Heme-Onc

Question 1

Iron Deficiency Anemia

Answer 1

Microcytic, hypochromic; low Hgb, MCV, MCHC, RBC. **low serum iron, ferritin. High TIBC, High RDW (red cell distribution width).
Most common cause of anemia. not common in elderly.
caused by: blood loss, inadequate iron intake or impaired absorption
Pica- weird food cravings; ice. fatigue, headache, palpitations, weakness, pallor.
Tx: oral iron after meals- don’t take with antiacids- decrease absorption. Take iron with orange juice (vit C) helps with absorption
Iron foods: raisins, green leafy veggies, red meat, citrus, iron fortified bread

Question 2

Thalassemia

Answer 2

genetic disorder- microcytic, hypochromic anemia- abnormal Hgb production; reduced or absent production of beta chains, Minor- only mild cases. Major- may need blood transfusions and splenectomy
Low Hgb, MCV, MCHC. Normal TIBC, ferritin. Decrease alpha or beta chains

Question 3

B12 deficiency

Answer 3

neurological symptoms: numbness & tingling of extremities

Question 4

folic acid deficiency symptoms

Answer 4

glossitis- big tongue, fatigue, DOE, pallor, headache, tachycardia, anorexia
no neurological deficits

Question 5

Folic acid deficiency anemia

Answer 5

Macrocytic (MCV elevated), MCHC normal (normochromic), Hct and RBC low, decreasesed serum folate, RBC folate low

Question 6

Pernicious anemia

Answer 6

Macrocytic, normochromic
B12 decreased absorption- due to deficiency of intrinsic factor. Neuro symptoms: paresthesia, loss of vibratory sense, loss of fine motor control, positive Romberg and Babinski. similar symptoms to folate deficiency: weakness, glossitis, palpitations, dizziness, anorexia.
Labs; Low Hgb, Hct, RBC.
Increased: MCV (macrocytic)
decreased B12 serum
Test:: anti-IF (intrinsic factor) and anti-parietal cell antibody test

Question 7

Anemia of chronic disease

Answer 7

Normocytic, normochromic; associated with chronic inflammation, infection, renal failure, malignancy
Most common cause of anemia seen in hospitalized patients, common in elderly
Fatigue, weakness, DOE, anorexia
Hgb, Hct low. Normal MCV, MCHC. Serum iron and TIBC low, high serum ferritin- increased capacity but decreased stores.
Epogen can be a treatment. Also treat the underlying chronic disease.

Question 8

Sickle cell anemia

Answer 8

genetic disorder; exacerbation caused by dehydration, infection, hypoxia, high altitude, physical or emotional stress, surgery, blood loss or acidosis
symptoms; severe pain in extremities (from microvascular obstruction), back, chest and abdomen, joint pain, weakness, dyspnea
Hgb: low, blood smear: distorted sickle shaped RBCs
Tx: fluids for dehydration, opioid pain management, oxygen for hypoxemia

Question 9

Von Willebrand Disease

Answer 9

genetic disorder: reduced ability to create blood clots; mutation of deficiency in von Willebrand factor and clotting factor 8
Symptoms: frequent bleeding, easy bruising- chronic,
Management: DDAVP: increases plasma levels of vWF, reduces bleeding time
Recombinant vWF/ factor 8 concentrate

Question 10

Acute Myelogenous Leukemia (AML)

Answer 10

80% of acute leukemia in adults.
2nd most common leukemia type in children.
remission rates: 50-85%
long term survival: 40%

Question 11

Acute Lymphocytic Leukemia (ALL)

Answer 11

More difficult to cure in adults.
Children - 90% remission rate. Most common leukemia seen in children.
Hallmark sign: pancytopenia with circulation blasts. CBC- all levels low.

Question 12

Chronic Lymphocytic Leukemia (CLL)

Answer 12

Most common leukemia of adults- middle and old age
Median survival is 10 years
Lymphocytosis: hallmark: increased peripheral blood WBCs- elevated WBC on CBC

Question 13

Chronic Myelogenous Leukemia (CML)

Answer 13

occurs in adults 40+
survival: 65% of diagnoses survive to 5 years
Philadelphia chromosome in leukemic cells: disease hallmark

Question 14

Leukemia Labs

Answer 14

CBC- subnormal RBC, neutrophils
elevated ESR (inflammation marker)
Peripheral blood smear: distinguish between acute and chronic- circulation blasts on acute
Bone marrow aspiration- required to confirm diagnosis

Question 15

Lymphoma Stages

Answer 15

1: single lymph node or group
2. more than one lymph group involved, one side of the diaphragm (axilla & groin)
3. Lymph nodes or spleen involved; both sides of the diaphragm
4. Liver or bone marrow involvement

Question 16

Non-Hodgkin’s Lymphoma

Answer 16

S/s: lymphadenopathy
cause: possible viral etiology
Age 20-40 most common cancer, also occurs in youg adults and older adults
Less predictable pattern of spread than Hodkin’s disease

Question 17

Hodgkin’s Lymphoma

Answer 17

Unknown cause.
More common in males. average age 32 years
cervical adenopathy, predictable spread along lymph node groups
***Reed-Sternberg cells differentiate from non-Hodgkin’s disease
Diagnostic: CT, x-ray, ultrasound, MRI- locate and stage the disease

Question 18

Lymphoma treatement

Answer 18

Chemo, radiation, bone marrow transplant

Question 19

Idiopathic Thrombocytopenia Purpura (ITP)

Answer 19

autoimmune destruction of platelets- may or may not involve decreased platelet production.
Thrombocytopenia: PLT< 150K
Chronic, mild, rarely causes bleeding that requires hospitalization
Women: 3:1
Labs: bone marrow analysis, CBC
Gums and kidneys seen first most common site of bleeding
Need bone marrow analysis to differentiate between ITP and SLE

Question 20

ITP treatment

Answer 20

tx once PLT< 20K
high dose corticosteroids- improve thrombocytopenia within 2-3 days
IVIG- 2-3 day response expected
Gamma globulin (IVIG) preferred in HIV related ITP
Platelet transfusions occasionally benefit- not standard of care.

Question 21

Heparin induced thrombocytopenia

Answer 21

stop heparin. start argatroban

This will reverse HIT and offer anticoagulant

Question 22

DIC: Disseminated Intravascular Coagulation

Answer 22

intravascular activation of coagulation and fibrinolytic systems; causes thrombosis and hemorrhage at the same time: mortality rate is 50-85%
associated with: cancer, infection, sepsis, liver disease, massive trauma, burns, shock, obstetric complications, acute leukemia;

Question 23

DIC labs

Answer 23

thrombocytopenia PLT< 150K
hypofibrinogenemia: fibrinogen < 170mg/dl
low RBC
**increase fibrin degradation products > 45mcg/ml ** predictive accuracy of 96%
prolonged prothrombin time > 19 seconds
prolonged partial prothrombin time > 42 seconds
D-dimer positive at > 1:8 dilution- reflects simultaneous activation of thrombin and plasmin

Question 24

DIC treatment

Answer 24

treat underlying condition and control bleeding
platelet transfusions (thrombocytopenia). FFP (replace clotting factors), cryo (maintain fibrinogen levels)- give these blood products if bleeding is severe
Goal: cessation of bleeding, increase plasma fibrinogen and platelet count, decrease fibrin degradation products (FDPs)

Question 25

what is pathophysiology of leukemia?

Answer 25

Leukemia is a type of cancer found in your blood and bone marrow and is caused by the rapid production of abnormal white blood cells. These abnormal white blood cells are not able to fight infection and impair the ability of the bone marrow to produce red blood cells and platelets.