Hematology/Oncology Flashcards
Causes of ITP
1) Idiopathic
2) HIV
3) SLE
4) CLL
5) Hep C
6) H. pyloir
Rule out HIV before starting treatment
Test used to measure acquired platelet dysfunction with a normal platelet count
Platelet Function Analyzer-100
A rapid screening test, has replaced bleeding time testing
Treatment for MDS to prevent progression to AML in -5q subtype
Lenalidomide
TKIs for treatment of CML (t9:22) can cause what EKG finding?
Prolonged QT, monitor with serial EKGs
Nonneoplastic causes of eosinophilia
CHINA C: Collagen vascular disease H: Helminthic infection I: Idiopathic N: Neoplasia (lymphoma, myeloproliferative) A: Allergy/Atopy/Asthma
Hypereosiniophilic syndrome
Moderate eosinophilia and end-organ damage commonly affecting: skin, lungs, GI, CV (restrictive CM )
R/o secondary causes of HES
What population can you not use a d-dimer in reliably to exclude VTE?
pregnant patients
Emergent reversal agent for vit K antagonists
Four-factor prothrombin complex concentrate (4f-PCC)
Contains II, VII, IX, and X as a lyophilized powder, quickly administered and effective >90% of the time
Plasma takes longer and is not indicated in major bleeding episodes 2/2 Vit K antagonists
Timeframe for delayed hemolytic transfusion reaction (DHTR)
7 to 14 days
Usually occurs as anamnestic antibody response to previous erythrocyte (non-ABO) antigen sensitization
Obtain DAT, LDH, Bili, and reticulocyte count to evaluate further
Cause of pure red cell aplasia in SCD?
Parvovirus B19
Can cause transient aplastic crisis
Triggers of G6PD
1) Chloroquine
2) Sulfonamides
3) Rasburicase
4) Dapsone
5) Phenazopyridine
Features of Waldenstrom macroglobulinemia
Indolent B-cell lymphoma
- elevated M spike (> 3 g/dL M protein)
- elevated gamma gap (>4)
- “B symptoms”
- peripheral neuopathy (antimyelin-associated glycoprotein)
- hyperviscosity symptoms (blurred vision, HA, vertigo)
- HSM, lymphadenopathy, anemia
- Send serum protein electrophoresis
- BMB with lymphoplasmacytic infiltrate (>10% clonal lymphoplasmacytic cells, differentiating it from MGUS)
Testing indicated after diagnosis of smoldering multiple myeloma
Whole-body MRI to look for lytic lesions
Smoldering MM has >10% plasma clonal cells in BM, >3 g/dL of M protein level, with no other MM-related signs or symptoms (normal Ca, renal function).
Reversal agent for dabigatran
Idarucizumab
Indicated for reversal for severe/life threatening bleeding, emergency surgery
Pre-operative hemoglobin goal for SCD patients (low to moderate risk surgery)
10 g/dL
Simple transfusion is equivalent to exchange transfusion pre-operatively, and is preferred given less risk and cost
Negative PERC, is d-dimer or imaging required?
No.
Do not order imaging or d-dimer
PERC criteria age <50 HR <100 O2 >95% on RA - No hemoptysis - No estrogen use - No previous DVT/PE - No unilateral leg swelling - No surgery or trauma requiring hospitalization within the last 4 weeks
Features of PNH
Membrane-bound protein loss leads to sensitivity to complement-mediated lysis (defective PIGA gene)
1) Pancytopenia
2) Intravascular hemolysis
3) Hemoglobinuria
4) Nonspecific abdominal pain
5) Thrombotic complications - Portal venous system (budd-chiari), sagittal veins in CNS
6) Increased risk of transformation to MDS or Acute Leukemia
Eval with flow cytometry (CD55/CD59)
ALL survivors (childhood) are at increased risk for what as adults?
Metabolic Syndrome
Folate vs. cobalamin deficiency
Folate - short lifespan (poorly stored), associated with diets low in green, leafy vegetables. Associate with alcoholism.
Features of cobalamin deficiency
Cobalamin - long lifespan (efficiently stored). Not usually associated with dietary inadequacy and NOT associated with alcoholism.
Pancytopenia, macrocytic erythrocytes, hypersegmented neutrophils
Can see intramedullary hemolysis
