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Medicine Clerkship > Heme > Flashcards

Heme Flashcards

1
Q

How to work up microcytic anemia?

A

Ferritin, fe, %sat, TIBC

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2
Q

How to work up normocytic anemia?

A

T.bili/direct bili
LDH
Haptoglobin

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3
Q

How to work up macrocytic anemia?

A

Megaloblastic vs nonmegaloblastic

If megaloblastic, get b12 folate mma.

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4
Q

Causes of nonmegaloblastic macrocytic anemia?

A

Liver disease, etoh, drugs (haart, 5fu), metabolic (lesch-nyhan, orotic aciduria).

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5
Q

Neurologic side effects of B12 deficiency?

A

DCML destroyed – loss of proprioception. Irreversible.

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6
Q

Thalassemia

A

Problem in globin creation.
Alpha thalassemia (1 missing=asx, 2 missing = mild, 3 missing = severe, 4 missing = hydrops fetalis)
Beta-thalassemia (1 missing mild, 2 missing severe)

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7
Q

How to diagnose thalassemia? How to distinguish between alpha and beta thal?

A

Hemoglobin electrophoresis. Beta thalassemia has weird hemoglobins (HbA2, HbF). Alpha thalassemia is a diagnosis of exclusion.

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8
Q

How to treat thalassemia minor and thalassemia major?

A

Minor- no treatment

Major – transfuse, be careful about iron overload. Give desferoxamine.

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9
Q

Causes of sideroblastic anemia

A

B6 deficiency, cancer, MDS – reversible

Reversible forms: EtoH, lead, low copper.

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10
Q

Sickle Cell anemia diagnosis?

A

Do a hemoglobin electrophoresis. In a crisis? Look at smear for sickling.

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11
Q

How to treat sickle cell crisis?

A

IVF, O2, pain control.

If priapism, acute chest, acute brain? Exchange transfusion

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12
Q

G6PD Deficiency

A

Oxidative stress caused by drugs, fava beans, etc causes rbc lysis.

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13
Q

Cells in G6PD

A

Heinz bodies leading to bite cells

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14
Q

How to diagnose G6PD deficiency?

A

Look at G6PD levels 6-8 weeks after event. Can’t check it during hemolysis.

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15
Q

Hereditary spherocytosis

A

Defect in ankyrin or spectryn, loss of central pallor. Hemolyzed in spleen.

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16
Q

How to treat hereditary spherocytosis

A

IVIG, splenectomy, folate, iron

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17
Q

How to treat warm hemolysis?

A

Steroids or eculizumab

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18
Q

PNH

A

Lack DAF, complement fixation during the night leads to intravascular hemolysis. Cells are CD55 negative. Platelets

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19
Q

Presenting signs of chronic leukemia

A

Increased white count, smear normal. Patient usually asymptomatic

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20
Q

Presenting signs of acute leukemia

A

Anemia, bleeding, fevers, bone pain. Younger patients.

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21
Q

AML

A

Seen in patients in their late 20’s usually. Can go into DIC, have auer rods. Show myeloperoxidate. Treat M3 with ATRA. Otherwise with chemo

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22
Q

ALL

A

Seen in young kids and downs syndrome.

Bone marrow biopsy reveals >20% blasts stain with tdt. Treat with chemo, make sure to give prophylaxis with AraC

23
Q

CML

A

Patient is middle aged, CBC shows neutrophils. 9,22 translocation treat with gleevec.

Can go into blast crisis which is a killer

24
Q

CLL

A

Seen in old men, chronic

Treatment is for men

25
Q

Lymphoma presenting symptoms

A

Nontender lymphadenopathy +/- B symptoms (fever, weight loss, night sweats)

26
Q

How to work up possible lymphoma?

A

Excisional biopsy

27
Q

4 possible results of excisional ln biopsy

A

Another cancer = met
Nothing = fungus, bacteria, TB
+RS cells = Hodgkins
-RS cells = NHL

28
Q

Next step after diagnosing lymphoma?

A

Stage by CXR, CT abd and pelvis or pet ct, bone marrow biopsy

29
Q

How to treat based on stage

A

Stage 2a or better, radiation

Stage 2b or worse, chemo

30
Q

How to stage

A

Stage 1 = 1 LN
IIA = 2+ LN on same side of diaphragm
III= 2+ on both sides of diaphragm
IV = mets

31
Q

Hodgkins lymphoma

A 
\+ b symptoms
\+ RS cells
Contiguous spreading
Pel-Epstein: fevers that come and go
Alcohol makes LN painful
32
Q

How to treat hodgkins lymphoma

A

ABVD or BEACOPP

33
Q

Nonhodgkins lymphoma

A 
- B symptoms
Usually diagnosed at 2b or worse
Hematogenous spreading
Burkitt's -> starry sky. 
Extranodal disease
34
Q

How to treat nonhodgkins

A

Tx with CHOPPER w/ CNS Ppx

35
Q

Primary hemostasis

A

Tissue factor exposed, binds vWF, then binds GP1B, then ADP receptor binds ADP, then Gp2b/3a binds fibrinogen, gets cross linked to fibrin

36
Q

Secondary hemostasis

A

XII, XI, IX, VIII, X, thrombinogen -Thrombin, fibrinogen fibrin

37
Q

Factor trouble leads to

A

Deep bleeding, prolonged bleeding after surgery. Hemarthroses

38
Q

Platelet dysfunction leads to

A

Petechiae, gums, vaginal bleeding

39
Q

Von Willibrand Disease

A

Defect in VWF so problem with ptt, bleeding time
Because of factor 8 insufficiency too.

Tx with DDAVP.

40
Q

Bernard soulier

Glansmann’s

A

Defect in GP1B

Gp2b3a

41
Q

HIT

A

5-7 days post heparin platelets drop by 50% due to heparin platelet factor 4 immune complex formation.
Confirm with HIT antibody.
Tx by switching to argatroban

42
Q

Time course for HIT if not heparin naive?

A

1-2 days. much faster than 5-7 days

43
Q

TTP

A

Defect in ADAMSTS13 which cleaves VWF multimers. Decrease in platelets. Causes renal failure, AMS, hemolytic anemia, fever.

44
Q

Treatment for TTP

A

Exchange transfusion. NEVER GIVE PLATELETS.

45
Q

ITP

A

Woman, diagnoses of exclusion, IVIG if acute, long term? Steroids or splenectomy.

46
Q

DIC

A

You know this

47
Q

Acquired factor disease

A

Due to liver disease or vitamin D deficiency. Increased PT PTT INR. Give K, if doesn’t correct? then liver disease.

48
Q

How to work up clotting diseases?

A

Factor 5 Leiden mutation, Prothrombin G20210A mutation, Protein C protein S, atIII levels, Lupus anticoagulant

49
Q

Multiple myeloma

A

Recurrent infections, lytic bone lesions, renal failure.

Work up with SPEP, UPEP, Skeletal survey.

Confirm with BMBX >10% plasma cells. Treat if

50
Q

MGUS

A

+Protein gap but

51
Q

Sxs of multple myeloma

A

Calcemia
Renal failure
Anemia
Bone pain

52
Q

Waldenstroms

A

IGM secretion, hyperviscosity w/stroke, MI.

SPEP is positive
UPEP is negative
SS is negative
BMBX is >10% lymphocytes

53
Q

Waldenstrom’s Bone Marrow Biopsy

A

BMBX>10%

Medicine Clerkship (12 decks)

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