Hematology Flashcards
(136 cards)
1
Q
List three ways to describe the genetic abnormality in CML?
A
922 - BCR-ABL gene - Philadelphia chromosome
2
Q
What leukemia would lymphoblast be associated with?
A
ALL (Blasts = Acute)
3
Q
What leukemia would myeloblasts be associated with?
A
AML (Blasts = Acute)
4
Q
What gene mutation is associated with polycythemia vera?
A
JAK2 mutation
5
Q
TTP symptom Mnemonic: FAT-RN. What dose FAT-RN stand for?
A
Fever - Anemia - Thrombocytopenia - Renal failure - Neurologic involvement
6
Q
List two conditions which predispose a patient to antiphospholipid syndrome.
A
Systemic Lupus Erythematosus - Women with recurrent abortions
7
Q
What disorder is a hemoglobin electrophoresis result of “SA” indicative of?
A
Sickle cell trait
8
Q
What disorder is a hemoglobin electrophoresis result of “SS” indicative of?
A
Sickle cell disease
9
Q
What type of anemia are cephalosporins PCN NSAIDS methyldopa associated with?
A
Autoimmune hemolytic anemia
10
Q
Erythropoietin analogs should be suspended once the hemoglobin is >_____?
A
11 mg/dl
11
Q
Erythropoietin analogs should only be initiated if the hemoglobin is < ____?
A
10 mg/dl
12
Q
What two types of anemia have macroovalocytes?
A
B12 and folate deficiency
13
Q
Which anemia has a decreased MCV, decreased MCH (hypochromic) yet normal TIBC and ferritin?
A
Thalassemia
14
Q
Acute chest syndrome occurs during the acute phase of which anemia?
A
Hemolytic sickle cell crisis
15
Q
What are some common oxidative events which may trigger hemolysis in G6PD deficiency?
A
Antimalarials - Sulfa drugs - Aspirin - Febrile Illness - Acidosis - Fava beans
16
Q
What type of anemia does a + osmotic fragility test indicate?
A
Hereditary Spherocytosis
17
Q
What do an increased LDH, decreased Haptoglobin and an increased indirect Bilirubin represent?
A
Hemolysis
18
Q
What type of anemia does a + direct coombs indicate?
A
Autoimmune hemolytic anemia
19
Q
What does a > 50% reduction in platelet count within 7-10 days of exposure to heparin define?
A
Heparin Induced Thrombocytopenia (HIT) syndrome
20
Q
Which type of anemia is most likely with associated leukopenia and thrombocytopenia?
A
Aplastic anemia
21
Q
How would you expect TIBC and ferritin to present in anemia of chronic disease?
A
Decreased TIBC - Normal/increased Ferritin
22
Q
Anemia of renal failure is defined by decreased levels of which hormone?
A
Erythropoietin
23
Q
Can oral B12 be used as an initial treatment in a B12 deficient patient?
A
Yes - Oral B12 is considered initial therapy - Other routes if oral fails or pernicious anemia is diagnosed
24
Q
Which route is best for administering B12 to a deficient patient?
A
Sublingual IM or deep subcutaneous
25
What tests other than a Schilling test are used to diagnose pernicious anemia?
Increased Methylmalonic acid levels - + Intrinsic factor and parietal cell antibodies
26
Increased MCV with smooth tongue, loss of proprioception and vibratory sense is likely which type of anemia?
B12 deficiency
27
List 5 common causes of folate deficiency.
EtOH abuse - Advancing age - Gastric bypass - Pregnancy - Methotrexate
28
What symptom differentiates B12 from folate deficiency ?
Neuropathy occurs with B12 deficiency but not with folate deficiency
29
Slowly decreasing MCV in an elderly patient?
Occult GI blood loss
30
Pica is a specific symptom of which type of anemia?
Iron deficiency anemia
31
Decreased Ferritin and Increased TIBC?
Iron deficiency anemia
32
What surgery can induce B12 deficiency?
Gastric bypass
33
Heavy menstrual cycle gum bleeding with teeth brushing?
Von Willebrand deficiency
34
What tests will confirm your diagnosis of multiple myeloma?
Serum: Protein electrophoresis may show monoclonal proteins - Urine: Bence Jones proteins
35
Autoimmune bleeding disorder in which patients develop antibodies against their own platelets?
Idiopathic Thrombocytopenia Purpura (ITP)
36
Deficient factor in hemophilia B?
Factor IX
37
Deficient factor in hemophilia A?
Factor VIII
38
What type of leukemia is most commonly seen in older men?
Chronic lymphocytic leukemia (CLL)
39
What is the most common type of kids leukemia?
Acute lymphocytic leukemia (ALL)
40
What does the presence of Heinz bodies indicate?
G6PD deficiency (May also be found in thalassemia)
41
Anemia due to renal failure may be confirmed by which test?
Decreased Serum erythropoietin levels
42
What type of megaloblastic anemia causes neurologic deficits?
Vitamin B12 deficiency
43
What type of anemia can occur in hypothyroidism?
Macrocytic non-megaloblastic anemia
44
What factor is produced in the stomach and required for Vitamin B12 absorption?
Intrinsic factor
45
What test confirms the diagnosis of pernicious anemia?
Schilling test or + antibodies to intrinsic factor and parietal cells
46
Which anemia is associated with bilirubin cholelithiasis?
Hereditary spherocytosis
47
What is the best test to determine whether a patient as a hemolytic anemia?
Reticulocyte count and haptoglobin
48
Which anemia has all 3 cells lines affected: Anemia leukopenia and thrombocytopenia?
Aplastic anemia
49
What is the Dx? Very low MCV, normal/high RBC, normal RDW and high/normal serum iron normal TIBC.
Thalassemia
50
What is the Dx? Low MCV, low RBC, high RDW, low serum iron, high TIBC.
Iron Deficiency Anemia
51
What is the Dx? Microcytic hypochromic anemia, low serum iron and low TIBC. Unresponsive to iron therapy.
Anemia of chronic disease
52
What is the result of homozygous alpha thalassemia (Alpha major) genetics?
Fetal death
53
Basophilic stippling of RBCs?
Lead poisoning (May also occur in thalassemia and chronic EtOH abuse)
54
Type of anemia in which serum iron is decreased and TIBC is increased?
Iron deficiency anemia
55
What is the Dx? Teenage African American with severe bone and joint pain severe anemia.
Sickle cell disease
56
What is the etiology of pernicious anemia?
Antibodies to gastric parietal cells and intrinsic factor
57
Increased serum protein with a decreased albumin/globulin ratio?
Multiple myeloma
58
Reed Sternberg cells?
Hodgkins lymphoma
59
Philadelphia (Ph) chromosome?
Chronic myeloid leukemia (CML)
60
Auer rods?
Acute myeloblastic leukemia (AML)
61
What hematological malignancy has a bimodal incidence by age of 15-45 years old or >60 years old?
Hodgkin lymphoma
62
Which malignancy has a peak incidence of 20-40 years old and can be associated with HIV?
Non-Hodgkin Lymphoma
63
Painless lymphadenopathy indicative of which malignant disorder?
Hodgkin lymphoma
64
What are the organ systems which may be involved in Thrombotic thrombocytopenia purpura (TTP)?
Renal - Neuro - Cardiac
65
List the four lab findings which support a diagnosis of DIC.
Decreased Fibrinogen - Thrombocytopenia - Increased D-Dimer - Increased PT and PTT
66
What disorder should be considered for a patient on warfarin who develops diffuse necrotic skin lesions?
Protein C deficiency
67
How is factor V Leiden disorder confirmed?
Activated protein C resistance assay - Genetic testing definitive
68
What is the most common genetic hypercoagulable state?
Factor V Leiden
69
List the three tests to confirm an DX of antiphospholipid syndrome in a hypercoagulable patient?
Lupus anticoagulant - Anticardiolipin antibody ELISA - Anti-beta2-glycoprotein-I ELISA
70
List the four direct thrombin inhibitors which may be used in HIT.
Lepirudin - Bivalirudin - Argatroban - Fondaparinux
71
Which antibody is positive in HIT syndrome?
+ platelet factor 4 (PF4) antibody
72
Which food is known to trigger hemolysis in a patient with G6PD deficiency?
Fava beans
73
List three medications which may trigger hemolysis in a patient with G6PD deficiency.
Antimalarials - Sulfa drugs - Aspirin
74
Which groups are most likely to be affected by G6PD deficiency?
Black or Mediterranean males
75
List three medications which may trigger autoimmune anemia.
Cephalosporins - Penicillins - NSAIDs
76
What is the most common autoimmune disorder associated with hemolytic anemia?
Systemic lupus erythematosus (SLE)
77
Which anemia is most commonly associated with EtOH abuse?
Folate deficiency
78
Priapism may occur in which acute anemia?
Sickle cell crisis
79
What test is diagnostic for sickle cell disease?
Hemoglobin electrophoresis
80
Which test is more sensitive than B12 levels for B12 deficiency in early disease?
Increased Methylmalonic acid levels occur in early B12 loss and may precede decreased serum B12 levels
81
What is the chronic treatment of Von Willebrand disease?
Chronic treatment: Factor VIII replacement
82
What is the acute treatment of Von Willebrand disease?
Acute/initial treatment: DDAVP
83
What assay is definitive for Von Willebrand disease?
Ristocetin cofactor assay
84
What factors are affected in Von Willebrand disease?
Von Willebrand factor and factor VIII are both decreased
85
What is first line treatment for Idiopathic thrombocytopenia purpura?
Steroids
86
Christmas disease is another name for deficiency of which clotting factor?
Decreased Factor IX (AKA Hemophilia B)
87
What disorder is usually diagnosed early in childhood and has hemarthrosis bruising and bleeding?
Hemophilia
88
How is hemophilia inherited?
X-linked recessive
89
What is the Dx? 75 year old male with adenopathy WBC 150K (90% lymphocytes).
CLL
90
What is the Dx? Child with fever bleeding bone pain and adenopathy?
ALL
91
What are the two medications available for treatment of anemia due to renal failure?
epoetin alfa and darbepoetin alfa
92
Increased reticulocyte count likely represents which two anemia etiologies?
Hemolysis or blood loss
93
Which test is most specific for hemolysis?
Haptoglobin is decreased in both extra and intravascular hemolysis
94
List three medications which may cause aplastic anemia.
ACE inhibitors - Sulfonamides - Phenytoin
95
What heritage is associated with an increased chance of thalassemia?
Mediterranean descent
96
What medication is commonly used for CML?
Imatinib
97
Translocation of chromosomes 9 and 22 or 922 suggests which disorder?
CML (This describes the Philadelphia chromosome)
98
WBC > 100000 and hyperuricemia are most likely associated with which disorder?
CML
99
Does AML primarily occur in adults or children?
Adults
100
The complications of multiple myeloma can be described by CRABI. List these 5 complications.
C: hyperCalcemia - R: Renal failure - A: Anemia - B: lytic Bone lesions - I: Infections
101
What tests are used to confirm monoclonal gammaglobulinopathy?
Protein electrophoresis + immunofixation (Monoclonal spike IgG or IgA - multiple myeloma)
102
Monoclonal proteinuria (Bence Jones proteins) are found in which disorder?
Multiple myeloma
103
A 73 year old male presents with back pain and high protein with an increased albumin/globulin ratio. Which laboratory tests would be appropriate to order next?
Serum protein electrophoresis + immunofixation and urine for Bence Jones protein in patient with suspected multiple myeloma
104
What is the most likely lymphoma to occur in a 31 year old male with HIV who presented to the ER after suffering focal neurological deficit?
Non-Hodgkin Lymphoma
105
Which is the only lymphoma that is bimodal in age of onset, painless lymphadenopathy and has Reed-Sternberg cells on pathology?
Hodgkin Lymphoma
106
An 82 year old male has recurrent infections, lymphadenopathy and lymphocytosis. What is the most likely type of leukemia the patient suffers from?
Chronic lymphocytic leukemia (CLL)
107
A patient has a leukemia with high uric acid levels and a WBC of 109,000. What chromosome abnormality would you expect to find upon further testing?
Philadelphia chromosome in patient with chronic myeloid leukemia (CML)
108
An acute leukemia causing lymphadenopathy, bone pain, bleeding and fever in a child is most likely which type of leukemia?
Acute Lymphoblastic Leukemia (ALL)
109
Which leukemia is more common in adults and on laboratory review has Auer rods with increased myeloblasts?
Acute Myeloid Leukemia (AML)
110
What organism associated with ground meat is often responsible for hemolytic uremic syndrome?
E. Coli 0157
111
What organ systems can be affected in thrombotic thrombocytopenia purpura (TTP)?
Renal, neuro and cardiac
112
An adult patient presents with acute thrombocytopenia, fever, multi-organ thrombosis, and hemolytic anemia. What is the best treatment for this patient?
Plasmapheresis for thrombotic thrombocytopenia purpura (TTP)
113
Is the onset of idiopathic thrombocytopenia purpura (ITP) usually faster or slower than TTP?
ITP has a slow onset whereas TTP is usually an acute onset
114
Chronic thrombocytopenia with an otherwise negative work up is most likely what disorder?
Idiopathic thrombocytopenia purpura (ITP)
115
What conditions other than trauma can lead to disseminated intravascular coagulation (DIC)?
Sepsis and malignancy
116
A patient presents 2 months after initiating warfarin with necrotic skin lesions. What underlying hypercoagulable state is most likely?
Protein C deficiency
117
What is the most common hypercoagulable state?
Factor V Leiden Mutation
118
A patient with SLE is admitted with a with new onset DVT. What antibodies should be ordered to aid in the diagnosis of the patients hypercoagulable state?
Anti-phospholipid antibodies
119
A 76 year old female develops a post op DVT after an ORIF if her hip. She has a platelet count of 72,000. What medication is the likely cause of her condition?
Heparin or low molecular weight heparin in patient with Heparin Induced Thrombocytopenia (HIT)
120
What is the difference between Von Willebrand disease and hemophilia in regards to platelet function?
Platelet function is normal in hemophilia and impaired in Von Willebrand disease
121
In addition to Factor VIII replacement, what medication may be used in the treatment of Von Willebrand disease?
DDAVP (desmopressin) = increased release of vWF
122
A 25 year old white female had prolonged bleeding after a dental procedure, bruises easily and has heavy periods. What is the most likely bleeding disorder?
Von Willebrand Disease
123
What anemia should be suspected in a 3 year old black male with anemia and priapism?
Sickle cell anemia
124
A 31 year old Mediterranean female has a hemoglobin of 10.3 gm/dl, MCV of 54, TIBC and Ferritin are normal. What is the most likely etiology of her anemia?
Thalassemia minor
125
Measurement of which laboratory value is the best indicator of whether or not a sickle cell crisis is resolving?
Reticulocyte count - Decreasing reticulocyte counts are the best indicator that a crisis is resolving
126
What medications related to travel can be an oxidative trigger for a patient with G6PD?
Anti-malarial medications
127
What is the most common malignancy associated with autoimmune hemolytic anemia?
CLL
128
A 42 year-old black female with SLE has an increased bilirubin and a mild anemia. Which test is most definitive to evaluate this patient's anemia?
Direct coombs in patient with autoimmune anemia
129
Name 2 things which can cause aplastic anemia other than medications.
Chemotherapy and radiation
130
A patient who recently started lisinopril has a hemoglobin 7.4, WBC 1.1, platelets 55. What is the most likely disorder?
Aplastic Anemia
131
A dialysis patient has been on darbepoetin alfa for 3 months. His most recent hemoglobin is 11.3 gm/dl. Should he continue to use this medication?
No. erythropoetin analogs must be stopped when the hemoglobin is greater than 11 gm/dL
132
A 36 year old black male s/p gastric bypass surgery has peripheral neuropathy. Oral B12 has not improved his symptoms. What is the next step?
Sublingual or IM B12
133
What antibody test would confirm a diagnosis of pernicious anemia?
Intrinsic factor and parietal cell antibodies
134
A 74 year old white male with a history of chronic ETOH abuse has an MCV of 102. Physical exam finds no neurological deficit. What is the most likely diagnosis?
Folate deficiency
135
A 23 year old white female has weakness, fatigue and has developed a habit of chewing ice. What are the expected findings in regard to TIBC and Ferritin?
Increased TIBC and decreased Ferritin in patient with iron deficiency anemia
136
What organism is likely responsible for Renal failure microangiopathic hemolytic anemia and thrombocytopenia?
E. Coli 0157
