Flashcards in Hem/onc Tx And Tests Deck (93):
How do you diagnose a bleeding disorder?
Get PT, PTT, TT, fibrinogen and bleeding time
Conduct a mixing study
Obtain factor assays
What is the tx for mild hemophilia?
What is the tx for bleeding episodes due to hemophilia?
Transfusion of clotting factors or cryoprecipitate to at least 40% normal concentration
How do you diagnose vWF disease?
Labs : prolonged PTT and bleeding time
Ristocetin cofactor assay is decreased
How do you treat vWF?
Tx menorrhagia with OCPs
What are diagnostic criteria for diagnosing a patient with a hereditary hypercoaguable state?
Must have 2 abnormal values while asx and untreated with 2 abnormal values in 2 other family members
How do you treat a DVT or PE?
Give heparin or LMWH
3-6 months of warfarin for first event
6-12 months for the second event
Lifelong anticoag if it happens 3 times
What is the best means of preventing a DVT or PE in a patient who can't be anticoagulated?
An IVC filter
How so you diagnose DIC?
PT, PTT, d-dimer, fibrin split products are increased
Fibrinogen level and ALL clotting factors are decreased
What is the tx for DIC.
What is the tx for HIT.
Start lepirudin or argatroban
What is the tx for TTP?
Steroids to decreases micro thrombus formation
What is CI in TTP?
Platelet transfusion - can make it worse!
How would you diagnose ITP?
Bone marrow aspirate would show increased megakaryocytes
When do you tx ITP?
When patients have symptomatic bleeding (usually when platelets are below 20,000)
What is the tx of sx ITP?
High dose gamma globulin
Splenectomy (consider if cannot be tapered off of corticosteroids after 3-6 months)
What are the second line therapies for ITP?
What test distinguishes between an absorption problem and a dietary deficiency of B12?
Give B12 IM and then give radiolabelled B12 - if shows up in the urine the problem is a dietary deficiency
What lab values are consistent with hemolytic anemia?
High LDH, elevated indirect bilirubin and decreased haptoglobin levels
High reticule yet count
What is used to detect autoimmune hemolytic anemia?
A Coomb's test
How do you diagnose aplastic anemia?
CBC and clinical
Bone marrow bx : hypocellularity and fat
What is the tx of aplastic anemia?
Stem cell transplantation
Cyclosporine A and antithymocyte globulin for immune suppression and to prevent autoimmune destruction of the marrow
What is the gold standard for diagnosing sickle cell?
How else is sickle cell diagnosed?
Peripheral blood smear
What is the tx for hereditary spherocytosis?
How do you diagnose hereditary spherocytosis?
CBC shows low MCV and high MHCH And high RDW
Osmotic fragility test= pos
See sphere RBCS and Howell-jolly bodies on peripheral smear
How do you diagnose G6PD?
Do enzyme assay right after an episode
Peripheral smear shows : Heinz bodies and bite cells
What is the tx for PNH?
What is tx for autoimmune hemolytic anemia?
What is the tx of SCD?
Chronic folate supplement
And penicillin BID when patient is less than 5 (MCC of death in children is pneumococcal sepsis)
What is the tx of veno-occlusive crises in SCD?
Antibiotics if infection was the trigger
How do you keep VOC from progressing to acute chest syndrome?
IVF and incentive spirometry
Keep sickling to less than 40% with simple transfusion or exchange transfusion in ICU
What is the chronic tx for SCD when the fail hydroxurea therapy?
How are thalassemia s diagnosed?
How do you treat B-thal major?
Need deferoxamine too to prevent iron overload
How do you great hemoglobin H disease?
Chronic blood transfusion + iron chelation
How do you diagnose PCV?
CBC with ABGs
Levels of EPO
JAK2 mutation test
What is the tx of PCV?
Phlebotomy, keep Hct under 45%
ASA (because prone to thrombotic events)
Hydroxyurea or INF (cytoreductive drugs)
How do you diagnose porphyria?
Elevated blood, urine and stool porphyrins
What is the tx of porphyria?
Glucose (to decreased heme synthesis)
INF alpha if have Hep C, hydroxychloroquine, phlebotomy
How do you diagnose leukemia?
Greater than 20-30% Blasts on smear
Bone marrow aspirate
How do you treat AML and ALL?
Bone marrow transplant
What should be started to prevent tumor lysis syndrome?
How do you treat leukostasis syndrome?
Hydroxurea and leukapheresis (to decrease WBC)
How do you diagnose CLL?
Flow cytometry demonstrating the presence of CD5, 20 and 21
CBC shows lymphocytosis ( greater than 5,000) and smudge cells
When do you treat CLL?
When the patient becomes symptomatic
How do you diagnose CML.
CBC shows high WBC (over 100,000)
What will the labs show with CML?
LAP is low
LDH, uric acid and B12 are elevated
How do you treat the chronic phase of CML?
If young, allogeneic stem cell transplant
How do you treat the blast phase of CML?
Dasatinib + hematopoietic stem cell transplant
How do you diagnose hairy cell leukemia?
Bone marrow bx or smear shows hairy cells
What is the first line tx for hairy cell leukemia?
Nucleoside analogs ->> cladribine = adenosine analog (toxic to neoplastic cells)
What are the other tx options for hairy cell leukemia?
How do you diagnose lymphoma?
Excisional bx of a lymph node AND extra nodal site
What should be done in patients with HIV if you suspect lymphoma?
How do you diagnose mycoses fungoides?
Histology of skin lesion
EM showing sezary cells
What is the mainstay of tx of mycoses fungoides?
What can be used for more severe or extensive mycoses fungoides?
How do you diagnose Hodgkin's lymphoma?
Excisional lymph node biopsy
What are the diagnostic criteria for multiple myeloma?
Greater than 10% plasma cells in the bone marrow and/or histo proven plasma cell infiltration
M Protein in the serum or urine
Lytic bone lesions
How do you evaluate a patient for multiple myeloma?
Bone marrow bx
Serum and urine protein electrophoresis
What is used in the initial tx of multiple myeloma?
Melphalan (alkylating agent)
How do you diagnose Waldenstrom's macroglobulinemia?
Bone marrow bx and aspirate
Shows Dutcher bodies (PAS+ IgM depositis around the nucleus)
Serum and urine protein electrophoresis and immunofixation
What is the tx for Waldenstrom's macroglobulinemia?
How do you confirm the dx of amyloidosis?
Bx with Congo red stain
What is the tx of amyloidosis?
How do you diagnose neutropenia?
CBC with ANC
What do you do if there is associated anemia or TCP with neutropenia?
Bone marrow bx and aspirate
What is the best next step if patient with neutropenia has a fever?
Give broad spectrum antibiotics (cefepime)
What can be used to shorten the duration of neutropenia?
How do you diagnose eosinophilia?
CBC with diff
What should you think of if have hematuria and eosinophilia?
How do you treat HSP
What is tx for tumor lysis syndrome?
How do you confirm HIT?
ELISA antibody test
How do you work up ITP?
Peripheral blood smear
How can you diagnose porphyria?
Aminolevunlimic acid and porphobilinogen in urine
When should gonadectomy be performed in androgen insensitivity?
What is the tx for ITP in children with skin manifestations only?
What is the tx for ITP in children with bleeding?
IVIG or corticosteroids
What is the tx for ITP in adults with platelet count less than 30,000 without bleeding?
What is the tx for ITP in adults with bleeding or platelet count less than 30,000?
What is the test for early detection of hemophilia arthropathy?
What is the prophylaxis for hemophilia arthropathy?
Factor XIII or IX
What is the gold standard lab test for hereditary spherocytosis?
Eosin-5-maleimide binding test with the Acidified glycerol lysis test
How do you diagnose amyloidosis?
What is the treatment for TTP?
Emergent Plasma exchange
What is cryoprecipitate used for?
Von willebrand disease
Factor 8 deficiency
When is a platelet transfusion given?
Platelets less than 10,000
Bleeding and platelets less than 50,000
What is the tx for primary CNS lymphoma?
What is the tx for neurocysticercosis?
How long is fluconazole administered for HIV patients for cryptococcal meningitis?
Until CD4 is greater than 100 for a year