Heme/Onc Flashcards
TTP
Suspect in patient with:
- MAHA –> Schistocytes
- Increase LDH
- Thrombocytopenia
Diagnosis: Peripheral smear
CTEPH
Criteria:
- Mean pulmonary artery pressure of greater than 25 mm Hg
- With normal pulmonary capillary wedge pressure, left atrial pressure, and left ventricular end-diastolic pressure
Diagnosis: V/Q scan- obstruction of medium sized or larger pulmonary arteries
+ V/Q scan warrants: Right heart cath
PNH
Suspect in patients with:
- Hemolytic anemia
- Pancytopenia
- Unprovoked atypical thrombosis
Diagnosis: flow cytometry results, which can detect CD55 and CD59 deficiency on the surface of peripheral erythrocytes or leukocytes
Budd-Chiari syndrome
Defintion: acute portal hypertension caused by thrombosis of the hepatic veins
Presentation: fulminant hepatic failure or subacutely with tender hepatomegaly and rapid-onset ascites
Mutation: JAK2 activating mutation
ITP association
- Idiopathic
- SLE
- CLL
- Lymphoma
- HIV
- Hepatitis C
- H. Pylori infection
Think about this with low platelet count and platelet type bleeding in young person.
Acquired platelet dysfunction
Can be caused by SSRI or gingko biloba
Test: Platelet function analyzer 100 to check for platelet function
When to test: normal platelet count and platelet type bleeding
Inflammatory anemia
Labs: Low iron Low TIBC Low transferrin saturation High Ferritin
Treatment: No specific therapy
Associated with:
- Malignancy
- Pregnancy
- Tuberculosis
- Osteomyelitis
- Rheumatological disorders (inflammatory)
Myelodysplastic syndrome treatment
Lenalidomide: improve quality of life and decrease transfusion-associated iron overload and alloimmunization
When to use: Multiple transfusion
Hypereosinophilia
Causes:
- Collagen vascular disease
- Helminthic infection
- Idiopathic
- Neoplasia
- Allergy/Atopy/Asthma
Acute aplastic crisis in hereditary spherocytosis
Trigger: by viral infection
Labs: Elevated bilirubin with low reticulocyte count
Treatment: Observation
Warfarin reversal
Four-factor prothrombin complex in serious GI or neurosurgical bleeds
Contraindicated: History of HITT (contains heparin)
Idarucizumab
Dabigatran reversal agent: binds non-vitamin K antagonist, decreases for 24 hours
Unprovoked DVT
10% of people will find malignancy within 1 year
To do: Age appropriate screening
Acute promyelocytic leukemia
Reduced total leukocyte count and features of disseminated intravascular coagulation
If DIC: Urgent cyroprercipiate, FFP and Platelets
Diagnosis: Bone Marrow Biopsy
Treatment: All-trans RA
MGUS cutoff
M spike of < 1.5 with normal SPEP and UPEP does not warrant any further evaluation
Delayed hemolytic transfusion reaction
Time period: 7-14 days after transfusion
Symptoms: Low grade fever and feature of hemolytic anemia
Diagnosis: Direct Antiglobulin (Coombs) test
Pure red cell aplasia
Cause: Parvovirus B19, affects erythrocyte precursors in bone marrow
Diagnosis: Just Hb decreased without decrease in WBC and platelets
- Decrease erythrocyte count
Essential thrombocytosis
Genes:
- JAK2
- Calreticulin
- MPL
Bone marrow biopsy: hypercellularity with increased numbers of enlarged megakaryocytes
Indication for treatment: Age > 60 with thromboembolic complications
Treatment: Hydroxyurea and ASA
Benign Ethnic Neutropenia
Isolated, mild neutropenia (1000-1500/µL [1-1.5 × 109/L]) found on routine testing in asymptomatic black persons or certain other ethnic groups (jews, west indians, arabs)
Anemia of Chronic Disease
Labs:
- Normocytic anemia
- Low reticulocyte count
- Normal erythrocyte morphology
Cause: Epo deficiency
Treatment: Erythropoiesis stimulating agents
Amylodosis
Symptoms:
- Proteinuria (nephrotic range)
- Cardiomyopathy
- Orthostatic hypotension
- Macroglossia
Labs: IgG gamma monoclonal gammopathy
Diagnosis: Abdominal fat pad biopsy (apple-green birefringence with Congo red staining)
Hemochromatosis lab findings
Transferrin saturation > 45% warrant additional testing
Imaging findings: Hook like osteophytes (especially in 2nd and 3rd MCP)
Waldenström macroglobulinemia
B-cell lymphoma with clonal lymphoplasmacytic infiltration of the bone marrow
Labs: IgM spike
Diagnosis: Bone marrow biopsy
Complications:
- Hyperviscosity: AMS, H/A, hearing loss, tinnitus, dizziness, nystagmus. If M protein level < 400 and no symptoms no need for testing
Patient with ALL are at risk for:
- Metabolic syndrome
- Truncal obesity
- Dyslipidemia
- ## High BMI
Isolated axillary lymph adenocarcinoma
- Should be treated as primary breast cancer until proven otherwise
Tumor lysis syndrome- Burkitts
Burkitts commonly presents with spontaneous tumor lysis syndrome
Other cancers:
- Leukemia
- CLL
- Large B cell lymphoma
Treatment: Rasburicase and IV hydration and Lasix
Tx in patients high risk, early stage, ER PR + that are premenopausal post chemotherapy
Ovarian suppression along with antiestrogen therapy
= increased surviva benefit
Tx: Leuoprolide with aromatase inhibitor (exemestane)
Optimally debulked stage III Ovarian CA Tx
IV/IP chemotherapy
Tumor size has to < 1 cm
Neuroendocrine tumors
If well differentiated, low mitotic grade usually are indolent and asymptomatic thus do not require treatment
Treatment Hairy Cell Leukemia
Cladribine or Pentostatin.
Follicular lymphoma progression
Look for:
- LDH elevation
- Increased uptake on PET scan
*** NEED TO RE-BIOPSY as it may have progressed
Isolated Inguinal lymph node
Prompt checking of:
- Vagina
- Vulva
- Cervix
- Anus
- Penis
Asymptomatic Follicular Lymphoma
Do not need to treat because they “live FOOOO ever”
Chest wall radiation age < 30, guidelines for breast cancer screening
Start Mammograms at age 25 or 8 years after radiation therapy is complete
Bladder cancer
RF: advanced age, white ethnicity, various occupational exposures, and cigarette smoking
Symptoms: Hematuria
Treatment: TURBT with six rounds of intravesical chemotherapy (BCG or Mitomycin)
