Hematology & Oncology Flashcards
Name the Blood transfusion Rxn occur within seconds to minutes of transfusion.
Anaphylactic
-Caused By recipient anti IgA Ab
Name the Blood transfusion Rxn occur within 1 hour of transfusion.
Acute Hemolytic
-Caused by ABO incompatibility
Name the Blood transfusion Rxn occur with 1-6 hours of transfusion.
Febrile Non Hemolytic
-Caused by cytokine accumulation during blood storage
Name the Blood transfusion Rxn occur within 6 hours of transfusion.
Transfusion related Acute lung Injury
-Caused By Dono anti leukocyte Ab
Name the Blood transfusion Rxn occur within 2-10 days after transfusion.
Delayed Hemolytic
-Caused by anamnestic antibody response
Name the Blood transfusion Rxn causing Hypotension
Bacterial sepsis
Primary Hypotension Rxn
Transfusion Related Acute lung Injury
Name the specialized RBC treatment for Febrile non Hemolytic Rxn
Leukoreduced Blood
Washed is the specialized RBC treatment in given in ;
IgA deficiency
Complement dependent autoimmune hemolytic Anemia
Continue allergic Rxn with red cell transfusion despite antihistamines t/m
Name the indication to irradiated blood
A) Bone marrow transplant recipients
B) Acquired Or Congenital cellular immunodeficiency
C) Blood components donated by first Or Second degree Relatives
Name the condition which show Tear drop cells (Dacrocytes)
Thalassemia
Bone Marrow infiltration
Name the condition which show burr cells (Echinocytes)
ESRD
Pyruvate kinase deficiency
Liver Diseases
Name the condition which shows Ringed sideroblast (Seen inside bone marrow)
Sideroblastic anemia
Name the condition which shows target cells
HALT H Hbc A asplenia L Liver disease T Thalassemia
Name the condition which shows Basophilic stippling
Seen in peripheral smear
Sideroblastic anemia due to lead
Thalassemia
Alcohol
Important information
Basophilic stippling in which there is aggregation of ribosomal precipitates
Important information
Single blue dot in RBC = Howell jolly body
Multiple Blue Dots in RBC= Basophilic stippling
What is Pappenheimer Bodies?
Siderocytes containing Basophilic granules of iron in sideroblastic anemia
Name the condition which shows Howell jolly bodies
-Nuclear Remnants In RBC
All those conditions in which spleen get removed or becomes dysfunctional
Name the condition which causes non megaloblastic macrocytic anemia
Diamond blackfan anemia
Liver Diseases
Alcoholism
Name the condition which causes megaloblastic macrocytic anemia
Defective DNA synthesis
- Folate and B12 Deficiency
- Orotic aciduria
Defective DNA Repair
-Fanconi anemia
Name the condition which causes microcytic anemia
Defective Globin Chain
-Thalassemia (High Ret count)
Defective Heme Synthesis
- Anemia of Chronic Disease
- Iron Deficiency
- Lead poisoning
Name the normocytic conditions which shows non Hemolytic (Ret count less than normal)
Aplastic anemia
CKD
Early Iron Deficiency
Most common cause of iron deficiency in adult male and post menopausal female
Chronic GI bleeding
What is the most earliest finding in iron deficiency anemia
RDW more than normal
-RDW≥20 suggest iron deficiency anemia
Normal in thalassemia is 12-14%
Beside increase in RDW in iron deficiency anemia what other parameters help in d/f it from thalassemia?
1) Decrease RBC and (2) increase HgB after iron supplements in iron deficiency anemia
2) Normal RBC count and (2) no change in Hb level even after iron supplements
3) Mentzer Index <13 in thalassemia and >13 in iron deficiency anemia
How to confirm Beta thalassemia minor?
Increase HbA2>3.5% on electrophoresis
What is the common cause of iron deficiency anaemia before age 1 yr?
Introduction of cow, goat Or Soy milk
Triad of Lead poisoning induced anaemia
Anaemia
Abdominal pain
neurological sign
Name the enzymes inhibit by lead in gene synthesis
1) ALA Dehydratase
2) Ferrochelatase
What is the reason behind basophilic stippling in lead poisoning?
Lead inhibits rRNA degradation result RBC retain aggregates of rRNA
What is the specific dx in Sideroblastic anaemia?
Ringer sideroblast in bone marrow sampling
How pernicious anaemia causes B12 deficiency?
1) By the presence of anti-IF Ab
2) Pt develop chronic atrophic gastritis—>Decreases production of IF by gastric parietal cells
Important information
Chronic atrophic gastritis increases the risk of intestinal type gastric Ca and gastric carcinoid tumors
Name the cause of megaloblastic anaemia in children
Orotic aciduria B/c of defect in UMP synthase
Triad of Diamond blackfan anaemia
Non megaloblastic macrocyctic anaemia
Short stature with upper extremity malformation (triphalangeal thumb)
Craniofacial deformities
Laboratory markers of Normocytic anaemia
Increase of following
1) LDH
2) Unconjugated Bilirubin (If haemolytic)
3) Urobilinogen in urine
4) Pigmented gallstones
5) Increase reticulocyte if haemolytic
6) Decrease Haptoglobin if intravascular haemolysis
Triad of Hereditary Spherocytosis
1) Hemolytic anemia
2) Inherited gallstones
3) Splenomegaly
Most important finding in cbc of Hereditary Spherocytosis
Increase MCHC
Name the gold standard test for Hereditary Spherocytosis
Acidified glycerol lysis test along with eosin 5 Maleimide binding test (Flow cytometry)
Triad of Paroxysmal nocturnal Hemoglobinuria
- Haemolytic anaemia
- pancytopenia*
- Venous thrombosis*
Name the monoclonal antibody used in t/m of PNH
Eculizumab inhibits terminal complement protein C5
Important information
All patients with haemolytic anaemia have a tendency for venous thromboembolism but PNH patients are at particular risk esp Intra Abdominal and cerebral vein
Name the complications of sickle cell anaemia
Think of sickle cell
1) Hematuria due to sickling in renal medulla
2) Vaso occlusive crisis like stroke, Chest pain, pain swelling of hands, pain erection and avascular crisis
3) Aplastic crisis
4) Autosplenectomy
5) splenic infarct
How to prevent stroke in sickle cell anaemia?
Exchange transfusion
What is the main side effect of Hydroxyurea?
Myelosuppression
Main renal finding in pts with sickle cell trait
- Painless microscopic Or Gross Hematuria
- Hyposthenuria due to impairment of counter current exchange and free water reabsorption by sickle cell
Name the causes of acute sever anaemia in sickle cell disease
Aplastic crisis in which ret count less than normal
Splenic sequestration crisis in which ret count more than normal
Name the MCC of bacteremia in sickle cell disease patients
S pneumonia usually from non vaccine aero types
Hb Electrophoresis patterns is * HbA is 0% *HbA is 85-95% *HbF 5-15% What’s the diagnosis?
Sickle cell disease
Hb Electrophoresis patterns is * HbA is 50-60% *HbA is 35-45% *HbF <2% What’s the diagnosis?
Sickle cell trait
Why is it necessary to check iron store before giving erythropoietin in CKD?
Erythropoietin supplements—>Increases New RBCs production—>Iron utilised—>Rapid Depletion of body iron stores
Important information
All patients with CKD and Ht<30% or Hb<10g/dl are candidates for recombinant erythropoietin therapy after iron deficiency has been rule out
Triad of aplastic anaemia
Pancytopenia
Decrease Ret count
Dry bone marrow tap
Triad of fanconi anaemia
Aplastic anaemia
Thumb/radial defect
Short height with macules
How much count to consider for neutropenia?
Absolute neutrophil count <1500
Severe infection typical when <500celle/mm3
How much count to consider for lymphopenia?
Absolute lymphopenia count <1500
But <3000cells/mm3 in children
How much count to consider for Eosinopenia?
<30cell/mm3
What is the major cause of Eosinopenia?
Steroids
And Cushing syndrome
Steroids sequester eosinophils in lymph nodes and cause apoptosis of lymphocytes
Name the enzymes inhibit by lead in heme synthesis
ALA dehydratase
Ferrochelatase
Name the substrate accumulated in blood if lead inhibit the enzymes in heme synthesis
ALA if ALA dehydratase inhibit
Protoporphyrin if ferrochelatase inhibit
Name the enzymes inhibit in acute intermittent porphyria and substrate accumulated
Prophobilinogen deaminase
Prophobilinogen and ALA
Triad of Acute Intermittent porphyria
Port wine urine
Abdominal pain
Polyneuropathy
Condition can precipitate if cytochrome p450 inducers drugs/ starvation/ alcohol
Name the porphyria associated with HCV
Porphyria cutanea tarda
- Uroporphyrinogen Decarboxylase deficiency or inhibit
Name the clotting factors whose deficiency wouldn’t increase PTT
Factor 7 and 13
After mixing stuides, PT get normal name the clotting factors which were deficient
Factors 7 (mainly) 1,2,5 and 10
After mixing stuides, PT doesn’t get normal what could be the reason?
Factor 7 inhibitor present in patients plasma
PTT normalised after mixing study what are factors deficient?
Factor 8,9,11 and 12
If PTT initially shortener then prolonged after mixing study what could be the reason?
Factor 8 inhibitor
If PTT not normalised even after mixing study what could be the reason?
Factor 9 inhibitor
Most commonly due to lupus anti coagulant
What is the t/m of ITP in children if skin manifestation only?
Just observed
What is the t/m of ITP in children if there is bleeding?
Give IVIg
Or Steroid
T/m of ITP in adult if PLT count ≥30k without bleeding
Observed
T/m of ITP in adult if PLT count ≤30k Or bleeding
IVIg
Or Steroid
What will be seen in peripheral smear in Bernard Soulier syndrome?
Large platelets
Also abnormal ristocetin test
What will be seen in peripheral smear in Glanzmann Thrombasthenia?
No platelets clumping
Difference between FFP and PCC
FFP contains all the clotting factors and plasma proteins
Whereas PCC contains clotting factors which are reduced by vitamin K
Causes of thrombophilias
Either mutations Viz Factor V Leiden Or Prothrombin mutation
Or Deficiency if Antithrombin or Protein C / S
Indication for Rivaroxaban in DVT
Acute DVR Or PE
Recurrent Or Refractory DVT
PT doesn’t want daily injection Or Has d/f with dietary restriction and frequent INR monitoring
Important information regarding DVT
Warfarin and IV Unfractionated Heparin prefer long term anticoagulant for patients with ESRD
(very HY HY)
LMWH and Rivaroxaban are contraindications in ESRD
Name the subtypes of Hodgkin lymphoma
Nodular Sclerosis
Lymphocyte rich
Mixed cellularity
Lymphocytes deplete
Important information regarding Mixed cellularity
Seen in immunocompromised with eosinophilia
Triad of Hodgkin lymphoma
- B symptoms with painless lymphadenopathy
- Normal peripheral blood smear with normal CBC
- Massive lymphocytes is not seen
Name the neoplasm of Mature B cells non Hodgkin lymphoma
Burkitt lymphoma
-Diffuse large B cell lymphoma
Follicular lymphoma
-Mantle cell lymphoma
Marginal Zone Lymphoma
-Primary CNA lymphoma
Name the neoplasm of Mature T cells non Hodgkin lymphoma
Adult T cell lymphoma
Mycosis Fungoides/Sezary Syndrome
Triad of Adult T cell lymphoma
Lytic bone lesion
Increase Sr Ca2+
Cutaneous lesion
MC type of non Hodgkin lymphoma in adult
Diffuse large B cell lymphoma
Triad of Follicular Lymphoma
Translocation of 14;18
BCL2 inhibits apoptosis
Painless waxing and waning lymphadenopathy
Name the mature neoplasm of B cell non Hodgkin lymphoma associated with chronic inflammation like sjogren syndrome or MALTOMA
Marginal Zone lymphoma
Name the mature neoplasm of B cell non Hodgkin lymphoma associated with HIV/AIDs
Primary CNS lymphoma
Triad of Hairy Cell leukaemia
Dry tap with massive splenomegaly
Pancytopenia
No lymphadenopathy
Markers specific for Hairy Cell leukaemia
TRAP
And CD11c
Name the types of polycythemia
Relative
Absolute appropriate
Absolute inappropriate
Polycythemia Vera
Name the types of polycythemia where plasma volume decrease
Relative
Name the types of polycythemia in which plasma volume increases
Polycythemia Vera
Name the types of polycythemia in which RBC mass increases
Except relative
All types have increased RBC mass
Triad Of MGUS
CRAB -ve
SPAP +ve whereas UPEP -ve
BM biopsy show less than 10% plasma cells
Triad of Waldenstrom’s Macroglobulinemia
Peripheral Neuropathy with Hyperviscosity syndrome
SPEP+ve whereas UPEP-ve
BM biopsy shows lymphocytes
Name the bony condition occur due to Sickle cell disease
If Afebrile without inflammation::
Avascular Necrosis
If febrile:
Osteomyelitis only focal pain
Vaso occulsive crisis more than 1 side involved
How to dx and manage HIT?
Dx via HIT-Ab Or Serotonin release assay
Tx:
Don’t wait for result and stop all heparin product
Give direct thrombin inhibitor meds (BAD)
Or
fondaparinux
Why allopurinol given in tumor lysis syndrome?
Allopurinol prevent acute urate nephropathy but not tumor lysis syndrome
How to manage CANCER RELATED ANOREXIA/CACHEXIA SYNROME (CACS)?
1) nutritional counselling and supplementation with enteral or parenteral feeding
2) progesterone analogues (eg megestrol acetate or medroxyprogesterone acetate) or glucocorticoids
3) Synthetic cannabinoids are useful in HIV cachexia but not CACS
How to manage CHEMOTHERAPY INDUCED NAUSEA AND VOMITING?
First hydrate and then control N/V
First line med—-> Serotonin receptor antagonists (eg ondansetron)
2nd or3rd line for refractory vomiting Is Dopamine receptor antagonists like metoclopramide and prochlorperazine
D/f b/w CML and Leukemoid reaction
CML::
Low LAP with Presence of absolute basophilias
Less mature neutrophils dominate like promyelocytes, myelocytes more than metamyelocytes
Leukemoid Reaction::
High LAP with Absence of absolute basophilias
More mature neutrophils dominate like metamyelocyte more than myelocytes
Triad of POLYCYTHEMIA VERA (PV)
Elevate Hb with low erythropoietin level
Viscous blood leads to HTN, headache , burning cyanosis in hand / feet
Aquagenic pruritus
What are examination findings and complications of POLYCYTHEMIA VERA (PV)?
O/E there is facial plethora and splenomegaly
Complications are thrombosis, myelofibrosis and acute leukaemia
How to manage POLYCYTHEMIA VERA (PV) ?
Phlebotomy
And
Hydroxyurea if there is risk of thrombosis
Triad of ANDROGEN ABUSE in Male
Gynecomastia with low testicular volume
Aggressive mood almost
Increase Ht, Hb and LDL with low HDL
What bacteria could attack HEMOCHROMATOSIS patient?
Listeria
Vibrio vulnificus
Yersinia
What are the parameters of iron in ANEMIA OF CHRONIC DISEASES?
Body will store iron so there will be:
Low serum iron and TIBC
Ferritin will be increase or normal
MCV and transferrin saturation will be normal or low
What are the parameters of iron in Thalassemia?
Lots of iron
So
Serum iron and ferritin, saturation
increases
TIBC decreases
What are the lab values of leads induced poisoning?
CBC-> microcytic anemia With basophilic stippling on peripheral smear
Elevated venous lead level
Elevated serum zinc proptoporphyrin level
What are d/f lab patterns in TTP?
Hemolytic anemia (decreases haptoglobin but increases LDH)
Low Platelets result increases bleeding time but normal PT/PTT
Schistocytes on blood smear
Deranged Urea/cr
Important point of CO poisoning dx
pulse oximetry cannot differentiate oxyHb from carboxyHb.
Diagnosis is made on ABGs with cooximetry
What are the clinical features of frost bite?
There will be superficial pallor and anaesthesia
Formation of blister and Eschar
Deep tissue necrosis and mummification
How to manage frost bite?
1) Rapid rewarming in water bath temp should be 37-39*c with analgesics
Name the condition which shows protein gap
Protein gap (difference between total protein and albumin >4g/dl): means increase non-albumin proteins in serum
polyclonal gammopathies(infection, connective tissue diseases)
excess monoclonal proteins (MM, Waldenstrom gammopathy)
Name the chemotherapeutic agents for d/f leukaemia and lymphoma
Chlorambucil and prednisone—for CLL
CHOP regimen—for non-Hodgkin lymphoma
cladribine for hairy cell Leukaemia
How to manage G6PD patient?
Remove or treat the responsible cause
Supportive care
What are the causes of warm agglutinin AIHA?
V-DIAL
V viral
D drug like penicillin
I immunodeficiency
A autoimmune like SLE
L lymphoproliferative CLL
Triad of warm agglutinin AIHA
Life threatening anemia but asymptomatic
Positive coomb test with Anti IgG, anti C3 or both
Rx is steroid or removal of steroid if refractory
What are the complications of warm and cold agglutinin AIHA?
Warm
Venous thromboembolism
Lymphoproliferative disorder
Cold:
Ischemia and peripheral gangrene
Lymphoproliferative disorder
What are the causes of cold agglutinin AIHA and How to manage it ?
Causes are infection like EBV, mycoplasma and lymphoproliferative diseases
Rx is avoidance of cold temperature
Rituximab and fludarabine
Triad of Cold agglutinin AIHA
Anemia SxS
Livedo reticularis and acral cyanosis with cold exposure which disappear with warm
Positive coomb test with anti C3 or anti IgM but not IgG usually
Triad of Acute intermittent porphyria
Abdominal pain with peripheral neuropathy
Autonomic disruption ± psychiatric sxs
Red color urine on air exposure
What are lab findings of Acute intermittent porphyria?
Increase Serum and urine porphobilinogen ALA and porphyrin, urobilinogen
Deranged LFT ± Hyponatremia
How to manage Acute intermittent porphyria?
Glucose and Hemin
How to Approach proximal DVT treatment along with pulmonary embolism with unstable vitals OR Massive proximal DVT with severe swelling or limb threatening ischemia?
Give Thrombolytics if no CI
If contraindications or no response—>mechanical or surgical thrombectomy OR iliac stenting
How to Approach proximal DVT treatment WITHOUT pulmonary embolism with unstable vitals OR Massive proximal DVT with severe swelling or limb threatening ischemia?
Give anticoagulant If no CI
If CI or no response—-> IVC filter
How to manage Acute Splenic Sequestration?
Isotonic fluid infusion
Blood transfusion for low Hb
± Removal of spleen
How to manage painful Erection due to Sickle cell disease?
Aspiration of blood from Corpora Cavernosa
Intracavernous injection of Phenylephrine
How to manage Stroke due to Sickle cell disease?
Tx —> Exchange transfusion Or simple transfusion if former not available
Important point of AML
1) Seen in adult
2) sxs of pancytopenia and RARELY seen HSM/LAD
4) DIC if subtype APML which shows Atypical promyelocytes on bone marrow bx
Name the vaccine given in Spenlectomy patient
1) Strep pnemonia
2) H influ
3) N meningitis
4) HAV HBV and TDap
How transfusion Transmitted bacteria occur and how does it present?
Due to platelets transfusion
Fever with low BP and tachycardia around 30 minutes after transfusion
When to consider HIT type 2?
Remember 4 indicators
If PLTs count reduce to ≥50% from baseline
Or
Arterial or Venous thrombosis
Or
Necrotic skin lesion at heparin injection sites
Or
Systematic Anaphylactic rxn after heparin
