HEME ONC Flashcards
acidified glycerol lysis test is used to dx…
hereditary spherocytosis
defect in spectrin and ankyrin
which lung cancers are peripheral and which are central?
peripheral = adenocarcinoma and large cell carcinoma
central = squamous cell and small cell
what syndromes are associated with squamous cell lung ca and which with small cell carcinoma?
squamous = hypercalcemia
small cell = cushing syndrome, SIADH, or lambert eaton
which lung ca is the most common type of primary lung cancer in both smokers and nonsmokers?
predominant type in nonsmokers?
adenocarcinoma
what tx is given to sickle cell patient with recurrent vasoocclusive crises?
its side effect?
hydroxyurea to boost amount of fetal hgb
can cause myelosuppression
auer rods are specific for which leukemia?
AML
aflatoxin is ass w what?
ebv reactivation ass w what?
hepatocellular carcinoma
nasopharyngeal carcinoma
normal reticulocyte count?`
what raises it?
0.5-2.5%
blood loss and hemolysis
at what hematocrit do i transfuse?
if patient is symptomatic or if patient is elderly or has heart disease
do NOT if patient is young and asx
each unit prbcs should raise the hct by
3
when do you transfuse cryoprecipitate first?
never.
never first line
only microcytic anemia with HIGH iron
sideroblastic anemia (cant incorporate iron with heme)
TIBC
in chronic disease and iron deficiency?
low in anemia of chronic disease
high in iron def
test used to look for ringed sideroblasts?
prussian blue stain
most accurate test for thalassemia?
electrphoresis
megaloblastic anemia + hypersegmented neutrophils
either B12 or folate def!
get B12 and folate levels!!
methotrexate can lead to __ deficiency
folate
both B12 and folate deficiency increase ____ but onlu B12 is associated with increased ___
homocysteine
methylmalonic acid
what decreases mortality in sickle cell disease?
hydroxyurea in prevention and antibiotics with fever
exchange transfusion for sickle cell vasoocclusive crisis is used when..
acute chest syndrome priapism stroke or visual disturbance from retinal infarction
what is the diagnosis? best test?
recurrent hemolysis, intermitternt jaundice, splenomegaly, family hx of anemia or hemolysis, and bilirubin gallstones
spherocytosis
osmotic fragility test
most accurate test for autoimmune hemolysis?
coombs +
detects IgG on rbc surface
colder parts of body showing mottling that resolves on warming?
tx?
cold agglutinin disease
steroids dont work with cold agglutinins…give rituximab and warm patient
warm agglutinins are Ig__ and cold are Ig___
warm are igG
cold are IgM
holly jowell bodies?
heinz bodies?
HJ = sickle cell
heinz = g6pd
in g6pd deficiency, g6pd level will be __ after acute event…..when to dx?
normal
get g6pd level after 1-2 months
HUS vs TTP
similarities and differences
both present with hemolysis with schistcytes, thrombocytopenia, and renal insufficiency
hus is due to e coli 0517h7 and is usually in kids
ttp is usually in adults due to meds or dz, and has neuro sx
paroxysmal nocturnal hemoglobinuria
decreased cd55 and cd59
episodic dark urine
pancytopenia
clots in weird places
aplastic anemia
pancytopenia
fatigue infections bleeding
dx: bone marrow biopsy
tx: young patient = bone marrow transplant,,,old patient = antithymocyte globulin and cyclosporine
polycycthemia vera
overproduction of all 3 cell lines but mostly rbcs! despite a low epo
hyperviscosity sx (htn, ha, thrombosis, fatigue)
hct high, plat and wbc high, rbc mass high, oxygen normal, epo low
dx;;;;JAK2 mutation most accurate
tx: phlebotomy and aspirin, hydroxyurea, allopurinol, antihistamines
essential thrombocytosis
plat count >1 mil leading to thrombosis and bleeding
myelofibrosis
panytopenia and bone marrow fibrosis – blood prodution shifts to sleen and liver (hepatosplenomegaly) + tear drop shaped cells and nucleated rbcs
APL (acute promyelocytic leukemia)
type of ALL 15:17 translocation auer rods associated with DIC blasts on blood smear + myeloperoxidase
tx: chemo + ATRA
philadelphia chromosome?
bcrabl 9:22 translocation
CML
Non hodgkin lymphoma
presentation?
dx?
tx?
painless LAD, nodes are NOT warm red or tender, fever, weightloss, sweats
best initial test is exisional biopsy (CBC is often normal)
stage with CT chest abd pelvis and bone marrow biopsy
DO NOT DO NEEDLE ASPIRATION of LN
tx for advanced dz: CHOP therapy
ccyclophosphamide
doxorubicin (hydroxydaunorubiin) or adriamycin
vincrisine (oncovine)
prednisone
staging for non hodgkins lymphoma
1 1 LN group
2 2 or more LN groups on same side of diaphragm
3 both sides of diaphragm
4 widespread
MALT
mucosal associated lymphoid tissue
=lymphoma of the stomach
associated with H pylori
tx with clarithromycin and amoxicillin
reed sternberg cells?
hodgkins disease
hodgkins versus NH lymphoma
hodgkins = local usually, centers around cervical area, reed sternberg cells on path, lymphocyte predominant = best prognosis, lymphocyte depleted = worst prognosis
NHL = usually found in late stage, widespread, no reed sternberg cells, burkitt and immunoblastic have worst prognosis
late hodgkins lymphoma tx
ABVD adriamycin (doxorubicin) bleomycin vinblastine dacarbazine
what do you use to determine cardiac toxicity from chemo?
MUGA (nuclear ventriculogram)
adverse effect of these chemo agents: 1 doxorubicin 2 vincristine 3bleomycin 4 cyclophosphamide 5 cisplatin
1 cardiomyopathy 2 neuropathy 3 pulm fibrosis 4 hemorrhagic cystitis 5 renal and ototoxicity
Multiple myeloma
hypercalcemia, hyper uricemia, renal failure (due to Ig and bence jones protein), anemia, and bone pain (lytic lesions)
xray --> punched out lesions smear --> reauloux formations serum electrophoresis (SPEP) --> IgG or IgA spike = monoclonal M spike UPEP --> bence jones proteins biopsy >10% plasma cells
most accurate test for myeloma?
bone marrow biopsy
waldenstrom macroglobulinemia
overproduction of IgM from malignant B cells –> hyperviscosity
lethargy, blurry vision, engorged eye vessels, mucosal bleeding, and raynauds
IgM spike
tx: plasmapheresis
ITP
isolated thrombocytopenia (normal ht, normal wbc, normal spleen)
mild bleeding tx = glucocorticoids
severe bleeding = IVIG, antiRho
before splenectomy, what do you need to vaccinate for?
neisseria meningitisis
haemophilus influenzae
pneumococcus
VWD
von willibrand
mc inherited bleeding disorder (AD)
gum bleeding with normal platelet count (decreased functioning, not count)
dx: low vWF, + ristocetin assay longer bleeding time
tx: DDAVP (desmopressin) to release vWF stores OR vWF replacement
DIC labs and tx
elevated PT and aPTT
low platelets
elevated d dimer and fibrin split products
decreased fibrinogen (it was consumed)
if plat <50k and serious bleeding –> FFP (to replace plats and clotting factors)
do not transfuse platelets into HIT patient,, why?
it may worsen thrombosis
BRCA cancer
breast
ovarian
pancreatic
lumpectomy w radiation vs modified radical mastectomy
equal in effectiveness
lumpectomy is less deforming (not for multifocal dz though)
radical mastectomy when?
never the right answer
all ER or PR + breast ca pt should get…
tamoxifen, raloxifene or an aromatase inhibitor (anastrozole)
side effects
1) tamoxifen
2) aromatase inhibitors (anastrozole)
1 enodmetrial ca risk and clots
2 osteoporosis
trastuzumab
given in her2neu + breast ca
antibodies that decrease risk of recurrence and improve survival
in prostate ca which is more likely to cause erectile dysfunction
surgery or radiation
surgery
