Hematology Flashcards
(82 cards)
1
Q
MCV>100
A
Macrocytic
2
Q
MCV
A
Microcystic
3
Q
Causes of Low MCV
3 have low reticulocyte count
A
Iron Def
Thalassemia
Sideroblastic anemia
Anemia of Chronic disease
4
Q
Causes of Macrocytic Anemia
A
B12 &Folate Alcholism Sideroblastic Anemia Liver disease/hypothyroidism Meds &Antimetabolite meds MDS
5
Q
Normocytic Anemia
A
Acute blood loss and hemolysis
will increase the reticulocyte count.
6
Q
Anemia Tx?
A
Packed RBC if severe
Symptomatic Transfuse
7
Q
Symptomatic Anemia
A
SOB
Light headed, confused, syncope
Hypotension and tachycardia
Chest pain
8
Q
Packed RBC raises Hct
A
by 3 points/unit
9
Q
FFP replaces
A
Clotting factors
10
Q
Microcytic Anemia- Iron Def
A
GI bleeds/Menstruation Low ferritin Increased TIBC Low serum iron RDW is increased
11
Q
Microcytic Anemia- Chronic Disease
A
Cancer/infection/rheumatoid arthritis
High Ferritin- iron trapped
Low TIBC
Low serum iron- all that is floating around is bound
12
Q
Microcytic Anemia- Sideroblastic
A
Alcoholic
High serum Iron
Prussian blue staining for ringed sideroblasts
13
Q
Microcytic Anemia-Thalassemia
A
typically asymptomatic Target cells Normal iron studies Best test: Hb electrophoresis Normal RDW High reticulocyte
14
Q
Megaloblastic=Hypersegmented
Seen in ??
A
Folate and B12 def
15
Q
Vitamin B12 Def caused by
A
Pernicious anemia
Pancreatic Insufficiency
Crohn’s
Diphyllobothrium latum
16
Q
Folate Def. causes
A
Diet
Psoriasis
Drugs: Phenytoin, sulfa
17
Q
Alcohol
A
Macrocytosis and neuro problems
18
Q
B12 def
A
Neuro probs- particularly peripherlal neuropathy. Posterior column damage most common
look for ataxia
Labs: Increase methylmalonic acid levels
19
Q
Pernicious Anemia confirmed with
A
antiintrinsic factor and anti-parietal cell antibodies
20
Q
Sickle cell mechanism
A
Glutamic at 6 position is replaced with valine
Point mutation
21
Q
Vaso-occlusive crisis caused by
A
hypoxia
dehydration
infection
cold temperatures
22
Q
African america
severe chest pain, butt/thigh pain
Fever (?)
A
Think sickle cell
Tx: with empiric antibiotics if there is a fever.
23
Q
Sickle Cell Manifestations
A
Bilirubin gallstones Increased infections--why? Osteomyelitis--common bug? Retinopathy Stroke Skin ulcers Avascular necrosis of femoral head Enlarged hear with hyperdynamic features and systolic murmur
24
Q
Sickle Cell
- ) Best initial test?
- ) Most accurate test?
A
- ) Peripheral smear-Howell Jolly Bodies
2. ) Hb electrophoresis
25
Tx. Sickle Cell
```
Oxygen/hydration/analgesia
Antibiotics if fever
Folic acid for all
Pneumococall vaccine
Hydroxyurea.
```
26
Sickle Cell Trait
inability to concentrate urine
| No treatment
27
Hereditary Spherocytosis
Cytoskeleton of RBC mutation
Low MCV
Increased MCHC
best test osmotic Fragility
28
```
Young child/newborn with hemolysis
Intermittent jaundice
Splenomegaly
FHx: anemia/hemolysis
Bilirubin gallstones
```
Hereditary Spherocytosis
| Tx: folic acid & splenectomy--will stop hemolysis
29
Autoimmune Hemolysis
aka?
diagnostic test?
Tx:
```
Warm IgG
Coombs test
Glucocorticoid therapy
Splenectomy
IVIG
Rituximab
```
30
Cold Agglutinin Disease
IgM antibodies against RBC
Direct coombs test
Tx: stay warm, administer rituximab, cyclophosphamide, cyclosporine, plasmapheresis
31
G6PD
| x-linked recessive
inability to generate glutathione reductase
Look for AA/Mediterranea males with sudden anemia/jaundice
Normal spleen
32
Heinz bodies + bite cells
G6PD
| Tx: avoid oxidant stress
33
HUS/TTP
E. Coli for HUS
Neuro +Fever with TTP
Both have schistocytes, Thromobocytopenia, renal insufficiency
34
Tx HUS/TTP
Plasmapheresis or plasma exchange
35
Paroxysmal Noturnal Hemoglobinuria
| MCC of death? Thrombosis
```
def in CD55 and CD59 (best test measures it)
causes increased sensitivity to acidosis/hypoxia which occurs at night time.
Tx: Prednisone, bone marrow transplant, eculizumab, folic acid and transfusions as needed.
```
36
Aplastic Anemia
invasion of bone marrow causing decreased production or hypoplasia
acts as an autoimmune disorder. T-cells attack patients own marrow.
37
Tx: for Aplastic Anemia
Treat underlying cause
Blood transfusion, antibiotics for infection and platelets for bleeding
BMT if young
Anti-thymocyte globulin and cyclosporine in older.
38
Polycythemia Vera
```
JAK2 mutation
Hct>60%
hypoxia excluded
Vit B12 levels are elevated.
Iron levels dec.
Platelets and WBC count increase
Erythropoietin decrease
```
39
Essential Throbocytosis
Platelet count>1 million
Tx if older than 60 with plt count>1.5 million
Tx hydroxyurea, aspirin
40
Myelofibrosis
Fibrosis of the bone marrow
look for teardrop shaped cells
Tx: thalidomide and lenalidomide
41
Acute Leukemia
ALL M3->DIC
Best test? blood smear
Accurate test? Flow cytometry
Myeloperoxidase--> characteristic for AML
42
Tx: ALL and AML
Chemo to remove blasts
Remission relapse +poor prognosis= BMT
Remission relapse + good prognosis= chemo
43
best indicator for acute leukemia
Cytogenetics
good genetics: chemo
bad genetics: BMT
44
Tx with M3
Add ATRA
45
Tx with ALL
Intrathecal chemotherapy prevents relapse of all in CNS
46
CML what to look for
high WBC: all neutrophils
vague symptoms
Splenectomy
Pruritius
47
Tests with CML
first test: LAP. Will be low in CML
| accurate: BCR-ABL the philly chromosome test
48
CML Tx:
Imatinidb, dasatinib, niotinib best 1st therapy
| BMT cures it
49
Acute Leukostasis reaction
elevated WBC emergency tx with leukapheresis
50
Myelodysplastic syndrome
Pancytopenia despite hypercellular bone marrow.
51
MDS labs
anemia with increased MCV, nucleated red cells, small #of blasts
Ringed sideroblasts
Pelger-Huet cells--bilobed nucleus
52
MDS Tx:
Transfuse
Erythropoietin
Lenalidomide
53
CLL
```
WBC elevated with all lymphocytes
Lymphadenopathy
Spleen/liver enlargement
Infection
Tx: stage 2+ give fludarabine (+rituximab)
PCP prophylaxis
refractory: cyclophosphamide
mild: chlorambucil
severe infection: IVIG
```
54
Hairy Cell Leukemia
TRAP positive
| Cladribine
55
Painless Lymphadenopathy
| Best test
Excisional biopsy
56
Nonhodgkin tx
stage 1+2: Local radiation
Adv. stage: chemotherapy (CHOP and rituximab)
Burkitt and immunoblastic bad.
57
Hodgkin
```
Reedsternberg cells
Lymphocyte predominant best prog.
around cervical area
Tx: radiation
ABVD
```
58
Multiple Myeloma
bone pain lytic lesions
don't light up on bone scan
```
Plasma cell proliferation
IgA and IgG proliferation
M spike
Bence jones protein
Rouleaux
```
59
Multiple Myeloma Best test
Bone marrow biopsy >10% plasma cells
60
Multiple Myeloma Tx
Steriods with lenalidomide, bortezomib, melphalan
61
MGUS
small number of plasma cells
| must get bone marrow biopsy to rule out MM
62
Waldentrom Macroglobinemia
Overproduction of IgM
Viscosity is a problem
Tx: plasmapheresis best initial therapy
Long term treatment is chlorambucil/fludrabine/prednisone
63
Platelet Bleeding
Superficial
64
Factor Bleeding
Deep
65
Brain bleeds
platelets or factor
66
Normal HCT, WBC, spleen
ITP
Diagnosis of exclusion
Tx: Prednisone if count
67
Neisseria
hemophilus
pneumococcus
Vaccinate before splenectomy
68
Most common inherited bleeding disorder
```
Von Willebrand Disease
autosomal dominant
platelet type bleeding with a Normal platelet count
worse after aspirin
PTT can go up
```
69
VWD-tests?
| Tx: DDAVP
Bleeding time- increased duration
VWF level will be discreased
Ristocetin cofactor assay
70
PT normal
| Delayed joint of muscle bleeding
Most accurate test: Factor 8 or 9 assay
| first study: Mixing study: correct to normal
71
Hemophila Tx
DDAVP
72
Factor 11 def.
| Tx: FFP if bleeding
With trauma or surgery there is increased bleeding.
Normal PT and prolonged aPTT
Mixing will correct it to normal
73
DIC RF
```
sepsis
burns
snake bites
cancer
tissue factor release
amniotic fluid emboli
consumptim coagulopathy
```
74
DIC
| Tx: FFP
elevated PT and aPTT
elevated D-dimer and fibrin split products
decreased fibrinogen level
low platelet count
75
2,7,9,10
Vit K factors when def. increase PT and aPTT
76
Factor V leiden mutation
MCC hypercoaguable state/thrombophilia
77
HIT
| clotting disorder
common with unfractionated heparin
drop in platelet count by 30%
confirmed with ELISA platelet factor 4 or serotonin release assay
Tx: stop heparin switch to Direct thrombin inhibitors (agatroban, lepiruidin, bivalirudin) and then warfarin
78
Lupus anticoagulant
| anti-cardiolipin antibodies
Antiphospholipid syndromes
clotting and increased aPTT
Tx: heparin/warfarin
APL gets lifelong anticoagulation
79
anti-cardiolipin antibodies
recurrent spontaneous abortions
80
Antiphospholipid Syndrome with Inc. aPTT
| Order what test?
mixing study still elevated
81
lupus anticoagulant test
russell viper venom test
82
Tumor Lysis Syndrome
Cell contents leak out
| Hyperkalema, hyperphosphotemia, hypocalcemia, hyperuricemia
