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Hematology, oncology > heme > Flashcards

heme Flashcards

1
Q

lymphoid cells

A

B lymphocytes, T lymphocytes, NK cells

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2
Q

usual exclusion criteria for HCT

A

age (>70 years old), uncontrolled infection, cardiac, pulmonary, liver or renal dysfunction, and/or psychosocial variables.

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3
Q

medical conditions that predispose people to bleeding

A 
hypothyroidism
cancer
liver disease
kidney disease
connective tissue disease
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4
Q

When do you use cryoprecipitate?

A

severe hypofibrinogenemia, usually arising as a consequence of disseminated intravascular coagulation (DIC) or liver failure

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5
Q

what is the reversal agent for dabigatran?

A

Idarucizumab

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6
Q

IVIG side effect profile

A

numerous adverse effects, including anaphylaxis, serum sickness, kidney failure, hypertension, and headache

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7
Q

what is cryoprecipitate?

A

manufactured from fresh frozen plasma and contains fibrinogen in a more concentrated form.

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8
Q

only clotting factor not produced in the liver

A

factor VIII

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9
Q

normal PT

A

11 to 13 seconds

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10
Q

normal PTT

A

25 to 35 seconds

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11
Q

inherited thrombophilias

A 
factor V leiden (50%)  
protein C deficiency 
protein S deficiency  
antithrombin deficiency  
prothrombin gene mutation
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12
Q

Indications for thrombophilia workup

A

At least one first degree relative with documented VTE before the age of 45 years
Younger than 45
Recurrent thrombosis
Thrombosis in multiple venous sites or in unusual vascular beds (eg, portal, hepatic, mesenteric, or cerebral veins)

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13
Q

acronym for malignancies associated with polycythemia

A 
PHUCK
Pheo
Hepatoma
Uterine leiomyoma
Cerebellar something
Kidneys
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14
Q

Conditions where you see spherocytes

A

All hemolytic anemias to some degree
ONLY spherocytes in warm AIHA
hereditary

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15
Q

target cells seen in

A

1) thalassemias
2) liver disease
3) some other condition?

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16
Q

only indication for hypertransfusion in sickle cell

A

stroke

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17
Q

indication for transfusion in SCD

A

1) surgery, transfuse to hgb to 10
2) Acute chest syndrome
3) Stroke
4) severe, symptomatic anemia

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18
Q

how many lobes can a neutrophil have

A

5 or 6 (confirm)

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19
Q

saturation threshold where you should worry about hereditary hemochromatosis

A

45%

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20
Q

conditions where you commonly see high iron

A 
Liver disease (NAFLD)
HLH
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21
Q

best screening test for hemochromatosis

A

transferrin saturation

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22
Q

rouleaux formations

A

are giant. don’t overcall it.

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23
Q

ITP physiology

A

increased platelet destruction + *decreased production

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24
Q

why do patients with liver disease have low platelets

A

Multi factorial — reduced TPO levels + portal hypertension

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25
Q

2 meds that cause cobalamin deficiency

A

1) metformin

2) PPIs

26
Q

what happens when you correct b12 deficiency with folic acid

A

corrects anemia but not neurologic stuff

27
Q

vitamin k dependent clotting factors

A

factors II, VII, IX, X, proteins C and S

28
Q

PT measures what pathway in coagulation cascade

A

extrinsic

29
Q

PTT measures what pathway in coagulation cascade

A

intrinsic

30
Q

warfarin mechanism

A

Works by blocking an enzyme called vitamin K epoxide reductase that reactivates vitamin K1. Without sufficient active vitamin K1, clotting factors II, VII, IX, and X have decreased clotting ability. The anticlotting protein C and protein S are also inhibited but to a lesser degree.

31
Q

DIC labs

A

PT/PTT + d-dimer + fibrinogen

32
Q

what is d-dimer a measure of

A

fibrinolysis

33
Q

what is von willebrand factor

A

protein that binds to factor VIII and is important in platelet adhesion to wound sites.

34
Q

general threshold for transfusing cryoprecipitate

A

Fibrinogen <100

35
Q

components of FFP

A
  • All of the clotting factors,
  • fibrinogen (400 to 900 mg/unit),
  • plasma proteins (particularly albumin)
  • physiological anticoagulants (protein C, protein S, antithrombin, tissue factor pathway inhibitor) - added anticoagulants
36
Q

FFP preparation

A

FFP is commonly thawed in a water bath over 20 to 30 minutes.

37
Q

cryoprecipitate contents

A

Fibrinogen – >150 mg of fibrinogen (range: 150 to 250 mg); half-life: 100 to 150 hours
Factor VIII – >80 international units (range: 80 to 150 units); half-life: 12 hours
Factor XIII – 50 to 75 units; half-life of 150 to 300 hours
Von Willebrand factor – 100 to 150 units; half-life: 24 hours

38
Q

neutropenia definition

A

Neutropenia definitions:
neutropenia = ANC <1500
severe neutropenia = ANC <500

39
Q

What you can’t use DOACs for

A

valvular AF

40
Q

Anticoagulants approved for DVT prophylaxis after hip and knee surgery

A

1) rivaroxaban and apixaban

2) mechanical heart valves

41
Q

why patients can be labile with VKA’s

A

1) Gastric bypass surgeries (ileal absorption)

2) Crohn’s (ileal absorption)

42
Q

basophilic stippling

A

basophilic granules that are dispersed through the cytoplasm of erythrocytes in a peripheral blood smear.

43
Q

what basophilic stippling suggests

A

problem with erythropoiesis

44
Q

basophilic stippling causes

A 
Thalassemia[2] (β-thalassemia Minor (i.e. Trait) &amp; Major, and α-thalassemia, only when 3 gene loci defective: (--/-α))
Severe megaloblastic anemia
Hemolytic anemia
Sickle-cell anemia
Pyrimidine 5' nucleotidase deficiency[3]
Alcoholism[4]
Myelodysplastic syndromes
Sideroblastic anemia[5]
Congenital dyserythropoietic anemia [6]
Primary myelofibrosis
Leukemia[7]
45
Q

function of monocyte

A

largest type of leukocyte and can differentiate into macrophages and myeloid lineage dendritic cells.

46
Q

atypical localization of immature precursors (ALIP)

A

atypically localized precursors (myeloblasts and promyelocytes) on bone marrow biopsy. In healthy humans, precursors are rare and are found localized near the endosteum, and consist of 1-2 cells. In some cases of myelodysplastic syndromes, immature precursors might be located in the intertrabecular region and occasionally aggregate as clusters of 3 ~ 5 cells.

47
Q

hypercellularity definition in BMB

A

ratio of hematopoetic cells to marrow fat

48
Q

what is MDS?

A

A heterogeneous group of malignant hematopoietic stem cell disorders characterized by dysplastic and ineffective blood cell production and a variable risk of transformation to acute leukemia. It is a clonal process.

49
Q

how FISH works

A

A molecular cytogenetic technique that uses fluorescent probes that bind to only those parts of a nucleic acid sequence with a high degree of sequence complementarity. It was developed by biomedical researchers in the early 1980s[1] to detect and localize the presence or absence of specific DNA sequences on chromosomes. Fluorescence microscopy can be used to find out where the fluorescent probe is bound to the chromosomes

50
Q

what is a mutation?

A

Alteration of the nucleotide sequence of the genome of an organism.

51
Q

diseases considered myeloproliferative neoplasms

A 
CML
Polycythemia vera
Essential thrombocythemia
Primary myelofibrosis
Chronic neutrophilic leukemia
Chronic eosinophilic leukemia (not otherwise specified)
Mastocytosis
52
Q

hemolysis labs

A

fractionated bilirubin + haptoglobin + reticulocyte count

53
Q

2 things that can cause a rapid drop in RBCs

A

hemolysis + acute bleed

54
Q

Deal with haptoglobin in diagnosis of hemolytic anemia

A

There’s a common conception that haptoglobin is a useless test because of low specificity but the problem is more so that because it’s an acute phase reactant, it may be elevated even if the patient is hemolyzing. So normal or elevated haptoglobin doesn’t rule out hemolysis. And I think it’s useful to order because the other tests like bilirubin and LDH are very nonspecific, that the combination of lab findings increases specificity.

55
Q

lab features of MDS

A

Anemia with low retic count + leukopenia (50%) + varying degrees of thrombocytopenia (25%) + dysplastic cells on smear (≥10 percent of erythroid precursors, granulocytes, or megakaryocytes) + inappropriately low retic count + blasts <20

56
Q

normal transferrin saturation

A

25 percent to 35 percent

57
Q

normal transferrin level

A

170 to 370 mg/dl

58
Q

Why does hypothyroidism predispose someone to bleeding

A

Decreased platelet number and function

Increased acquired Vw syndrome

58
Q

Why do spherocytes form in hemolytic anemia? What is a spherocyte?

A

Cytoskeletal defect. FC region of antibody is recognized and grabbed onto by FC receptors found on monocytes and macrophages in the spleen. These cells will pick off portions of the red cell membrane, almost as if they are taking a bite. The loss of membrane causes the red blood cells to become spherocytes.

59
Q

Function of a lymphocyte

A

subtypes of a white blood cell in a vertebrate’s immune system.[1] Lymphocytes include natural killer cells (which function in cell-mediated, cytotoxic innate immunity), T cells (for cell-mediated, cytotoxic adaptive immunity), and B cells (for humoral, antibody-driven adaptive immunity).[2][3] They are the main type of cell found in lymph,

Hematology, oncology (218 decks)

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