ITE Heme/Onc Flashcards
What is PRCA caused by?
parvo typically
How to treat PRCA?
IVIG
Initial imaging modalities used for patients with monoclonal gammopathy ?
Low-dose CT
then PET-CT
A whole-body low dose CT scan negative for smoldering myeloma should be followed by what?
whole-body MRI
Guidelines state that patients treated for Multiple Myeloma with proteasome inhibitors (bortezomib) should receive what type of prophylaxis?
Antiviral (acyclovir, valacyclovir) to avoid herpes zoster
What is acute chest syndrome?
SS anemia; where pulmonary vasculature is occluded by sickled cells
What is the treatment for acute chest syndrome in SS patient’s?
erythrocyte exchange transfusion
Most appropriate long-term treatment for high risk antiphospholipid syndrome?
Warfarin
What should patients with diagnosed Polycythemia Vera (PV) always be treated with?
Phlebotomy and aspirin (goal hematocrit should be 45%)
High Risk Polycythemia Vera with additional risk factors including older age (>60) or a hx of thromboembolic event should receive what?
cytoreductive therapy: hydroxyurea or interferon-alpha in addition to phlebotomy
What is the treatment of choice for red blood cell aplasia related to parvovirus?
IVIG
Should you always scan a pregnant patient that you suspect a PE in the setting of an elevated D-Dimer? Why or why not?
No. D-dimer elevation is common in pregnancy and you do not want to subject patient to unnecessary radiation
What other drug would you want to add if patient was started on Bortezomib? (Hint: think prophylaxis)
Herpes Zoster prophylaxis: Valacyclovir
If you suspect Acute Chest Syndrome (ACS) in someone with sickle cell anemia, what is the first thing to do for management?
Erythrocyte Exchange Transfusion
What treatment should patients with anti-phospholipid be placed on?
Warfarin
What is the most appropriate initial management for PV patients when first diagnosed (especially if they are not exhibiting signs/symptoms)?
Low dose aspirin and phlebotomy
What are medicinal options for patients with PV and symptoms (or frequent phlebotomy)?
Hydroxyurea and interferon-alpha
What agent is indicated in PV when patient is symptomatic and has resistant symptoms (1st line therapy failed)?
Ruxolitinib
Characterized by anemia, reticulocytosis, elevated LDH, low haptoglobin and an indirect bilirubinemia
Hemolytic Anemia
How to confirm diagnosis of Warm Autoimmune Hemolytic Anemia?
Direct Antiglobulin Test (DAT)
How to reduce risk of febrile neutropenia when initiating chemotherapy?`
Start G-CSF at the time of chemotherapy
Increased aPTT pathway in setting of common post-surgical bleeding could indicate what?
Factor level decrease (Factor 8, 9 and 12)
Difference between alpha thal trait and carrie?
Alpha trait: elevated MCV and anemia
Alpha carrier: no anemia and normal or decreased MCV
Difference between alpha-thal and beta-thal?
Alpha-thal: normal hemoglobin electrophoresis
Beta-thal: abnormal hemoglobin electrophoresis
Difference between beta thal minor and Hemoglobin E trait?
Beta thal: decreased Hgb A components
Hemoglobin E trait: elevated Hgb E (>50%)
Patients with mild forms of hereditary spherocytosis should be monitored and placed on what medication?
folate
If patient, who has hereditary spherocytosis, develops transfusion dependence, symptomatic anemia, and massive splenomegaly, what is the indicated treatment?
Splenectomy
Platelet levels of gestational thrombocytopenia and ITP?
Gestational: rare and rarely go under 100k
ITP: first trimester low platelets and less than 70k
(9;22) mutation is associated with what cancer?
CML
What’s the treatment for CML?
Imatinib which is a TKI
Fever, dyspnea, hypotension, flank pain, and pink colored urine appearing shortly after blood transfusion
Acute hemolytic transfusion reaction; tx is volume expansion and supportive care
Prolonged aPTT time should prompt what diagnostic test?
Mixing Study
How to additionally treat HIGH-RISK acute myeloid leukemia after completing induction chemotherapy?
Stem Cell transplant
How to treat anemia of chronic inflammation?
Treat the source; for instance, if PMR is suspected, start prednisone
How to manage minimally symptomatic ITP?
glucocorticoids; only give platelet transfusion if platelets are between 10-20k
Sepsis patient who then develops low platelets, prolonged coag studies, low fibrinogen, and elevated D-Dimer
DIC
What level of platelets require a transfusion if patient is about to undergo an invasive procedure?
less than 50,000
How much should one unit of platelets transfused increase the total count?
20-30k
What drugs cause neutropenia?
Methimazole and thionamides
In older patients with splanchnic vein thrombosis or Budd-Chiari syndrome, what should be tested?
Myeloproliferative disorders; order a JAK-2 tyrosine Kinase test
What should you do in a patient with supratherapeutic INR less than 10 and is asymptomatic?
just watch and wait; follow up with INR weekly
INR greater than 10
Vitamin K
INR greater than 10 and life-threatening BLEEDING
Vitamin K and PCC should be administered
Patients with essential thrombocythemia who have JAK2V617F mutation, what treatment regimen should be started?
aspirin and hydroyxurea
The initial tests you should order with immune thrombocytopenic purpura should include what?
HIV and Hep C = early signs are low platelets
What medication do you use for life-threatening bleeding on dabigatran?
Idarucizumab
What medication do you use to reverse Factor Xa inhibitors (Eliquis, Xarelto)?
Andexanet alfa
What vaccines are indicated for a patient starting chemotherapy for MM?
13-valent pneumococcal
23-valent pneumococcal
yearly influenza vaccine
What are some underlying causes of erythrocytosis?
Hypoxia = smoking and OSA must be treated first
Young age onset of bleeding symptoms and family history of bleeding; typically mucocutaneous, and menorrhagia and bleeding after minor procedures; aPTT would be normal or prolonged
vWD disease
Macrocytic anemia with MCV of 110-115 would commonly include what differential?
- B12/folate deficiency
- treatment of HIV infection with anti-retrovirals
- Hydroxyurea
How to treat DIC?
Treat the underlying disorder (ie. sepsis)
Also, platelet transfusions, cryoprecipitate, and fresh frozen plasma are provided as needed
How to treat Warm autoimmune hemolytic anemia when patient has Hgb less than 7 and is symptomatic and hemodynamically unstable?
HAVE TO STABILIZE; use cross type erythrocyte transfusion therapies to get blood counts up; think about autoimmune treatments after
What disease causes an IgM monoclonal gammopathy?
Waldenstroms macroglobulinemia (hyper IgM syndrome); can cause hyperviscosity
How to immediately treat hyperviscosity syndrome associated with Waldenstrom?
Plasmapheresis
Middle aged patient with headache, altered mentation, change in vision and hearing, nystagmus and ataxia
Hyperviscosity syndrome
Patient with hemolytic anemia with a positive direct antiglobulin test to anticomplement (C3) but, not IgG
Cold agglutinin
Cold agglutinin can arise as a primary process or secondary to what?
infection, lymphoproliferative disorder, autoimmune disease
What is the management of upper extremity DVT associated with central venous catheter?
Left in: continue AC until cath is removed up to 3 months
removed: 3 months of AC
Which anticoagulant has lowest renal elimination?
Eliquis
Treatment of acute TTP?
Plasma Exchange with rituximab and glucocorticoids
How to reverse warfarin bleeding?
4-factor PCC
Protamine sulfate is used to reverse what?
heparin
Heterozygous C282Y mutation of HFE gene without H63D or S65C in hemachromatosis
No treatment
Management of superficial DVT that measures greater than 5cm?
6 weeks of oral DOAC
Patients requiring chronic blood transfusions should be monitored for what?
evidence of iron overload with serial ferritin measurements; consider MRI to evaluate if iron deposition is suspected in heart/liver
Patients requiring chronic blood transfusions should be monitored for what?
evidence of iron overload with serial ferritin measurements; consider MRI to evaluate if iron deposition is suspected in heart/liver
What is the treatment for secondary iron overload?
iron chelation therapy
What is the treatment for secondary iron overload?
iron chelation therapy
What factor is most specific to the liver when evaluating for coagulopathy of liver disease?
Factor 8
What are one of the medications that can cause hemolytic anemia associated with G6PD deficiency?
Nitrofurantoin
Patient who has newly diagnosed triple positive anti-phospholipid disorder should be initiated with what therapy in the hospital? What oral medication should be initiated after discharge?
Heparin bridge to warfarin
In patients taking DAP following coronary revascularization with significant hemorrhage, the best strategy is what?
discontinue Plavix and continue aspirin at least
How to treat Hemophilia A patients who are bleeding?
Factor 7; PCC; or porcine derived factor 8 concentrate
What medication can you give patient with MDS with 5q-cytogenic abnormality who are transfusion dependent?
Lenalidomide
