Heme/Onc Flashcards by Halley Flammer

Pentad of: thrombocytopenia, microangiopathic hemolytic anemia (anemia + schistocytes), neurologic signs, renal insufficiency, and fever

TTP

Schistocytes on smear (microangiopathic hemolytic anemia) is required, usually LDH is also elevated due to hemolysis

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Factor VIII deficiency

Hemophilia A

Long PTT

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Factor IX

Hemophilia B

Long PTT

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When do you get concerned about thrombocytopenia?

<50,000

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Pt has a hard and immobile lymph node. Now what?

Get surgery to excise

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Middle aged male, gradual onset of fatigue, Inaspirable BM, BM bx reveals CD11c/CD22

Hairy cell leukemia

Cancer of B lymphocytes

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BM bx with high IgM and lymphoblastic infiltrate

Waldenstrom macroglobulinemia
Monoclonal IgM causes hyperviscosity (dizziness, HA, Hearing/vision problems)
Roleaux formation

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Diagnostic test for Hemophelia?

1:1 mixing studies

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Pt with recurrent infections, hepatic fibrosis. Low IgG, IgA but very high IgM

Hyper IgM syncrome

X linked deficiency in CD40

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Overproduction of RBC, WBC, and plates with chr translocation of 22 and 9

CML
Philadelphia chromosome
Fatigue, night sweats, low fever

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Insidious bone pain and osteolytic lesion on Xray

Multiple myeloma
Need a Sr protein electrophoresis, Urine protein electrophogesis, free light chain analysis
Confirm dx with BM bx

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Marked leukocytosis (>50K) after an infection

Leukemoid reaction (LR)
High alk phosphatase score
Greater proportion of late PMN precursors (metamyelocytes, bands)
No basophils

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Back pain in a pt with suspected malignancy

Epidural spinal cord compression
Give IV steroids
May or may not have bowel/bladder dysfunction

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Work up for possible SVC syndrome

CXR

Suspect small cell lung cancer, non Hodgkins, fibrosing mediastinis, thrombosis.

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Hemolysis after taking bacrim. NL G6PD activity

G6PD deficiency

Often have NL enzyme activity during hemolytic episode b/c rets will have NL G6PD levels

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Management of thrombotic thrombocytopenic purpura (TTP)

Plasma exchange
TTP can be life threatening hemoltic anemia and thrombocytopenia
Caused by autoantibodies to plasma protease ADAMTS13

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Genetic finding in polycythemia vera

JAK2
Tend to have low epo levels (vs. other causes of polycythemia)
Aquagenic pruritis

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Initial screening test for thalassemia

CBC

Microcytic anemia warrants further testing

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Why are MM pts more prone to infection?

Impaired effective Ab production

this is d/t BM infiltration by neoplastic cells which alter the NL WBC population leading to hypogammablovulinemia

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Microcytic anemia d/t hemolysis in otherwise healthy pt

Look for calcific heart valve

“Macrovascular traumatic hemolysis”

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Alcoholic with bleeding at venopuncture site

Vit K deficiency

d/t inadequate dietary intake, malabsorption, hepatocellular dz

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PE most commonly comes from a clot in the?

Femoral v.

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HD pt has crazy high HTN. Why?

Erythropeoietin therapy

Those that receive large doses experience a rapid rise in Hgb leading to HTN

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If you suspect TTP (thrombocytopenia, hemolytic anemia) order a?

Blood Smear

Look for schistocytes

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What lab findings are present in anti phospholipid Ab syndrome

Prolonged PTT Diluted Russell viper venom test kaolin clotting time

Most common cause of B12 deficiency

Pernicious anemia | 2x risk of gastric cancer

Why do multiple myeloma pts get constipation?

Hypercalcemia | Fatigue, constipation, depression

What are potential infectious causes of ITP?

HCV and HIV

Macrocytic anemia | hypersegmented PMN's

Folic acid and/or B12 (cobalamine deficiency) | Causes increased homocysteine levels d/t both vitamins being needed in homocysteine metabolism

Increased methylmalonic acid concentration is specific to

Cobalamin (B12) deficiency

Anemia after partial gastrectomy

Vit B12 deficiency | Necessary cofactor in purine synthesis -> deficiency leads to defective DNA synthesis

Thrombocytopenia after heparin use

HIT Ab mediated platelet activation heparin -> conformational change on platelet surface exposes a neoantigen -> Ab binds -> platelet activation, thrombocytopenia, prothrombotic state Type 2 = 5-10 days after heparin

Pain, decreased ROM at a joint. X ray w/ osteolytic lesions | "soap bubble" on radiograph in the epihpyseal region of the long bone

Giant cell tumor | Benign but locally aggressive

Pt works in parking garage presents with HA, nausea, dizziness, polycythemia

CO poisoning Dx - Carboxyhemoglobinemia on ABG Tx - high flow 100% O2

Elevated LFTs DM skin hyperpigmentation

Hereditary hemochromatosis "bronze diabetes" Can progress to cirrhosis, HCC

RFs for DVT

Immobilization Surgery Malignancy Medication

CBC findings in hereditary spherocytosis

High Hgb High RBC distribution width Triad: hemolytic anemia, jaundice, splenomegaly

Tx for CML

Tyrosine kinase inhibitors (imatinib) | 9;22 forms BCR-ABL fusion creates a constitutively active tyrosine kinase -> leukomogenesis

Fatigue 1 or more cytopenias presents with DIC

``` APML AML will look similar but no DIC Smear = Auer rods BM bx = hypercellular and premyeloid blasts Most common adult leukemia ```

Young guy Hemolytic anemia Jaundice splenomegaly

HEreditary spherocytosis RBC membrane fragility high risk of cholecystitis d/t pigmented gallstones

Fever jaundice, abd pain, dark urine Blood Smear - bite cells, RBC inclusion after crystal violet staining Dx?

``` G6PD deficiency bite cells and Heinz bodies X linked Black men episodic hemolysis in response to oxidant durgs, infection, fava beans ```

Pt with lytic bone mets has hypercalcemia. tx?

Bisphosphonates | Stabilize the bone

Warfarin inhibits synthesis of vit K dependent factors

1972 II, VII, IX, X Protein C protein S

Best way to improve a patient's anorexia d/t chronic dz?

Progesterone analogue (megestrol acetate, medroxygrogeserone acetate) and steroids

When starting chemo, pts are at risk of tumor lysis syndrome. What metabolic abnormalities are seen?

``` Hyperuricemia Hyperkalemia hyperphosphatemia hypocalcemia (binds phosphate) Causes ARI, cardiac arrhythmias Tx fluids, allopurinal ```

How do you manage anticoagulation if you suspect HIT?

Stop Heparin Start DOAC Once plts return to >150k pt can be switched to warfarin

A PE pt cannot tolerate anticoagulation. They need a?

IVC filter

DVT pt has been taking warfarin since discharge but his diet is inconsistent. His DVT has grown since discharge. How do you manage?

Stop warfarin | Start DOAC

How do you tx anemia of chronic disease?

Treat the underlying disorder

Recurrent nose bleeds Oral lesions Young pt

Hereditary telangiectasia (Osler-Weber-Rendu syndrome) Develop pulmonary AVMs -> hemoptysis, right to left shunting. Get an increased HCT d/t shunting

``` Elderly pt (60) with weight loss, fatigue Peripheral blood smear -> leukocytosis w/ mature lymphocytes and smudge cells ```

CLL most common leukemia in the US median age = 70 Hallmark = lymphocytosis

Pt develops fever 2 hours after receiving blood transfussion. What could have prevented this?

Leukoreduction of donor blood | This can prevent febrile nonhemolytic reaction by reducin the risk of HLA alloimmunization and CMV transmission

Hyperviscosity syndrome (diplopia, tinnitus, HA, dilated funduscopic findings) Neuropathy Cryoglobulinemia serum electrophoresis -> sharp IgM spike

Waldenstrom macroglobulinemia Monoclonal expansion of IgM (Mult Myeloma would have expansion of IgA, IgG, light chains) Both W and MM have rouleaux bodies BM - >10% clonal B cells (MM, plasma cells)

Fatigue, dyspnea 2 weeks after amoxicillin tx | Splenomegaly, anemia, high ret count

Autoimmune hemolytic anemia d/t abx therapy + Direct Coomb's test with anti-IgG, anti C3 Tx - steroids, splenectomy Complications - VTE, lymphoproliferative disorders

Pain management for a pt with metastatic prostate cancer to the bone that is s/p orchiectomy?

Radiation therapy

Why are splenectomy pts at increased risk of infection to encapsulated organisms (Strep pneumo, H. flu)?

Deficit in Ab response and ab-mediated phagocytosis/complement activation

PNA pt has a marked leukocytosis with 85% lymphocytes. What should you do next?

Start Abx, fluids Flow cytometry of the peripheral blood (suspicious for CLL) Flow will reveal clonality of B cells

Pt with significant EtOH and smoking hx and Bx of LN reveals squamous cell carcinoma. CT is NL. Now what?

Panendoscopy (esophagoscopy, bronchoscopy, laryngoscopy)

``` Anemia High total Bili High serum lactate Low serum haptoglobin Direct Coombs + ```

Autoimmune hemolytic anemia | If + Fhx, and - Coombs think Hereditary Spherocytosis

Tx for B-thalassemia minor?

Reassurance | Usually mild anemia