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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
Pt with severe chest pain, fever, leukocytosis, hypoxia, CXR infiltrates
Acute chest syndrome of Sickle Cell
26
When to do exchange transfusion in Sickle Cell pt
Acute Chest Syndrome Priapism Stroke/TIA Retinal infarction - visual disturbance
27
Test for Parvo B19
PCR for DNA
28
Sickle Cell Trait
Only defect - isosthenuria (defect in urine concentration) Hematuria - gross of painless microscopic Increased UTIs, esp pregnancy Normal CBC and smear No TX
29
What vaccines are necessary to give before splenectomy?
Pneumovax | HiB
30
Splenectomy
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
Rituximab
anti-CD20 Ab
32
Tx for Warm Agglutinin AIHA
1. Steroids 2. IVIG 3. Splenectomy
33
Tx for Cold Agglutinin AIHA
1. Stay warm 2. Rituximab 3. Cyclophosphamide, cyclosporine NEVER STEROIDs or Splenectomy
34
Test for PNH
Flow cytometry - measure CD55 and CD59
35
PNH Presentation
Early am hemoglobinuria | Venous thrombosis - large vessel of mesenteric and hepatic veins MC site
36
PNH Tx
1. Prednisone 2. Allogenic BM transplant- only cure 3. Eculizumab - inactivates C5 in complement to decrease cell destruction. Costly
37
Intravascular Hemolysis findings
High LDH, BR, Reticulocyte count Normal MCV LOW haptoglobin and hemoglobinuria
38
What is induce remission in acute leukemia?
Removal of over 99.9% leukemic cells in body and eliminate peripheral blasts in circulation
39
Chemo in acute leukemia
Consolidates the leukemia further after remission - if pt relapses -> BM transplant Initial chemo AML = AraC = cytosine arabinoside + danarubicin/idarubicin ALL = Danarubicin + Vincristine + Prednisone
40
AML M3
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
AML
Auer rods = eosinophilic inclusions
42
ALL tx
Add intrathecal chemo - MTX to prevent relapse in CNS
43
Tumor Lysis Syndrome PPX
1. Hydration | 2. Allopurinol (Rasburicase)
44
Leukostasis RXn
WBC: 200,000-500,000, clog up vasculature | Si/sx: dyspnea, blurry vision, priapism, thrombosis, stroke
45
Low LAP Score
CML | PNH
46
Leukomoid Rxn
High LAP score
47
Tx for CLL Stage 0 and I
none 0 = lymphocytosis I =LA
48
Tx for CLL Stage II, III, and IV
II = HSM, III = Anemia
49
Tx for CLL Stage II, III, and IV -Advanced stage or symptomatic
Fludarabine + Ritximab (pts expressing CD20)
50
Refractory CLL Tx
Cyclophosphamide
51
Mild CLL
Chlorambucil
52
CLL with severe infxn
IVIG
53
CLL with AI thrombocytopenia or hemolysis
Prednisone
54
JAK2 mutation
1. Polycythemia Vera | 2. Essential Thrombocytopenia - 50%
55
Treatment for Essential thrombocytopenia
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
Myelofibrosis
HSM teardrop-shaped cells and nucleated RBCs tx: thalidomide and lenalidomide
57
Multiple Myeloma
Both have monoclonal IgG/IgA spike on SPEP
58
Smoldering Myeloma
In b/t MGUS and MM If progress to sx's -> MM Increased plasma cells but no evidence of organ damage
59
Waldenstrom Macroglobulinemia
Overproduction of IgM engorged blood vessels in eye, mucosal bleeding, lethargy, blurry vision, vertigo, Raynaud IgM spike on SPEP = hyperviscosity Tx: Plasmapheresis
60
MGUS
MGUS = small # of plasma cells, Normal Cr, Calcium, Hb, B2 microglobulin

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