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Clinical Medicine > heme/onc > Flashcards

heme/onc Flashcards

1
Q

this is the most severe type of hemolytic reaction and is caused by ABO isoagglutinin

A

acute hemolytic

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2
Q

s/s of hemolytic transfusion rxn

A

fever, flank pain, red urine, rigors, tachy, DIC

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3
Q

dx of hemolytic transfusion rxn

A

+ coombs test

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4
Q

tx of hemolytic transfusion rxn

A

stop transfusion
IV fluids and mannitol
monitor for DIC

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5
Q

delayed hemolytic rxn cause

A

minor RBC antigen discrepancies

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6
Q

this is the MC transfusion rxn

A

febrile non-hemolytic transfusion rxn

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7
Q

s/s of febrile non-hemolytic transfusion rxn

A

fever, chills, rigors within 12 hrs

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8
Q

tx of febrile non hemolytic transfusion rxn

A

acetaminophen and benadryl
severe- IV corticosteroids

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9
Q

s/s of allergic transfusion rxns

A

bronchospasm, urticaria, pruritus, anaphylaxis, shock

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10
Q

tx of allergic transfusion rxn

A

stop
epi and glucocorticoids

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11
Q

s/s of graft vs host transfusion rxn

A

fever, rash, diarrhea, lymphadenopathy, hepatitis

SEVERE pancytopenia
usually fatal

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12
Q

prevention of graft vs host transfusion rxns

A

radiation of cellular components

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13
Q

TRALI s/s

A

non-cardiogenic pulmonary edema

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14
Q

TACO s/s

A

cardiogenic pulmonary edema

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15
Q

prevention of TRALI

A

male only plasma donors

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16
Q

dx of TACO

A

elevated BNP

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17
Q

tx of TACO

A

stop transfusion
diuretics and inotropes

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18
Q

what is essential thrombocythemia/ thrombocytosis?

A

increased platelets, but do not adhere properly

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19
Q

s/s of thrombocytosis

A

thrombosis in uncommon sites
erythromelaglia and calor
hemorrhage

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20
Q

dx of thrombocytosis

A

elevated platelet count
large platelets and megakaryocytes
genetic testing- JAK2, MPL, CALR

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21
Q

tx of thrombocytosis

A

oral hydroxyurea and aspirin

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22
Q

what is polycythemia vera?

A

overproduction of all 3 cell lines

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23
Q

list 2 things polycythemia vera is associated with

A

JAK2 mutation
PUD

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24
Q

s/s of polycythemia vera

A

pruritus
bone pain
decreased vision (retinal veins enlarge)
tinnitus
palpable spleen

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25
Q

dx of polycythemia vera

A

increased Hct
confirm- JAK2 mutation

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26
Q

tx of polycythemia vera

A

phlebotomy

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27
Q

what is hemochromatosis?

A

increased iron

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28
Q

s/s of hemochromatosis

A

hypogonadism
cirrhosis, HF
arthritis
bronze skin and DM1

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29
Q

iron labs of hemochromatosis

A

increased iron and ferritin
decreased TIBC

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30
Q

Tx of hemochromatosis

A

symptomatic–> phlebotomy
asymptomatic–> diet

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31
Q

what is myelodysplasia?

A

hematopoietic stem cell malignancy–> cytopenia and increased blasts

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32
Q

s/s of MDS

A

asymptomatic
s/s of pancytopenia (infection, pallor, fatigue, bleeding)

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33
Q

dx of MDS

A

defining- genetic testing
- hypercellular, left shift
-ringed sideroblasts
- dwarf megakaryocytes
<20% blasts

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34
Q

tx of MDS

A

bone marrow stem cell transplant is only cure

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35
Q

what is plasma cell/ multiple myeloma?

A

proliferation of plasma cells–> paraprotein production and bone destruction

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36
Q

s/s of plasma cell myeloma

A

C- high calcium
R- renal issues
A- anemia
B- bone issues

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37
Q

dx of plasma cell myeloma

A

paraprotein (M protein)
Rouleaux formation
Bence Jones- protein in urine

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38
Q

what is the cause of non-hodgkin’s lymphoma?

A

chromosomal translocation–> oncogene overexpression

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39
Q

s/s of non-hodgkin’s lymphoma

A

enlarged lymph nodes (peripheral or central)
weight loss >10%, fever, night sweats
Burkitt lymphoma- abd pain/ fullness

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40
Q

dx of non-hodgkin’s lymphoma

A

tissue or lymph node biopsy

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41
Q

tx of non-hodgkin’s lymphoma

A

indolent w/ 1 or 2- cure intent
aggressive- RCHOP

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42
Q

pathological hallmark of hodgkin’s lymphoma

A

Reed-Sternberg cells (owl eyes)

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43
Q

s/s of hodgkin’s lymphoma

A

painless mass (common in neck)
contiguous spreading

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44
Q

dx of hodgkin’s lymphoma

A

lymph node biopsy–> Reed Sternberg cells

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45
Q

tx of hodgkin’s lymphoma

A

ABVD (chemo)

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46
Q

s/s of ALL

A

pancytopenia
hepatosplenomegaly
lymphadenopathy

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47
Q

dx of ALL

A

mediastinal mass on CXR
bone marrow- >20% lymphoblasts

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48
Q

tx of ALL

A

chemo
daunorubicin, vincristine, prednisone, asparaginase

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49
Q

s/s of CML

A

fatigue, night sweats, fever
splenomegaly–> fullness
blurred vision, priapism

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50
Q

Dx of CML

A

philadelphia chromosome (9 and 22, bcr/ abl gene)
left shift
hypercellular marrow

51
Q

tx of CML

A

tyrosine kinase inhibitors (imatinib)

52
Q

AML presentation

A

pancytopenia

53
Q

AML dx

A

auer rod

54
Q

tx of AML

A

anthracycline + cytarabine

55
Q

2 conditions that may progress to AML include…

A

MDS
CML

56
Q

what cell type is affected by CLL

A

B lymphocytes

57
Q

s/s of CLL

A

pancytopenia, lymphadenopathy, splenomegaly

58
Q

dx of CLL

A

isolated lymphocytosis
small lymphocytes
smudge cells

59
Q

tx of indolent/ early CLL

A

indolent/ early– observe

60
Q

list 3 indications for tx of CLL

A

progressive fatigue
lymphadenopathy
anemia of thrombocytopenia

61
Q

list tx of CLL if indications are present

A

BTK inhibitors w/ anti CD20
allogenic transplant

62
Q

s/s of iron deficiency anemia

A

glossitis, koilonychia, pica, plummer vinson syndrome (esophageal webs)

63
Q

lab studies in iron deficiency anemia

A

hypochromic microcytic
low iron and ferritin, increased TIBC

64
Q

tx of iron deficiency anemia

A

iron supplementation
- oral ferrous sulfate w/ vit C

65
Q

labs of anemia of chronic disease

A

micro to normo cytic
decreased TIBC, normal or increased ferritin

66
Q

dx of anemia of chronic disease

A

bone marrow biopsy with iron stain

67
Q

tx of anemia of chronic disease

A

tx chronic condition + EPO + iron supplements

68
Q

what is aplastic anemia?

A

pancytopenia due to bone marrow failure

69
Q

s/s of aplastic anemia

A

pancytopenia
- anemia
- infections
- bleeding

70
Q

labs of aplastic anemia

A

pancytopenia and reticulocytopenia

71
Q

dx of aplastic anemia

A

hypocellular bone marrow biopsy

72
Q

tx of aplastic anemia

A

mild- erythropoietic or myeloid GFs
severe-
- <40: bone marrow transplant
- >40: immunosuppressiona dn hematopoietic agent

73
Q

what is sideroblastic anemia?

A

decreased Hb synthesis due to impaired ability to incorporate iron into Hb

74
Q

s/s of sideroblastic anemia

A

anemia (pallor, SOB, fatigue)

75
Q

labs of sideroblastic anemia

A

increased iron and ferritin, decreased TIBC
low retic count
decreased B6
ringed siderob lasts
dimorphic cell population

76
Q

tx of sideroblastic anemia

A

oral pyridoxine (B6)

77
Q

s/s of vitamin B12 (cobalamin) def

A

paresthesias, balance, proprioception, glossitis, anorexia, diarrhea, dementia

s/s of anemia

78
Q

labs of B12 def

A

low B12
elevated MMA and homocysteine
low retic count
macrocytic RBCs
hypersegmented neutrophils

79
Q

tx of B12 def

A

IM B12 injection

80
Q

s/s of folate def (B9)

A

no neuro symptoms
glossitis, anorexia, diarrhea, pallor, tachy

81
Q

labs of folate def

A

decreased folate
elevated homocysteine and normal MMA

82
Q

tx of folate def

A

oral folic acid

83
Q

s/s of hemolytic anemia

A

jaundice, icterus, dark urine
splenomegaly
anemia s/s

84
Q

labs of hemolytic anemia

A

increased retic count
increased LDH and bilirubin

85
Q

list 3 subtypes of hemolytic anemia

A

autoimmune
hereditary spherocytosis
G6PD

86
Q

+ spherocytes and + coombs test is what type of hemolytic anemia

A

autoimmune hemolytic anemia

87
Q

+ spherocytes and - coombs test, hyperchromic microcytosis
+ osmotic fragility test

A

hereditary spherocytosis

88
Q

bite cells and Heinz bodies suggest what type of hemolytic anemia

A

G6PD

89
Q

list 3 triggers for G6PD hemolytic anemia

A

infection
meds
fava beans

90
Q

tx of G6PD hemolytic anemia

A

avoid oxidant meds/ triggers

91
Q

tx of hereditary spherocytosis

A

folic acid
splenectomy

92
Q

tx of autoimmune hemolytic anemia

A

steroids

93
Q

HUS triad

A

thrombocytopenia
hemolytic anemia
renal dysfunction

94
Q

dx of HUS

A

thrombocytopenia with normal coag studies and increased bleeding time
normal ADAMTS13
schistocytes, reticulocytosis, increased LDH and bilirubin
increased BUN and creatinine

95
Q

tx of HUS

A

supportive

96
Q

what causes TTP?

A

destruction of ADAMTS13

97
Q

pentad of TTP

A

thrombocytopenia
hemolytic anemia
neuro
fever
kidney failure

98
Q

dx of TTP

A

schistocytes, increased LDH, bilirubin
decreased ADAMTS13 and antibodies

99
Q

tx of TTP

A

plasmaphoresis
glucocorticoids
immunosuppression

100
Q

cause of ITP

A

autoimmune destruction of platelets

101
Q

s/s of ITP

A

asymptomatic
purpura, petechiae, gum bleeding
severe bleeding
NO splenomegaly

102
Q

dx of ITP

A

isolated thrombocytopenia
increased megakaryocytes

103
Q

tx of ITP

A

kids- observation
platelets low- glucocorticoids, IVIG, anti-D

104
Q

factor V Leiden disorder cause

A

mutated factor V–> resistant to breakdown via protein C

hypercoaguability

105
Q

s/s of factor V Leiden disorder

A

VTE- DVT, PE

106
Q

dx of factor V leiden

A

activated protein C resistance assay
if +–> confirm with DNA testing

107
Q

tx of factor V Leiden

A

asymptomatic- not treated
moderate- prophylaxis for procedures
high risk- warfarain indefinitely

108
Q

what type of genetic disorder is hemophilia?

A

x linked recessive

A- VIII
B- IX
C- XI

109
Q

s/s of hemophilia

A

deep tissue bleeding/ hemarthrosis

110
Q

dx of hemophilia

A

increased PTT
decreased factor

111
Q

tx of hemophilia

A

factor infusion
A- DDAVP and emicizumab

112
Q

what causes Von Willebrand’s disease and what type of genetic disease is it?

A

ineffective platelet adhesion
autosomal dominant

113
Q

s/s of vWD

A

prolonged bleeding

114
Q

Dx of vWD

A

increased PTT and bleeding time
normal platelets and PT
diagnostic- decreased vWF antigen
ristocetin induced platelet aggregation (RIPA)

115
Q

tx of vWD

A

DDAVP
severe- vWF containing product

116
Q

timeline for heparin induced thrombocytopenia

A

5-14 days after exposure

117
Q

heparin induced thrombocytopenia s/s

A

thrombocytopenia and thrombosis
often asymptomatic

118
Q

dx of heparin induced thrombocytopenia

A

initial- PF4 heparin antibody ELISA
confirm- functional assay

119
Q

tx of heparin induced thrombocytopenia

A

discontinue heparin and start different anticoag

120
Q

cause of DIC

A

coagulation and fibrinolysis

121
Q

s/s of DIC

A

bleeding- IV and catheter sites, ecchymosis, purpura
thrombosis- gangrene, cyanosis

122
Q

labs for DIC

A

decreased platelets, increased bleeding time, PT and PTT
decreased fibrinogen
increased D dimer
schistocytes

123
Q

tx of DIC

A

tx underlying cause
severe- platelets, FFP

Clinical Medicine (8 decks)

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