IM-Heme/Onco Flashcards
Hx of gastrectomy, glossitis and anemia
Vit B12 deficiency post total or partial gastrectomy - megalobalstic anemia
Microcytic/hypochromic anemia, elevated serum iron, decreased TIBC with patient treated for TB infection? Tx?
- Sideroblastic anemia - vitamin B6 deficiency
- Pyridoxine
Someone from Mediterranean origin like Greece will most commonly have what kind of hemoglobinopathy
Beta- Thalassemia
Common manifestations f hemoglobinopathy like Beta- Thalassemia in peripheral smear
Hypochromic microcytic anemia
Suspect Multiple myeloma in elderly patient with lab findings (4)
- Hypercalceimia
- Normocytic anemia
- Renal insufficiency
- Protein gap
Define protein gap and what is it’s indication ?
- Difference b/n total protein and albumin >4
- elevated nonablumin protein in the serum, may be seen with polyclonal gamma patties
Name disease that cause polyclonal gammapathies (4)
- Infection
- connective tissue disease
- Monoclonal protein (Multiple myloma & Walden storm macroglobulinemia)
How to differenciate polyclonal vs monoclonal cause of protein gap
Serum protein electrophoresis (SPEP)
Findings seen in elevated serum protein
Rouleaux formation( stocking of RBC like coins)
Majority of head and neck cancers are
Squamous cell carcinoma (SCC)
Older, smoker, non-tender lymph node in the submandibular or cervical region
Cancer- SCC
Serum haptoglobin is reduced ins intravascular hemolysis due to
Hemoglobin released from hemolysis RBCs binds to it and hemoglobin-haptoglobin complex gets removed by liver
Raised serum lactate dehydrogenase (LDH) in RBC hemolysis is due to
RBCs releases of LDH
Two reticuloendocthelial systems that phagocytes RBCs
Lymph nodes
Spleen
3 Causes of Extravascular hemolysis ( and example of disease)
- antibody-mediated RBC destruction (AIHA- Autoimmune hemolytic anemia)
- Interinsic RBC enzyme (G6PD definicency)
- membrane defects (hereditary sphrocytosis)
Negative family history and positive Coombs test that causes extravascular hemolysis
Auto immune hemolytic anemia (AIHA)
Positive family history and negative Coombs test that causes extravascular hemolysis
Hereditary spherocytosis
Peripheral blood smear with Heinz’s bodies
Glucose-6-phosphate dehydrogenase deficiency (x-linked, triggered by medication like sulfa drugs)
Cell membrane anchor that leads to complement-mediated hemolysis
Paroxysmal nocturnal hemoglobinuria (PNH)
PNH has positive or negative cooks test?
-Negative
But evidence of venous thrombosis or intravasular hemolysis
Autosplenoctomy is seen in
Sickle cell anemia
Aquagenic pruritus is?seen in?
Itching after bathing
Polycythemia Vera
4 financings in polycythemia vera
- aquagenic pruritus
- Facial plethora
- Splenomegaly
- elevation in all 3 cell lines on CBC
Facial plethora is
Ruddy cyanosis
Polyscytmia Vera is caused by
JAK 2 mutation (Tyrosine kinase activated by EPO activities)
The difference between primary and secondary polycythemia Vera is
Low EPO level in primary
High EPO level in secondary
A myeloproliferative disordering Marked by erythrocytosis
Polycythemia Vera
Atrophic glossing is in pernicious anemia the touge looks like
Shiny
Megalobalstic anemia Atrophied glossitis Vitiligo Thyroid disease Neurological abnormalities Whites of Northern European ancestry
pernicious anemia
8 causes of macrocytic anemia (MCV >100)
- Folate deficiency
- Vit B 12 deficiency
- Myelodysplastic syndromes
- AML
- Drug induced (hydroxyurea, zidovudine, chemo agents)
- Liver disease
- Alcohol abuse
- Hypothyroidism
The two types of Autoimmune hemolytic anemia
Cold agglutinatinin AIHA
Warm agglutinatinin AIHA
Cause of warm agglutinin AIHA (5)
Drugs (PCN) Viral infection Autoimmune (SLE) Immunodeficiency states Lymphoproliferative (CLL)
Cause of cold agglutinin AIHA (2)
- Infections (Mycoplasma pneumonia infection & Infectious mononucleosis)
- Lymphoproliferative disease
Direct Coomb’s positive with anti-IgG, anti-C3, or both is which type of AIHA
Warm agglutinin AIHA
Direct coomb’s positive with anti-IgM, anti-C3, but NOT IgG is which type of AIHA
Cold agglutinin AIHA
Tx for warm Vs cold agglutinin AIHA
Warm- Corticosteroids & splenectomy
Cold- Avoide cold & Ritubimab +/- fludarabine
Common complication seen in warm agglutinin AIHA (2)
- Venous thromboembolism
- Lymphoproliferative disorders
Common complication seen in cold agglutinin AIHA (2)
- Ischemia & peripheral gangrene
- Lymphoproliferative disorders
Common virus that cause thrombocytopenia (3)
- EBV
- Hep C
- HIV
cause of decrease platelet production (6)
- Viral infection (EBV, Hep C, HIV)
- Chemotherapy
- Myelodysplasia (>60year old)
- Alcohol use
- Congenital (Fanconi syndrome)
- Vit B12 or folate deficiency
Cause of increased platelet destruction (4)
- SLE
- Medication (heparin)
- ITP, DIC, TTP-HUS
- Antiphospholipid syndrome
Isolated thrombocytopenia without anemia or leukopenia
Idiopathic thrombocytopenia (ITP)
Pseudothrombocytopenia due to platelet clumping can happen from (3)
- EDTA
- Abciximab
- Inadequate anticoagulation of the blood sample
Pain, itching, red streaks on arm that is tender, erythematous and palpable cord-like veins on arm and upper chest , Dx? NSIM?
- Trousseau’s syndrome (migratory superficial thrombophlebitis)
- CT of abdomin to r/o pancreatic, lung, prostate, stomach, colon and acute leukemia cancers
The two most common clinical manifestation in antiphospholipid antibody syndrome are
- Vascular thrombosis
- Pregnancy morbidity
The 3 lab findings in antiphospholipd antibody syndrome (APS) are
- Lupus anticoagulant
- Anticardiolipin antibody
- Anti-Beta-2 glycoproteins 1 antibody
APS mostly occurs with women that have
SLE
Prolonged ______ is an indirect indicator for the presence of Lupus anticoagulant (LA) and highly suggestive in the correct clinical settings
PTT
Specific tests used to diagnose APS (2)
Diluted Russell viper venom test
Kaolin clotting time
It is an anti-phospholipid antibody that is a pro-thrombotic immunoglobulin that causes a spuriously prolonged PTT in vitro
Lupus anticoagulant
-Hemolytic anemia (elevated LDH, low haptoglobin) with schistocytes
- Thrombocytopenia (elevated bleeding time, normal PT/PTT)
Dx?
Thrombotic thrombocytopenic purpura (TTP)
Tx of TTP (3)
- Plasma exchange
- Glucocorticoids
- Rituximab
Two pathophysiology for TTP
- decreased ADAMTS 13 level (uncleaved vWF multiverses causing platelets trapping and activation
- Acquired (autoantibody) or hereditary
Classical pentad of TTP
- Thrombocytopenia
- Microangiopathic hemolytic anemia (MAHA)
- Renal insufficiency
- Neurologic changes
- Fever
Tx of polycythemia Vera (2)
- Phlebotomy
- Hydroxyurea
-Increased mean corpuscular hgb concentration (MCHC)
- hemolytic anemia
- Jaundice
- splenomegaly
In pt with Northern European decent
Hereditory shperocytosis
Why does pt with hereditary spherocytosis have cholecystitis symptoms?
Due to pigment gallstones (from overwhelm conjugation and elimination of bilirubin from the body)
The electrolyte imbalance in Tumor lysis syndrome (4)
Increased phosphorus
Increased potassium
Increased Uric acid
Decreased calcium
What causes Calcium to be low in Tumor lysis syndrome (TLS)?
Phosphate binds and precipitates calcium reducing IV levels
Screening tool for multiple myeloma
Serum protein electrophoresis (SPEP)
Abnormal eosin-5- maleimide binding test is seen in
Hereditory spherocytosis
What are the 2 forms of HIT?
Type 1- non immune direct effect of heparin on platelet activation, presents 2 days after heparin exposure
Type 2- Immune mediated due to antibodies to platelet factor 4 (PF4) complexed with heparin causing >50% drop
Low hgb and haptoglobin, High bilirubin and LDH Bite cells and Heinz bodies Negative Coombs test Normal G6PD activity
G6PD deficiency ( G6PD activity is low unless messured during attack)
Tx for stabilizing bony metastatic lesions to prevent hypercalcemia of malignancy and pathological fractures
Bispohphonates (Zoledronic acid, pamidronate)
3 steps in management of Spinal cord compression due to malignancy
- Emergency MRI
- IV glucocorticoids
- Radiation-oncology and neurosurgery consultation
Tx for children with Immune thrombocytopenia (if bleeding) 3
- observe if cutaneous symptoms only
- Glucocorticoid, IVIG or anti-D if bleeding
Tx for adult with Immune thrombocytopenia (if bleeding) 3
observation if cutaneous or plt > 30,000
- Glucocorticoids, IVIG, or anti D if bleeding or plt/30,000
Drugs that can cause folic acid deficiency (3)
- Phenytoin (impairs absolution)
- Methotrexate, Trimethoprim (antagonize its physiologic effects)
How to diagnosis CLL?
Flow cytometry (clonality of mature B cells)
Common complication of CLL
infections
