Heme/Onc Flashcards
What are the macrocytic anemias? What would we see on a blood smear with these anemias?
B12 and Folate deficiency
Megaloblastic (hypersegmented neutrophils)
What would a pt have with B12 deficiency?
Peripheral neuropathy
What type of anemia may be secondary to alcoholism?
Folate deficiency
What type of anemia is associated with glossitis?
Folate (can also occur in B12)
What are the microcytic anemias? What consititues as microcytic?
*TICS* MCV is less than 80 Anemia or chronic disease Iron def anemia Thalassemia Sideroblastic
What are the differences between Anemia of chronic dz and iron def anemia?
Both have LOW Serum Iron
Ferritin is NORMAL in ACD
Ferritin is LOW in IDA
IDA will also have a high iron binding capacity
What is the max amount of ferrous sulfate a person absorb/day?
Max = 4mg
Males require 1mg
Females require 2mg (more if preggo)
If the iron levels are normal but the MCV is still less than 80, what should you think of?
Thalassemia or sideroblastic
What is thalassemia?
Reduced or absent beta or alpha chain
*Normal hemoglobin is made up of two alpha globin & two beta globin chains
How do you diagnose a thalassemia?
Electrophoresis (Hgb A2 and F)
When would we see Beta thalassemia diagnosed?
Intermediate and Major occur between 4-6months when the switch from fetal hemoglobin to adult occurs
Minor is asymptomatic
How do we treat alpha vs beta thalassemia?
Alpha H – folic acid supplements, avoid iron supplements
Beta = transfusions, iron chelation
What is the MC cause of sideroblastic anemia? Dx?
Lead toxicity
Lead level followed by bone marrow biopsy
What would normocytic anemia be caused from? What are the MCV levels?
Acute blood loss, organ failure, or impaired marrow function.
MCV 80-100
What is hemolytic anemia?
HIT (hereditary, immune attack, and trauma to the RBCs); characterized by decreased RBC survival and increased cell lysis
What are some of the causes of hemolytic anemias?
spherocytosis, elliptocytosis, G6PD, thalassemias, and sickle cell
How might a patient present with hemolytic anemia?
Jaundice, delayed puberty (from sickle cell), hepatosplenomegaly, and petechiae and purapura
Target cells are associated with what?
Thalassemias
Heinz body or bite cells are associated with what?
G6PD
What would we see on labs for G6PD?
Increased indirect bilirubin, reticulocyte count, LDH
Decreased Haptoglobin
What causes G6PD?
oxidative stress = Infection, meds, and fava beans
What meds have to be avoided with G6PD?
oxidant drugs = nitrofurantoine, sulfa, TMP-SMX, antimalarials
Howell-Jolly cells are associated with what?
Folate def (can also be seen in a Sickle cell smear)
What is the classification system for leukemias?
Acute or Chronic
Myelocytic or Lymphocytic
What do you see on labs in a pt with leukemia?
Pancytopenia (decreased RBC, platelets, and WBC) OR elevated WBC
Blasts seen on smear = Acute Leukemia
Flow cytometry distinguishes the classification of acute leukemia
What type of leukemia MC occurs in young children?
ALL – MC form of childhood cancer
What type of leukemia typically occurs in adults over the age of 60?
AML
What type of leukemia presents in young to middle aged adults?
CML
What type of leukemia has the worst prognosis and occurs in those over the age of 70?
CLL
Auer rods are associated with what type of leukemia?
AML
The Philadelphia chromosome is associated with what?
CML
Smudge cells are associated with what?
CLL
What is the standard of treatment for acute leukemias?
Chemotherapy
*better prognosis in AML if under the age of 60
How do we treat CML? CLL?
CML = tyrosine kinase inhibitors Imatinib and allogeneic bone marrow transplantation
CLL is palliative care
Reed-Sternberg cells are associated with what?
Hodgkin disease (along with enlarged spleen and liver)
What type of hodgkin’s is found in patients aged 15-45?
Hodgkin’s disease
How do we treat Hodgkin’s?
chemo and radiation
Which type of hodgkin’s has a better prognosis?
Hodgkin’s
What are the B symptoms?
Fever, night sweats, weight loss
A pt presents with bone pain and anemia – what dx? Workup?
Multiple myeloma Monoclonic spike on serum protein electrophoresis *Bence-Jones protein in urine Lytic lesions on xray
How do we treat multiple myeloma?
chemotherapy, dexamethasone
What is the cause of sickle cell anemia?
abnormal hemoglobin S
What’s worse – sickle cell homozygous or heterozygous?
homozygous (heterozygous means they carry the trait)
What are some risk factors to vasoocclusive disease in sickle cell?
infection with parvovirus B19
COLD, dehydration, hypoxia, stress, menses, and alcohol
What are the sxs of vaso-occlusion in sickle cell?
sudden pain, commonly chest, back, abdomen, and extremities
What are some of the complications of sickle cell?
growth issues, Asplenia + recurrent infection, increased risk of stroke, retinopathy
How do we diagnose sickle cell?
CBC shows hemolysis
Confirmed with hemoglobin electrophoresis
How do we treat the chronic form of sickle cell?
Folic Acid for ALL!!!
Vaccines: pneumococcal, influenza, and meningococcus
Children under 5: Prophylactic PCN to prevent infection
Hydroxyurea (to increase level of HgF)
How do we treat an acute vaso-occlusive episode?
O2, hydration, and opioids
If a fever is present give ceftriaxone (cephalosporin allergy = clinda or levo)
If a pregnant woman has a DVT can you give warfarin?
NO
