Aplastic anemia most commonly involves all cell lines.
When should essential thrombocytosis be treated?
In patients > 60 years old who have had thromboembolic events.
Treat with hydroxyurea.