Hematology / Oncology - Specific Findings Flashcards
PT
Tests function of common extrinsic coagulation pathway, factors I, II, V, VII, and X
PTT
Tests function of common intrinsic coagulation pathway, all factors EXCEPT for VII and XIII
Follicular Lymphoma - Gene Translocation
t(14;18) - translocation of heavy-chain Ig (14) and BCL-2 (18)
DIC - Lab Findings
Elevated D-dimer / decreased fibrinogen
Decreased factors V and VIII / elevated PT and PTT
Decreased platelet count
Schistocytes seen on smear - RBCs are damaged by passage through obstructed vessel lumen
Reed-Sternberg Cells
Classic finding in Hodgkin Lymphoma; neoplastic cells of B-cell origin
CD15+, CD30+
Bi-nucleated / bi-lobed with “Owl Eye” appearance
Burkitt Lymphoma - Gene Translocation
t(8;14) - translocation of c-myc (chromosome 8) and Ig heavy chain (chromosome 14)
Diffuse large B-cell lymphoma - Gene Translocation
t(14;18)
Mantle Cell Lymphoma - Gene Translocation
t(11;14) - translocation of cyclin D1 (chromosome 11) and Ig heavy chain (chromosome 14)
“Starry Sky”
Describes the appearance of lymph nodes seen in Burkitt’s lymphoma; characterized by sheets of lymphocytes interspersed with macrophages
Basophilic Stippling of RBCs
Seen in lead poisoning
Pb inhibits ribonucleases in RBCs causing accumulation of rRNA, which appears basophilic on smear
Burton Lines
Seen in lead poisoning
Evident at the metaphyses of long bones on X ray
Amyloidosis - Staining
Congo red stain shows amyloid (Ig light chain) deposits with apple green birefringence under polarized light
M-spike on serum protein electrophoresis
Represents high levels of monoclonal Ig light chain in the serum
Finding in Monoclonal Gammopathy of Undetermined Significance (<3g/dL) and Multiple Myeloma
Bence-Jones Protein
Monoclonal Ig light chain in the urine
Finding in multiple myeloma
Osmotic Fragility Test
Positive osmotic fragility test seen in Hereditary Spherocytosis
Which clotting factors are monitored by PT/INR?
Common & Extrinsic Pathway factors:
I II V VII X
Affected by Warfarin
Which clotting factors are monitored by PTT?
Common & Intrinsic Pathway Factors:
(All except VII and XIII)
Affected by Heparin
Prolonged PTT - NOT correctable by 1:1 mixing with FFP
Anti-phospholipid antibody syndrome (“Lupus anticoagulant”)
Which HLA type is associated with psoriatic arthritis, ankylosing spondylitis, arthritis of inflammatory bowel disease, and reactive arthritis?
HLA-B27
Which HLA types are associated with SLE?
HLA-DR2
HLA-DR3
Which HLA type is associated with rheumatoid arthritis?
HLA-DR4
Sunburst pattern on long bone X ray
Osteosarcoma
Which autoantibody is most specific for SLE? What other autoantibodies are seen?
anti-dsDNA is the most SPECIFIC
anti-nuclear antibodies (ANA)
anti-Smith antibodies
anti-cardiolipin antibodies - false positive on tests for syphilis, prolonged PTT
anti-histone antibodies - sensitive for drug-induced lupus
Libman-Sacks endocarditis
Wart-like (non-infectious) vegetations on both sides of a valve
Commonly seen in SLE
How do gout crystals look under microscopy?
Uric acid crystals from aspirated joint fluid are needle-shaped and negatively bi-refringent (yellow under parallel light, blue under perpendicular light)
M-spike on serum protein electrophoresis - IgG or IgA
Multiple Myeloma
M spike on serum protein electrophoresis - IgM
Waldenstrom macroglobulinemia
5 “Ps” - Painful abdomen, port-wine colored urine, polyneuropathy, pyschiatric disturbances, precipitated by drugs, alcohol, starvation
Acute Intermittent Porphyria
Deficiency of porphobilinogen deaminase with accumulation of porphobilinogen in blood and urine
“Soap bubble” on X-ray
Giant Cell Tumor - benign tumor of bone, usually seen at the epiphyseal ends of long bones (distal femur, proximal tibia)
Heinz Body
Precipitates of hemoglobin seen within the RBCs of patients with hemolytic anemia due to G6PD Deficiency upon exposure to oxidizing agents
TdT
Marker of pre-T and pre-B cells
Positive in acute lymphoblastic leukemia (ALL)
CD10
Marker of pre-B cells
Positive in acute B-ALL
Direct Coomb’s Test
i.e. used to diagnose warm agglutinin hemolysis
anti-Ig antibody is added to patient’s serum; if patient’s own RBCs are coated with Ig then agglutination occurs
Indirect Coomb’s Test
i.e. used to asses blood compatibility before transfusion
Normal RBCs are added to patient’s serum; RBCs will agglutinate if patient’s serum as anti-RBC surface Ig
Oat Cells
Neoplastic proliferation of neuroendocrine Kulchitsky cells; small, blue cells resembling lymphocytes but 2x bigger
Stain chromogranin A +
Target Cells
DDx = HALT
Heboglobin C Disease
Asplenia
Liver Disease
Thalassemias
Sarcoidosis - Lab findings
Elevated serum ACE levels
Elevated CD4 / CD8 ratio
Hypercalcemia
Sarcoidosis - Imaging findings
Bilateral hilar lymphadenopathy
Coarse reticular opacities
Sarcoidosis - Other associated clinical findings
Restrictive lung disease (interstitial fibrosis)
Erythema nodosum
Bell’s palsy
Uveitis
