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ACNP Certification > Heme-onc > Flashcards

Heme-onc Flashcards

1
Q

HGB

A

Male - 14 to 18g/100ml

Female - 12 to 16g/100ml

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2
Q

HCT

A

Male - 40 to 54%

Female - 37 to 47%

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3
Q

MCV

A

Normal: 80-100

*Cytic=Size (avg volume and size of individual blood cell)

Micro (iron def vs thalessemia)

Macro >100 (B12 vs folate def)

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4
Q

MCHC

A

Normal = 32-36

Avg HG concentration %

Chromic=color

Hypochromic <32, hyperchromic >36

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5
Q

Serum Iron / ferritin

A

50-150 ug/dl

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6
Q

TIBC

A

250-450 ug/dl

Capacity for binding more iron

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7
Q

Iron deficiency

A

*Micro/Hypo (due to overall deficiency of iron)

Causes:

  • Blood loss is most common due to slow GI bleed (SCOPE the patient)
  • dysmenorhhea
  • Rarely absorption issue
  • Decreased intake

*Exhibit Pica*

TIBC is high, capacity for more iron is high

Ferritin (stores) low

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8
Q

Low MCV Conditions

A

Iron deficiency, thalassemia

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9
Q

High MCV Conditions

A

B12 or folate deficiency, alcoholism, liver failure, drug effects

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10
Q

Normocytic anemia

A

Anemia of chronic dz, renal failure, sickle cell dz, blood loss, hemolysis

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11
Q

Thalassemia

A

Genetically inherited resulting in abnormal Hgb production mediterranian, indian, asian, (not western european)

*Micro/Hypo

TIBC normal, ferritin (stores) normal

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12
Q

Folic acid Deficiency vs Pernicious Anemia

A

Folic Acid Deficiency:

Fatigue, dyspnea, pallor, glossitis

*No neuro signs in folic acid def., check alcohol intake

*Both are macrocytic, normochromic

Tx: Folic acid replacement, PB, fish , bananas, green leafy

Pernicious Anemia

Deficiency of intrinsic factor leading to malabsorption of B12

PERnicious has POSitive neuro signs

Schilling test (radioactive) may help determine cause

Tx: B12 (cyclobenazprine) 100mcg IM daily x 1 week load then monthly injections for life

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13
Q

Anemia of chronic disease

A

Most common in-hospital and in elderly

*Normocytic, normochromic

Associated with chronic inflammation, infection, renal failure and malignancy

TIBC and serum iron low, ferritin (stores) high

Correct underlying first, good diet, epoitin alpha

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14
Q

Sickle cell

A

Chronic hemolytic anemia

Cellular hypoxia results in acidosis and tissue ischemia

*Precipitated by infection, high altitude, stress, hypoxia, blood loss, dehydration, surgery or acidosis

Testing by cellulose acetate and citrate agar gel electrophoresis

Fluids first, O2 with pain management

Morphine or Dilaudid IV

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15
Q

Leukemia

A

Neoplasms from hematopoietic cells of bone marrow

More common in men, unkown cause

Tx: Chemotherapy, BM transplant, symptomatic care

(No surgery or radiation)

Lymphadenopathy and weight loss, fatigue

Confirm with bone marrow aspiration

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16
Q

Leukemia types

A

4 types:

ANL/AML

ALL

CLL

CML

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17
Q

Lymphoma

A

Cancer arising from lymph tissue

Confirmed by lymph node bx

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18
Q

Hodgkins vs Non-Hodgkins Lymphoma

A

Non-hodgkins, possibly viral cause, presents with lymphadenopathy, most common neoplasm between ages 20-40, advanced dz usually on dx

Hodgkins-better prognosis, more common in men, age 32, presents with cervical adenopathy and spreads predictably, Unknown cause

*Reed Sternberg cells

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19
Q

Idiopathic Thrombocytopenic Purpura

ITP

A

Normal platelets 150-400,00

Autoimmune destruction with or w/o suppression of thrombopoiesis, ususally chronic, women> men 3:1

Dx: bone marrow evaluation, hx,

Sx: gingival bleeding first, then hematuria (check a UA)

20
Q

DIC

A

Acquired disorder from intravascular activation of coag and fibrinolytic systems (thrombin and plasmin)

Mortality 50-85%

Causes:

Acute leukemia, amniotic fluid embolus, burns, shock, sepsis, liver disease, trauma, malignancy

21
Q

DIC Diagnostics

A

Hypofibrinoginemia =Fibrin <170

Thrombocytopenia= plts<150,000

Decreased RBC, Increased FDP>45

Prolonged PT (>19),

pTT (42),

+ Ddimer >1:8 dilution (reflects simultaneous activation of thrombin and plasmin)

22
Q

DIC Tx

A
  • Thrombocytopenia=plt transfusion
  • Coag factors low = FFP
  • Fibrinogen= Cryoprecipitate
  • Heparin is controversial

Therapy is aimed at decreasing bleeding and FDP’s and increasing fibrinogin and platelet count

23
Q

Heme Gero Considertions

A

Immunosenescence

Decreased thymic production=decreased T cells

Decreased immune cells and response to antigens

Waning of induced antibody response

24
Q

Lifespan of the avg RBC

A

25 days

25
Q

2 types of microcytic anemias

A

iron deficiency

thalessemia

26
Q

2 types of macrocytic anemias

A

folic acid deficiency

pernicious (b12)

27
Q

DIC cascade

A

1) Thrombin causes conversion of fibrinogen to fibrin and causes fibrin clots in the microcirculation
2) Coag factors are reduced (Fibrinogen, prothrombin, fplatelets, actors V and VIII)
3) Circulating thrombin activates the fibrinolytic system which lyses fibrin clots into fibrin degradation products FDP’s
4) Hemorrhage results from anticoagulant activity of FDP’s and depletion of coag factors

28
Q

What is the most common anemia in adults?

(not elderly)

A

Iron-deficiency

29
Q

Treament for iron deficiency anemia

A

Tx: iron 300-325 oral , take on empty stomach or with juice

Source: Raisins, red meat, green leafy

30
Q

Thalessemia tx

A

No treatment indicated unless severe, RBC transfusion or splenectomy

Iron tx is contraindicated

31
Q

Which anemia has associated neuro signs?

A

Pernicious anemia

Positive neuro signs=Pernicious

32
Q

Diagnosis/Treatment for ITP

A

Tx: high dose corticosteroids, gamma-globulin preferred in HIV, plt transfusions (<20,000)

ITP vs SLE: Need a BM asp to differentiate

33
Q

Treatment for HIT

A

Tx: Stop the heparin

Anticoagulate with: Argatroban, Lepirudin if HIT induced

(usually from unfrac hep, not LMW heparin)

34
Q

Bleeding occurs from what 2 things in DIC?

A

Circulating FDP’s

Decreased coag factors

35
Q

What is the role of cryoprecipitate in DIC?

A

Maintain fibrinogen

36
Q

difficult to cure in adults, pancytopenia with circulating blasts (hallmark of dz)

A

ALL

37
Q

Most common leukemia in adults, middle and old age

Hallmark is leukocytosis

Long term survival 10 years

A

CLL

38
Q

Age >40 years, survival 3-4 years,

philidelphia chromosome marker (hallmark of dz)

A

CML

39
Q

What autoimmune condition causes neutropenia?

A

Felty’s syndrome- RA

40
Q

accounts for 80% ACUTE in adults

Remission rates 50-85

Long term survival 40%

A

AML

41
Q

Criteria to perform a lymph node bx

A

perform for any node >1 cm, not associated with infection lasting longer than 4-6 weeks

42
Q

Staging of lymphoma:

A

Stages: I-IV

I : Single node or group

II: > 1 lymph node group on 1 side of diaphragm

III: >1 Lymph node or spleen on both sides of diaphragm

IV: Liver or bone marrow involvement

43
Q

What is the diagnostic testing regimen for lymphoma?

A

Testing: CT, XR US, MRI for localization and staging

bx with histology confirmatory

44
Q

Treatment strategy for lymphoma

A

Radiation

Chemotherapy

BM transplant

45
Q

Non-Hodgkins lymphoma

A

do Not want Non-Hodgkins

Not predictable

does NOT have Reed-sternbergs cells

ACNP Certification (17 decks)

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