Hematology/ Oncology Flashcards
Macrocytic Anemia MCV
> 100
Causes of nonmegaloblastic Anemia
Liver disease
EtOH
Drugs
Metabolic
Causes of Megaloblastic Anemia
B12 or Folate deficiency
Drugs that cause a nonmegaloblastic anemia
5FU
Ara-C
AZT, Zidovudine
Causes of Microcytic Anemia
Thalassemia
Iron Deficiency
Chronic Inflammation
IDA
Thalassemia Hx, Dx, Tx
Anemia Dx: Iron studies normal Hgb Electropheresis find any other hemoglobin other than normal = beta thalassemia Tx: beta-transfusion for iron overload use defuroxamine
Normocytic anemia Dx
LDH elevated
Bilirubin Elevated
Haptoglobin Decreased
Means hemolysis
G6PD deficiency Hx, Dx
African American male taking Dapsone, TMP-SMX, Nitrofurantoin
Dx-Heinz bodies, Bite cells
Tx: Supportive
Avoid Stress
Sickle Cell Vasoocclusive Crises Dx and Tx
Acute chest-MI Brain CVA- Exchange transfusion Priapism Dx: Hgb electrophoresis Smear- Sickled Cells Long term treatment hydroxyurea Acute- IVF, pain meds, O2
AHI Coombs test
IgM-cold type caused by mycoplasma and mono
IgG warm Type-AI, CA,
use steroids, rituximab, splenectomy
AML M3 Variant Treatment
All Transretnoic Acid
presence of Auer Rods
CML bone marrow biopsy finding
Philadelphia Chromosome t(9,22) BCR-ABL
Non-tender lymphadenopathy indicates?
Cancer
Hodgkins with B symptoms presentation
Night Sweats
Fever
Weight loss
LN pain with ingestion of alcohol
Hodgkins Tx
ABVD or BEACOPP
Non-Hodgkins Tx
Rituximab or R-CHOP
Reed Sternberg cells found in what disease and what are the markers
CD 15 , CD 30
Hodgkins
Adriamycin, Doxirubicin AE
Cardiotoxicity
Vincristine/Vinblastine
Peripheral Neuropathy
Bleomycin AE
Pulm Fibrosis
Cisplatin AE
Ototoxicity
Nephrotoxicity
Cyclophosphamide AE
Hemorrhagic cystitis
which is worse hodgkins or non-hodgkins
Non-hodgkins
Plasma cell disorder presentation (Multiple Myeloma) CRAB
Hypercalcemia
Renal Failure
Anemia
Bone Pain
Multiple Myeloma Dx
Spep=M spike
Upep=M-Spike
Skeletal changes
BMBx->10% Plasma
Multiple Myeloma Tx
> 70, no donor=chemo
<70, donor-Stem cell transplant
MGUS Hx, Dx, Tx
Asx
Dx- online Spep Positive
BMBx <10% Plasma cells
Tx: Monitor and observe
Waldenstroms Hx, Dx, Tx
Hyperviscosity with constitutional symptoms Dx: Spep positive Upep and skeletal negative BMBx- >10% plasma Tx: Rituximab Plasampheresis
TTP presentation
FATRN
Fever Anemia (microangiopathic) Thrombocytopenia Renal Failure Neuro Sxs
TTP Dx
Decreased platelets
PT/PTT normal
Fibrinogen Normal
D-Dimer Normal
TTP Tx
Exchange transfusion
DIC Dx
Platelets decreased
PT/PTT increased
D-Dimer Increased
Fibrinogen Decreased
Elevated T. bili LDH Decreased Haptoglobin
Hemolysis
perform Smear
Folate Deficiency Presentation
Pt: Tea and Toast Diet
Dx: Folate level
MMA normal
Tx: Folic Acid
B12 Deficiency Presentation
Pt: Neuro Sxs Strict vegan Dx: Decreased B12 increased MMA Schillings Test Tx: PO- nutritional deficiency IM B12- Impaired Absorption
Schillings test
Give IM B12
then oral B12 if
Urine (+) B12-nutritional def
Urine (-) B12- Absorption
Iron Deficiency Anemia Presentation
Pt: Slow bleeds Old Male (+) Fecal Occult Blood Test Woman W/ Mennorrhagia Dx: Decreased Fe, Ferritin Increased TIBC Tx: replace, 324mg Iron Stool Softeners
Anemia of Chronic Disease Presentation
Pt: Chronic Inflammatory Disease (SLE, RA) Usually Asx Hgb >8 Dx: Increased Ferritin Decreased TIBC, Fe Tx: Usually nothing maybe EPO
Heriditary Spherocytosis Presentation
(Spectrin, ankryin, Pallidin) Pt: Hemolysis Smear shows Spherocytes Dx: Smear Osmotic Fragility Test Tx: Splenectomy
Paroxysmal Nocturnal Hemolglobinuria Presentation
Deficiency PIGA gene
Dx: Flow cytometry showing deficiency CD 55
Tx: Supportive
Ecluzimab
AML presentation
Pt: Acute 67 y.o. Exposure- Benzine, Radiation CML: Blast crisis transformation Dx: Smear Bone marrow Bx->20% blasts \+ Myeloperoxidase non-M3 Variant-Chemo
CML presentation
Pt: Asx with increase white count
Dx: Bone marrow Bx- Philadelphia Chromosome t(9.22) BCR-ABL
Tx: Imatinib
can transform into AML (Blast Crisis)
ALL presentation
Pt: Acute, Young Patient Dx: Smear BMBx >20% blasts (Positive Tdt) Tx: Chemo ppx CNS with ARA-C
CLL Presentation
Pt: Chronic Older Patient Dx: Diff BMBx Tx: >65 +Asx= no treatment >65 + Sx = Chemo <65 +Donor = Stem Cell Transplant
Von Willebrand Disease Presentation
Decreased vWF and Factor 8 Pt: Platelet bleeding (superficial-Gums, vagina, petechiae) Normal platelet count Dx: vWF Tx: DDVAP Factor 8
DIC Presentation
Very sick patient
Sepsis, ICU
Shock
Heparin Induced Thrombocytopenia Tx
Stop heparin
Start Argatoban
Bridge to Warfarin
HIT Presentation
Presents 7-14 days after starting
Idiopathi Thrombocytopenic Purpura Presentation, Tx
Usually a Female with AI Diagnosis of exclusion Tx: Steroids-Acute Critically Low- IVIg Splenectomy-Refractory Rescue therapy-Rituximab
