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MKSAP 19 > Hematology > Flashcards

Hematology Flashcards

1
Q

Value of ferritin to R/O IDA

A

> 100

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2
Q

To confirm IDA

A

Low IRON
High TIBC
TRansferrin Sat < 15
Ferritin < 14

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3
Q

How long should be continued oral iron after normalization of Hb

A

3-6 months

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4
Q

Anemia of inflammation

A

High ferritin
Low iron & TIBC
TF sat normal / low

Normocytic , over time microcytic

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5
Q

Fo ESRD , erythropoietin indicated if ?
What’s the target Hb

A

Hb < 10

Hb Should not exceed 11.5 to avoid adverse effects: uncollected HTN, volume overload, thrombosis

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6
Q

Ferritin & TF sat in patient taking erythropoietin?

A

Ferritin > 100
TF sat > 20

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7
Q

Vit B12 > …….? To exclude B12 deficiency

A

221

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8
Q

Best indicator of B12 deficiency

A

High methylmalonic acid & Homocysteine

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9
Q

Best indicator of folate deficiency

A

Normal methylmalonic acid

High Homocysteine

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10
Q

What’s the preferred test when folate deficiency suspended despite of normal serum folate level ?

A

RBC folate

Or

High Homocysteine

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11
Q

Drug indicated for ttt of anemia in patient who requires regular RBC transfusion

A

Luspatercept

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12
Q

Cure treatment of sickle cell disease

A

allogeneic HSCT

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13
Q

Hydroxyurea indicated in SCD with

A
  1. Frequent pain event > 3 per year
  2. Severe symptomatic anemia
  3. Previous acute chest syndrome
  4. Stroke
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14
Q

Agents approved for ttt and prevention of painful events in SCL

A
  1. L- glutamine
  2. Crizanlizumab
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15
Q

Acute Chest syndrome treatment

A

Empiric antibiotic
Hydration
O2
Spirometry
Analgesia

RBC transfusion either with PRBC or as exchange transfusion

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16
Q

Sildenafil in SCD

A

Increase painful crises

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17
Q

Preoperative transfusion target Hb

A

10

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18
Q

Hb target in SCD to avoid problem with blood hyperviscosity

A

Hb < 10

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19
Q

Management of hereditary spherocytosis

A

Acute hemolytic crisis:
1. supportive
2. transfusion if needed

Longer term treatment:
1. Folic acid replacement
2. Splenectomy

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20
Q

Hereditary spherocytosis labs

A

High MCHC , osmotic fragility

Flow cytometry : reduced EMA binding to band 3 on erythrocytes

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21
Q

Warm hemolytic anemia treatment

A
  1. Steroids
  2. Rituximab
  3. Splenectomy
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22
Q

Cold hemolytic anemia treatment

A

1.Avoid cold exposure
2. Steroids
3. Splenectomy
4. Rituximab + fludarabine or bendamustine

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23
Q

PNH diagnosis

A

Flow cytometry : loss of CD 55 and CD 59

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24
Q

PNH treatment

A

Eculizumab and ravulizumab

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25
Q

Which vaccine should be received before using Eculizumab and ravulizumab?

A

Meningococcal vaccination

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26
Q

Hemochromatosis diagnosis

A

Ferritin > 200
TRF sat > 45

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27
Q

What is Factor V Leiden

A

Mutated Factor V is resistant to cleavage by activated Protein C, leading to a prothrombotic state.

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28
Q

How to diagnose factory V Leiden

A

FVL genetic testing or activated protein C resistance test

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29
Q

What is the most common inherited thrombophilia type

A

FVL

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30
Q

Prothrombin G20210A Gene Mutation ?

A

Increase production of prothrombin ( F II)

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31
Q

What is the natural anticoagulant?

A
  1. Antithrombin III
  2. Protein C
  3. Protein S
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32
Q

What’s the main role of AT III ?

A

Inhibit thrombin & activated factor IX

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33
Q

AT III deficiency is high risk in …?

A

Pregnancy, leading to VTE related pregnancy loss & pregnancy morbidity

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34
Q

Common causes of Acquired decreased anticoagulant factor levels AT III, protein S and Protein C

A
  1. Acute thrombosis
  2. Liver disease
  3. DIC
  4. Nephrotic syndrome
  5. Protein losing enteropathy
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35
Q

Acquired decreased anticoagulant factor

protein S and Protein C only

A
  1. Warfarin therapy
  2. Vit K deficiency
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36
Q

Acquired decreased anticoagulant factor

protein S only

A
  1. Inflammatory states
  2. Estrogen
  3. HIV
  4. L asparaginase chemotherapy
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37
Q

Acquired decreased anticoagulant factor

levels AT III only

A

ECMO
Hemodialysis
Severe trauma or burns
L asparaginase chemotherapy

38
Q

Risk of DVT after Hip fracture surgery

A

60 %

39
Q

Risk of DVT in patient undergo general surgery

A

15-30 %

40
Q

APLAS evaluation includes?

A

anticardiolipin antibodies

anti–β2-glycoprotein antibodies

lupus anticoagulant

41
Q

in patients with confirmed APLAS being managed with anticoagulant therapy, the 2021 CHEST guideline suggests adjusted-dose vitamin K antagonist , Target INR

A

target INR 2.5

adjusted-dose vitamin K antagonist over DOAC therapy during the treatment phase

42
Q

Signs of DVT

A
  1. Unilateral swelling
  2. Pain
  3. Warmth
  4. Erythema
43
Q

What’s the indication for IVC filter

A

Acute proximal DVT or Acute PE
With contraindication to anticoagulation

44
Q

Thrombolytic therapy indication in DVT

A

Massive DVT leading to impaired venous drainage, severe edema , acute limb ischemia

45
Q

Thrombolytic therapy indication in PE

A

Massive PE and shock from cardiac output

46
Q

What to do if INR > 4.5 - 10 on warfarin

A

Withhold warfarin

47
Q

What to do if INR > 10 without bleeding on warfarin

A

Oral Vit K

48
Q

What to do if INR high And there is life threatening bleeding on warfarin

A

Iv Vit K and 4 factor prothrombin complex concentrate

49
Q

Leukemia with splenomegaly + pancytopenia+ dry tap on aspiration

A

Hairy cell leukemia

50
Q

APML t ( ……;…..)

A

t ( 15;17)

51
Q

ALL t ( ……;…..)

A

T(12;21)
T(8;4)
T(4;11)

52
Q

Diagnosis of AML by cytogenetic

A

T ( 15;17) , t ( 8;21 ) , inv ( 16)

53
Q

Favorable AML

A

T ( 8;21)
T( 15;17)
Inv (16)

54
Q

Unfavorable AML

A

Monosomal karyotype
11q23
T( 6;9) , t ( 9;22) , inv (3) , -5/5q , -7/7q, TP53 mutation

55
Q

Unfavorable prognostications for AML

A

-Age > 60

-Poor performance status

-WBC > 100

-Prior disease of bone marrow ( MDS , MPLD )

56
Q

Leukemia + infiltrate gums

A

Acute monocytic leukemia

57
Q

Pancytopenia + hypo cellular marrow

A

Aplastic anemia

58
Q

Pancytopenia + hyper cellular marrow

A

MDS

59
Q

Treatment of aplastic anemia

A
  1. Age > 50 or younger but no suitable stem cell donor , antithymocyte globulin , cyclosporine , prednisone, eltrombopag
  2. Younger patient, allogeneic HSCT
  3. Asymptomatic with mild , close monitoring without immediate treatment
60
Q

Idiopathic Pure red cell aplasia treatment

A

Prednisone, cyclosporine , cyclophosphamide

61
Q

Pure red cell aplasia treatment due to thymoma

A

Thmectomy

62
Q

Pure red cell aplasia treatment in immunocompromised

A

Iv Ig

63
Q

Evaluation of polycythemia To R/O 2ry causes

A

1.Pulse oxygenation
2.sleep study
3.Echo
4.kidney U/S

64
Q

Treatment of PV?
HCT level target?

A
  1. Phlebotomy : HCT < 45%
  2. ASA
  3. Cytoreductive therapy: Hydroxyurea & interferon alpha
  4. JAK1/2 inhibitor: ruxolitinib
  5. Patient with venous thrombosis will require lifelong anticoagulation
65
Q

Indication of cytoreductive therapy in PV

A
  1. Age > 60
  2. Hx of MI, stroke , venous thrombosis
66
Q

Indication of JAK1/2 inhibitor

A

Ruxolitinib
If resistant or can’t tolerate first line

67
Q

causes of 2ry thrombocytosis

A

1.IDA
2.chronic bleeding
3.splenectomy
4.infection
5.inflammatory condition

68
Q

treatment of ET of low risk

A

Patients at low risk (age <60 years, JAK2 negative, no venous or arterial thrombosis) can be monitored without therapy or

aspirin if vasomotor symptoms are present, such as headache or erythromelalgia.

69
Q

treatment of ET of high risk

A

age > 60 years and who are JAK2 positive (with or without venous or arterial thrombosis) and should be treated with
1.aspirin and
2. cytoreductive therapy with hydroxyurea or Interferon-α should be considered in younger patients and during pregnancy

  • hydroxyurea is potentially teratogenic.

Anagrelide is effective at decreasing platelet counts; however, it is typically reserved for patients who cannot tolerate or do not respond to hydroxyurea.

patients with acute venous thromboembolism will require lifelong anticoagulation.

70
Q

treatment of PMF

A

1.allogeneic HSCT
2.Asymptomatic patients with low-risk disease can be monitored

however, most patients have some degree of symptomatology and may benefit from supportive medications. JAK1/2 inhibitor ( Ruxolitinib, Fedratinib) that has been shown to significantly improve constitutional symptoms in patients with PMF and reduce spleen volume

71
Q

Causes of eosinophilia

A

can be recalled by the mnemonic CHINA
C collagen vascular disease ( eosinophailic granulomatosis with polyangitis )

H h=Helminitic (parasite ) infection (strongyloides)

I idiopathic hypereosinophilic syndrme

N neoplasia (PMF,AML,Lymphomas)

A allergy

72
Q

Treatment of primary HES

A

low doses of imatinib

Glucocorticoids are effective, but it is imperative to rule out active Strongyloides infection first because glucocorticoids can cause dissemination, which can be fatal.

73
Q

VWD investigation

A
  1. Prolonged bleeding time & Maybe aPTT
  2. F VIII level may be moderately reduced
74
Q

Diagnosis of mastocytosis

A

1.Skin biopsy for cutaneous mastocytosis

  1. BM biopsy for systemic mastocytosis
75
Q

Treatment of mastocytosis

A

Anti histamine & Anti leukotriene to control symptoms

Cytoreductive therapy for aggressive forms

76
Q

MDS treatment

A

1.Asymptomatic low risk can be monitored

  1. Allogeneic HSCT is curative option but not in old age

Hypomethylating agents ( azacytidine & decitabine ) decrease transfusion dependence & risk of conversion to AML

77
Q

Low risk MDS with the 5q cytogenetic abnormality can be treated with

A

Lenalidomide if they are transfusion dependent

78
Q

Treatment of hemochromatosis

A

Phlebotomy one or twice weekly then tapering to maintain a target ferritin 50-100

Once reached the target, phlebotomy 2-6 times yearly and check ferritin 3-6 months

79
Q

Screening for HCC in hemochromatosis

A

Patient with cirrhosis ( stage 4 )

80
Q

Indication for autologous HSCT

A

MM
Relapsed non Hodgkin lymphoma

81
Q

Frequent transfusions may lead to?

A

alloimmunization, increasing the risk of hemolytic disease of the newborn

82
Q

Painful vaso-occlusive crises increase during pregnancy; pain should be managed with

A

opioid analgesics,

NSAIDs should be avoided after the 30th week of gestation to avoid premature closure of the fetal PDA

83
Q

gestational thrombocytopenia?

A

no history of thrombocytopenia, and

the platelet count does not decrease until late in gestation

84
Q

Differentiating ITP from gestational thrombocytopenia may be difficult, but features suggesting ITP include

A

1.earlier presentation (first trimester)

2.lower platelet count nadir <70 × 109/L,

3.history of thrombocytopenia before pregnancy (even if it was only mild)

85
Q

Treatment of ITP in pregnancy

A

Patients should receive iv Ig
or

glucocorticoids at any time during pregnancy if the platelet count decreases to < 30 .

86
Q

Platelets targets for delivery (vaginal or cesarean section)

A

Plt > 50

therapy should begin approximately 1 week before the expected delivery date to achieve that goal.

Neuraxial anesthesia requires a platelet count > 80 .

87
Q

acquired asymptomatic increase in neutrophil count, including

A
  1. asplenia
  2. chronic inflammatory conditions such as IBD,
  3. obesity

4.vigorous exercise

88
Q

Screen for………. in survivors of pediatric leukemia.

A

1.dyslipidemia

  1. DM
89
Q

whole-body low-dose CT scan negative for smoldering myeloma should be followed by …..?

A

whole-body MRI.

90
Q

Which DOAC approved in ESRD?

A

Apixaban

MKSAP 19 (12 decks)

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