Heme onc Flashcards
Redness/tenderness/migratory thrombophlebitis at unusual sites i.e. arms and chest
Trousseau syndrome: hypercoag disorder ass. with visceral malignancy (usually pancreatic cancer)
“pain, itching, and red streaks on arm and chest. tender, erythematous, palpable cord-like veins on arm and chest”
Tx for HIT
STOP Heparin, give Argatroban or Fondaparinux. Switch to warfarin once platelet >150k
what causes thrombocytopenia/leukopenia in SLE pt?
Peripheral auto-immune destruction
Woman with menorrhagia
vWD!! (not hemophilia)
Hemophilia: PT, PTT, BT, Platelet count
All normal except for increased PTT
Hemarthrosis w/ +FHx
Hemophilia
Tx of hemophilia
Give Factor 8/9
Desmopressin for mild Hem A
T/F: HIT is highly thrombogenic
True–>high risk of arterial and venous clots
Thrombosis and hx of miscarriage in SLE pt
Anti-phospholipid syndrome
Tumor lysis syndrome electrolytes
Hyper: Uricemia, Kalemia, Phosphatemia
Hypo: Calcemia
Contents of cell is released. Low calcium b/c it gets bound by phosphate
- AKI from uric/phosphate
- Arrythmia from potassium
Tx for ITP
Platelets <30K: IVIG or Glucocorticoids
Features of androgen (steroid) abuse (athletes)
- Mood changes, gynecomastia, aggressive behavior
- Polycythemia (so don’t be a peasant and pick EPO abuse if they have above changes)
CML translocation and tx
9,22 = BCR-ABL
–>Tyrosine Kinase inhibitor = Imatinib
wbc and LAP in CML vs Leukomoid Rxn
CML: wbc»_space;> (up to over 100k). LAP low
Leukomoid: wbc»_space; (up to 50k). LAP high.
what increases appetite in cancer/cachetic pt with anorexia?
Progesterone analog (megestrol acetate), Corticosteroids
Why are asplenic patients at increased risk of encapsulated organism infection?
Splenic macrophages make opsonizing antibodies, which facilitiates phagocytosis of encapsulated organisms. These capsules protect against innate phago and req antibody-mediated complement activation
Drugs that cause megaloblastic anemia
*have BLAST with PMS
Phenytoin (impair folic acid absorption), Methotrexate, Sulfa’s (including trimethoprim) (these impair folates physiologic effect)
Tx for TTP
PLEX
Not platelets
will present with hemolytic anemia and
thrombocytopenia, possibly renal failure, neuro manifestations, and dfever
What is the mechanism of developing skin necrosis at abdominal injection site/thrombocytopenia in patients on heparin?
HIT = IgG against heparin-bound platelet factor 4 (PF4)
What kind of anemia do CKD/ESRD patients have?
EPO deficiency!!!!!!!!
–>Normocytic normochromic anemia
Most common side effects of EPO injections (i.e. dialysis patient with anemia)
- Hypertension (duh, increased volume)
- HA
- flu-like syndrome
PT and PTT in Factor V Leiden
Normal sonny boy!
“the assembly line is fine, and that’s what we are measuring”. the factor 5 functions straight, you make fibrin normal speed. problem is you can’t turn it off, so once the fibrin comes off the line its piling up you aren’t turning it off as fast.
b12 deficiency in whites of eastern european descent
Pernicious anemia
Anemia of lymphoproliferative disorders:
this means leukemia/lymphoma
–>Bone marrow infiltration by cancer cells
absent CD55
paroxysmal nocturnal hemoglobinuria
Increased MCHC and RDW
Spherocytosis
most common leukemia age >65
CLL. shit ton of lymphocytes.
Painless lymphadenopathy, splenomegaly, resp infections, lymphocytosis, age >60
CLL
Peripheral smear for CLL
lymphocytosis + smudge cells
how do you dx CLL
Flow Cytometry
False prolongation of PTT and hx of clots
Antiphospholipid syndrome (as well as FP syphilis and abortions)
criteria that increase pretest probability of DVT: Name and scoring
Wells Critera
2 or higher = DVT likely
1 or 0 = DVT unlikely
Wells criteria for pretest probability of DVT
- prior dvt
- active cancer
- recent immobilization (including bedridden >3 days)
- localized pain (along vein dist)
- swollen leg
- calf swelling >3cm more than other leg
- Pitting Edema
- non varicose veins
Initial test if suspecting DVT
Compression Ultrasound
Warfarin inhibits the synthesis of :
vit k dependent clotting factors: 2, 7, 9, 10 and Proteins C and S
Dx workup of MM
-Urine/serum protein electrophoresis (m-spike)
-Peripheral blood smear (rouleux)
-serum free light chain analysis
can confirm w/bone marrow bx
chronic anemia following gastrectomy or autoimmune gastritis
pernicious anemia = B12 def (loss of intrinsic factor)
T/F: B12 deficiency leads to anemia due to abnormal DNA synthesis
true. So even though its a production anemia, will see hemolysis labs (indirect bilirubinemia, increased LDH from intramedullary hemolysis)
Leukemoid rxn vs CML
Leuk: wbc>50k, caused by severe infx, HIGH LAP, METAMYELO>MYELO (mature)
CML: wbc >100k sometimes, caused by BCR-ABL fusion, LOW LAP, Myelo>Metamyelo (immature), Absolute basophilia
Antibodies that bind to platelet surface causes platelet activation, thrombocytopenia, and a prothrombotic state
HIT
why are multiple myeloma patients prone to infection?
Neoplastic infilt. of bone marrow –> alters normal lymphocytes –> ineffective antibody production and hypogammaglobulinemia
recurrent epistaxis, widespread AV malformations and telangiectasias (red blanching papules)
Osler-Weber-Rendu aka hereditary telangiectasia
how does OSA lead to polycythemia?
Get hypoxemia, which results in kidneys increasing EPO
hemolysis, cytopenias, venous thrombosis (intraabdominal = abdominal pain). Also, hematuria.
PND
Use Eculizumab for this patient with hematuria, venous thrombosis and hemolytic anemia
PND
most common leukemia in the US
CLL: dramatic lymphocytosis with smudge cells in the elderly
rare lymphocytic leukemia with splenomegaly and pancytopenia and dry tap on BM bx
Hairy cell leukemia
intense itching after hot shower and facial plethora (ruddy cyanosis) and splenomegaly
Polycythemia vera (due to basophils)
lab findings in polycythemia vera
Inc Hgb, and inc plt and wbc
Low EPO
JAK2 mutation
Tx polycythemia vera
Phlebotomy and hydroxyurea
Low Fe, High Ferritin, Low TIBC, Low Transferrin sat
Anemia chronic disease
Low Fe, Low Ferritin, High TIBC, Low Transferrin sat
Iron def anemia
Tx for a patient with DVT/PE and contraindication to anticoagulation (sig active bleeding, recent surgery, hemorrhagic stroke)
IVC Filter!
Neuropathy, hyperviscosity sxs (diplopia, tinnitus, clots, ) and excessive monoclonal IgM with >10% clonal B cells
Waldenstorm macroglobulinemia
Patient has folic and b12 deficiency combined. What does replacing folic acid do?
Corrects the megaloblastosis, but leads to rapid progression of neuro sxs: loss of vibration/proprioception in LE
FAT RN
TTP: Fever Anemia Thrombocytopenia Renal Failure Neuro sxs
Adam got high alone to the purp with the fat rn
ADAMSTS13
Hyaline clot
TTP
Fever, Anemia, Thrombocytopenia, Renal failure, Neuro sxs
Dx step when suspecting TTP
Peripheral smear (shows schistocytes)
Tx for TTP
Plasma exchange/transfusion
causes of transfusion rxns (hypotensive)
- Anaphylactic
->resp distress w/in minutes. recipient anti-IgA
2 . Transfusion-related acute lung injury
->resp distress and pulm edema within 6 hours. Donor anti-leukocyte - Primary Hypotension rxn
->transient hypoT minutes after in pt on ACE-I. Due to bradykinin in blood products
Spherocytes on blood smear + anemia
Hereditary spherocytosis OR Autoimmune Hemolytic Anemia
