HemeOnc Flashcards
What are some RBC morphogies we may see on the boards?
Spherocytes- autoimmune/drug-induced
Schistocytes- DIC, TTP
Bite cells- G6PD deficiency
What are the endpoints of an MTP?
Hemodynamic stability and adequate tissue oxygenation
Hgb 7-9
INR <1.5x normal
Plts 50-100k
fibrinogen >150
What are the platelet targets for various procedures?
What are some of the buzzwords for leukemias?
AML: gingival hyperplasia, rash, LAD
APL: bleeding, thrombosis (DIC, hyperfibrinolysis)
ALL: LAD, organomegaly, CNS, bone pain, tumor lysis
TCell leukemia: hypercalcemia, bone lesions
What are the features of APL differentiation syndrome?
15-25% of patients treated with ATRA, 2-47days post treatment
Due to cytokine release, increased APL adhesion (beta2 integrins)
Fever, leukocytosis, pulm infiltrates, effusions, rapidly improves with dexamethasone
How is hyperleukocytosis treated?
Leukopheresis, dexamethasone, cranial irradiation
How is TLS prevented and treated?
Low risk: fluid status and look at labs for allopurinol?
Intermediate risk: 7 days allopurinol and crystalloids
High risk: rasburicase (unless G6PD deficiency), crystalloid
Febuxistat in allopurinol hypersensitivity
Rasburicase in established TLS
HD for refractory cases
When to consider NSGY versus radiation for brain mets?
How is spontaneous splenic rupture managed?
Embolization. US has 90% specificity for splenic rupture
What are some side effects of dasatinib?
Second generation TK inhibitor
Cytopenias, pleural effusions, bleeding (decreases platelet function)
Recall shapes of TEG results and what they mean
What complications can be triggered by chimeric antigen receptor Tcell treatment?
Cytokine release syndrome
will see fever, multiorgan dysfunction, shock and hypoxemia
Tx with anti IL-6 (tocilizumab)
How is refractory TTP treated?
PLX, steroids, rituxumab, and caplacizumab (vWF monoclonal antibody fragment)
What are the features of vaccine-induced immune thrombocytopenia?
IgG antibodies that recognize platelet factor 4 but with different epitpoe than HIT. 5-10 days post adenovirus vector vaccine
Will have thrombocytopenia around 50, has disproportionate cerebral/splanchinic involvement compared to HIT
Can still use heparin despite the similarities with HIT
What is the Pelger-Huet anomaly signify on peripheral smear?
Neutrophils with fewer lobes than normal.
Seen in COVID, leukemia, myelodysplasia, myxedema, malaria, or drugs. May also be inherited
Iron deficiency can cause hypersegmentation FYI
