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Flashcards in Hematology Deck (92):
1

Sideroblastic anemia pathophysiology

Decreased Heme synthesis

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Common causes of sideroblastic anemia including most common cause

pyridoxine-dependent impairment***most common Increased levels of iron Decreased TIBC

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Treatment of cancer related anorexia/cachextia

Progesterone analog (megestrol or medroxyprogesterone acetate) Corticosteroids

4

Management of solitary pulmonary nodule

Find another Xray -if no growth over 2-3 years no further testing No previous imaging or growth: Chest Ct Benign features- serial CT Suspicious for malignancy- biopsy or PET Highly suspicious- surgical removal

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Causes of warm agglutination

Drugs-penicillin Autoimmune Viral Immuno deficiency Lymphoproliferative disorders

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Causes of cold agglutiation

Mycoplasma Mononucleosis Lymphoproliferative disease

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Lab testing in Warm and Cold agglutination

Warm: anti-IgG, anti C3, Direct Coombs Cold Agglutination: Direct Coobs, anti-C3, anti-IgM

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Treatment of Warm and Cold agglutination

Warm: corticosteroids and splenectomy Cold: Rituximab and fludarabine

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Smudge Cells

Seen in CLL

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Malaise lymphadenopathy anemia thrombocytopenia in elderly

Leukemias CLL

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Clinical staging for CLL with prognosis

0 Lymphocytosis only Good 1 Lymphocytosis + adenopathy Fair 2 Splenomegaly Fair 3 Anemia Intermediate 4 Thrombocytopenia POOR

12

Tetrad of findings in multiple myeloma

CRAB Calcium-hypercalcemia Renal Anemia Bones-lytic lesions

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Pathogenesis of HIT

Heparin is neutralized by PF4. Attacked by IgG, attached to a platelet and consumed by splenic macrophages--> thrombocytopenia. There is also considerable activation of other platelets

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Treatment Protocol of DVT

A image thumb
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Treatment of anemia in End stage Renal Disease

Give EPO

If a microcytic anemia results-provide iron supplementtation

 

(The EPO can vastly reduce iron stores)

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Management of Pulmonary Nodule

A image thumb
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Assessing malginancy in a pulmonary nodule

A image thumb
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Manangement of Pain in Prostrate Cancer

Orchiectomy for androgen ablation

Radiation therapy for METS

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Long term concern in pernicious anemia

Gastric cancer from chronic atrophic gastritis

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Direct and Indirect factor Xa inhibitors

Direct

Rivaroxaban

Apixaban

 

Indirect

Fondaparinux

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Direct Thrombin Inhibitors

Argatroban

Bivalirudin

Dabigatran

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Hemolytic anemia

Thrombocytopenia

renal failure

Neurologic symptoms

TTP-HUS

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Pathophysiology of TTP-HUS

deficeincy or autoantibody against ADAMTS13 leads to accumulation of von Willibrand multimers because of decreased clevage leading to platelet aggregation

24

Treatment of TTP-HUS

Plasmaphoresis or plasma exchange

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Conditions with elevated protein but abnormal albumin

Multiple Myeloma

Waldenstrom macroglobulinemia

amyloidosis

monoclonal gammopathy of undetermined significance

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Elevation of monocloncal protein in serum

asymptomatic

not elevated in urine

MGUS

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Serum monoclonal <3g/dL

<10% plasma cells in bone marrow

Lacking anemia, hypercalcemia, renal failure lytic lesions

MGUS

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Management of MGUS

metastatic bone scan to rule out MM

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abdominal fat pad biopsy

used to diagnose amyiloidosis

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Most common cause megaloblastic anemia in alcoholics

folate deficeincy 

31

Management of anaphylaxis following transfusion

IM epinephrine

Anti-histamine

glucocorticioids

Future transfusions require washed RBC

32

Mechanism of anaphylaxis post transfusion

IgA deficeint individuals are suseptable to the anti-IgA IgG antibodies

33

Pathophysiology of G6PD Deficency

X Linked Recessive Enzyme Deficiency

Decreased production of NADPH

Decreased production of glutathione

Oxadization denaturation of hemaglobin to  Heinz bodies

Denatured hemaglobin disrupts cell membrane

Hemolysis

 

34

Hyposthenuria

Inability of kidneys to concentrate urine in sickle cell and sickle cell trait due to the sickling or RBCs in the vasa recta.

35

Tartrate Resistant Acid Phosphotase

Hairy Cell Leukemia

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Treatment of Hairy Cell Leukemia

Cladribine

 

A Purine analog

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Side Effects of Cladribine

Neurologice toxicity

Renal toxicity

Bone Marrow Toxicity

38

Dry tap, fibrotic bone marrow

Hairy Cell Leukemia

Primary myelofibrosis

39

Jak2 mutation diseases

Polycythemia Vera

Essential thrombocytosis

Primary myelofibrosis

40

9;22 Philadelphia Chromosome

Chronic myelogenous Leukemia

BCR/ABL 

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Pruritis

Erythromyalgia

splenomegaly

ERYTHROCYTOSIS

thrombocytosis

Polycythemia Vera

 

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Massive leukocytosis with left shift

Constitutional symtpoms 

splenomegaly

Chronic Mylogenous Leukemia

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Basophilia and eosinophila 

CML

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Diseases with increased bone marrow iron

hemachromatosis

anemia of chronic disease

sideroblastic anemia

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Auer rods

Acute promyelocytic leukemia

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Hyperviscosity

Elevted levels of IgM

Waldenstrom Macroglobinemia

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Vitamin B 12 deficiency will have elevated levels of______

Homocysteine and methylmalonic acid

 

 

Vitamin B 12 converts homocysteine to methionine and methanyl CoA to succinyl CoA

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Folate deficiency will have elevated levels of ______

Homocysteine only

 

Not Methanylmalonic acid

49

Hematologic Manifestations of SLE

Anemia of Chronic Disease

Autoimmune Hemolytic anemia

Renal insufficiency

Iron deficiency anemia

Immune mediated thrombocytopenia

Immune mediated leukopenia

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Treatment of bleeding disorder in liver failure

Fresh Frozen Plasma

51

Drugs that cause peripheral neuropathy

Taxanes

Vincristine

Cisplatin

phenytoin

Topamax

Isoniazid

amiodorone

Hydralazine

52

Pathophysiology of Benign Paroxysmal Hemoglobinuria

Acquired Genetic Defect

glycosylphosphotidyl linositol anchor defect

CD 55 and CD 59 longer connect to cell surface

Complement inhibition does not occur

Membrane attack complex forms

intra and extravascular hemolysis

53

Fourth Decade

Hemoglobinuria

cytopenias

Hypercoaguable state

Benign Paroxysmal Hemoglobinuria

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Confirmatory test for benign paroxysmal hemoglobinuria

Flow cytometry testing

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Parastesias following transfusion

Hypocalcemia results from the citrate used as an anticoagulant in the blood

56

Lab findings in Hemohilia A and B

Prolonged activted PTT

Decreased or absent factor VIII/IX activity

Normal platelet count, PT and bleeding time

 

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Ruby Colored Papules on mucous membranes

AVM

recurrent epistaxis 

Hereditary telangiectasia

Osler Weber Rendu

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Pathophysiology of Polycythemia in Osler-Weber-Rendu

AVM formation in lungs causes chronic hypoxemia which leads to rebound polycythemia

59

Diagnosis of CLL

flow cytometry

60

Electrolyte Abnormalities in Tumor Lysis Syndrome

and Pathophysiology

Hyperkalemia

Hyperphosphatemia

(Both intracellular ions the get released from cells)

Hypocalcemia

(Released phosphate binds calcium)

Hyperuricemia

(Protein breakdowns)

61

Causes of Microcytic anemia

Iron deficiency

Thalassemia

Anemia of Chronic Disease

Sideroblastic Anemia

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Causes of idiopathic thrombocytopenia purpura

HIV

EBV and Hep C

Chemotherapy

Myelodysplasia

Alcohol

Congenital-Fanconi

Vit B12/folate deficiency

SLE

Meds

Antiphospholipid syndromev

DIC

63

Treatment of Rheumatoid arthritis

Methotrexate

Hydroxychloroquine

TNF inhibitors: infliximab and etanercept

64

Pathophysiology of renal failure in multiple myeloma

Proteins block the distal tubule and collecting duct leading to hypercalcemia, hyperuricemia and pyelonepristis

  

65

Haptoglobin

Is a serum protein that binds to hemoglobin and promotes its excretion through the reticulor endothelial system

 

Decreases in cases where there is increased hemoglobin in the serum (ie: intravascular hemolysis)

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When to suspect HIT

When platelets fall >50% from baseline 5-14 post heparin

New onset, unexplained thrombocytopenia

With thrombosis in patients taking heparin

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Lab findings in steroid abuse

erythrocytosis

hepatotoxicity

dyslipidemia

68

Treatment of CML and MOA

imatinib: binds to ATPbinding site of BCR-ABL protein inhibiting the conformational change

69

Treatment of acute promyelocytic leukemia

all trans retinoic acid

70

Most likely cause of macrocytic anemia in sickle cell patient

folate deficiency

71

Post transfusion

Within 1-6 hrs

Fever chills

 

Febrile nonhemolytic reaction

Caused by an accumulation of cytokines

72

Post transfusion

Within one hour

Fever, flank pain, hemoglobinuria, renal failure & DIC

Positive direct Coombs

 

Acute Hemolytic reaction caused by ABO incompatability

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Post Transfusion

2-10 days

mild fever and hemolytic anemia

Positive Direct Coombs

Delayed hemolytic response from anamnestic antibody response

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Post transfusion

Rapid 

Shock, angioedema/utricaria, respiratory distress

Anaphylactic reaction from recipeint anti IgA antibodies

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Post transfusion

2-3 hours post transfusion

Utricaria, flushing, angioedema, pruritis

Utricarial/ allergic reaction from recipient IgE and mast cell activation

76

Post transfusion

Within 6 hours

Respiratory edema, non cardiogenic pulmonary edema

Transfusion related acute lung injury

donor anti-leukocyte antibodies

77

"Soap bubble" apperance in bone radiograph

Giant cell Tumor fo Bone

78

Drugs that cause folate deficiency

phenytoin

primadone

phenobarbitol

Trimethoprim

Methotrexate

79

asymptomatic petechia and ecchmoysis

mucocutaneous bleeding/ epistaxis

thrombocytopenia

 

Immune Thrombocytopenia

80

mild thrombocytopenia

Circulating "giant platelets"

bleeding out of proprotion with thrombocytopenia

Bernard-Soulier Syndrome

absent platelet glycoprotein Ib-IX-V which normally acts as a von willibrand receptor

81

Hemolytic anemia

Jaundice

Splenomegaly

Spherocytosis

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Complications of spherocytosis

pigment gallstones

Aplastic crisis from B19

83

Side Effects of EPO therapy 

Hypertension

Headaches

Flu-like symptoms.

Red cell aplasia

84

excessive daytime sleepiness

snoring

Morning headaches

impotence

arterial hypertension

Obstructive Sleep Apnea

Causes increase in EPO and thus an increase in hematocrit

85

Unexplained superficial venous thrombosis

Trousseau's Syndrome

From a tumor that causes microthrombi

86

Vascular Thrombosis

Past History of Pregnancy Loss

Antiphospholipid syndrome

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Lab antibodies in Antiphospholipid syndrome

Lupus anticoagulant

Anti-cardiolipin

beta 2 glycoprotein 1

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Coagulation studies in antiphospholipid syndrome

Increased PTT

mild thrombocytopenia with no change in bleeding time

89

Leukemoid Reaction

Has elevated alkaline phosphatase

90

Diseases associated with Acute leukemias

Down Syndrome

Kleinfelter syndrome

Mylodysplastic disease

 

91

Reviewing a Chest X Ray

Rotation- look at teh clavicles for rotation

Bones- examine the bones 

92