Heme 3 Flashcards
Name (4) Long-term Complications of NonHodgkin Lymphoma and how to screen for them.
- Breast Cancers (Due to chest radiation) Annual Mammograms age 40
- CAD- Minimize Risk Factors (HTN, HLD Obesity)
- Hypothyroidism - Check TSH, neck radiation
- Depression, PTSD.- Screen
Patients with BRCA 1 or 2 mutations should be offered
Prophylactic Mastectomy.
Salpingo-oophorectomy for women > 35-40
- 26 yo Women presents with dry cough, low grade fever, night sweats and weightloss. She has lymphadenopathy in the supraclavicular area, cervical and axillary region. What is the next step in management?
- Management of a patient presenting with generalized Lymphadenopathy?
- Localized > 4 weeks. Next Step in Management?
- Excisional (take full node out) Biopsy of Supraclavicular Lymph Nodes.
- CBC and CXR. If normal RPR, HIV, HBsAg, PPD, Heterophile testing.
If all negative then biopsy. - Excisional Biopsy
61 yo M with 20 minutes of Slurred Speech, Episode of Blurry vision. Active 35 pack year Smoking hx.
Spleen tip Palpable on inspiration. Hematocrit 64%
Dx? Test?
Rx for Low risk and High risk thrombosis patients ?
Polycythemia Vera
Jak-2, low EPO levels (Suppressed Epo)
Rx: Phlebotomy and Aspirin
Those that are high risk require (old)
Myelosuppression with Hydroxyurea.
PV can convert to Myeloproliferative disorders/AML.
60 yo MAN, presents with Vague abdominal pain, fatigue, hepatosplenomegaly. WBC 45,000, Platelets 550,000 and there is evidence of Basophilia (9%)and Eosinophilia (10%).
Dx?
CML (Myeloproliferative Disorders have Basophilia and Eosinophilia
- Pt presents with Spherocytes, Anemia, Jaundice and Splenomagly?
What is next step in Management and Why? - What test confirms HS?
- Rx?
DAT or Coombs test to differentiate from Hereditary Spherocystosis and Autoimmune Hemolytic Anemia.
DAT is negative in HS
- Eosin-5-Maleimide Binding (Flow Cytometry) or Acidified Glycerol Lysis test
- Transfusion or if needed Splenectomy
Pt with 35 year smoking hx presents with Right Shoulder pain, Horner Syndrome and Paraesthesias of the of the C8-T2 region causing tingling in 4th and fiifth digit on the Right side. Dx?
Pancosat Tumor
Differential diagnosis of Thrombocytopenia:
- Preceding Viral Infection. No Microangiopathic hemolytic Anemia. No fever, No Neurological changes and No AKI. No increase in LDH, Bili. Dx?
- Microangiopathic Hemolytic Anemia, AKI, Neurological Changes, Increase in LDH, BIli
- Prodromal illness of Diarrhea, Abdominal Vomiting, Microangiopathic Hemolytic Anemia, AKI, increase in LDH, and Bili. No neuro Symptoms.
- ITP
- TTP
- HUS
Pt presents with Heavy Menstrual Bleeding and Epitaxis. Platelet Counts and Coagulation studies are normal.
Dx?
Test?
Rx for Mild Cases?
Rx for Severe Cases or patients under going surgery?
Von Willebrand disease (Muocutaneous bleeding)
Check Plasma von Willebrand Factor Antigen and Activity assays (Risoetin)
Rx is Desmopressin
Rx for Severe Cases give vWF
- Mild Thrombocytopenia within the first 2 days of Heparin Exposure. Dx? Management?
- Mild or Moderate Thrombocytopenia with or without DVT 5-10 days AFTER Heparin initiation. Dx?
- Develop of High-titer antibodies against Heparin-PF4 Complexes in ABSENCE of circulating Heparin. Occurs 5-19 days AFTER Heparin Cessation. Dx? Rx? Test?
- HIT Type 1 Non-immune. It resolves spontaneously. Plt count does not drop < 100,000. Do not discontinue Heparin.
- HIT Type 2 Immune Mediated due to PF4
at least 50% drop - Delayed-Onset HIT immune mediated due to high-titer Heparin PF4 complexes.
Direct thrombin inhibitor. (Agatroban), Blivirudin, Fondapurinux
Test: Serotonin Release Assay
Heparin Induced Platelet Aggregation
Assay
- Pt with Hodgkin lymphoma receiving chemotherapy receives emergency blood transfusion after an MVA and develops Fever, Rash, Profuse Diarrhea, Elevated LFTs and Lymphopenia. Dx? How to prevent this?
- Pt with IgA deficiency should receive what kind of red blood cells?
- Graft-Versus Host Disease.
Immunocompromised patients need to receive Irradiated Blood Products to Inactivate donor Lymphocytes BEFORE transfusion. - exclusion is HIV patients. - Washed red blood cells.
Pt presents with Recurrent Acute abdominal Pain with Constipation, Attacks of Dark Urine, Peripheral Neuropathy and Hyponatremia.
Dx?
Test?
Rx?
Acute Intermittent Porphyria (Attacks Precipitated by Starvation, Stress, Infection) Elevated Urinary Porphobilinogen (PBG) During an ACUTE ATTACK, And Alpha Aminoevulinic Acid
Rx: Glucose Loading and IV Hemin (Reconstitutes Heme in Liver.)
Pt treated for Breast Cancer 6 years with Anthracycline Develops Anemia, Thrombocytopenia and WBC 17,000. Smear Shows Polychromasia With Nucleated RBCs, Metamyelocytes and Large Nuclei, Prominenet Nucleoi with scant Cytoplasm. Dx?
Chemotherapy Induced Acute Myeloid Leukemia.
Pt treated with Chemotherapy agents are at risk for developing Myelodysplastic/Myeloproliferative Neoplasms and AML.
Rx for Bone Metastases ?
Denosumab (Osteonecrosis of Jaw, Hypocalcemia, Safe in Renal Function) and IV Bisphosphenates (Zoledronic Acid or Pamidronate).
Rx for Triple negative Invasive ductal Carcinoma with 4 involved Lymph Nodes.
Chemotherapy Followed by Radiation.