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Step 2 > Heme > Flashcards

Heme Flashcards

1
Q

Why are blood smears not effective for microcytosis

A

All are hypo chromic and can have target cells

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2
Q

What patients with anemia are transfused?

A

Symptomatic or low hct in elderly or heart diseased

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3
Q

Low ferritin microcytosis?

A

Iron deficiency

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4
Q

High iron microcytosis?

A

Sideroblastic

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5
Q

Normal iron microcytosis?

A

Thalassemia

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6
Q

Iron deficiency anemia unique lab features?

A

Increased rdw and increased platelet count

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7
Q

Sideroblastic unique lab features

A

Ringed blasts with Prussian blue

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8
Q

Thalessamia diagnosis test

A

Electrophoresis

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9
Q

First step in distinguishing macrocytic anemia

A

Peripheral blood smear to detect hypersegmented neutrophils

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10
Q

Classic neuropathy of b12 deficiency

A

Posterior column damage to position and vibratory sensation possibly causing ataxia

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11
Q

What test distinguishes b12 and folate deficiency

A

Mma is elevated in b12 only

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12
Q

What is a complication of b12 or folate deficiency

A

Hypokalemia

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13
Q

Sickle cell mutation?

A

Point mutation at position 6 of beta globin changes glutamic acid to valine

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14
Q

Diagnostic tests in scd

A

Initial: peripheral smear
Accurate: hb electrophoresis

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15
Q

Where do you see Howell jolly bodies

A

Scd

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16
Q

What lowers mortality in scd

A

Hydroxyurea + Abx with fever

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17
Q

Vaccine for asplenia in scd?

A

Pneumococcal

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18
Q

Test for aplastic crisis in scd? And tx?

A

Initial: reticulocyte count
Accurate: pcr for parvo b19 dna
Treat: IVIG

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19
Q

Treat hereditary spherocytosis

A

Chronic folic acid + splenectomy

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20
Q

Treating AIHA

A

Warm: steroids –> splenectomy –> IVIG –> Rituximab
Cold: stay warm –> Rituximab –> other immunosuppressive

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21
Q

G6pd presentation

A

African or Mediteranean male with sudden anemia after infection or dapsone/quinidine/sulfa/primaquine/nitrofurantoin/fava beans
Initial: Heinz bodies
Accurate: test g6pd level 1 to 2 months after hemolysis

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22
Q

What disease is worsened by platelet transfusion

A

Ttp and hus

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23
Q

PNH cause of death and treatment

A

Thrombosis (mesentaric or hepatic V)

Tx: steroids –> BM transplant (cure) –> Eculizumab to inactivate C5

24
Q

Inhibitor of JAK2

A

Ruxolitinib

25
Q

AML (4 things)

A

M3 gene (causes DIC, treat with ATRA)
Auer Rods
cr1517
myeloperoxidase

26
Q

Persistently elevated WBC count of all neutrophils

A

CML

27
Q

CML test + initial tx + cure

A

Accurate test: BCR-ABL (922) on PCR or FISH
Tx: TK inhibitor (imatinib)
Cure: BMT = never 1st therapy!

28
Q

Leukostasis rxn 1st step

A

Leukapheresis

29
Q

Classic abnormality of MDS

A

5q deletion

30
Q

Distinct lab abnormality of MDS

A

Pelger Huet cells (bilobed nucleus)

31
Q

Treating MDS

A

Lenalidomide for 5q deletion to decrease transfusion dependence
Azacitidine also decreases transfusions and increases survival

32
Q

Treating CLL

A 
Stage 0 (elevated WBC): None
Stage 1 (lymphadenopathy): none
Stage 2 (hepatosplenomegaly): none
Stage 3 (anemia), stage 4 (thrombocytopenia): fludarabine + cyclophosphamide + Rituximab
Fludarabine failure: Alemtuzumab
Refractory cases: Cyclophosphamide 
Mild cases in elderly: Chlorambucil
Severe infection: IVIG
AIHA/thrombocytopenia: prednisone
33
Q

Accurate test for hairy cell leukemia

A

Immunotyping by flow cytometry

34
Q

Treat hairy cell leukemia

A

Cladrabine or Pentostatin

35
Q

NHL initial test and severity correlation

A 
excisional biopsy (NOT needle aspiration)
High LDH indicates worsening severity
36
Q

Staging NHL

A

1: lymph node group
2: 2 or more nodes on 1 side of diaphragm
3: both sides of diaphragm
4: widespread disease

37
Q

NHL tx

A

Local (1a/2a): local radiation and small chemo dose

3+: CHOP (Cyclophosphamide/Adriamycin/Vincristine/Prednisone) + Rituximab

38
Q

HL

A

RS cells

Lymphocyte predominant is good for prognosis

39
Q

Treating stage 3 or 4 HL

A

ABVD: Adrimycin (doxorubicin)/Bleomycin/Vinblastine/Dacarbazine

40
Q

Radiation complications

A

Cancer (screen 8 years later), CAD

41
Q

What does the EF need to be for Adrimycin and how do you screen

A

> 50%

MUGA or nuclear vetriculogram

42
Q

4 presenting factors of Multiple Myeloma

A

Bone pain
Hyperuricemia (high turnover)
Anemia (bony infiltration)
Renal Failure (accumulated IG and Bence Jones)

43
Q

Diagnostics of MM

A 
Punched out lyric lesions
SPEP shows IgG or IgA spike
HyperCa
Bence JOnes
Rouloux formation
decreased AG due to IgG (cationic) increasing Cl and HCO3
44
Q

Why does urinary level of protein stay low in MM

A

Dipstick only measures albumin

45
Q

SPEP results

A

99% of those with an M spike do NOT have MM –> must do BM biopsy

46
Q

Waldenstrom Macroglobinuria (pathophys/sx/tx)

A

Increased IgM causes hyper viscosity
Lethargy/engorged eye vessels/mucosal bleeding
Plasmapheresis initially

47
Q

Bleeding disorders (platelet vs factor)

A

Superficial vs deep

48
Q

Initial management of mild bleeding

A

Prednisone

49
Q

Vaccines before splenectomy

A

Meningitis
H flu
Pneumococcus

50
Q

VWD dx and tx

A

Dx: normal platelet count, worsened by ASA, Ristocetin +
Tx: DDAVP

51
Q

Hemophilia dx

A

Delayed joint or muscle bleeding in a male child, prolonged PTT

52
Q

Confirming HIT

A

ELISA for platelet factor 4 (PF4) ABs or the serotonin release assay

53
Q

Tx for HIT after stopping heparin containing products

A

Administer direct thrombin inhibitors (Argatroban, Lepirudin, Biivalirudin, Fondaprinux) –> administer Warfarin after

54
Q

Most common cause of hyper coagulation

A

Factor V Leiden

55
Q

Tx for Anti Phospholipid Syndrome

A

Possibly lifetime anticoagulation

56
Q

Initial evaluation of anemia

A

CNBC

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