Week 10 Hematology/Oncology Flashcards
Platelet
small, colorless, disc shaped cell fragment without nucleus, found in large numbers in blood and involved in clotting
Eosinophil
WBC type; granulocyte that is release during infections, allergic reactions, and asthma
Basophil
WBC type; least common granulocyte; plays a role in allergy induced inflammation
Leukocyte
Colorless cell that circulates int eh blood and body fluids and is involved in counteracting foreign substances and disease
Neutrophil
Most abundant WBC; phagocyte and a granulocyte
Monocyte
Large, phagocytic WBC with a simple oval nucleus and clear, grayish cytoplasm; becomes a macrophage to surround and kill microorganisms
Lymphocyte
Form of a small leukocyte (WBC) with single round nucleus, occurring especially in the lymphatic system
The primary care pediatric nurse practitioner sees a 12-month-old infant who is being fed goat’s milk and a vegetarian diet. The child is pale and has a beefy-red, with sore tongue and oral mucous membranes. Which tests will the nurse practitioner order to evaluate this child’s condition?
A. Hemoglobin electrophoresis
B. RBC folate, iron, and B12 levels
C. Reticulocyte levels
D. Serum lead levels
B. RBC folate, iron, and B12 levels
Infants and children who are fed goat’s milk or who are on a strict vegetarian diet are at risk for folic acid and vitamin B12 deficiency. These should be evaluated, along with iron, to rule out IDA. Hemoglobin electrophoresis is used to evaluate diseases associated with altered hemoglobin, such as beta-thalassemia and sickle cell anemia, neither of which is indicated by this child’s history. Reticulocyte levels are evaluated to evaluate transient erythroblastopenia of childhood, a condition that frequently follows a viral infection. Serum lead levels are not indicated based on this history.
A patient reports recent mild fatigue and palpitations. A complete blood count reveals a decreased hemoglobin level and a normal ferritin level. What other findings are likely to be present?
A. Decreased hematocrit
B. Decreased MCV, MCH, and MCHC
C. Elevated total iron-binding capacity
D. Paresthesias, koilonychia, and pica
A. Decreased HCT
This patient has signs of milder iron-deficiency anemia and will also have a low hematocrit level. The RBC indexes are the last to change as the anemia becomes more severe. When the ferritin level drops, the TIBC will become elevated. Paresthesias, koilonychia, and pica occur with more severe anemia.
The primary care pediatric nurse practitioner evaluates a 5-year-old child who presents with pallor and obtains labs revealing a hemoglobin of 8.5 g/dL and a hematocrit of 31%. How will the nurse practitioner manage this patient?
A. Prescribe elemental iron and recheck labs in 1 month
B. Reassure the parent that this represents mild anemia
C. Recommend a diet high in iron rich foods
D. refer to hematologist for further evaluation
A. Prescribe Elemental iron and recheck labs in 1 month
The child has mild to moderate iron-deficiency anemia and will need iron supplementation. The hemoglobin, hematocrit, and reticulocytes should be reevaluated in 4 weeks after initiation of treatment. The child needs iron supplementation, so reassurance alone is not indicated. It is difficult to get iron from foods, so supplementation will be needed. Children with hemoglobin levels less than 4 g/dL and some children with hemoglobin levels less than 7 g/dL must be referred.
A complete blood count on a 12-month-old infant reveals microcytic, hypochromic anemia with a hemoglobin of 9.5 g/dL. The infant has mild pallor with no hepatosplenomegaly. The primary care pediatric nurse practitioner suspects what disorder?
A. Hereditary spherocytosis
B. Iron-deficiency anemia
C. Lead Intoxication
D. Sickle-cell anemia
B. Iron Deficiency Anemia
Iron-deficiency anemia is the most common type of anemia in infants and children, accounting for approximately 90% of cases. It is characterized by decreased hemoglobin, with microcytic, hypochromic RBCs. Hereditary spherocytosis is characterized by pallor and jaundice with splenomegaly. Lead intoxication is accompanied by neurobehavioral problems. Sickle-cell anemia involves the presence of HgbS.
During a well-child examination of a 2-year-old child, the primary care pediatric nurse practitioner palpates a unilateral, smooth, firm abdominal mass which does not cross the midline. What is the next course of action?
A. Order a CT scan of the chest, abdomen, and pelvis
B. Perform urinalysis, CBC, and renal function tests
C. Reevaluate the mass in 1–2 weeks
D. Refer the child to an oncologist immediately
D. refer to oncologist immediately
The finding is consistent with Wilms tumor, and referral, diagnosis, and treatment are urgent. Palpating a mass too vigorously could lead to the rupture of a large tumor into the peritoneal cavity so care should be taking in conducting the physical examination. The other tests may be ordered by the oncology team. Treatment and diagnosis must occur immediately.
A patient reports a neck mass that has been present intermittently for 5 or 6 weeks, which varies in size. The provider palpates a lymph node that measures 1.25 cm. Which test will provide proper histologic diagnosis for this patient?
A Bone marrow aspirate
B Computed tomography (CT) scan with intravenous (IV) contrast
C Lymph node biopsy,
D Positron emission tomography (PET) scan
C. Lymph node biopsy
The lymph node biopsy is used to provide proper histologic diagnosis and precise classification. Bone marrow aspirate identifies the presence of dysplastic cells. PET and CT scans will identify the presence of other lesions.
Which situations are considered oncologic emergencies in a patient diagnosed with cancer and require urgent referral to an oncologist? Select all that apply.
response - incorrect
A Bone marrow suppression
B Metastasis of cancer cellsMetastasis of cancer cells
C Superior vena cava syndrome,
D Syndrome of inappropriate antidiuretic hormone
E Tumor lysis syndrome
C, D, E
Superior vena cava syndrome, SIADH, and tumor lysis syndrome are all oncologic emergencies requiring urgent referral to the oncologist. Bone marrow suppression and metastasis occur with cancer but are not emergencies.
What is the most important role of the primary care provider in cancer management?
A Counseling about healthy practices to reduce risk factors
B Performing regular screenings to detect cancer
C Referring patients for genetic testing to identify those at risk
D Teaching patients about cancer management once diagnosed
A. Counseling
About three-fourths of cancer risks are related to elements that patients can control themselves and include diet, tobacco, alcohol, sun exposure, physical activity, and risky sexual behaviors. Emphasizing healthy lifestyle practices is a principle component of primary care. Screenings are next in importance and should be performed according to guidelines based on risk and age. Genetic testing is useful in a small percentage of patients; a good family history is important before referral for testing. The primary care provider may assist oncology specialists in teaching patients about cancer management.
The primary care pediatric nurse practitioner is examining a 5-year-old child who has had recurrent fevers, bone pain, and a recent loss of weight. The physical exam reveals scattered petechiae, lymphadenopathy, and bruising. A complete blood count shows thrombocytopenia, anemia, and an elevated white blood cell count. The nurse practitioner will refer this child to a specialist for what diagnostic testing?
A A bone marrow biopsy,
B Corticosteroids and intravenous immunogloblin (IVIG)
C Hemoglobin electrophoresis
D Immunoglobulin testing
A. Bone marrow biopsy
This child has symptoms and initial lab tests consistent with leukemia and should be referred to a pediatric hematologist-oncologist for a bone marrow biopsy for a definitive diagnosis. Corticosteroids and IVIG are given for severe idiopathic thrombocytopenic purpura (ITP). Hgb electrophoresis is used to diagnose sickle cell anemia (SCA). Immunoglobulins are evaluated when immune deficiency syndromes are suspected.
A patient being treated for cancer has had chemotherapy within the past 2 weeks and comes to the primary care clinic with a fever of 38.5 °C. What is the initial action?
A Obtain a STAT complete blood count (CBC) with differential
B Order a chest radiograph
C Order blood and urine cultures
D Prescribe empirical antibiotics
A. STAT CBC w/diff
Patients receiving chemotherapy who have a temperature >38°C and an absolute neutrophil count (ANC) of less than 500/mm3 require immediate hospitalization and treatment. The primary provider should order a CBC to determine this risk and plan immediate hospitalization and referral to the oncologist. Once hospitalized, the patient will have further workup to determine the cause of the infection and then antibiotics to treat the infection.
Most common causes of anemia in elderly are…
anemia of chronic disease
nutritional deficiency (iron, b12, folate)
decreased bone marrow response erythropoeitin
What are the 3 etiologies of anemia?
RBC production disorders
RBC destruction disorders
Blood loss (acute or chronic)
What are the RBC production disorders
Iron deficiency anemia (IDA)
anemia of chronic kidney disease (ACKD)
vitamin B12 & folate deficiency
Anemia of chronic disease
aplastic anemia (bone marrow stem cell failure)
The most important factor in the body’s ability to increase RBC production is…
iron
without adequate iron stores, the marrow cannot increase erythropoeisis
_____ is a glycoprotein secreted by the kidney that induces erythroid precursor cells to differentiate, thereby increasing new RBC production.
Erythropoietin
What are the RBC destruction disorders?
Sickle cell
RBC membrane defects (hereditary spherocytosis; hereditary elliptocytosis)
RBC enzyme defects (G6PD)
Autoimmune antibody production (autoimmune hemolytic anemia)
What does MCV indicate?
Mean Corpusular volume
The average size of RBC
Can be microcytic, normocytic or macrocytic
What is a reticulocyte?
What does it evaluate?
Immature RBC
Larger than mature RBC d/t nucleus
Evaluates:
- bone marrow production of RBC
- if causative factor is decreased production or loss
What is reticulocytosis?
What condition causes this?
an increased number of reticulocytes
Usually in response to decreased numbers of RBCs
>100,000 = bone marrow is responding to anemia conditions
What is reticulocytopenia?
Poor marrow function/failure
What does the reticulocyte index calculate?
What does a low RI mean? Examples?
Elevated RI meaning?
calculates bone marrow response
low RI = bone marrow unable to account for anemia
EX: IDA, ACD, B12, folate deficiency
Elevated RI = marrow attempting to recover from anemia or hemolysis
In the presence of anemia with significant reticulocytes, hemolysis needs to be in the differential…What would you order to rule out hemolysis and why?
Serum bilirubin: r/o hyperbilirubinemia (conjugaed bilirubin is marker of hemoglobin catabolism)
Increased serum lactate dehydrogenase (LDH) - indicative of direct cellular injury
A low reticulocyte count with anemia points to…
impaired erythropoiesis indication a reduction in RBC precursors or ineffective production
A bone marrow biopsy and aspiration report says erythroid hyperplasia….what does this mean?
RBCs are being produced but are not viable and usually do not leave the marrow
What are the size of RBCs in iron deficiency anemia?
microcytic and can be seen on peripheral blood smear before indices change
Define anisocytosis
define poikilocytosis
- significant variations of size
- significant variation of shape
What labs should be evaluated with a low MCV/microcytic anemia?
- Ferritin,
- serum iron,
- total iron bindng capacity
- transferrin saturation percetage
Help differentiate between iron def anemia and anemia of chronic disease
____ is the first lab value to be abnormal when iron stores are becoming depleted even before IDA is reflected in morphology
What could cause Ferritin to be falsely elevated?
Ferritin
<12 = absence iron stores
acute-phase reactant,
- liver damage and other iron rich sources,
- iron overload,
- inflammatory disorders &
- ETOH
What are common causes of microcytic anemia
Iron deficiency
Anemia of chronic disease
thalassemia
sideroblastic anemia
What should be suspected as a cause of IDA in adult men and postmenopausal women?
Chronic GI blood loss
What will iron studies show in a person with IDA?
low ferritin
high TIBC
What are common complaints with IDA 4
Physical exam findings of severe IDA 4
- paresthesias
- pica for starch, clay, ice
- sore tongue
- brittle/spoon shaped nails
Physical exam
- more forceful apical pulse
- tachycardia on exertion
- systolic flow murmur
- CHF in older patient
What is the first change on a CBC in IDA?
HgB drop
…with increasing severity/duration RBCs become microcytic and hypochromic
What lab values would you expect in Thalassemia minor?
hgB
MCV
MCHC
RDW
Hgb low end of normal
MCV = low
MCHC = low
RDW = normal
What lab values would you expect for anemia of chronic disease?
hgB = low end of normal
MCV = low
MCHC = low
RDW = normal
Serum iron = low
ferritin = high
TIBC = low
what lab values would you expect in sideroblastic anemia?
hgB
MCV
MCHC
RDW
hgB = low
MCV = low
MCHC = low
RDW = varies
Serum Iron = high
Ferritin = high
TIBC = normal
When is iron absorption optimum?
When should there be an improvement in blood work?
before meals with ascorbic acid
Improvement = 1 to 2 weeks; MCV corrected in 2 months
Universal screening for IDA begins at age ___
all children 1 year old should be screened
What changes are important in the diagnosis of thalassemia?
changes in the normal amount of adult hemoglobin
Normally predominantly hemoglobin A1, then small amounts hgb A2 & F
What is Cooley anemia?
B-thalassemia major
Severe, life-threatening during 1st year of life
Associated with developmental problems, decreased life expectancy
Lifelong chronic RBC transfusions
What labs would you order for determining the presence of thalassemia?
CBC w/diff
serum iron studies
hemoglobin electrophoresis
Hemoglobin electrophoresis shows Bart’s hemoglobin. what does this mean?
A-thalassemia
A child presents with severe microcytic, hypochromic anemia, jaundice, and hepatosplenomegaly…what diagnosis are you going to consider?
Thalassemia major
When should you refer a patient with thalassemia intermedia to a hematologist?
- abnormal facies
- growth retardation
- pathologic fractures
What is Deferoxamine?
complications
chelating agent that removes iron from tissues and allowed excretion of iron in urine and stools
IV
given weekly for life
complications
- if high dose with low ferritin
- toxic eye effects
- hearing loss
- skeletal lesions
what is Deferasirox?
complication
Oral iron chelator
daily dose with adjustment Q3 months
complications:
- Renal toxicity = electrolyte dysfx
What are the complications of iron overload? 8
Endocrine
- Growth retardation
- DM
- Hypothyroidism
- Hypoparathyroidism
- Disturbed pubertal development
Cardiac
- Arrhythmias
- Pericarditis
- Cardiac Failure
What is macrocytic macrocytic anemia and what does it look like on a peripheral smear?
What are its common causes?
oval shaped; hypersegmented neutrophils, elevated RDW
Causes: vitamin B12 & folate deficiency
What are causes of folate deficiency?
causes of B12 deficiency?
Folate
- ETOH #1
- goat’s milk feeding in infants
B12
- Vegan diet long term
- BF by mother with pernicious anemia
- Pernicious anemia (loss of intrinsic factor in stomach cells)
pernicious anemia onset
after 50 years
Folate and B12 deficiency
symptoms (early and late)
Symptoms specific to B12
Symptoms
- decreased vibratory sensation
- propioception loss
- peripheral neuropathy
- ataxia
- LATE: spasticity, hyperractive reflexes, +Romberg
B12 only: sore mouth & taste loss, beefy red toungue
Myelodysplastic syndromes
What
Clinical presentation
Diagnosis
Population
What: Bone marrow defect where cells produced do not mature into functional RBCs, WBCs & PLTs
Clinical Presentation
- depends on which cells aren’t maturing EX RBCs immature = anemia
- Usually found incidentally
Diagnosis
- Bone marrow biopsy = gold standard
Population: >65
Folate and B12 deficiency
Diagnostics:
- find on CBC? (hgb, mcv, rdw, retic, ri)
- peripheral smear
- other labs
CBC:
- low hgb; MCV >100; elevated RDW;
- low reticulocyte count & RI
Peripheral smear
- Oval macrocytes *earliest signs*
- hypersegmented neutrophils *earliest signs
Other labs
- serum cobalamine (b12)
- folate level
- vit b12 metabolites of methylmalonic acid
- homocysteine (elevated in both)
How would you differentiate between vitamin b12 deficiency caused by malabsorption VS lack of intrinsic factor?
What medication can cause malabsorption
anti-IF assay
anti-parietal cell antibodies **highly specific for pernicious anemia
long term H2 blockers
Acute Lymphoblastic Leukemia (ALL)
Patho
WHO
S/S
Patho: originates in lymphoblasts >>> invade/replace healthy bone marrow. >>> production of RBCs prevented
Who: <5 yrs & >50 years
Symptoms
- fever
- infection
- bleeding
- bone pain
- swelling extremities or face
- unexplained blood clots
Acute Myeloid Leukemia (AML)
symptoms 6
risk factors
who
*most common type of leukemia in adults*
Symptoms:
- weakness
- Dyspnea
- infection
- bruising/bleeding
- unexplained H/A
- blood dyscrasias
Risk factors
- Environmental irritants: smoking, radiation, chemo etc
Who:
- mostly older men
AML
Patho
- hematopoietic precursor cells (stem cells) don’t fully turn into mature RBC
- stem cells rapidly replicate & spread in bone marrow
- RBC production prevented
Chronic Lymphocytic Leukemia (CLL)
what
s/s
What: abnormal/dysfunctional lymphocyte production, “crowds out” healthy cells
Symptoms
- fever/chills
- persistent fatigue
- frequent infection
- weight loss
- swollen lymph nodes
- easy bleeding
- bone pain/tenderness
Colorectal cancer
Risk factors
Risk factors
- high fat diet
- low fiber
- sedentary lifestyle
- FMH
- obesity
- diabetes
- smoking
- advanced age
Gallbladder cancer
symptoms
symptoms
- Jaundice
- pain above stomach
- fever
- n/v
- bloat
- abdomen lumps
What are the most common organs for liver cancer to spread to?
lungs
bones
adrenal glands
what is the most common type of lung cancer?
What are the 3 most common forms?
non small cell lung cancer (NSCLC)
Common forms:
- Adenocarcinoma
- SCC
- Large cell carcinoma
common places for lung cancer to metasize?
liver
bones
brain
Non-Hodgkin’s lymphoma
Patho
s/s 5
Patho:
- Arise from B lymphocytes originating in lymph nodes and spread through lymph system
- Lymphocytes are abnormal, replicate rapidly and avoid programmed death
- Out number healthy lymphocytes & body can no longer fight infection
Symptoms
- Abdomen pain
- fever
- weight loss
- appetite loss
- fatigue
Pancreatic cancer
most common type & describe
Adenocarcinoma: arises from exocrine cells in pancreas
How would you describe an anemia of chronic disease?
normocytic (normal MCV)
normochromic (normal MCH/MCHC)
Hgb >9
insidious onset
normally affects elderly & hospitalized patients
Anemia of Chronic Disease
Diagnostics
Diagnostics
- CBC
- normocytic, hgb 10-11, decreased retic,
- Bone marrow exam
- normal - increased bone marrow stores
- CRP; ESR
- Ferritin/TIBC/Transferrin/serum iron (r/o IDA)
- LFT
- Renal function
**want to find underlying cause**
What is the treatment of ACKD?
Recombinant human erythropoietin (rHuEPO)
or
Darbepoetin alfa
how to diagnose sickle cell disease
hemoglobin electrophoresis
What would you see on the CBC with sickle cell?
peripheral blood smear?
- Evidence of hemolytic anemia
- low hgb
- reticulocytosis
- hyperbilirubinemia
- elevated LDH
Peripheral blood smear
- anisocytosis
- poikilocytosis
- Howell-Jolly bodies (shows fxal asplenia)
- target cells
Causes of hemolytic anemia
sickle cell
hereditary spherocytosis
hypersplenism
autoimmune hemolysis
delayed hemolytic transfusion reaction
Hydroxyurea
Indication 4
Monitoring
Indication
- >3 sickle crisis/year
- pain interferes with ADLs
- Hx severe/recurrent chest syndrome
- Offer >9months to reduce sickle disease complications
Monitoring
- Q2weeks toxicity signs (low neut & plt; hgb drop 2)
Hematopoietic stem cell transplantation indication
Indication: sickle cell curative therapy
complications of sickle cell in children
Dactylitis:
- infants and toddlers
- painful swelling hands&feet r/t bone marrow expansion from ^erythropoeisis
Acute Splenic Sequestration
- Life threatening emergency
- RBCs trapped in splenic sinuses
- Progresses to hypovolemic shock
What is the leading cause of morbidity and mortality in sickle cell?
pulmonary HTN
Dx w/ echocardiogram
Acute Chest Syndrome
what
s/s/ 5
progression
Acute pulmonary event in sickle cell; infectious or non infectious cause
S/S
- Fever
- dyspnea
- cough
- pulmonary infiltrates
- severe CP
Progression
- 1st hospitalized for vaso occlusive crisis then develops respiratory distress
what is the most common cause of death in children with sickle cell?
What vaccinations/schedule should these children receive for prevention?
s. pneumoniae sepsis d/t splenic malfunction & inability to make IgG antibodies to antigens
Prevention
- PNA Vaccine
- 2 months = PCV 13
- 2 years = PPV23
- 7 years = 2nd dose PPV23 (5 years after 1st)
- Prophylactic PCN
- newborn to 5 years old
Aplastic Anemia
Patho
s/s 5
Diagnostics
Patho: damage to bone marrow’s ability to generate stem cells d/t infection/autoimmune/exposure
Symptoms
- Sudden onset
- Recent viral infection/chronic disease/exposure
- petechiae/ecchymosis/abnormal bleeding
- pallor
- mild lymphadenopathy
Diagnostics
- CBC (pancytopenia, normochronic/normocytic)
- low retic = lack of bone marrow activity
- Bone marrow biopsy for diagnosis****
Lymphoma
What
Clinical Presentation
What: Arise from lymphocytes
Presentation
- Lymphadenopathy >4 weeks & >1.5cm
- Lymph nodes wax & wane
- “B symptoms”= disseminated disease
- >38C
- night sweats
- weight loss >10% body weight
Which of the following is the most sensitive test to assess for iron deficiency?
Select one:
a. Mean corpuscular volume (MCV)
b. Serum iron
c. Total iron binding capacity
d. Ferritin
d. Ferritin
A low reticulocyte count can be seen with which of the following?
Select one:
a. Thalassemia minor
b. Iron or vitamin B12 deficiency
c. Acute blood loss
d. Hemolytic anemia
b. Iron or vitamin B12 deficiency
A 25-year-old female with mild microcytic anemia is diagnosed with beta thalassemia minor. Which of the following should be included in the patient management plan?
Select one:
a. A referral to a hematologist for further evaluation and treatment
b. Treatment with iron therapy indefinitely
c. Referral to a genetic counselor if considering conceiving
d. Check a serum haptoglobin level
c. Referral to a genetic counselor if considering conceiving
A patient has a CBC showing a pancytopenia (low hemoglobin, decreased leukocytes and platelets). Which of the following should be included in the differential diagnosis?
Select one:
a. Idiopathic thrombocytopenia
b. Von Willebrand disease
c. Aplastic anemia
d. Anemia of chronic disease
c. Aplastic anemia
An adult patient who is currently receiving treatment for lymphoma presents for swelling of the neck and face along with a cough. There are signs of venous distention in the upper body on physical exam. The nurse practitioner suspects which of the following?
Select one:
a. Tumor lysis syndrome
b. Hyperviscosity syndrome
c. Malignant spinal cord compression
d. Superior vena cava syndrome
d. Superior vena cava syndrome
What is the most common leukemia?
Chronic lymphocytic leukemia
Presentation of acute leukemia
What is more common in ALL vs AML?
- Symptoms r/t anemia
- weakness
- fatigue
- pallow
- dyspnea
- Thrombocytopenia symptoms (bleeding)
- Lymphadenopathy
- Hepatosplenomegaly
- Bone pain r/t expanded bone marrow
- Joint pain/swelling
- CNS symptoms
Lymphadenopathy, hepatosplenomegaly, testicular invovlement
Chronic Leukemia presentation
cardinal finding on physical exam?
- Asymptomatic in beginning
- PROGRESSION DISEASE =
- Bone pain
- bleeding problems
- infection
- fatigue
- pallor
- adenopathy
- fever/night sweats
Cardinal finding = splenomegaly (sensation fullness LUQ)
- compresses surrounding organs, weight loss, leg edema
Acute Leukemia Diagnostics
Other diagnostics
- CBC
- Blood smear
- ^blast cells
- decrease granulocytes, RBC & PLT
- Blast cells 20% total
- Bone marrow aspirate *definitive diagnosis*
- Blast cells >20% total cell population
Other diagnostics
- Hyperuricemia
- LDH: elevated
- PT/INR/APTT: r/o DIC in bruising patients
- Myeoblast count: ^^^ = leukostasis
What is leukostasis?
Complication of Acute Leukemias
Affects lungs and brains primarily
Seen with ^^^ myeloblast count
Chronic Leukemia Diagnostics
CML specific 1
CLL specific findings 7
- Normal RBC
- Slight anemia
- ^^myelocytes & basophils
CML specific (does not make masses)
- ^uric acid
CLL specific
- non tender adenopathy (lymph nodes wax and wane)
- splenomegaly
- fatigue, night sweats, fever, malaise
- sustained lymphocytosis
- decreased IgG
- Peripheral blood smear **diagnosis
- CXR: detects hilar & mediastinal adenopathy
Tumor Lysis Syndrome
What
Prevent
Findings
Cancers associated with
What:
- Rapid release of intracellular products
- Occurs within 7 days of treatment
Prevention:
- Hydration
- limit electrolytes during high risk period
Findings:
- ^Phos, K, Uric Acid
- hypocalcemia
- with or w/o renal failure
- fluid overload
Associated with: Leukemia, Lymphoma, solid tumors
Leukostasis
What: blood stasis when blood vessels overcrowded with blast cells
Neutropenia is worst _____ after chemotherapy and recovers _____ after chemo therapy
Neutropenic patients with a fever is a sign of ______
Neutropenia is worst 10-14 days after chemotherapy and recovers 4 months after chemo therapy
Neutropenic patients with a fever is a sign of life threatening sepsis
Hodgkin Lymphoma
Patho
Presentation
Patho: germinal B cells, “Reed-Sternberg cells”
Presentation
- Painless adenopathy to neck
- Mediastinal mass
- Pruritus
- “b symptoms”
- hepatosplenomegaly
Diagnosis
- Lymph node biopsy
How would you treat a patient with persistent, unexplained lymphadenopathy for 1 month?
Referral for biopsy to r/o malignant disease
When would you prescribe prophylactic antibiotic therapy in severe neutropenia?
What would you prescribe?
Neutropenia = ANC <500
Fluoroquinolones
Superior Vena Cava syndrome
What?
Common Cause 2
S/S (hallmark)
How to diagnose
What: SVC obstruction by external compression, invasion or thrombosis
Common cause: lung cancer & lymphoma
Symptoms: (usually insidious)
- Facial & neck edema ***hallmark****
- Chest & shoulder pain
- cough
- hoarsness
- dysphagia
Diagnosis: CT scan
most patients with myelodysplastic syndromes become ______ dependent for the rest of their lives
blood transfusion-dependent and will need chelation therapy to avoid iron overload
For a patient with myelodysplastic syndrome, what are the indications for urgent referral/emergency care? 4
- with neutropenia <1000 and Fever
- Any bleeding that does not resolve with 15 mins pressure
- Increasing trend of peripheral blasts (r/o transformation to acute leukemia)
- Nodular or flat diffuse rash (r/o acute leukemia)
Malignant Spinal Cord Compression
Symptoms
Diagnosis
Symptoms:
- New onset back pain (constant dull ache)
- worse when lying down
- Rapid progression to paraplegia
Diagnosis: MRI or CT (if MRI contraindicated)
Hypercalcemia of Malignancy
cause
s/s 6
Diagnosis
Treatment
Prognosis
Cause: stimulated osteoclast activity release ca+ from bone
Symptoms:
- Ca >10
- AMS/lethargy/confusion
- weakness
- hypovolemia
- polyuria, polydipsia
- Hyporeflexia
Diagnosis: Ionized serum calcium & total serum calcium & albumin
Treatment:
- Rehydration & refer
- Hospitalize Ca+ >14 or more than mild symptoms
Prognosis <1 month
Tumor Lysis Syndrome
WHAT
WHEN
PREVENTION
S/S
What: Rapid release of intracellular products
When: within 7 days of treatment
Prevention: Hydration, limit K & phos during high risk period
Symptoms:
- Cairo Bishop
- Azotemia/ elevated electrolytes
- ARF
- Symptoms r/t electrolyte imbalance N/V/D cramps
- low UO
Malignancy associated SIADH
Symptoms:
- na <135
- concentrated urine
- N/V CONSTIPATION
- muscle weaknesss
- Babinkski
- Edema
Treatment: Fluid restriction, raise Na, hospital
hemophilia typically has low levels of
factor 8
in what conditions would you see basophil stippling?
thalassemia
Lead intoxication
Myelodysplasia
