L31/32:Hem Flashcards
An older adult comes into clinic with bone pain, anemia, and elevated creatine. They state they have felt they keep getting sick lately. Which condition is this?
Multiple Myeloma
In plasma cell disorders, the monoclonal plasma cells produce monoclonal immunoglobulins that is identified on serum protein electrophoresis as a monoclonal spike, also known as…
A. IgG
B. M protein
C. IgM
D. IgA
B. M protein
Which test is used to identify the subtype of immunoglobulin and the light chain (kappa/lamda) present on the immunoglobulin responsible for the monoclonal spike seen on serum protein electrophoresis?
Serum immunofixation
True or False: Monoclonal immunoglobulins are found in serum of patients with multiple myeloma and Wldenstroms macroglobulinemia
True
Clonal bone marrow plasma cells ≥10% or biopsy-proven bony/
extramedullary plasmacytoma suggests a dx of…
multiple myeloma
Waldenstrom Macroglobulinemia is a malignancy of lymphoplasmacytoid cells that secrete ___
IgM
Unlike multiple myeloma, in Waldenstrom Macroglobulinemia, patients present with ____ and ____
lymphadenopathy and hepatosplenomegaly
True or False: There are no lytic lesions in Waldenstrom Macroglobulinemia
True
____: Bone marrow infiltration by IgM plasma cells and lytic bone lesions
IgM Myeloma
True or False: Hyperviscosity is a symptom of multiple myeloma
False - symptom ov Waldenstrom Macroglobulinemia
Monoclonal IgM on serum protein electrophoresis (SPEP) test, as well as Rouleaux formation in peripheral blood RBC suggests….
Waldenstrom Macroglobulinemia
_____: Clonal stem cell disorder that occurs in patients who have the Philadelphia chromosome (translocation between chromosome 9 and 22)
Chronic Myeloid Leukemia
True or False: Chronic Myeloid Leukemia results in abnormally low expression of tyrosine kinase gene and abnormal proliferation of granulocytes
False -
1) while yes, there is abnormal proliferation of granulocytes
2) there is tyrosine kinase that is “on”
A 55 y/o patient presents with fatigue, night sweats, sternal tenderness, and splenomegaly. Which condition do they have?
A. Waldenstrom Macroglobulinemia
B. Chronic Myeloid Leukemia
C. IgM Myeloma
D. Multiple Myeloma
B. Chronic Myeloid Leukemia
True or False: Leukocytosis with left shift + hypercellular bone marrow with left shift suggests Multiple Myeloma
False - suggests Chronic Myeloid Leukemia
Three stages of CML? Features?
1) Chronic Phase: Increased WBC - due to granulocyte proliferation
2) Accelerated: blast count 10-20%
3) Blast phase: Blast >20% in blood/bone marrow
Treatment for CML?
Tyrosine kinase inhibitors
_____: Elevated red cell mass in the absence of a secondary condition
Polycythemia Vera (PV)
Mutation in auto-inhibitory, pseudokinase domain of tyrosine kinase JAK-2 is most closely associated with which condition…
PV (polycythemia vera)
Expanded blood volume and hyperviscosity are clinical features of polycythemia vera. How does this manifest?
1) Headaches
2) Fatigue
3) Blurred vision
True or False: General pruritus occurs in polycythemia vera, as well as hepatomegaly and engorged retinal veins
False - all true, except there’s splenomegaly (not hepato)
Increased Hb and Hematocrit, decreased erythropoietin, as well as (+) JAK2 mutation suggests which condition….
A. MM
B. PV
C. Chronic Myeloid Leukemia
B. PV
How do you decreased blood viscosity and improve oxygenation in PV patients?
Phlebotomy
Which type of bone marrow transplantation is prone to graft vs. host disease vs. rejection?
A. Autologous
B. Syngeneic
C. Allogeneic
C. Allogeneic
