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Heme/onc Flashcards

1
Q

Iron deficiency anemia- Eti

A
  • Bleeding MC

- Colon CA, hook worms, menstruation

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2
Q

Iron deficiency anemia- Sx

A
  • Craving ice, pica
  • Angular chelitis
  • Pale mucous membranes
  • Angular chelitis
  • Koilonychia
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3
Q

Iron deficiency anemia- Dx

A
  • Microcytic anemia
  • Low ferritin, serum iron, transferrin sat
  • High TIBC
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4
Q

Iron deficiency anemia- Tx

A

Fe replacement

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5
Q

B12 anemia- Eti

A
  • Malabsorption (pernicious) MC
  • ETOH, crohns
  • Low intake (vegans)
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6
Q

B12 anemia- Sx

A
  • Neuro sx: paresthesias, peripheral neuropathy
  • Glossitis, stomatitis, pallor
  • Spinal cord demylenation- ataxia, wkness
  • Decreased DTR
  • Abd babinski
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7
Q

B12 anemia- Dx

A

Macrocytic anemia

  • High MMA, homocystine
    • schilling test (decreased B12 in urine after injection)
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8
Q

B12 anemia- Tx

A

IM B12 (cobalamine)

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9
Q

Folate deficiency anemia- Eti

A
  • Absorption occurs in jejunum

- Malabsorption, preg.

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10
Q

Folate deficiency anemia- Sx

A
  • No neuro sx

- Glossitis, stomatitis, pallor

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11
Q

Folate deficiency anemia- Dx

A
  • Macrocytic anemia
  • Low folate, B12 normal
    Hypersegmented neutrophils
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12
Q

Folate deficiency anemia- Tx

A

Folic acid

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13
Q

Hemolytic anemia- Eti

A

Intrinsic: sickle cell,

  • thalassemia,
  • G6PD,
  • hereditary spherocytosis
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14
Q

Hemolytic anemia- Extrinsic

A
  • Autoimmune
  • DIC
  • TTP
  • HUS
  • Hypersplenism
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15
Q

Hemolytic anemia- Dx

A
  • Increased retics
  • Schistocytes
  • Increased LDH
  • Increased indirect bili
  • decreased hatoglobin
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16
Q

Bone marrow exam

A
  • Cancer
  • cytopenias
  • Hemochromatosis
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17
Q

EPO in anemia

A
  • Hormone for RBC production
  • Indicated for anemia d/t cancer, CKD, IBD
  • CI in HTN, aplasia. May cause MI, TIA, VTE, increased tumors
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18
Q

Alpha thalassemia- Eti

A
  • MC in SE asians

- 4 genes- increased number of deletions = worse disease. Hyrops fetalis = still birth

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19
Q

Alpha thalassemia- Sx

A
  • Heinz bodies
  • Pallor
  • Hepatosplenomegaly
  • Skull overgrowth
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20
Q

Alpha thalassemia- Dx

A
  • Microcytic anemia with normal Fe, no response to Fe
  • Target or teardrop cells on smear
  • Increased RBCs
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21
Q

Alpha thalassemia- Tx

A
  • Folate, avoid sulfa
  • Severe dz = weekly transfusions
  • Iron chelating agents
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22
Q

Beta thalassemia- Eti

A
  • Mediterranean MC
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23
Q

Beta thalassemia- Sx

A
  • Frontal bossing
  • Severe hemolysis (jaundice, dyspnea, pallor)
  • Gallstones
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24
Q

Beta thalassemia- Dx

A
  • Same as alpha

- Distinguish with Hgb electrophoresis

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25
Beta thalassemia- Tx
- Weekly transfusions | - Iron chelating agents- deferoxamine
26
Sickle cell anemia- Eti
- Autosomal recessive, african americans - Decreased Hgb solubility under hypoxic conditions - RBC sickling -> microthrombosis -> sickled cells, destroyed by spleen
27
Sickle cell anemia- Sx
- Dactylitis MC - Delayed growth, infections - Painful occlusive crisis: Abrupt onset of chest, back and bone pain, priaprism
28
Sickle cell anemia- Triggers of admit
- Painful occlusive crisis: - Cold weather - Hypoxia - Infxn - Dehydration - ETOH
29
Sickle cell anemia- Tx
IV hydration and O2 | - Hydroxyurea- reduced freq of crisis
30
Throbocytopenia- Patho/ Eti
- Splenic sequestration - Destruction or consumption - Dilution - D/t drugs, infxn, bone marrow supression
31
Throbocytopenia- Sx
- Purpura, petechiae - prolonged bleeding - blood in urine, stool - Heavy menses, fatigue
32
Thrombocytosis- Patho/ eti
- Myloproliferation - Rxn to chronic inflammatory disorders - Iron deficiency
33
Thrombocytosis- Sx
- HA, dizziness - Chest pain, weakness - Vision changes - Numb hands and feet
34
Hemophilia A: Eti
- Factor 8 deficiency, Intrinsic pathway - MC type - Males
35
Hemophilia A: Sx
- Hemearthrosis, ankles - Excessive hemorrhage - Normal platelets so petechia, purpura less common
36
Hemophilia A: Dx
- Low factor 8 - Prolonged PTT, normal platelets - Mixing study will normalize
37
Hemophilia A: Tx
- Factor 8 infusion | - Desmopressin (increases 8 and von wilibrand)
38
Hemophilia B- Eti
- Factor 9 deficiency - Males - X-linked recessive
39
Hemophilia B- Sx
Deep tissue bleeding | - Clinically indistinguishable from A
40
Hemophilia B- Dx
- Low factor IX | - Prolonged PTT, corrects with mixing study
41
Hemophilia B- Tx
- IX infusions | - Desmopressin not useful
42
Von willebrand- Eti
- Autosomal dominant | - Ineffective platelet adhesion
43
Von willebrand- Sx
- Bleed with minor cuts - Mucocutaneous bleeding - Easy bruising - Petechiae
44
Von willebrand- Dx
- Ristocetin activity test = gold standard, no platelet agglutination - Increased PTT, bleeding time
45
Von willebrand- Tx
- DDAVP - Cryoprecipitate - Avoid ASA
46
Factor V leiden- Eti
- MC cause hypercoaguability | - Mutated factor V, resistant to Protein C breakdown
47
Factor V leiden- Sx
- Increased PE, DVT | - No increase in MI or CVA
48
Factor V leiden- Tx
Indefinite anticoagulation
49
Protein S deficincy- Eti
- Uncommon | - Allows protein C to cleave V
50
Protein S deficincy- Sx
- Unregulated pro coagulation of factor X - Unprovoked DVT, PE - Purpura fulminans - Warfarin induced necrosis
51
Protein S deficincy- Tx
- Anticoagulation
52
Vit K deficiency- Eti
- MC coagulopathy | - Diet (teat and toast), liver failure, malabsorption
53
Vit K deficiency- Sx/ dx
- Increased bleeding | - Prolonged PT (extrinsic)
54
Vit K deficiency- Tx
- Vit K replacement | FFP for hemorrhage
55
DIC- Eti
- Gram - endotoxins - Malignancy - Obstetric (pre-eclamp)
56
DIC- Sx
- Widespread hemorrhage - Severe thrombocytopenia, diffuse bleeding - Renal failure, gangrene - Extensive bruising
57
DIC- Dx
- Increased PT/ PTT/ INR, fibrinolysis, D-dimer | - Decreased fibrinogen
58
DIC- Tx
- Underlying cause - FFP is severe bleeding - Cryoprecipitate - Transfusion if
59
Coagulopathy of liver dz- Eti
- Advanced liver dz, can't produce coag factors - Malabsorp Vit K - Portal HTN -> splenomegaly -> thrbocytopenia
60
Coagulopathy of liver dz- Sx
Bleeding in setting of chronic liver dz
61
Coagulopathy of liver dz- Dx, Tx
- Increased PT, low albumin | - Tx: Fresh frozen plasma
62
Hypercoaguable states
- Malignancy - Preg, estrogen - TTP, HUS - Immobilization - Hx of surg
63
PT
- Extrinsic factors - I, II, V, VII, X - Prolonged with warfarin, low Vit K, DIC
64
PTT
Intrinsic - VIII, IX, XI, XII - Prolonged with heparin, DIC, vWD, hemophilia
65
Platelet count
- High = marrow disorders | - Low = bleeding disorders
66
Factor assay
- Eval of specific factor missing - PT long= look at VII - PTT long = VIII, IX, XII
67
Coombs test
- Direct- detects abs on RBCs- CLL, SLE, transfusion rxn, syphilis - Indirect- Free floating Abs: autoimmune anemia, erythroblastosis fetalis, bad blood match
68
INR
- Normalize PT - Measures extrinsic and common clotting cascade - Warfarin tx
69
D-dimer
- Indication of clotting, fibrin formation and lysis | - Sensitive- allows to RO DVT, PE if -
70
Whole blood- Indications
Massive hemorrhage | cardiac surg
71
Plasma or albumin- Indications
- Correct coag deficiency | - TTP, HUS
72
PLatelets- Indications
- Thrombocytopenias
73
Cryoprecipitate- Indications
Hemophilia | - Replaces fibrinogin
74
Packed RBCs
- Raise Hct,
75
Transfusion rxn
- Dyspnea, hypotn - Fever, chills, HA - CV collapse - Tx: Stop infusion, rehydrate, mannitol for forced diuresis
76
Hodgkin lymphoma- Eti
- Peaks at 20 again at 50 | - Boys, assoc w/ EPV
77
Hodgkin lymphoma- Sx
- Painless, upper body lymphadenopathy - Cyclical fevers, wt loss - Reed sternberg cells- clonal B cell proliferation - Owl eye appearance - Hepatosplenomegaly
78
Non-hodgkin lymphoma- Eti
- MC > 50 | - Risk = immunosuppression, HIV, age
79
Non-hodgkin lymphoma- Sx
- Peripheral lymphadenopathy | - Extranodal- GI, skin, CNS
80
Multiple myeloma- Eti
- Proliferation with single clone of plasma cells - Accum in marrow, inturrupt normal production - Elderly, african american, men
81
Multiple myeloma- Sx
- Bone pain - Recurrent infxn - Hypercalecemia - Anemia - Kidney fail
82
ALL- Eti
MC childhood malig | - Malig of lymph stem cells
83
ALL- Sx
Hepatosplenomegaly - lymphadenopathy - Hypercellular marrow with blasts - CNS: HA, stiff neck, vis change
84
CLL- Eti
- B cell malig | - >50 y
85
CLL- Sx
- Asymptomatic - Smudge cells - Well differentiated lymphocytes
86
AML- Sx
- Leukostasis WBC >100,000 - Gingival hyperplasia, splenomegaly - Auer rods - 20% blasts in marrow
87
CML- Sx
- Philadelphia chromosome - Splenomegaly - Asymptomatic
88
Neutropenic fever- Sx
- > 38.3 or >38.0 longer than 1 H - Low neutrophil count, expected to decline - CA + chemo + fever
89
Neutropenic fever- Tx
- Broad spectrum abx, B lactam

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