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Hematology / Oncology > Heme-Onc Lab > Flashcards

Heme-Onc Lab Flashcards

1
Q

Why are tumor markers tricky?

A

certain tumor markers can be elevated in multiple types of cancer; tumor markers are not always elevated; tumor markers have not been identified for all cancers

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2
Q

Cancer HPI:

A

Weight loss, fatigue, night sweats, pain, cough, blood in stool

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3
Q

PET Scan

A

Injecting someone with radioactive sugar and if it lights up, it means they have Cancer

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4
Q

Tumor markers don’t diagnose a cancer, a _____________ diagnoses a cancer

A

Pathologist

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5
Q

Sensitivity

A

% of people who DO have cancer and WILL have an abnormal test

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6
Q

Specificity

A

% of people withOUT cancer who will have a NEGATIVE test

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7
Q

What are the 5 general categories of tumor markers?

A

Antigens, Enzymes, Hormones, Oncogenes, Tissue Receptors

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8
Q

What is an antigen?

A

Protein found in larger amounts during fetal development; sometimes cancer cells will have high levels of fetal antigens

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9
Q

Antigen examples:

A

AFP, CEA, PSA, Ca-125, Bence Jones Proteins

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10
Q

Malignant tissue might cause the blood to have increased enzymes. How do you measure them? / Examples

A

Immuneoassay / Prostatic Acid Phosphatase, all ase’s

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11
Q

What are common hormones that indicate cancer?

A

Beta-HCG, Human Calcitonin

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12
Q

Examples of Oncogenes you could look for

A

BRCA1, BRCA2, Philadelphia Chromosome

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13
Q

Tissue receptors can be helpful in guiding:

A

Therapy choices

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14
Q

Most tumor markers are used to monitor:

A

Recurrence of cancer following treatment

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15
Q

What is AFP?

A

Antigen: Alpha Fetoprotein; found in fetal GI tract; increased in 80-90% of pts with hepatocellular carcinoma; used to screen patients with cirrhosis/hepatitis

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16
Q

What is Bence Jones Proteins?

A

Antigen; used to detect and monitor Multiple Myeloma; found in urine; 2-20% don’t produce this

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17
Q

What is HCG?

A

Hormone. Usually absent except in pregnant women. Presence otherwise is due to germ cell tumors in men or cancer of the uterus

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18
Q

What are BRCA1 and 2?

A

Oncogenes

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19
Q

What risk do men with BRCA 1 or 2 have?

A

risk for prostate or breast cancer; can pass mutation on to daughter

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20
Q

What is Ca-19-9?

A

An ANTIGEN; useful in diagnosing hepatobiliary cancer.

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21
Q

What is CA-125?

A

ANTIGEN. Elevated in 80-90% of women with ovarian cancer; after 2 cycles of chemo is a good prognostic indicator.

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22
Q

What is CEA?

A

ANTIGEN: useful in diagnosing GI, colorectal cancers.

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23
Q

What is the PSA antigen?

A

Antigen for detecting prostate cancer

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24
Q

Sensitivity and specificity of PSA?

A

High sensitivity, LOW specificity.

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25
Q

Tumor markers generally make _____ screening tests

A

poor

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26
Q

Tumor markers are helpful for ______________

A

following a known Ca / evaluating therapy

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27
Q

Surgical Needle Biopsy:

A

Can be either incisional (take part of the tissue & test it) or Excisional (take all of the suspicious tissue)

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28
Q

Endoscopic Biopsy

A

Lighted tube w/lens is used to look inside body and take tissue samples

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29
Q

Frozen Section:

A

Think Moh’s: tissue sections are prepared during surgery. Frozen –> sliced –> stained

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30
Q

Exfoliative cytology:

A

Scraping scalpel over lesion

31
Q

TIBC

A

Total Iron Binding Capacity; measures the extra room transferritin has to shuttle iron around (high TIBC means low iron b/c lots of available iron transport)

32
Q

Serum Ferritin

A

Should be higher than your age; best test to get at iron level; ferritin needs iron to be synthesized

33
Q

MCHC

A

Mean Corpuscular Hemoglobin Concentration = Hemoglobin / Hematocrit… this number tells you hwo dark the cells are (the darker they are, the more hemoglobin they have in them)… hyper vs hypochromic

34
Q

HgB Electrophoresis

A

useful in detecting odd hemoblogin (i.e. in Thalassemia, Sickle Cell Anemia)

35
Q

Bone Marrow Biopsy

A

Gold standard in anemia treating, however, VERY expensive

36
Q

Bilirubin

A

If this is elevated, it indicates hemolytic anemia b/c cells are breaking apart and dumping their contents into the blood stream

37
Q

Reticulocyte count in a patient with anemia

A

you would expect it to be elevated to make up for decreased RBCs… if it is not, then that is a very bad sign!

38
Q

Where do the intrinsic and extrinsic clotting pathways converge?

A

At the activation of Factor X

39
Q

Extrinsic Pathway:

A

Tissue factor activates Factor VII which activates Factor X

40
Q

Common pathway

A

After Factor X is activated, the pathways come together. Common pathway: Factor X activates Factor V which converts prothrombin to thrombin. Thrombin activates fibrinogen to its active state, fibrin.

41
Q

Which pathway does a PT test?

A

Extrinsic pathway

42
Q

You would draw a PT to monitor which med?

A

Warfarin

43
Q

What does a prolonged PT mean?

A

Either a factor 7 defect or Vit K deficiency

44
Q

A prolonged PT indicates?

A

Lack of clotting; a problem in the extrinsic clotting cascade.

45
Q

Which pathway does an INR measure?

A

Extrinsic

46
Q

What is an INR a ratio of?

A

A patient’s PT / Normal mean PT

47
Q

What pathway does an aPTT test?

A

Intrinsic

48
Q

What does an elevated PTT indicate?

A

Deficiency or inhibition of intrinsic clotting factors

49
Q

What medication is a PTT used to monitor?

A

Heparin

50
Q

What is an FSP?

A

Fibrin Split Product

51
Q

What does an elevated FSP mean?

A

Either excessive activation of thrombin OR excessive degredation of fibrin/fibrinogen.

52
Q

What can an elevated FSP indicate?

A

DIC.

53
Q

What pathway does FSP measure?

A

Common

54
Q

What pathway do Factor Assays measure?

A

Could measure any component of either pathway

55
Q

When would you run a factor assay?

A

When you have an elevated PT or PTT and want to isolate why.

56
Q

What do you use the Direct Coomb’s Test for?

A

Autoimmune Hemolytic Anemia b/c it measures surface antibodies

57
Q

When is an Indirect Coomb’s Test done?

A

pregnancy or before transfusion to ensure hemolytic anemia does not occur

58
Q

Which pathway does a D-Dimer measure?

A

Common

59
Q

What does a D-Dimer measure?

A

Fiber degradation; it tells us that there was a clot and it is being busted up.

60
Q

What is different about frozen packed RBCs vs packed RBCs

A

Frozen is devoid of WBCs and plasma cells

61
Q

What do you give someone with a low hematocrit or Hgb?

A

Packed RBCs not whole blood

62
Q

Autologos RBCs

A

Patient’s own blood

63
Q

When can hemolysis occur during a blood transfusion?

A

If someone is given the wrong type of blood

64
Q

Leukoagglutinin Reactions

A

Reaction to antigens on WBCs

65
Q

What type of blood would you give someone who has experience leukoagglutinin reactions?

A

leukocyte poor blood or frozen PRBCs

66
Q

Warfarin works by:

A

Antagonizes Vitamin K & interferes with synthesis of Vitamin K-dependent clotting factors

67
Q

Dabigatran works by:

A

Inhibiting Thrombin (thus preventing cleavage of fibrinogen to fibrin)

68
Q

Heparin works by binding to:

A

Antithrombin III; this inhibits factor X and the conversion of fibrinogen to fibrin

69
Q

Low Molecular Weight Heparin

A

Lovenox

70
Q

What are the advantages of LMWH?

A

in/out pt use, longer half life, greater bioavailability

71
Q

Heparin can be:

A

Injected only

72
Q

List the 3 platelet inhibitors:

A

Asparin, Ticlopidine, Clopidrogel

73
Q

How does asparin work?

A

Inhibits cox-1 and 2 enzymes which inhibit prostaglandins and inhibit platelet aggragation

74
Q

How do clopidrogel and ticlopidine work?

A

By blocking ADP receptors and causing a reduction in platelet aggregation

Hematology / Oncology (9 decks)

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