Heme/Onc Flashcards
Excessive exposure to oxidizing agents (dapsone, nitrites, local/topical anesthetics) can lead to
Methemoglobinemia
- ferrous Fe converted to ferric Fe
- pulse ox sat is low & not corrected with O2
- PaO2 is normal
- Tx with methylene blue or ascorbic acid if CI (G6PD)
microcytic anemia, constipation (GI), forgetfulness, sensory neuropathy, fatigue and unsteady gait. Worked with cars and drinks home distilled whiskey
Lead toxicity - impaired heme synthesis
Febrile nonhemolytic transfusion reaction
1-6 hours after beginning transfusion
- Caused by residual plasma/leukocyte debris releasing cytokines in storage
- Prevent with leukoradiation
gamma tetramers on hemoglobin electrophoresis, tired infant with mild scleral icterus
alpha thalassemia - microcytic anemia, elevated erythrocyte count, and target cells
Pt with recent URI tx with amox develops normocytic anemia with reticulocytosis, splenomegaly, mild scleral icterus
Warm agglutinin autoimmune hemolytic anemia
- due to drugs (penicillin), viral infection, autoimmune (SLE), immunodef, lymphoproliferative (CLL)
- anti IgG-Ab, anti C3 or both
- treat with corticosteroids or splenectomy
Infection with mycoplasma pneumoniae or infectious mono or lymphoproliferative
Livido reticularis and acral cyanosis with cold exposure, Improves with warming
Anemia
Cold agglutinin AIHA
- anti-IgM and anti-C3 antibodies
- avoid cold
- tx with Rituximab
Pt starts dapsone for dermatitis herpetiformis and develops scleral icteris, anemia, dark urine with blood on UA
G6PD deficiency - after starting dapsone, TMP/SMX, primaquine
- erythrocytes unable to produce enough NADPH to protect from oxidative injuries
- leads to hemolytic anemia
5 year old with bone pain, diffuse LAD, and pancytopenia
ALL (>25% lymphoblasts)
Testing for hereditary spherocytosis
Autosomal dominant
Coombs negative hemolytic anemia, jaundice, splenomegaly
-eosin-5-malemide (EMA) binding test
-acidified glycerol test
Blood smear finding of a patient with multiple myeloma
Rouleaux formation - due to elevated serum protein
Sx of MM: systemic systems, bone pain, normocytic anemia, renal insufficiency, protein gap, hypercalcemia
Side effect of glucocorticoids on CBC
leukocytosis due to mobilization of marginated neutrophils into the bloodstream
How to distinguish iron deficiency anemia from thalassemia with CBC
iron deficiency: low MCV, increased RDW, low RBCs
- Mentzer index (MCV/RBC) >13
thalassemia: low MCV, normal RDW and RBCs - Mentzer index <13
66 year old man with constipation, low back pain, and lab evidence of anemia, renal insufficiency, and hypercalcemia
Multiple myeloma
- hypercalcemia (from osteolytic bone destruction) –> constipation
Pt receives a blood transfusion. Within minutes starts to wheeze
Anaphylactic
- due to anti-IgA antibodies
- within a few seconds to minutes
TRALI
- respiratory distress and signs of noncardiogenic pulmonary edema
- within six hours of transfusion
- caused by donor anti-leukocyte antibodies
Pt with progressively worsening tingling and burning in the hands and feet. Refinished antique furniture as a hobby. Also has hyper and hypo pigmentation of the skin on the back of the neck. Hyperkeratosis on palms and soles. Plantar and dorsiflexion weak. 1+ DTRs in UE and LE. Anemic
Arsenic poisoning
- pressure treated wood
Pt with viral URI sx and pancytopenia
Aplastic anemia due to hematopoietic stem cell deficiency
Child presents with splenomegaly, jaundice, and anemia. Multiple family members have had splenectomy in the past.
Hereditary spherocytosis
- increased MCHC
Aplastic crisis vs. aplastic anemia
Crisis: sudden halt in RBC production, usually due to parvovirus
Anemia: pancytopenia due to bone marrow failure
Homeless man with chronic alcoholism presents with delayed wound healing. He has poor dentition and his gums bleed easily. Why is his wound not healing appropriately?
Scurvy - vitamin C deficiency
Tx for HIT
stop heparin and start direct thrombin inhibitor (agatroban)
side effect of EPO
hypertension
Pt with increasingly heavy periods, myalgias, arthralgias, petechiae, increased fatigue, and platelets 24,000
Immune thrombocytopenic purpura
- ANA testing is advisable
- dx of exclusion
- normal coag studies with platelets <100,000
Complications of sickle cell trait
- hgbA (50-60%), hgbS (35-45%), hgbF (<2%)
- hematuria, hyposthenuria (impairment in concentrating ability)
- UTIs and splenic infarctions less common
Findings on peripheral smear in patient with sickle cell disease with functional asplenia due to autoinfarction
Howell-Jolly bodies = nuclear remnants of RBCs that are usually removed by a functional spleen
Tx for ITP (child 2-5 with petichiae and low platelets, often preceded by a URI)
no mucosal bleeding: observe
w/ mucosal bleeding: IVIG
What is elevated in a patient’s blood who has colbalamin (B12) deficiency
homocysteine and methylmalonic acid
Pt with sickle cell has three weeks of progressive hip pain. X-rays and ESR are normal. Restricted in abduction and internal rotation
`Osteonecrosis of femoral head
- disruption of microcirculation
managment of elevated lead
check venous lead level
chelate if lead >45
most common cause of sepsis in SCD
Strep pneumo
Tx for Burkitt lymphoma
Rituximab - CD20 antibody which is on the surface of all B cells
26 year old construction worker with irritability, fatigue, muscle aches and microcytic anemia. Peripheral smear shows nucleated erythrocytes surrounded by groups of blue dots.
Lead poisoning - basophilic stippling
- order a DMSA
NSAIDs can cause `
iron deficiency anemia through chronic blood loss from GI tract
Tx for warfarin induced intracerebral hemorrhage
Prothrombin concentrate complex - contains vitamin K dependent clotting factors
MOA of: Heparin LMWH Abciximab (ReoPro), tirofiban (Aggrastat), and eptifibatide (Integrilin) Aspirin
- binds to anti-thrombin III (AT III) and increases the rate of AT III inactivation of thrombin and Factor Xa.
- same as above but has preference for Xa
- both require significant dose reduction in CKD - don’t use!
- GPIIb/IIIa inhibitors – decrease platelet aggregation
- irreversibly inhibits COX-1 in platelets
Tumor markers:
- pancreatic ca
- ovarian
- hepatocellular
- colon
- medullary thyroid
- Ca 19-9
- Ca 125
- AFP
- CEA
- Calcitonin
normal platelet count, normal PT, prolonged aPTT, increased bleeding time, and a low ristocetin cofactor assay
von willebrand disease
-tx is DDAVP
Pathophys of ITP
autoantibody targeting the platelet glycoprotein IIb/IIIa or platelet glycoprotein Ib/IX
type 2 hypersensitivity
sx: epistaxis, gingival bleeding, petechiae, and ecchymosis with isolated thrombocytopenia
tx: high dose prednisone
How to tx HIT
stop heparin
- initiate alternate anticoagulation (argatroban, fondaparinux)
Tumor Lysis Syndrome electrolytes
Hyperkalemia, hyperuricemia, hyperphosphatemia (inner cell contents) secondary hypocalcemia (from hyperphosphatemia)
Organophosphate poisoning
inhibits acetylcholinesterase - build up of ACh - hypermotility and hypersecretions with bradycardia
tx: atropine (sx) and pralidoxime (definitive)
Cancer associated with radon
lung cancer
Rash, GI sx (diarrhea), and liver dysfunction 15 days after a transplant
GVHD (CD8 t-lympocyte mediated injury)
- tx: methylprednisolone
Burkitt lymphoma translocation/gene
t (8;14) c-myc
pentad of neurological symptoms, acute renal failure, microangiopathic hemolytic anemia (with the presence of schistocytes), thrombocytopenia, and fever
TTP
- tx: plasma exchange
Patient’s with APL (subtype of AML with Auer rods) are at extremely high risk of
catastrophic hemorrhage due to tumor-induced consumptive coagulopathy
- give all-trans retinoic acid
Beta thalassemia major
Patients have increased hemoglobin A2 and F
Transfusion dependent
Require chelation due to iron overload
6 year old boy with pancytopenia, bleeding gums, short stature, hypopigmented macules, hypoplastic thumbs, flat thenar eminences
fanconi anemia
- dna repair defect
drugs to avoid in G6PD
nitrofurantoin dapsone isobutyl nitrate primaquine rasburicase
sideroblastic anemia
Acquired causes include exposure to lead, drugs (isoniazid, alcohol, chloramphenicol), collagen vascular disease, and neoplasm.
- abnormality in iron metabolism
- microcytic anemia
- increased ferritin and iron with normal or elevated TIBC
- anisocytosis and siderocytes
35 year old male presents with recurring fevers that wake him up at night. He also noticed an enlarging mass in his neck that hurts after he goes out with his friends and has a few drinks. He also notices an enlarged cervical LN with several other palpable ones
Hodgkin lymphoma
- Pel-Ebstein fevers
- pain with alcohol
- pruritis
