Heme/Onc Part 1 Flashcards
What will be seen on peripheral smear with a Macrocytic Anemia?
Hypersegmented Neutrophils (>5 lobes)
What can differentiate a folate and B12 deficiency on lab value?
Methylmalonic Acid
– High with B12 deficiency
Which occurs faster, Folate or B12 deficiency?
Folate
Where is B12 found?
Animal products
What 3 conditions may have a Vitamin B12 deficiency?
Vegan
Crohn’s
Gastric Bypass
How is Vitamin B12 absorbed?
Parietal cells in the stomach secrete IF which binds B12 and helps it be absorbed in the terminal ILEUM
What test can be used to assess if a Vitamin B12 deficiency is nutritional or an absorption problem?
Schilling’s Test
Following a Schilling’s Test, if Vitamin B12 IS in the urine, what kind of deficiency does the patient have?
Nutritional deficiency
If a patient has impaired absorption of Vitamin B12 due to Crohns or Gastric Bypass, what is the treatment?
IM Vitamin B12
Vitamin B12 deficiency will have what symptoms that a Folate deficiency will not have?
Neuro Sx – loss of proprioception/vibratory/etc.
= Subacute Combined Degeneration
What are the levels of Iron, Ferritin and TIBC with Iron Deficiency Anemia?
LOW iron and ferritin
HIGH TIBC
What causes Anemia of Chronic Disease?
Chronic inflammation with cytokines, often autoimmune or malignancy
What are the levels of Iron, Ferritin and TIBC with Anemic of Chronic Disease?
LOW iron and TIBC
HIGH Ferritin
If you see a Microcytic Anemia with normal iron studies and a significantly low MCV, what may be the condition?
Alpha Thalassemia
What are 3 Microcytic Anemias?
Iron deficiency
Anemia of Chronic Disease
Thalassemias
If a Hemolytic Anemia is occurring, what 3 lab changes will be present?
Low Haptoglobin
HIGH LDH and bilirubin
If a Hemolytic Anemia is occurring, what 3 lab changes will be present?
LOW Haptoglobin
HIGH LDH and bilirubin
What are the signs of a Febrile Non-hemolytic transfusion reaction?
Fever, chills and malaise following transfusion
What causes a Febrile Non-hemolytic transfusion reaction? What do you do?
Cytokines in the transfused blood
– Give Acetaminophen and stop the transfusion
What are the signs of an Acute Hemolytic transfusion reaction?
Fever and chills
Hypotension
Flank pain and possible renal failure
What causes an Acute Hemolytic transfusion reaction?
ABO incompatibility where recipient antibodies attack donor blood
What will be seen with a Delayed Hemolytic transfusion reaction?
A week after a transfusion, the patient may have a fever
If a patient has an allergic reaction with a transfusion it will occur in minutes. Why does it occur?
Recipient antibodies to plasma proteins
Ex. IgA Deficiency
Signs of an Allergic reaction following a transfusion?
Urticaria and itching
Anaphylaxis
What is the mutation with Sickle Cell Disease?
Glutamic acid replaced by Valine on Beta globin gene Chr. 16
Under conditions of acidosis and hypoxemia, RBCs will sickle with sickle cell disease. In general, what 2 things does that cause?
Clot/Ischemia
Hemolysis
If you believe a Sickle Cell patient is having an Acute Chest Syndrome or a Cerebral infarction, what is the treatment?
Exchange transfusion
If you believe a Sickle Cell patient is having a vaso-occlusive pain crisis, what are 3 things that they should be given?
IVF
Oxygen
Pain control
If a Sickle Cell patient comes in with abdominal pain, what could be the cause?
Pigmented gallstones from chronic hemolysis
Due to autoinfarction of the spleen, what should children with Sickle Cell be given until age 5? After that?
Penicillin until age 5
Pneumococcal vaccine after that
Following the initiation of chemotherapy treatment, what may occur if patients are now sick or having arrhythmias?
Tumor Lysis syndrome
Pneumonic to remember Tumor Lysis Syndrome electrolyte changes?
PUKE Calcium
Electrolyte changes with Tumor Lysis Syndome?
PUKE Calcium
- phosphorus
- uric acid
- potatssium
= ELEVATED
- Calcum LOW
What is the treatment of Tumor Lysis Syndrome?
Normal saline and Uric acid inhibitors
What is a Myelodysplastic Syndrome?
Disorder of the formation of 1 or more myeloid lines
What will be seen with a Myelodysplastic Syndrome?
Cytopenias
BM is < 20% blasts!
What may be seen on peripheral smear with a Myelodysplastic Syndrome?
Oval Macrocytes
What is the result of a BM biopsy with a Myelodysplastic Syndrome?
< 20% blasts!
Side effect of Vincristine and Vinblastine?
Peripheral Neuropathy
Side effects of Cisplastin/Carboplatin?
Ototoxicity
Nephrotoxicity
Side effect of Cyclophosphamide
Hemorrhagic Cystitis
Side effect of Bleomycin?
Pulmonary Fibrosis
Side effect of Adriamycin, Doxorubicin, Daunorubicin?
Cardiomyopathy
How do you differentiate mature cells from blasts?
Mature cells have very little cytoplasm
– BLASTS = CYTOPLASM
Exposed collagen on injured vasculature will expose vWF, which binds what platelet antigen?
GP1B
