HemOnc (Step up son) Flashcards
What can cause a left shift of the hgb-O2 dissociation curve?
Metabolic alkalosis
Decreased body temp
Increased Hgb F
What can cause a right shift of the Hgb-O2 dissociation curve?
Metabolic acidosis
Increased body temp
High altitude
Exercise
A patient presents with AMS, cherry lips, and hypoxia despite normal pulse ox reading. What is going on?
CO poisoning
What causes microcytic anemias?
Iron deficiency Lead poisoning Chronic disease Sideroblastic Thalassemias
What causes normocytic anemia?
Hemolytic
Chronic disease
Hypovolemia
What causes macrocytic anemia?
Folate deficiency
B12 deficiency
Liver disease
Booze
What does agglutination with direct Coombs test indicate?
Presence of IgG and complement on RBC membranes (warm and cold agglutinin disease)
What does agglutination with indirect Coombs test indicate?
Anti-RBC antibodies in serum
Patient develops fatigue, pallor, and icterus after being treated with penicillin. What happened? What would be seen on a smear?
Drug induced hemolytic anemia (Direct Coombs +)
Burr cells and shistocytes
Patient has a microcytic anemia with the following labs: low iron, normal/high ferritin, low TIBC, normal iron:TIBC (>18). What is this?
Anemia of chronic disease
Patient has a microcytic anemia with the following labs: normal/high iron, normal ferritin, normal TIBC, and stippled, microcytic RBCs on smear. What is this?
Lead poisoning
Stippled means dotted
Patient has a microcytic anemia with the following labs: low iron, low ferritin, high TIBC, and low iron:TIBC (
Iron deficiency anemia
Patient has a microcytic anemia with the following labs: high iron, high ferritin, low TIBC and ringed sideroblasts. What is this? What can cause this? What can it progress to?
Sideroblastic anemia (cells of different sizes may be seen on smear)
Congenital: X-linked most common
Reversible: alcohol is most common; B6 deficiency (isoniazid); Cu deficiency; Pb poisoning
Acute leukemia
What causes target cells? Basophilic stippling?
Thalassemia alpha –> microcytic target cells
Thalassemia beta –> variably sized target cells; basophilic stippling
RECAP: how can iron deficiency anemia and ACD be differentiated?
TIBC…high in Fe deficiency and low in ACD
Besides anemia symptoms, what else is seen with lead poisoning?
Gingival lead lines
Peripheral neuropathy
Which one, folate or B12 deficiency, causes a sore tongue?
Folate deficiency
Which one, folate or B12 deficiency, causes neurologic symptoms?
B12 deficiency
symmetric paresthesias, ataxia, possible psychosis
What kind of anemias can phenytoin cause?
Folate deficiency (macro) Aplastic anemia
A patient comes in with persistent infections, poor clotting, pallor, systolic murmur, and increased pulse pressure. What could be going on?
Aplastic anemia
Worse in old people
Caused by parvovirusB19 in sickle cell patients
A smear shows target cells, sickle cells, and nucleated RBCs. What does the person have?
Sickle cell anemia…only deoxygenated cells would be sickled
How does hydroxyurea help with sickle cell disease?
Increases HgB F
An African patient with a history of recurrent infections comes in with bone pain. What could be going on?
Salmonella osteomyelitis…sickle cell patients are more susceptible to it
What can cause neutropenia w/o immune deficiency (agranulocytosis)?
Viral infections: hepatitis, HIV, EBV
Drugs: clozapine, antithyroids, sulfasalzine, TMP-SMX
Chemo
Aplastic anemia
Asthma, allergic rhinitis, and anaphylaxis are examples of? which is mediated by?
Type I hypersensitivity reaction
IgE antibodies attached to mast cells –> mast cell and histamine release
Drug-induced or immune hemolytic anemia are examples of? which is mediated by?
Type II hypersensitivity reaction
IgM and IgG antibodies –> complement cascade
Arthus reaction, serum sickness, and glomerulonephritis are examples of? which is mediated by?
Type III hypersensitivity reaction
IgM and IgG immune complexes –> deposit in tissue –> complement cascade
Allergic contact dermatitis, transplant rejection, and PPD testing are examples of? which is mediated by?
Type IV hypersensitivity reaction
T cells and macrophages
Warfarin is tracked with INR (normalized PT). How is heparin tracked? LMWH?
Heparin is monitored with PTT
LMWH does not need to be monitored
What are the genetics of vWF disease? What labs are seen with it?
vWF disease is autosomal dominant
Increased PTT and bleeding time; decreased factor VIII antigen, decreased vWF antigen, decreased ristocetin cofactor activity
How is vWF disease treated?
minor bleed –> desmopressin (increases factor VIII)
Major bleed/surgery –> vWF and factor VIII concentrate
Avoid ASA
Patient comes in because of uncontrolled bleeding. Testing shows increased PTT, normal PT, and normal bleeding time. What could be going on?
Hemophilia A (VIII) or B (IX)
How do thienopyridines work?
Clopidogrel and ticlopidine work by blocking ADP receptors
Besides increased risk of hemorrhage, what else can be caused by GP IIb/IIIa inhibitors?
nausea, back pain, hypotension
How does heparin work?
Binds to antithrombin to increase activity…decreasing clot formation
How does LMWH work?
Binds to factor Xa to prevent clot formation
How do direct throbbing inhibitors work?
Lepirudin and argatroban are highly selective inhibitors of thrombin to suppress activity of factors V, IX, and XIII and clot formation
What causes Heparin-Induced Thrombocytopenia (HIT)? What is seen on labs? How is it treated?
Development of antiplatelet antibodies
Sudden >50% drop in platelets
Stop heparin
Start direct thrombin inhibitor (Lepirudin or argatroban)
A patient has a platelet count
Idiopathic Thrombocytopenic Purpura…autoimmune B-cell directed production of anti-platelet antibodies
Adults…steroids, delayed splenectomy, IVIG, plasmapheresis, or recombinant factor VIIa
E. coli O157:H7 can cause TTP-HUS. What is the path? What are the symptoms?
Diffuse platelet aggregation d/t autoantibodies against preventative enzyme
Hemolytic anemia ARF Thrombocytopenia W/O severe bleeding Neurologic sequela
How is HIV diagnosed?
Positive ELISA –> repeat ELISA also positive –> positive Western Blot
ELISA = sensitive
Western Blot = specific
What is a possible complication of polycythemia vera? How is PCV treated?
Leukemia
Serial phlebotomy
Antihistamines (for pruritus)
ASA (thrombus prophylaxis)
Hydroxyurea (bone marrow suppression)
In what disease do IgA and IgG produce an abnormal monoclonal protein (M protein) and Bence Jones proteins? What can be seen on x-rays?
Multiple Myeloma…poor prognosis
Punched out bone lesions on skull and long bones
Hodgkin Lymphoma originates in what kind of cells?
B cells
What is the most common Hodgkin lymphoma?
Nodular sclerosis (low grade)
A hodgkin lymphoma is found to have a lot of lymphocytes in it. Is that good or bad? Depleted of lymphocytes?
Lymphocyte rich is best prognosis
Lymphocyte depleted is worst prognosis
Lymph node biopsy shows ‘owl-eyes’ (Reed-Sternberg cells). What is this?
Hodgkin lymphoma
Is Hodgkin lymphoma generally fatal?
No, 80% cure rate…unless too far progressed
Non-Hodgkin Lymphoma originates in what kind of cells?
Lymphocytes (mostly B cells)
Natural killer cells
What is the most common NHL?
Diffuse large B cell
Which NHL is relate to EBV? What is seen on biopsy?
Burkitt lymphoma t[8;14]
Starry sky
Which type of NHL is of T cell origin?
Peripheral
Besides EBV, what are other risk factors for NHL?
HIV
Congenital immunodeficiencies
Rheumatic disease
An NHL shows cleaved cells. What kind is this?
Follicular small cell variant t[14;18]
Which NHL is basically the same as CLL?
Small lymphocytic
Is the prognosis as good for NHL as it is for HL?
NO…poor prognosis…palliative treatments
Who commonly gets ALL? what is the cell of origin?
White kids (2-5yo)
B-cell precursor is most common
What can be present in adult ALL? What is this usually found in?
Philadelphia chromosome (t[9;22])…carries poor prognosis
CML
A bone marrow biopsy shows blasts of MYELOid origin and staining with MYELOperoxidase. What is it? What would be seen on a blood smear? What is the prognosis
Acute MYELOgenous Leukemia (AML)
Large myeloblasts with notched nuclei and Auer rods
Poor…multiple remissions, but relapse is common
An older patient is in for a regular exam and CBC shows a really fuckin high WBC. What is a possible diagnosis? What is the cell of origin? What would be seen on smear?
This is possibly Chronic Lymphocytic Leukemia (CLL)
Which is a proliferation of mature B cells
Could see numerous small lymphocytes and smudge cells
What is the survival with CLL?
Some > 10 years
some less than 4
A middle aged patient with a history of radiation exposure is found to have a really freakin high WBC with high proportion of neutrophils. Cytogenic analysis shows t[9;22]. What is the likely disease? What is the progression?
Chronic Myeloid Leukemia
Doing fine for a while…start to have some fatigue, sweats, weight loss…gets worse (blast crisis) and bone pain…death
A middle aged guy comes in because he’s lost some pep and has noticed a mass in his LUQ. A blood smear shows numerous lymphocytes with hair projections. What is this?
Hair cell leukemia…proliferation of B cells
A child comes in for an infection and is found to have pancytopenia. On exam, cafe-au-lait spots are found. What does this kid likely have? What else could be seen? What is the prognosis?
This is likely Fanconi Anemia
Could find a horseshoe kidney on imaging
Death in childhood d/t bone marrow failure or leukemia
A kid is found to have a microcytic anemia with decreased Hgb, Hct, and retic count, but increased erythropoietin. What could be going on?
Diamond-Blackfan anemia (pure RBC anemia)
Where do neuroblastomas present? What are risk factors? What is the prognosis?
Adrenal glands or sympathetic ganglia
Turner syndrome
Low maternal folate intake
Found 1yo…bad, metastasize to brain and bone
What is the most common soft tissue sarcoma in kids?
Rhabdomyosarcoma
