Hematology/Oncology Flashcards
folate deficiency path
leafy greans 3-6 wk stores pregnancy
folate deficiency pt
tea + toast diet EtOH pregnancy
folate deficiency dx
folic acid levels decreased normal methylmalonic acid increase homocysteine (not done)
folate deficiency tx
folate, 1mg po
B12 deficiency path
3-10 yrs storage animal products neuro symptoms
B12 deficiency pt
strict vegan pernicious anemia Crohn’s disease gastric bypass
B12 deficiency dx
B12 levels decreased increase homocysteine (don’t check) increase methylmalonic acid
B12 deficiency tx
B12 - PO = nutritional - IM = impaired absorption
B12 deficiency f/u
never choose Schilling test prolonged deficiency is loss of DCMLS (proprioception, Vibration)
pernicious anemia path
antibodies against parietal cells no intrinsic factor, no B12 absorption
pernicious anemia pt
weakness, sore tongue, paresthesias
pernicious anemia dx
Ab-intrinsic factor Ab-Anti-parietal
pernicious anemia tx
IM B12 cannot treat pernicious anemia
pernicious anemia f/u
gastric cancer
non-megaloblastic anemias
liver disease EtOH medications (AZT, HAART, 5-FU, ARA-C) Metabolic syndrome - Lesch-Nyhan - Hereditary orotic aciduria
iron deficiency anemia path
slow bleed consumption of iron stores
iron deficiency anemia pt
woman = menorrhagia man = colon cancer
iron deficiency anemia dx
iron studies - iron decrease - ferritin decrease - TIBC increase best: Bone marrow bx (rarely needed)
iron deficiency anemia tx
iron 2-6wks for anemia iron 2-6mo for iron stores
anemia of chronic disease path
chronic inflammatory disease
anemia of chronic disease pt
anemia
anemia of chronic disease dx
iron studies - iron decrease - ferritin increase - TIBC decrease best: bone marrow bx (rarely needed)
anemia of chronic disease tx
give EPO treat inflammatory disease
thalassemia path
genetic mutations, loss of genes, 4alpha, 2beta
thalassemia pt
asx (1 α deleted) minor (2alpha deleted, 1beta deleted) major (3alpha deleted, 2beta deleted) dead (4alpha)
thalassemia dx
iron normal ferritin normal TIBC normal Hgb electrophoresis
thalassemia tx
minor = do nothing major = transfusion = deferoxamine
sideroblastic path
irreversible, B6, cancer Reversible, Lead, EtOH, copper, isoniazid
sideroblastic pt
anemia
sideroblastic dx
iron increase (done) ferritin normal TIBC normal Best: bone marrow bx (ringed sideroblasts)
sideroblastic tx
remove exposure, give back B6, try to treat cancer
sickle cell path
autosomal recessive, HgbSS valine for glutamic acid sickle under stress - acidosis - dehydration
sickle cell pt
emergency acute - acute chest = MI, CHF - acute brain = CVA - priapism hospitalize acute - vaso-occlusive crisis chronic - asplenia - avascular necrosis - osteomyelitis
sickle cell dx
1st: smear = sickled cells - use 1st time and crisis best: Hgb electrophoresis (SC, SS) - use 1st time only
sickle cell tx
hydroxyurea = increase HgbF, decrease HgbSS IVF, O2, pain control (hospital) exchange transfusion (emergency)
sickle cell f/u
iron overload (deferoxamine)
G6PD deficiency path
decrease G6PD hypoxemic = hemolysis
G6PD deficiency pt
African American males Dapsone, TMP-SMX, nitrofurantoin
G6PD deficiency dx
1st: smear = bite cells, Heinz bodies best: G6PD levels 6-8wks
G6PD deficiency tx
supportive avoid stress
hereditary spherocytosis path
deficiency in Spectrin, Ankrin, Pallidin
hereditary spherocytosis pt
hemolysis, spherocytes
hereditary spherocytosis dx
1st smear = spherocytes best = osmotic fragility
hereditary spherocytosis tx
folate + Fe splenectomy
paroxysmal nocturnal hemoglobinuria path
PIG-A deficiency
paroxysmal nocturnal hemoglobinuria pt
paroxysmal (once in a while) nocturnal (happens at night) hemoglobinuria (dark urine) + abdominal vein thrombosis
paroxysmal nocturnal hemoglobinuria dx
flow cytometry decrease CD55, decrease CD59
paroxysmal nocturnal hemoglobinuria tx
biologics (eculizumab)
warm autoimmune hemolytic anemia path
IgG (cancer, drugs, rheum)
warm autoimmune hemolytic anemia pt
hemolysis everywhere
warm autoimmune hemolytic anemia dx
Coomb’s test IgG
warm autoimmune hemolytic anemia tx
1st line: steroids recurrent: splenectomy severe: IVIG refractory to splenectomy: rituximab
cold autoimmune hemolytic anemia path
IgM (mycoplasma, mono)
cold autoimmune hemolytic anemia pt
hemolysis in the cold - tips of digits - tips of nose
cold autoimmune hemolytic anemia dx
1st: Coomb’s test negative for IgG
cold autoimmune hemolytic anemia tx
avoid the cold refractory: rituximab
microangiopathic hemolytic anemia path
schistocytes = MAHA
microangiopathic hemolytic anemia pt
TTP vs DIC
microangiopathic hemolytic anemia dx
decrease Hgb (both) decrease plt (both) decrease fibrinogen (DIC) increase INR (DIC) increase split products (DIC)
acute myelogenous leukemia path
acute = blasts myelogenous = neutrophils leukemia = cancer in the blood
acute myelogenous leukemia pt
acute, age 67 exposure: benzene radiation CML: blast crisis
acute myelogenous leukemia dx
1st: smear = blasts BM bx > 20% blasts + myeloperoxidase
acute myelogenous leukemia tx
M3: Vit A (auer rods on bx) no M3 = chemo
acute lymphocytic leukemia path
acute = blasts lymphocytic = leukocytes leukemia = cancer in the blood
acute lymphocytic leukemia pt
acute, age 7
acute lymphocytic leukemia dx
1st: smear = blasts BM b >20% blasts + cALLa and + TdT
acute lymphocytic leukemia tx
chemo ppx CNS ARA-C+/- radiation
chronic myelogenous leukemia path
chronic = mature cells myelogneous = neutrophils leukemia = cancer in the blood
chronic myelogenous leukemia pt
chronic, age 47
chronic myelogenous leukemia dx
diff (way more cells than should be) BM bx = philadelphia + t(9, 22) + BCR-ABL
chronic lymphocytic leukemia path
chronic = mature cells lymphocytic = lymphocytes leukemia = cancer in the blood
chronic lymphocytic leukemia pt
chronic, age 87
chronic lymphocytic leukemia dx
diff (way more cells than should be) BM bx
chronic lymphocytic leukemia tx
> 65 + asx = nothing > 65 + sx = chemo < 65 + donor = HSCT
Hodgkin’s lymphoma path
contiguous spread usually B sxs Pel-Ebstein fevers painful lymphadenopathy on EtOH
Hodgkin’s lymphoma pt
nontender lymphadenopathy +/- B sxs
Hodgkin’s lymphoma dx
excisional biopsy + reed Sternberg cells stage = PET/CT or CT chest/abd/pelvis
Non-hodgkin’s lymphoma path
hematogenous spread usually NO B sxs Burkett’s starry sky extra nodal disease
non-hodgkin’s lymphoma pt
nontender lymphadenopathy + sxs
non-hodgkin’s lymphoma dx
excisional biopsy NO Reed-Sternberg cells stage = PET/CT or CT chest/abd/pelvis
non-hodgkin’s lymphoma tx
IIA or better = radiation IIB or worse = chemo - CHOP-R - CNS ppx
cancer staging: I
1 lymph node
cancer staging: II
>/= 2 lymph nodes same side diaphragm
cancer staging: III
>/= 2 lymph nodes opposite side diaphragm
cancer staging: IV
mets
chemoman
Cisplatin = ototoxicity
bleomycin = pulmonary fibrosis
Adriamycin/Doxarubicin = cardiac toxicity
Vincristine/Vinblastine = peripheral neuropathy
Cisplatin = nephrotoxicity
Cyclophosphamide = hemorrhagic cystitis

multiple myeloma path
IgG
monoclonal expansional plasma cells
- Ig = recurrent infxn
- Bence-Jones = AKI
- osteoclasts = lytic lesions
multiple myeloma pt
>70s (old men)
CRAB
- hyperCalcemia
- Renal failure
- Anemia
- Bone pain, lytic lesions
multiple myeloma dx
Spep +
Upep +
skeletal survey +
BM bx > 10% plasma
multiple myeloma tx
>70, no donor: chemo
<70, + donor: HSCT
multiple myeloma f/u
melphalan + steroids
- thalidomide
- bortezomib
MGUS path
IgG
early myeloma
MGUS pt
>85
no CRAB
MGUS dx
Spep +
Upep -
skeletal survey -
BM bx <10% plasma
MGUS tx
watch and wait
converts to multiple myelmoa 2%/yr
Waldenstrom’s path
IgM
Waldenstrom’s pt
hyperviscosity syndrome
constitutional symptoms
Waldenstrom’s dx
Spep +
Upep -
skeletal survey -
BM Bx > 10% lymphoma
Waldenstrom’s tx
rituximab - chemo
hyperviscosity = plasmapheresis
Waldenstrom’s f/u
blast crisis
trombophilic disorders
Factor V leiden = mutation
prothrombin 20210A = mutation
Protein C def = level
Protein S def = level
antithrombin def = level
who gets warfarin in a DVT: all patients
provoked 3mo
unprovoked 6mo
recurrence lifetime
who gets warfarin in DVT: other options
LMWH in cancer
NOACs = warfarin
DVT ppx: risk
trauma, surgery (10x)
LMWH ppx
LMWH -> warfarin
DVT ppx: cancer
LMWH ppx
LMWH tx (no warfarin in met cancer)
APLA path
lupus ‘anticoagulant’
hypercoaguability in artery and veins
APLA pt
lupus +
arterial clots AND venous clots
APLA dx
russel viper venom assay
APLA tx
warfarin goal 2-3
failure meanse increase INR goal
TTP path
hyaline clots
ADAMTS-13 deficiency
TTP pt
Fever
Anemia
Thrombocytopenia
Renal failure
Neuro symptoms
TTP dx
CBC - decrease plt
Smear - schistocytes
PT/PTT - normal
fibrinogen - normal
D-dimer - normal
TTP tx
exchange transfusion
TTP f/u
NEVER platelets
DIC path
fibrin clots
tremendous catastrophic injury
DIC pt
sick as shit
sepsis, ICU, shock, then they start bleeding
DIC dx
CBC - decrease platelets
smear - schistocytes
PT/PTT - increase
fibrinogen - decrease
D-dimer - increase
DIC tx
fix underlying disease
give blood products
- decrease fibrinogin = cryo
- increase INR = FFB
- decrease platelets = platelets
- decrease Hgb = blood
HIT path
antibodies to platelets
HIT pt
heparin products administered
7-14d
platelets very decreased ~50%
new clots
HIT dx
antiplatelet factor 4 ELISA +
confirm with serotonin release assay
HIT tx
stop heparin
argatroban -> warfarin INR 2-3
ITP path
antibodies to platelets
splenic destruction
ITP pt
woman and autoimmune disease
decrease platelets
ITP dx
dx of exclusion
ITP tx
steroids
IVIG
splenectomy
rituximab
Von Willebrand path
deficiency of vWD
autosomal dominant
most common bleeding disorder
Von Willebrand pt
platelet bleed, normal count
(can have factor VIII def)
Von Willebrand dx
1st: CBC = normal count
Best: vWF assay
may have increase PTT from factor VIII deficiency
Von Willebrand tx
DDAVP
other platelet bleed normal count
Bernard-Soulier - glycoprotein Ib
Glanzmann’s - glyco IIb-IIIa
Drugs - ASA, clopidogrel, abciximab
uremia - CKD
hemophilia path
x-linked disorder of..
factor VIII (hemophilia A)
factor IX (hemophilia B)
hemophilia pt
hemarthrosis
bruises easy
hemophilia dx
Increase PTT, can have increase PT or Increase iNR
mixing studies (corrects)
factor levels
hemophilia tx
factors whent hey bleed (short term)
hemophilia f/u
may develop inhibitors that will not correct with mixing studies
antiphoshoplipid antibody syndrome path
lupus
antiphospholipid antibody pt
bleeding AND clotting
hemarthrosis (bleeding)
arterial thrombosis (clotting)
antiphospholipid antibody dx
PT/PTT/INR
mixing studies (does not correct)
viper venom assay
antiphospholipid antibody tx
treat lupus
heparin to warfarin bridge for APLA
acquired factor deficiency path
liver dysfunction, warfarin, Vit K deficiency
acquried factor deficiency pt
long ICU stay
on warfarin
has cirrhosis
acquired factor deficiency dx
PT/PTT/INR
acquired factor deficiency tx
vitamin K