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Heme > MTB > Flashcards

MTB Flashcards

1
Q

IDA Lab values

A

Low Ferritin <10mg/dL - can be falsely elevated as an acute phase reactant
Low Reticulocyte count
High TIBC
High RDW and Platelet count
RDW - newer RBCs are smaller and Fe deficient

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2
Q

Sideroblastic Anemia

Causes

A

Microcytic - Iron trapping in mitochondria
ALA synthase or B6 problem
Drugs: Chloramphenicol, INH, alcohol

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3
Q

Sideroblastic Labs

A

High Ferritin
Very high - Transferrin
Low TIBC

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4
Q

Anemia of Chronic Dz Labs

A

Normal or High serum Ferritin
Low serum Iron
Low TIBC
Low reticulocyte count

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5
Q

When does the body switch from fetal Hb to Adult Hb?

A

6 months

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6
Q

Cooley Anemia

A

Beta thal major

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7
Q

Thalassemia Dx

A 
Varies with type: 
Beta thal - increased HbF and HbA
Beta thal major - Hb low (3-4)
Alpha thal - normal HbF and A2
Target cells and Normal RDW
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8
Q

Reticulocyte count in Microcytic

A

Low except Alpha thal 3 gene deletion has High

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9
Q

Reticulocyte count

A

Production problems

Blood loss and hemolysis - increased

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10
Q

Microcytic anemia Tx

A 
Severe - Packed RBCs -Transfuse when:
1.Symptomatic 
SOB, HypoTN, tachy, syncope, chest pain
2. Hct very low in elderly or heart disease pt
Very low = 25-30
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11
Q

1 Unit PRBCs raises Hct by?

A

3 points per unit - 1 mg/1mL of Iron

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12
Q

Most Accurate test for Microcytic Anemias

A

IDA: BM Bx
Sideroblastic: Prussian blue for ringed sideroblasts

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13
Q

B12 Deficiency

A

Increased MMA

B12 level can be normal/normal low so if highly suspect, do MMA level

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14
Q

Macrocytes in B12 and Folate deficiency

A

Oval

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15
Q

Macrocytes in hemolysis, liver dz, myelodysplasia

A

Round

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16
Q

B12/Folate deficiency heme pattern

A

Reduced reticulocyte count
BM hypercellular
High LDH, Billirubin (Unconjugated), Iron level
Increased homocysteine

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17
Q

Pernicious anemia test

A

Confirm with anti-intrinsic factor and anti-parietal cell abs

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18
Q

Electrolyte change seen with B12/folate replacement

A

Hypokalemia - cells in marrow produced so rapidly that marrow packages up all K, lowering serum level
Caution in heart pts and digoxin pts
K is a cofactor for B12

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19
Q

Myelodysplastic syndrome

A

High MCV, low retic
BM Bx
Pelgar Huet polymorphs - bilobed

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20
Q

Hemolytic Anemia Labs

A

Sudden drop in Hct

Low Haptoglobin

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21
Q

Haptoglobin

A

Intravascular hemolysis

transports RBC Hb from vascular space to spleen, liver, RES

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22
Q

Indirect BR

A

Bound to Albumin

Should not filter thru glomerulus

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23
Q

Hemosiderin

A

metabolic product of Hb

present in urine if hemolysis - severe and lasts for days

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24
Q

What does dark urine indicate

A

Hemosiderin (Hb) in urine

Renal Failure, ATN

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25
Q

Pt with severe chest pain, fever, leukocytosis, hypoxia, CXR infiltrates

A

Acute chest syndrome of Sickle Cell

26
Q

When to do exchange transfusion in Sickle Cell pt

A

Acute Chest Syndrome
Priapism
Stroke/TIA
Retinal infarction - visual disturbance

27
Q

Test for Parvo B19

A

PCR for DNA

28
Q

Sickle Cell Trait

A

Only defect - isosthenuria (defect in urine concentration)
Hematuria - gross of painless microscopic
Increased UTIs, esp pregnancy
Normal CBC and smear
No TX

29
Q

What vaccines are necessary to give before splenectomy?

A

Pneumovax

HiB

30
Q

Splenectomy

A

Risk for pneumococcal sepsis up to 30 years after
Immunize with pneumovax, HiB
PPX: Oral PCN for 3-5 years after (children) or until adulthood

31
Q

Rituximab

A

anti-CD20 Ab

32
Q

Tx for Warm Agglutinin AIHA

A
  1. Steroids
  2. IVIG
  3. Splenectomy
33
Q

Tx for Cold Agglutinin AIHA

A
  1. Stay warm
  2. Rituximab
  3. Cyclophosphamide, cyclosporine
    NEVER STEROIDs or Splenectomy
34
Q

Test for PNH

A

Flow cytometry - measure CD55 and CD59

35
Q

PNH Presentation

A

Early am hemoglobinuria

Venous thrombosis - large vessel of mesenteric and hepatic veins MC site

36
Q

PNH Tx

A
  1. Prednisone
  2. Allogenic BM transplant- only cure
  3. Eculizumab - inactivates C5 in complement to decrease cell destruction. Costly
37
Q

Intravascular Hemolysis findings

A

High LDH, BR, Reticulocyte count
Normal MCV
LOW haptoglobin and hemoglobinuria

38
Q

What is induce remission in acute leukemia?

A

Removal of over 99.9% leukemic cells in body and eliminate peripheral blasts in circulation

39
Q

Chemo in acute leukemia

A

Consolidates the leukemia further after remission
- if pt relapses -> BM transplant
Initial chemo
AML = AraC = cytosine arabinoside + danarubicin/idarubicin
ALL = Danarubicin + Vincristine + Prednisone

40
Q

AML M3

A

Acute Promyelocytic
Ass’d with DIC, Auer Rods
Translocation b/t Chrom 15 and 17
ATRA - add all trans retinoic acid for chemo tx

41
Q

AML

A

Auer rods = eosinophilic inclusions

42
Q

ALL tx

A

Add intrathecal chemo - MTX to prevent relapse in CNS

43
Q

Tumor Lysis Syndrome PPX

A
  1. Hydration

2. Allopurinol (Rasburicase)

44
Q

Leukostasis RXn

A

WBC: 200,000-500,000, clog up vasculature

Si/sx: dyspnea, blurry vision, priapism, thrombosis, stroke

45
Q

Low LAP Score

A

CML

PNH

46
Q

Leukomoid Rxn

A

High LAP score

47
Q

Tx for CLL Stage 0 and I

A

none
0 = lymphocytosis
I =LA

48
Q

Tx for CLL Stage II, III, and IV

A

II = HSM, III = Anemia

49
Q

Tx for CLL Stage II, III, and IV -Advanced stage or symptomatic

A

Fludarabine + Ritximab (pts expressing CD20)

50
Q

Refractory CLL Tx

A

Cyclophosphamide

51
Q

Mild CLL

A

Chlorambucil

52
Q

CLL with severe infxn

A

IVIG

53
Q

CLL with AI thrombocytopenia or hemolysis

A

Prednisone

54
Q

JAK2 mutation

A
  1. Polycythemia Vera

2. Essential Thrombocytopenia - 50%

55
Q

Treatment for Essential thrombocytopenia

A

Under age 60 + asymptomatic - no Tx
Above 60 + thromboses or platelet count >1.5 million - treat with hydroxyurea. if intolerable - anagrelide (cardiac dysfnc)
ASA for erythromelalgia = painful red hands

56
Q

Myelofibrosis

A

HSM
teardrop-shaped cells and nucleated RBCs
tx: thalidomide and lenalidomide

57
Q

Multiple Myeloma

A

Both have monoclonal IgG/IgA spike on SPEP

58
Q

Smoldering Myeloma

A

In b/t MGUS and MM
If progress to sx’s -> MM
Increased plasma cells but no evidence of organ damage

59
Q

Waldenstrom Macroglobulinemia

A

Overproduction of IgM
engorged blood vessels in eye, mucosal bleeding, lethargy, blurry vision, vertigo, Raynaud
IgM spike on SPEP = hyperviscosity
Tx: Plasmapheresis

60
Q

MGUS

A

MGUS = small # of plasma cells, Normal Cr, Calcium, Hb, B2 microglobulin

Heme (1 decks)

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