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Hemonc2 Flashcards

1
Q

Pt has fatigue and pallor- what lab should be run? What to expect?

A

suspect anemiaH&H- Hbg and Hct are low

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2
Q

What is the general rule for calculating hbg and hct?

A

hbgx3

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3
Q

What lab to do next if H&H are low?

A

retic index

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4
Q

What if retic is low/high, what does it mean and what is next step?

A

retic is high - bone marrow is able to compensate for blood loss –> check for blood loss or hemolytic anemiaretix is low - bone marrow is not making RBC –> MCV

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5
Q

What are the categories for MCV and what is next step?

A

microcytic check iron studiesnormocytic 100 –> aplastic anemia, tumor, renal failure, G6PDmacrocytic >100 –> check B12 and folate deficiency

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6
Q

What if Fe and TIBC is decreased? What should RDW and Ferritin be?

A

anemia of chronic dzRDW: normalferritin: normal

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7
Q

What if Fe is low but TIBC is high? What if older age-what to suspect? What should RDW and Ferritin be?

A

iron def. anemiacolon cancerRDW: high Ferritin: low

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8
Q

What if Fe if normal but TIBC is norm/low? What should RDW and Ferritin be?

A

lead poisoningthalassemiaRDW: high/norm Ferritin: high/norm

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9
Q

If pt has high TIBC and low Fe and ferritin - what PE to expect?

A

iron def anemiakoilnychiaglossitisplummer-vinson sx -thin tissue growth to blocks esophageal pipe

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10
Q

How to tx iron def anemia?

A

iron replacement - ferrous sulfate

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11
Q

Is MCV high or low in iron def. anemia?

A

low

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12
Q

How to dx B major thalassemia/Cooley’s anemia and what to expect on PE?

A

electrophoresis: HbF elevatedblood smear: microcytic anemia + target cellsPE: chipmunk face; normal at birth

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13
Q

How many genes are affected in B major thalassemia?

A

2

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14
Q

Pt is mediterranean but Fe, Ferritin, TIBC, and RDW is normal and iron supplements don’t help - what lab should be done and what to expect?

A

Beta minorblood smear- howell jolly bodieselctrophoresis- high A2 and F

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15
Q

What Beta thalassemias are entirely blood transfusion dependent?

A

intermediate and severeintermediate only needs after stressors

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16
Q

Pt has trouble exercising at school - what labs should be done and what to expect?

A

alpha thalassemiairon studies - low hct and MCV but normal RBCblood smear - Aconthocyteselectrophoresis - LOW HbA, HbA2 and Hb F

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17
Q

What dz have acanthocytes on blood smear - what is next step (what to expect on labs)?

A

alpha thalassemiahemoglobin Helectrophoresis- hemoglobin H: HbH; alpha thalassemia: low HbA, HbA2, and HbF

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18
Q

What is hydrops fetalis?

A

still born d/t all thalassemia being goofed up

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19
Q

How to differentiate anemia of chronic dz and iron def anemia via labs?

A

anemia of chronic dz has high ferritin but iron def has low ferritin

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20
Q

Pt is mediterranean and has chipmunk face - how to tx?

A

blood transfusion

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21
Q

What is the pathophys/cx of anemia of chronic dz? Tx?

A

anemia is secondary to some sort of underlying dz (TB)tx: self limiting-do not give iron

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22
Q

Pt has fatigue, recurrent infxn, easy bruising and seizures (carbamazepine)?

A

aplastic anemia

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23
Q

What can occur in aplastic anemia and what can this lead to eventually?

A

pancytopenia - anemia, neutropenia, thrombocytopeniaacute leukemia

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24
Q

What age does aplastic anemia affect?

A

15-30yo or >60yo

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25
Q

How to dx and tx aplastic anemia?

A

bone bxbone marrow transplant

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26
Q

Pt has Crohn’s dz and had colon resected-what are they at risk for?

A

B12 def b/c it cannot be absorbed- resected out

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27
Q

Where is B12 absorbed and what does vit B12 bind to?

A

where: terminal ileumwhat: intrinsic factor

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28
Q

Pt has NO intrinsic factors? How should labs look like?

A

pernicious anemialabs: low MCV, low B12, HIGH methylmalonic acid

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29
Q

How to differentiate between B12 def and folate def? What can be the same in BOTH?

A

B12 has NEUROPATHY - numbness in extremitiesB12 has HIGH methylmalonic acid both: homocysteine

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30
Q

How to dx pernicious anemia?

A

schilling testEGD

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31
Q

How to tx B12 def?

A

supplemental shots: daily –> wkly –> monthly

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32
Q

Pt has seizures (phenytoin) + alcoholic-what PE should you expect?

A

folate defNO neurological probs

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33
Q

Which dz have howell-jolly on blood smear?

A

beta minorfolate def

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34
Q

What are indications for hemolysis (RBC)?

A

lack of haptoglobin (LOW) - if hbg is destroyed then haptoglobin that is attached to hbg is destroyed too!LDH is high (HIGH)- LDH is released from RBC during destructionDARK urine- suggesting intravascular hemolysis

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35
Q

What are the different blood smears re: hemolytic anemia and what dz could they suggest?

A

helmet cells/spherocytes - extravascular hemolysisheinz bodies - G6PDsickle cellschistocytes -intravascular

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36
Q

What is an autosomal recessive dz and what to expect on electrophoresis (why)?

A

sickle cellHb S - Hb S replaces Hb A

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37
Q

What supplement is crucial for pts w/ hemolytic anemia?

A

FOLATE

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38
Q

Sickle cell have anemia?

A

NO

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39
Q

Pt has splenomegaly, AA- what to expect on lab results? What to do w/ spleen?

A

leukocytosisthrombocytosishigh bilirubin sickle-dex testHb Ssplenectomy

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40
Q

Pt with sickle cell got infxd w/ parvovirusb19- tx?

A

aplastic crisis occurs - blood transfusion to tx

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41
Q

Pt w/ sickle cell - what haps to heart, bone, skin, lung?

A

heart- cardiomegalybone- pain crisis; avascular necrosisskin - non healing ulcers lung- acute chest syndrome - similar to pneumonia

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42
Q

How to tx sickle cell - acute vs chronic?

A

acute: O2, hydration, abx - NO TRANSFUSIONchronic: folic acid, vaccinate, bone marrow transplant, HDYROXYUREA

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43
Q

What are the 2 types of extravascular hemolytic dz?

A

hereditaroy spheroctyosisautoimmune hemolytic anemia

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44
Q

How to differentiate between hereditary spherocytosis and autoimmune hemolytic anemia?

A

direct coomb’s test: hereditary spherocytosis is negative

45
Q

Pt has splenomegaly, gallstone, jaundice, and high MCHC- what to expect on blood smear and what dx test?

A

hereditary spherocytosisblood smear: spherocytesosmotic fragility test - dx

46
Q

How to tx hereditary spherocytosis?

A

folatesplenectomy

47
Q

Pathophys of spheroctyosis?

A

autosomal dominant dz where the RBC size is defected and cannot go through the spleen –> EXPLODES!

48
Q

Male mediterranean that ate fava beans + dark urine + jaundice- what to expect on blood smear?

A

G6PD defheinz body + bite cells

49
Q

Male w/ MD that is recovering from UTI?

A

G6PD defcx: nitrofuratoin, bactrim, glipizide, NSAIDs

50
Q

Pt has leukemia and went to Hawaii for summer vacation - fatigue + jaundice + splenomegaly?

A

warm autoimmune hemolytic anemia - extravascular IgG

51
Q

What is happening in autoimmune hemolytic anemia?

A

depending on type of AIHA, antibody attacks RBC –> goes into spleen –> macrophage eat them –> spherocyte (defect on membrane occurs) –> splenomegly –> anemia sx

52
Q

How to tx IgG vs IgM AIHA?

A

IgG responds to steroids b/c it is extravascularIgM does NOT respond to steroids b/c it is intravascular; use Riuximab

53
Q

Pt has polycythemia vera- what to expect on labs?

A

HIGH:RBC, platelet, B12, uric acids

54
Q

What is happening in polycythemia vera? Tx?

A

blood is too thick and getting sludgytx: drain blood out, PREVENT THROMOBSIS , splenectomy

55
Q

Pt has hard time swallowing cold drinks?

A

cold autoimmune hemolytic anemia -intravascular IgM

56
Q

Pt has lead poisoning-what to expect on blood smear?

A

BASOPHILIC STIPPLING

57
Q

Pt has recurrent epitaxis - what are cx of this dz?

A

thrombocytopeniacx: bone marrow fails, invasion, injury; autoimmune destruction; exogenous destruction: HIV, HIT2

58
Q

Pt is healthy and in for annual exam but labs show thrombocytopenia?

A

pseudothrombocytopenia

59
Q

Child had flu and now has petechiae and ecchymoses- what to expect on lab?

A

immune thrombocytopenic purpuraisolated thromboctyopenia

60
Q

What to expect in adults w/ immune thrombocytopenic purpura and how to tx?

A

mucocutaneous bleedingtx: PLASMAPHERESIS +/- steroids +/- splenectomy

61
Q

Pt has HUS + fever + altered mental status? What is this a def of? What to expect on labs-why?

A

thrombotic thrombocytopenic purpuramicroangiopathic hemolytic anemia -MAHA –> def of ADAMTS13Labs show NORMAL PT and PTT b/c it is only platelets getting eaten NOT clotting factors!

62
Q

Child has acute renal failure + thrombocytopenia-what to expect on blood smear?

A

hemolytic uremic syndrome (HUS)MAHA schistocytes

63
Q

How to tx HUS?

A

self limiting+/-dialysis

64
Q

What is CONTRAINDICIATED IN TTP?

A

platelet trasnfusion

65
Q

Pt has DVT after heparin-what drug was probably used? How many days does it take to take effect?

A

heparin induced thrombocytopeniaunfractionated heparin5-14days

66
Q

Pt has recurrent epitaxis, easy brusing since childhood-what to expect on labs?

A

von willebran dznormal platelet count and PT, PTT but b/c platelets are useless d/t lack of von wille bran –> bleeding time is LONG

67
Q

How to tx von willebran dz?

A

ddAVP to help stimulate vWF from endotheliumavoid NSAIDs

68
Q

Male pt has hemoarthrosis - what to expect on labs?

A

hemophilia Anormal bleeding time and normal platelet count but LONG PT

69
Q

Defect of factor VIII can lead to what dz?

A

vWD and hemophilia A in males

70
Q

How to tx hemophilia A?

A

cryoprecipitate

71
Q

PT vs PTT vs bleeding time vs thrombin time?

A

PT: extrinsic pathway - prolonged by warfarinPTT: intrinsic pathway - prolonged by heparinthrombin time: how much fibrinogenbleeding time: fxn of platelet

72
Q

Pt has coagulopathy, what to think of and how to differentiate the two?

A

vita K def and liver dzvia K def: PT is LONG but PTT is normalliver dz: PT AND PTT is LONG *both platelet ct is normal

73
Q

Pt has a blood draw but cannot stop bleeding and has sepsis? What is going on? What are they at risk for?

A

Disseminated Intravascular Coagulationbody is clotting and bleeding at random placesrisk: organ failure, PE

74
Q

What labs for DIC-increased and decreased?

A

increased: PTT, PT, bleeding time, d-dimerdecreased: platelet ct

75
Q

Tx for DIC?

A

support pt

76
Q

Pt took abx, on warfarin, and now cannot stop bleeding after cutting hand? What to expect on labs?

A

vita K def-cx: abx and wafarinlabs: long PT

77
Q

Tx for vita K? Acute?

A

acute: FFP/cryo

78
Q

What organ is responsible for making clotting factors?

79
Q

How to reverse heparin?

80
Q

Pt has rash after taking herbal supplements? What is it?

A

drug induced thrombocytopenia - type II hypersensitivity

81
Q

Platelet count for thrombocytosis? Risk for?

A

> 400,000DVT, PE, stroke

82
Q

What are the sx for multiple myeloma?

A

CRABCalcium (hypercalecmia)Renal failureAnemiaBone lesions

83
Q

Pt is in ICU + NPO- at risk for?

A

vita K def

84
Q

What dz have M spike on electrophoresis? What is the pathophys?

A

multiple myelomawaldenstrom macroglobulinemiasmonocolonal gammopathy of undetermined significance pathophys: monoclonal neoplasms of B cell line –> increase neoplastic cells

85
Q

Pt has fever, night sweats, wt loss, 65yo and M spike on electrophoresis?

A

waldenstrom macroglobulinemias

86
Q

Pt is asymptomatic but has monocolonal proteins in urine - may lead to?

A

monocolonal gammopathy of undetermined significancelead to: multiple myeloma

87
Q

Pathophys in multiple myeloma?

A

bone marrow is replaced by malignant plasma cell

88
Q

Pt has bone pain, anemia, renal failure - what do they die from and what to see in urine?

A

recurrent infxnfree light chains: bence jones + M-protein in urine

89
Q

Tx for multiple myeloma?

A

hematopoietic cell transplantation - usually for the youngchemo/radiation

90
Q

Pathophys for Waldenstrom macroglobulinemia?

A

hyperviscosity

91
Q

Pt has painless lymphadenopathy w/ fever and wt loss? Labs-diagnostic?

A

Hodgkinlymph node bx- REED STERNBERG CELL CXR and CT to eval how much lymph nodes bone marrow bx- if bone is invaded

92
Q

What staging is in Hodgkin lymphoma? What is it?

A

ann arbor stage I: ONE lymph nodestage II: involving 2+ lymph nodestage III - BOTH sides of diaphragm stage IV - extralymphatic sites A- no sxB - fever, wt loss, night sweats

93
Q

Hodgkin has a strong association w/what virus?

94
Q

How to tx Hodgkin?

A

Stage I, II, and IIIA - radiationStage IIB, IV - chemo

95
Q

Pt has painless lymph node + abdominal pain/hepatosplenomegaly + anemia? Labs -diagnostic?

A

non hodgkin lyphoma labs: lymph node bx - 4wks-diagnostic

96
Q

What is low, inter, and high grade non hodgkin? Which are B cell and T cell origin?

A

low: elderlyintermediate: middle agedHigh grade: kids B cell origin: low and intermedT cell origin: high

97
Q

Rapid progressing tumor - non hodgkin? Common in? What to expect on bx?

A

burkitkidsstarry night

98
Q

What is mycosis fungoides?

A

t cell lymphoma of the skin

99
Q

Pt has acute renal failure after chemo? What to expect on labs?

A

tumor lysis syndromeHYPERkalemiaHYPERuricemiaHYPERphosHYPOcalcemia

100
Q

Tx for acute lymphocytic leukemia?

A

chemo-good prognosis

101
Q

What are the two types of acute leukemia?

A

acute myelogenous (AML)acute lymphoblastic (ALL)

102
Q

Pt is adult (40-60yo) w/ pancytopenia after radiation? What to expect on labs?

A

acute myelogenous labs: aure rods

103
Q

Pt is >60yo coming in for annual exam and find isolated increase in WBC? How is this staged?

A

Chronic lymphocytic leukemia stage 0- lymphocytosisstage I - lymphadenopathystage II - organomegalystage III - anemicstage IV - thrmboctopenic

104
Q

How to dx chronic lymphocytic leukemia? Tx?

A

bone marrow bxsupportive

105
Q

How phases are there in chronic myelogenous leukemia? What would you see on lab? Tx?

A

crhonic, accelerated, blast crisisphiladelphia chromosomeimatinib

106
Q

Pt has severe prutitus after a hot bath or shower? What to see on lab?

A

polycythemia vera lab: high RBC ct, B12; low erythropoietin

107
Q

Polycythemia vera tx?

A

phlebotomy

108
Q

Polycythemia vera at risk for-life threatening?

A

thrmobitc (DVT, CVA, MI)bleeding- GI bleeding

109
Q

Pt has exposure to radiation and now has anemia with pancytopenia? Tx?

A

myelodysplastic syndrome (MDS)supportive

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