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Clerkship > Hematology > Flashcards

Hematology Flashcards

1
Q

What is a thrombophilia? broadly

A

Thrombophilias can be defined as a group of inherited or acquired disorders that increase a person’s risk of developing thrombosis (abnormal “blood clotting”)

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2
Q

Gold standard to diagnose lymphoma?

What technique shouldn’t you do?

A

Excisional biopsy is the gold standard for lymphoma diagnosis

  • imaging-guided core biopsy can be acceptable
  • dont do an FNA
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3
Q

Risks of RBC transfusion? … why you shouldn’t do them willy nilly

A

allergy, fever, infections, volume overload and hemolysis

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4
Q

3 big complications of acute leukemias

A
  1. Tumor lysis syndrome
    - the blasts run out of resources and start to massively lyse, releasing contents and causing inflammation - hyper K, hypo Ca, AKI
  2. DIC - disseminated intravascular coagulation, balance between coag and fibrinolysis gets disrupted, INR/PTT too long, low platelets, maybe schiztocytes
  3. leukostasis - big fat blasts are sticky and cause infarcts in various systems
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5
Q

Definitive criteria for acute leukemia? (2)

A

Blasts in peripheral blood smear AND

>20% blasts in bone marrow

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6
Q

How to assess lineage (ie AML vs ALL, myeloid vs lymphoid)

A

flow cytometry

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7
Q

Heme history you might not think to ask

A

Exposure to cytotoxic things..

  • chemo, radiation
  • work - ionizing radiation, pesticides, solvents

PMHx - cancer, autoimmune disorders, blood product transfusions

Meds - immunosuppressive medications

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8
Q

Heme important to look for on physical exam

A 
conjunctival pallor (signs of anemia)
petechia, purpura (thrombocytopenia)
lymphadenopathy (suggests ALL)
splenomegaly (suggests CML)
mouth - poor dentition, candida, risk of infection
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9
Q

Labs to assess for tumor lysis syndrome (5)

A

Uric acid (urate)
potassium, calcium, phosphate
lactate dehydrogenase

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10
Q

Labs to assess for DIC

A

CBC (platelets)
INR/PTT
fibrinogen
?d-dimer

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11
Q

AML vs ALL, which is more likely to occur in which age group (adults vs children)

A

AML acute myeloid leukemia - 80% adults

ALL acute lymphoid leukemia - 80% children

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12
Q

Goal and broad method for treatment of leukemia

A

goal is remission
chemo to induce this
then consider post-remission things such as stem cell transplants

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13
Q

what defines remission in leukemia? (4)

A

bone marrow with less than 5% blasts
peripheral blood with no detectable blasts
normalization of peripheral blood cell counts
and absence of extramedullary disease (for at least four weeks).

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14
Q

What is myelodysplastic syndrome, MDS?

A

Persistent, progressive, and otherwise unexplained cytopenias (eg. macrocytic anemia refractory to replacement of vitamin B12 and folate)

myelo - think lineage
dysplastic - think “misformed/shaped”

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15
Q

What is a high reticulocyte count?

A

> 2%
ask yourself whether this is appropriate or not..
if low, think substrate..
if high, think loss..

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16
Q

What can MDS progress to?

A

AML!

MDS = ineffective hematopoeisis, function or form
AML = arrested hematopoeisis, non-functional, stop at the blast stage
17
Q

Most common cause of anemia in children?

ddx (3)

A

Iron deficiency anemia
- remember how we harp on parents to feed their kids iron rich cereals and not too too much milk…

ddx: malabsorption (celiac), blood loss (bleeding disorder, GI), anemia of inflammation (ask and infectious sx, order ferritin and CRP)

18
Q

Labs for ?hemolytic anemia (6)

A

LDH (lactate dehydrogenase) - will be high
Haptoglobin - will be low if there is hemolysis
Bilirubin
Reticulocyte count
DAT (direct antiglobulin test)
Blood film

19
Q

What four tests should you order when you suspect multiple myeloma?

A

Serum protein electrophoresis
Urine protein electrophoresis
Light chains
Immunoglobulins

20
Q

When should you order a blood smear?

A

All the time.

Anemia NYD
Any cell line is down or up
Pancytopenia
Concern for hemolysis (TTP, DIC, HELLP)
Concern for leukaemia or lymphoma
21
Q

ddx to child with anemia

A

iron deficiency (by far most common cause)
- malabsorption
bleeding (ask about GI, GU)
inflammation (viral illness, fever, malaise, sick contacts)
hemolytic anemia (jaundice, dark urine, bruising)
malabsorption (celiac)
bleeding disorder (family history)
hemoglobinopathy (sickle cell, thalassemia)

22
Q

What percentage of the time is a lymphoma hodgkins? Is hodgkins the better or worse prognosis of the lymphomas?

A

15%, more curable!

23
Q

What two tests do you need to diagnose TTP?

A

CBC - anemia, low platelets

Smear - schistocytes

24
Q

What’s the “mainstay” of lymphoma treatment?

A

Steroids

25
Q

What’s the broad difference between leukaemia and lymphoma?

A

Leukaemia is in the bone marrow and blood

Lymphoma is in LNs or spleen

26
Q

Where to the Tcells do their training?

A

In the thymus

27
Q

Where does lymphoma like to hide? (2)

A

CNS, testis

28
Q

What is the mainstay of treatment for TLS?

A

++ Fluids
Allopurinol or rubricase for urate
Manage the lyte abnormalities (high K, low Ca - because it binds to the PO4)

29
Q

Treatment of DIC, three things you can give and one you shouldn’t

A

Don’t give platelets

Can give plasma (clotting factors), fibrinogen (prevent severe bleeding), …

30
Q

Labs for ?hemolytic anemia (6)

A

LDH (lactate dehydrogenase) - will be high
Haptoglobin - will be low if there is hemolysis
Bilirubin - high, breakdown of hgb from lysed RBCs
Reticulocyte count - takes 3-4 days to rise
DAT (direct antiglobulin test) - vertical or transfusion..
Blood smear !!! schistocytes

31
Q

ddx to child with anemia

A

iron deficiency (by far most common cause)
malabsorption (celiac)
bleeding disorder
hemoglobinopathy (sickle cell)

32
Q

why should you order iron studies with your ferritin?

A

to help differentiate between anemia of inflammation vs iron deficiency anemia.

If ferritin and iron saturation are low, more suggestive of iron deficiency

33
Q

ddx for macrocytic anemia?

A 
BFHARM
B12
Folate
Hypothyroidism
Alcoholic liver cirrhosis
Reticulocytosis - think hemolysis
Myelodysplastic syndrome
34
Q

Anemia of inflammation vs iron deficiency anemia

Lab findings?

A

ferritin - low in Fe def, normal or high in AoI
serum iron - low in both
iron saturation - low in Fe def, normal or low in AoI
TIBC - HIGH in Fe def, low in AoI (all bound up!)

Clerkship (21 decks)

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