Heme/Onc - Week 2 Review - Part 2 Flashcards
LDH - Lab Value Meaning
Indicates Tumor or Hemolysis
Acute Leukemia Differentiation
AML - Auer Rods + MPO + CD33
ALL - TdT + Lymph (B=CD19/20/23 vs. T=2/7)
AML-M3 - Alternative Name + Genetics + Treatment + Associated Disease
Acute Promyelocytic Leukemia
t(17:15) - RAR Activated - Treatment = ARTA, vitamin will activate the receptor and force differentiation
Associated with DIC
Multiple Myeloma Labs (7)
1) Leukopenia
2) Thrombocytopenia
3) Low Hb
4) Low Hct
5) Elevated Total Protein with Low Albumin
6) High Creatine
7) Hypercalcemia
Multiple Myeloma Finds + Causes (6)
All due to Monoclonal Plasma Cells
1) Bone Break Down with Lytic Lesions - Osteoclast Activating Factor
2) Hypercalcemia - Osteoclast Activating Factor
3) Monoclonal Spike - Increased Ig
4) Infection - Monoclonal Ig
5) Proteinuria (with kidney damage) - Bence Jones Proteins - Light Chain
6) Roulox Formation on Smear - Spherocyte RBC Linking
Nodular Sclerosisng HL - Classic Case + Histology
Young Female with Medistinal/Cervical Mass
Reed Sternberg Cells - CD 15/30+
Nodular Sclerosing HL - ABVD Treatment
1) Adriamycin (Doxorubicin - Cardiotoxicity)
2) Belomycin (Anti-Tumor Abs - Pulm. Fibrosis
3) Vinblastine (Microtubule Inhibitor - Peripheral Neuropathy
4) Dacarbazine (Alkylating Agent)
Mechanisms of Drug Resistance (7)
1) Mutation
2) Gene Amplifaction (Overproduction of the drug’s target)
3) Efflux Pumps
4) Lack of Transport into cancer
5) DNA Repair - Cancer can learn DNA Repair
6) Drug Inactivation - Oxidation of the rug
7) Presence of Cancer Stem Cells (Hide)
Imatinib - Mechanism + Use (2) + Resistance Method (2)
Inhibits BCR-Abl and C-Kit
Use - CML (BCR) + Gastrointestinal Stromal Tumor (GIST) - C-Kit
Resistance - BCR-Amplication + Mutation in the drug binding site
hENT1-2 - Role In Resistance
Normally at the blood brain barrier to remove unwanted substance
Development elsewhere - Become drug efflux pumps
BRCA2 - Resistance Mechanism
BCRA2 - Mutation in DNA Repair Enzyme
Give drugs - it will mutate back and it can repair the DNA Again
Alkylating Agent Resistance (Platinums)
Gutathion S-Transferase Metabolizes Platinums and triggers their efflux
Increasing the GST System increases the efflux of the platinums
Atripimod - Mechanism + Resistance
JAK2 Inhibitor (works great in vivo)
In the body the cancer cells (SET2) are protected via the stromal cells
ABO Blood Groups - Sugars + Chromosome
Chromosome 9
A Antigen - N-Acetyl-Galactosamine
B Antigen - Galactose
O Antigen - None
Type O = Least vWF = Most Bleeding
Type AB = Most vWF = Least Bleading
Anti-ABO Antibodies - Key Points (3)
IgM - Warm Agglutanin - React at Normal Body Temperatures (key for transfusion)
IgM - Triggers Compliment Cascade - Rapid Intravascular Hemolysis - Why Matching Is Key
Anti-Rh Antibodies - Key Points (3)
IgG - Made in response to exposure
To small for compliment - bind and trigger splenic macrophage destruction (extravascular hemolysis)
Hemolytic Disease of Newborn (Small enough to cross placenta)
Hemolytic Disease of the Newborn
IgG for Rh+ Crosses from baby #1 to mom (Rh(-)) - Not an issue for the first child
During second pregnancy mom has built anti Rh+ IgG which goes into the new Rh+ baby and attacks - Worse with each pregnancy
Transfusion Implications of ABO (2)
Type O - Universal Donor - Won’t be attacked by any antibodies the person may have (E.g. Type A with Anti-B antibodies won’t get the Type O)
Type AB - Universal Recipient - No antibodies - can receive any type
Rh-Immune Globulin - Mechanism + Use
Prevents hemolytic disease of the newborn
Give IgG Ab’s to the RhD Antibody - and newborn blood that escapes in the mom is knocked out before it has time to trigger mom’s Ab response
Mycoplasma Pneumonia - Impact on Blood (3)
I Antigen - Triggers IgM and IgG after infection
IgM - Agglutinante in Cold Temps
IgG - Compliment Activation - Donath-Landstiener Anemia
Blood Transfusion Components (4)
1) Packed RBCs
2) Platelets (HLA)
3) FFP
4) Cryopercipitate
Packed RBCs - Key Points (3)
1) ABO Compitability
2) Expiration 3-6 Weeks (fridge)
3) Stored to long - low pH = hemolysis + 2,3 BPG drop (left shift)
Platelets - Key Points (2)
1) HLA Matching if Possible
2) Expiration = 5 Days (then bacterial infection
FFP - Uses (3) + Keys (2)
1) DIC
2) TTP
3) Warfarin Overdose
1) Stored Frozen (Expiration after 24 Hours)
2) Storage Factors V and VIII lost first
Cryopercipitatie - Keys (3)
1) Thawed FFP
2) Fibrinogen + Factor VIII + vWF
3) Used for DIC
Complications of Transfusion (6)
1) Infection
2) Febrile Reactions
3) Allergic Reaction
4) Acute Immune Mediated Hemolytic Reaction
5) Transfusion Associated Circulatory Overload (TACO)
6) Transfusion Related Acute Lung Injury (TRALI)
Febrile Transfusion Reaction - Key Point
Reaction to donor HLA - Mild Fever
Allergic Transfusion Reaction - Key Points (3)
1-3% of Transfusions - Circulating Ab’s Against Donor Proteins
KEY FOR EXAM
IgA Deficient Recipient - Receives Blood with IgA - Recipient Anti-IgA Ab’s attack the IgA from the donor causing sever anaphalxis
Classic Presentation - Family Hx. of anaphlaxis with a “matched” patient (e.g. anaphalaxis not due to clerical error)
Acute Immune Mediated Hemolytic Reaction - Key Points (2)
1 Cause = Clerical Error - Also Cross and Type
Un-matached ABO Donor/Recipient
Transfusion Associated Circulatory Overload - Key Point
TACO
Transfusion alters hemodynamic state - HTN + Pulm Edema
Transfusion Related Acute Lung Injury (TRALI) - Key Points (4)
1) 1-2 Hours After Transfusion
2) Severe Hypotension + Pulmonary Edema
3) Antibodies against donor HLA - Antibodies cause massive immune reaction with endothelial damage and fluid leak (pulm. edema)
4) #1 Cause of Transfusion Death
