Heme/Onc Flashcards
Most causes of microcytic anemia have what kind of reticulocyte count
Low reticulocyte count, implies production problem
Macrocytic anemia has a low reticulocyte count as well
Causes of macrocytic anemia
B 12/folate deficiency,Sideroblastic anemia, alcoholism, anti-metabolite medications, liver disease or hypothyroidism, zidovudine, phenytoin, Milo dysplastic syndrome, cold agglutinin’s
FFP versus cryoprecipitate
FFP replace his clotting factors, used in those with elevated PT, PTT it, INR and bleeding, used as replacement with plasmapheresis
Cryoprecipitate is used to replace fibrinogen, used in DIC, provides clotting factors in smaller classroom about you, has high levels of factor 8 and VWF
Causes of sideroblastic anemia
Can be associated with Milo dysplasia, most common cause is alcohol – suppressing bone marrow, other causes: blood poisoning, INH, vitamin B6 deficiency
Unique features on iron studies of microcytic anemias:
Low ferritin
Hi iron
Normal
Low ferritin: iron def
Hi iron: sideroblastic
Normal: thalassemia
Difference between anemia of chronic disease and iron deficiency anemia
TIBC will be hi in iron deficiency, but low in anemia chronic disease
Thalassemia diagnosis
Alpha: DNA analysis
Beta: hemoglobin electrophoresis
RDW will be normal as well iron studies
Labs in vitamin B 12 and folate deficiency
Increased LDH and indirect Billy Rubin, decreased reticulocyte count, hypercellular bone marrow, increased homocysteine levels, only vitamin B 12 will have an elevated MMA
Both may cause pan cytopenia
Diagnosing sickle cell disease
Best initial test: peripheral smear
Most accurate test: hemoglobin electrophoresis
Sickle cell disease treatment
Oxygen, hydration, analgesia, if fever or high white count: antibiotics: ceftriaxone, Levofloxacin, moxifloxacin
Folate replacement, pneumococcal vaccination,
Exchange transfusion: ACS, Priya prism, stroke, visual disturbance from retinal infection
Features of sickle cell trait
Isothenuria: defect and ability to concentrate urine
Occasionally hemateria
Causes of autoimmune hemolysis – warm or IgG
CLL, lymphoma, SLE, penicillin, methyldopa, Ray famine, funny tone
Coombs test is most accurate, will have spherocytes on peripheral smear
Treat with steroids, if re current: splenectomy, severe/acute hemolysis not responding to steroids: I VIG
Rituximab, other immunosuppressant
Cold agglutinin disease
Most accurate test is cold agglutinin titer, direct Coombs’ test was positive only for complement
Treat by staying warm, rituximab, sometimes plasmapheresis, anti-metabolites/immunosuppressive’s – steroids in splenectomy do not work in cold
TTP is associated with?
Ticlodipine, cyclosporine, Plavix, AIDS, SLE
Episodic dark urine, pancytopenia, clots in unusual places think?
Paroxysmal nocturnal hemoglobinuria – PNH
MCC OD: thrombosis
Treat,with prednisones, eculizumab, bone marrow transplant, give folate
If a patient with a plastic anemia is too old for bone marrow transplant – about 50 or there’s no match donor treat with?
Antithymocyte globulin and cyclosporine/tacrolimus
Treatment for polycythemia vera
Phlebotomy, aspirin: prevent thrombosis, hydroxyurea: lowers cell count, allopurinol, rasburicase: protects against Uric acid road, anti histamines
Essential thrombocytosis will have platelet count around? Very difficult to distinguish from?
Platelet count above 1 million, difficult to distinguish from reaction to another stress: infection, cancer, iron deficiency
Will have both bleeding and thrombosis
Treat with hydroxyurea
Treatment for myelo fibrosis
Thalidomide, lenalidonide, bone marrow transplant under age 50 to 55
ruxolitibib inhibits JAK2
Leukemia associated with the DAC
AML M3 subtype: acute promyelocytic leukemia
15:17 translocation
Best initial test: blood smear showing blast
Most accurate: flow cytometry
Myeloperoxidase characteristic of AML
Add all trans retinoic acid to Tx for M3
If ALL add mtx - intrathecal
Pruritis after shower, splenomegaly, high WBC think?
CML
Diagnosed with BCR-ABL on pcr or fish
Most likely to transform into acute leukemia – blast crisis, differentiate from leukemoid reaction with low LAP
Myelodysplastic syndrome
Pre-leukemic disorder in older patients over 60 – pancytopenia with hypercellular bone marrow, increased MCV, nucleated red cells in small number of blasts, ring sideroblasts, severity based on percentage a blast, 5q deletion has excellent response to a lenalidomide
Pelger-Huet cells: bilobed nucleus
Azacitidine
Treatment for CLL
Stage 3/4: fludarabine, cyclophosphamide, rituximab
Mild: chlorambucil
Infections: IVIG
Prednisone for autoimmune thrombocytopenia or hemolysis
PCP prophylaxis
Radiation increases the risk of?
Solid tumors: breast, direct, long, also increases chance of premature coronary artery disease
Chemotherapy increases the risk of acute leukemia, MDS, NHL
Best diagnostic test for MM
Bone marrow biopsy with greater than 10% plasma cells
Blurry vision, vertigo, engorge blood vessels in the eye, mucosal bleeding, Ray nods, think?
Walden Strom macroglobulinemia: hyperviscosity, no bone lesions, best therapy is plasmapheresis to remove the IgM and decrease viscosity
Immune thrombocytopenic Purpera will have? How to treat?
Isolated thrombocytopenia, normal sized spleen, Megakaryocytes are elevated, Platelets are large
If platelets under 30,000: steroids, if severe bleeding in less than 10,000: I VIG, anti-Rho, with recurrent episodes/steroid dependent: splenectomy, if still refactory: immunosuppressants
Give meningitis, pneumococcus, H. Flu vaccination before splenectomy
Superficial bleeding, elevated bleeding time with normal platelet count possibly elevated PTT, worsened after use of aspirin think?
VWD: AD
No platelet aggregation with ristocetin assay
Treat with desmopressin
Hemophilia’s have what PT/PTT?
Normal PT, elevated PTT implying intrinsic pathway defect, factor 8/9, May have prolonged bleeding time, treat with DDAVP or factor replacements
DIC risk factors and labs?
Risks: sepsis, burns, placenta abruption, amniotic fluid embolism, snakebites, trauma, cancer
Bleeding related to clotting factor deficiencies and thrombocytopenia
Elevated PT, PTT, BT, low platelets, elevated D dimer, decreased fibrinogen
DIC treatment
If platelets are under 50,000in the patient has serious bleeding: use FFP – replace his platelets and clotting factors, use cryoprecipitate if bleeding not controlled with FFP
Platelets drop more than 30%, Venus more than arterial thrombosis, think? How do you diagnose and treat?
HIT – confirm with ELISA. For platelet factor 4 Abs or serotonin release essay
APL Dx
Best initial test: mixing study, will not correct, PTT will remain elevated (paradoxical)
Best: Russell viper venom test
Testicular cancer
Alpha fetal protein: only in nonseminomatous cancers, hCG up in all of them
Staging performed with CT of abdomen pelvis chest, as his cancer metastasizes up through lymphphatic channels and the retroeritoneum moves into the chest
Seminoma: sensitive to chemo and radiation, non-seminoma: just chemo
If low or high-grade dysplasia is seen on Pap smear what to do next?
Colposcopy and biopsy
If ASCUS on pap, what to do next?
Get HPV testing, if positive get colposcopy, if negative: repeat Pap smear in six months
