UW - Med/HemeOnc Flashcards
What are the signs of acute and chronic lead poisoning?
Acute: GI-ab pain/constipation, Neuro-HA, cog defects, periph neuropathy, MSK-joint pain, aches, Heme-anemia, basophilic stippling, anorexia
Chronic: Similar to acute PLUS Fatigue/insomnia, HTN, Neuropsych sx, Nephropathy, miscarriages/stillbirths
What are the clinical features associated w/ Giant Cell Tumor?
Pain, swelling, decreased range of joint motion in involved site, pathological fractures from thinning of bone cortex in weight bearing areas
Loc: distal femur and proximal tibia around knee joint
XRay: expansile and eccentric lytic area (soap buble appearance)
What hematological problem is associated w/ chronic kidney failure? How do you treat and what precautions should be taken?
- Normocytic, hypoproliferative anemia from decreased erythropoietin
- Tx = Epo which leads to surge in iron usage for new RBCs
- Provide iron supplementation to prevent microcytic anemia
What are the clinical features of CLL?
Pneumonia w/ extreme WBC elevation and 85% lymphocytes, atypical lymphocytes w/ smudge appearance (flow cytometry to confirm clonality), median age 70, recurrent infections
What is a major complication of Heparin induced thrombocytopenia and why? What should be done?
Thrombosis - because Heparin-platelet-Ab bound immune complexes activate adjacent platelets to release pro-coagulant factors causing platelet aggregation, thrombin formation and thrombosis
-Can also activate endothelium to release prothrombotic cytokines (vWF)
Monitor closely for Arterial/Venous clots
What are the clinical features of autoimmune hemolytic anemia and how can you differentiate from hereditary spherocytosis?
- Auto-Abs to RBCs cause Extravascular hemolysis (anemia, indirect hyperBR, low-normal haptoglobin and slightly elevated LDH)
- Sx: Jaundice, pallor, splenomegaly, spherocytes w/o central pallor
- Negative family history and POSitive Coombs test (unlike HS w/ which has strong genetic link and -coombs)
What lab test and clinical presentation can distinguish warm vs. cold agglutinin?
Warm: Asymptomatic to life threatening anemia, Direct Coombs + w/ anti-IgG, anti-C3 or both
Cold: Sx of anemia, livedo reticularis, acral cyanosis w/ cold exposure disappears w/ warmth; direct Coombs + w/ anti-C3 or anti-IgM, but not anti-IgG usually
How can you distinguish intravascular vs. extravascular hemolysis?
Intra: Significant RBC structural damage (PNH, DIC), lots of Hb released, bound/excreted w/ Haptoglobin at very high levels (undetectable hapto), elevated indirect BR, elevated LDH
Extra: RBCs mainly destroyed by phagocytes in reticuloendothelial system (lymph nodes, spleen), less Hb release leads to Norma/low haptoglobin, slightly elevated LDH, elevated indirect BR (usually Ab mediated, G6PD def, or membrane defects)
What is a typical presentation for patients w/ multiple myeloma?
- Back pain, anemia, renal dysfxn, elevated ESR (70%)
- Hypercalcemia in 28% of patients leading to constipation and polyuria (HyperCa from bone lysis by plasma cells)
What is the most common cause of malignancy associated hypercalcemia? Which cancers is this associated w/?
PTH related peptide (PTHrP) in 80% of cases - SCC, Renal/bladder, ovarian/endometrial, breast
What causes bone resorption in 20% of metastasized breast cancers?
Secretion of factors that activate osteoclasts leading to direct bone resorption
In which situations do you most often see hypercalcemia from extra-renal production of calcitriol?
Granulomatous disease and lymphoma
What is the preferred anti-emetic used in chemotherapy induced nausea? What is less effective but can also be used?
- Seratonin antagonists (target 5HT3-R) are first line (e.g. Ondansetron)
- Anti-dopamine antagonists (metoclopromide and prochlorperazine
What lab values/markers are elevated w/ choriocarcinoma? Non-seminomatous GCTs? Hepatocellular carcinoma?
Chorio - beta-HCG
HCCa - AFP
NSGCT - both b-hCG and AFP
What can be used to help patients w/ cancer related anorexia/cachexia syndrome?
Progesterone analogs (megestrol acetate, medroxyprogesterone acetate) and corticosteroids -> increase appetite, cause weight gain, provide sense of well being
-Also can use Mirtazepine (TCA)
What are the symptoms/clinical features of hereditary telangiectasia (Osler-Weber-Rendu syndrome)?
AD dz -> diffuse telangiectasias, recurrent epistaxis, and widespread AVMs
What can result from lung AVMs that shunt blood from the right to left side of the heart?
Chronic hypoxemia, reactive polycythemia
Risk of massive fatal hemoptysis
What clinical features are useful for diagnosing multiple myeloma and how can you confirm?
- Normocytic anemia, hypercalcemia, renal failure, elevated total protein w/ normal albumin (monoclonal protein release)
- Presents in old age, back pain common
- Labs show increased ESR, Bence jones proteins in urine
- Serum immunoelectrophoresis confirms
What organ is at great risk of damage in multiple myeloma and how does this develop?
50% get renal insufficiency from Hypercalcemia, Hyperuricemia, amyloid deposition, and pyelonephritis
What should all patients w/ isolated thrombocytopenia be tested for?
- HIV and Hep C virus
- Bone marrow bx if tests negative
What can cause decreased platelet production leading to thrombocytopenia?
-Viral infections (HIV, HCV, EBV), Chemo, Myelodysplasia, Alcohol use, Congenital (Fanconi), Vitamin B12 or Folate deficiency
What conditions cause increased platelet destruction leading to thrombocytopenia?
SLE, Meds (heparin), Idiopathic thrombocytopenic purpura, DIC, thrombotic thrombocytopenia purpura-hemoytic uremic syndrome, Antiphospholipid syndrome
At what point would lymph nodes warrant a biopsy?
- Size >2cm
- Hard nodules (esp older pts w/ smoking history)
What exam should patients w/ newly diagnosed BPH get?
UA to r/o hematuria (cancer, stones) and infection
Which cells are affected in CLL?
B-cells
What is the overall prognosis for CLL? What worsens prognosis?
- 8-10 median survival
- Anemia and thrombocytopenia worsen prognosis
What electrolyte abnormalities develop from tumor lysis syndrome?
- Destruction of cells release large amounts of potassium and phosphate
- released phos binds calcium –> hypocalcemia
- Degradation of cell proteins causes elevation of uric acid
What are the signs of a delayed hemolytic transfusion reaction and what causes it?
- Mild fever and hemolytic anemia, 2-10 days after transfusion, + direct Coombs test
- Caused by anamnestic antibody response
What causes anaphylactic transfusion reactions?
Recipient anti-IgA Abs
What type of anemia results from lead poisoning?
Microcytic anemia
What is a side effect of hydroxyurea?
Macrocytosis
What is the classic tetrad of multiple myeloma? What deficiency will these patients have?
CRAB - Calcium (hypocalcemia), Renal impairment, Anemia, and bones (bone pain, lytic lesions, fractures)
-Inability to produce effective antibodies
What are the risks of cyclophosphamide therapy? How can you overcome?
- Acute hemorrhagic cystitis, bladder ca,
- Excess fluid intake, voiding frequently, take MESNA
How do you manage progressive pain and boney Mets in patients w/ prostate cancer who got orchiectomy?
Radiation therapy
What is the hematological finding in basal cell carcinoma?
Invasive clusters of spindle cells, surrounded by palisaded basal cells,
What is the most common cause of macrocytic anemia in patients w/ Sickle?
Folate deficiency (from overuse of folate w/ increased RBC production 2/2 increased RBC destruction)
What is hyperhemolytic crisis in SCD?
Acute severe anemia w/ reticulocytosis
How often should women from 50-74 be screened w/ mammograms?
Every 2 years
How does anemia result in patients w/ lymphoma/leukemia?
Bone marrow infiltration by cancerous cells leading to replacement of RBC progenitors
What drugs can cause megaloblastic anemia?
Phenytoin, primidone, phenobarbital, trimethoprim, methotrexate
