8/28- HemeOnc Review Flashcards Preview

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Flashcards in 8/28- HemeOnc Review Deck (43):
1

What are the main 2 diseases that cause stem cell failure?

- Acquired

- Congenital (Fanconi's)

2

What causes stem cell failure (or aplasia)? What does BM look like?

Aplastic anemia - Empty marrow

3

What is the condition where the stem cell differentiates but is ineffective? What does BM look like?

MDS - Cellular marrow but cytopenic pt - Dyspoietic cells

4

What is the condition where the stem cells differentiate but proliferators are out of control? What does BM look like?

MPD (neoplasms) - Marrow is hypercellular - High Hct, WBC, or platelets - Abnl megakaryoctyes---fibrosis, big spleen

5

What is the condition where the stem cells proliferate out of control but do not fully differentiate? What does BM look like?

Acute myelogenous leukemia (AML) - Cellular marrow with primitive cells (blasts) replace marrow and circulate

6

What can cause pure red blood cell aplasia?

- Congenital (Diamond-Blackfan) - Parvovirus - Thymoma (autoimmune) - MDS (5q minus syndrome)

7

T/F: Anemia of CRD involves platelet dysfunction? Why/why not?

True! Bleeding in uremic pts

8

What may cause reticulocytosis (4)?

- Treatment/resolution of hypo-proliferative anemia (recovery after aplastic crisis, from relative hypoproliferative state like moving from Houston to Denver, or with treatment of iron, folate, or B12 deficiency) - Bleeding (in iron replete pt) - Myelophthisis (marrow w/ fibrosis or tumor) - Hemolytic anemia

9

What are the main microcytic anemias (4)?

- Iron deficiency anemia - Sideroblastic anemia - Thalassemias - Anemia of chronic disease

10

What are hepcidin levels/characteristics in the following states: - Anemia of chronic inflammation - Hemochromatosis - Renal failure

- Anemia of chronic inflammation: increased - Hemochromatosis: mutate or downregulated - Renal failure: not cleared; higher levels

11

What are the key characteristics of Beta thal minor. Hb allotype specifics?

- Decreased beta chain production - Damage to RBCs from excess alpha - Increased A2 on electrophoresis!

12

What are the key characteristics of Alpha thal minor. Hb allotype specifics?

- Decreased alpha chain production due to gene deletions - Common in Black Americans - Damage due to beta tetramer (hemoglobin H) - Normal hemoglobin electrophoresis

13

What is a common cause of congenital sideroblastic anemia?

dALA synthase deficiency - Pyridoxine may be effective

14

What is the inheritance of sideroblastic anemia?

X-linked (some AR)

15

What is the most important cause of cobalamin (B12) deficiency from an impaired absorption standpoint?

- Gastric bypass - (Also pernicious anemia)

16

What substances will be elevated in folate deficiency? B12 deficiency?

Folate - Increased homocysteine B12 - Increased homocysteine - Increased MMA

17

What are some RBC characteristics you will see with liver disease (histo)?

- Target RBCs - Acanthocytes/spur cells

18

What symptoms/signs are seen with macrocytosis?

- Megaloblastic anemia - Liver disease (target RBCs, acanthocytes/spur cells) - Extreme reticulocytosis - Hypothyroidism - Artifactual: cold agglutinin disease

19

How do you treat hypoproliferative anemias?

- Iron - B12 - Folate - EPO

20

What organs are affected in hemochromatosis? How?

- Liver: cirrhosis, hepatoma - Heart: congestive CM, conduction blocks/arrhythmias - Endocrine: diabetes, pituitary (hypogonadism, etc.) - Joints - Skin

21

What gene commonly is affected in hemochromatosis?

- HFE gene near HLA-A on chrom 6 - Also TfR-2 (ferroportin) can cause the phenotype as well

22

What could this be? (Pic 1)

- HUS - DIC

23

When do we commonly see cold agglutination?

- Mycoplasmic infections - Indolent lymphomas

24

What do EPO levels look like in secondary erythrocytosis vs. primary?

Secondary: EPO high Primary (polycythemia vera): EPO low

25

What are common translocations in AML?

- t(8;21)- good prognosis - t(15;17)- AML type 3, acute promyelocytic leukemia (response to ATRA, presents with DIC) - inv(16)- AML type 4

26

What translocation is commonly seen in Burkitt's lymphoma? Gene expressed?

t(8;14) - Bcl-2

27

What translocation is commonly seen in follicular lymphoma? Gene expressed?

t(14;18) - C-myc BCL6

28

What are some tie ins/closely related lymphomas and leukemias?

(pic 2)

29

What is Richter's transformation?

CLL transforming into malignant lymphoma

30

What do they following translocations correspond to? - t(14;18) - t(11;14) - t(8;14) - t(2;8) - t(8;22)

- t(14;18): Follicular lymphomas (NHL), BCl-2 - t(11;14): Mantle cell lymphomas, Cyclin D1 - t(8;14): Burkitt lymphomas, IgH/K/n and c-myc - t(2;8): Burkitt lymphomas, IgH/K/n and c-myc - t(8;22): Burkitt lymphomas, IgH/K/n and c-myc

31

Describe staging process/criteria

Stage I: 1 LN region/structure Stage II: > 1 LN, same side of diaphragm Stage III: both sides of diaphragm Stage IV: extranodal sites beyond "E" designation (e.g. bone marrow, liver...) Also A: No B symptoms B: B symptoms E: single extranodal site S: spleen X: bulky

32

Lytic bone lesions are seen in what condition?

Multiple myeloma

33

What causes this? (pic 3)

Coumadin

34

What is the initial anticoagulant of choice for new thrombosis?

DOACs (2) - NOT warfarin!!

35

Where in pregnant women is thrombosis most commonly seen?

Left leg

36

When is risk of thrombosis highest in pregnant women?

6 week period post partum

37

What deficiency is common in newborns? Results in what?

Vitamin K deficiency - Causes hemorrhagic disease of the newborn

38

What chemotoxic drugs cause neuropathy?

- Taxanes - Platinum (oxaliplatin) - Vinca alkaloids

39

What chemotoxic drugs cause cardiac issues?

Anthracyclines (doxorubicin)

40

What chemotoxic drugs cause hand-foot syndrome?

5FU/capecitabine

41

What chemotoxic drugs cause nephrotoxicity?

Cisplatin

42

What chemotoxic drugs cause diarrhea?

- 5FU - Irinotecan

43

What are the side effects of Sunitinib (Sutent), VEGFR?

- Rash - Hand Foot - Diarrhea