Hematology Flashcards
(100 cards)
1
Q
most sensitive assay for IDA
A
transferrin receptor index (TRI)
2
Q
if Hb 10 g/dL, MCV 85, TIBC low, transferrin saturation 22%, ferritin 120, what will BM bx show?
A
ACD: INCREASED Fe2+ in macrophages (RES) and decreased sideroblasts
3
Q
70 yo male or post-menopausal female w/ Hb 9.5 g/dL, MCV 70, decreased ferritin, wtd?
A
GI w/u
4
Q
young pt, < 40 yoa w/ Hb 9.5 g/dL, MCV 70, decreased ferritin, wtd?
A
EGD
5
Q
older pt, > 50 yoa w/ Hb 9.5 g/dL, MCV 70, decreased ferritin, wtd?
A
colonoscopy first
6
Q
45 yo pt w/ LEFT supraclavicular LAD w/ Hb 9.5 g/dL, MCV 70, decreased ferritin, wtd?
A
EGD to r/o stomach CA
7
Q
25 yo female w/ Hb 9 g/dL, MCV 63, decreased ferritin, RDW 17%
- smear: hypochromic microcytic, anisocytosis, target cells, pencil/cigar cells
- dx
A
either menstrual loss or pregnancy w/ increased need
8
Q
25 yo female w/ Hb 9 g/dL, MCV 63, decreased ferritin, RDW 17%
- smear: hypochromic microcytic, anisocytosis, target cells, pencil/cigar cells
- tx
A
ferrous sulfate PO
9
Q
pt started on tx for IDA w/ Fe2+ and vitamin C, what to check for response and how soon?
A
- reticulocyte count
- 5-7 days
10
Q
60 yo female w/ h/o DM and CKD p/w fatigue, Hb is 9 g/dL, stool guaiac negative, serum EPO is 10 mg/dL, is started on EPO tx, 4 weeks later Hb is 9.2 g/dL, wtd?
A
start supplemental ferrous sulfate
11
Q
pregnant female in 2nd trimester, Hb 10.5 g/dL, MCV 80, RDW 14%
A
increased plasma volume
12
Q
pregnant female in 2nd trimester, Hb 10.5 g/dL, MCV 75, RDW 17%
A
IDA
13
Q
elderly male p/w nausea, abd pain and diarrhea, on exam, slight confusion, gait abnormality, and decreased vibration sensation, Hb 9 g/dL, MCV 78, wtd?
A
urine heavy metal screening
14
Q
elderly pt works at factory that makes batteries, or lives in an old building, or is a chronic alcoholic, p/w h/o anemia, and gout, Hb 9 g/dL, MCV 80, dx?
A
lead poisoning
15
Q
young pt presents for regular check up, Hb 12.2 g/dL, MCV 70, RDW 13.5%, smear shows hypochromic microcytic cells, target cells, how to establish dx?
A
Hb electrophoresis
16
Q
Asian pt (India/Vietnam/Laos/Cambodia) p/w Hb 12 g/dL, MCV 75, blood refused when trying to donate, smear shows target cells, dx?
A
alpha thalassemia trait
17
Q
black male p/w SC anemia w/ arthralgia, fever, Hb 8 g/dL, increased LDH, increased reticulocyte count, normal ferritin, dx?
A
painful vaso-occlusive crisis
18
Q
painful vaso-occlusive crisis tx
A
hydration, analgesics, O2
19
Q
painful vaso-occlusive crisis, best way to prevent
A
hydroxyurea
20
Q
black male p/w SC anemia w/ arthralgia, fever, Hb 8 g/dL, increased LDH, increased reticulocyte count, normal ferritin, supportive tx started, next day Hb drops, wtd?
A
don’t transfuse, c/w current management
21
Q
Hb level to transfuse pt
A
< 7 g/dL
22
Q
how many units PRBC to transfuse in pt NOT bleeding?
A
ONE unit and recheck
23
Q
pt w/ chronic IDA scheduled for surgery, Hb 8 g/dL, wtd?
A
iron
24
Q
black male w/ SC disease p/w right hip pain, no h/o recent trauma, XR hip shows diffuse articular sclerosis and patches of decalcification, dx?
A
avascular necrosis of femoral head
25
pt w/ SC anemia w/ CP, fever, sputum negative for PMNs, CXR shows infiltrate, IV morphine given, dx?
acute chest syndrome
26
acute chest syndrome tx
IV abx, O2 if hypoxic, PRBCs if severe anemia
27
acute chest syndrome tx if hypoxia persists despite O2 and PRBCs
EXCHANGE transfusion
28
pt w/ SCT w/ LUQ pain, enlarging spleen and dropping H/H, BP 100/80 and HR 96 supine, SBP 80 and HR 114 sitting up, dx?
splenic sequestration crisis
29
splenic sequestration crisis tx after IVF
PRBCs
30
school teacher w/ arthralgias, Hb 8 g/dL, no h/o bleeds, no rash, reticulocyte count 0.2%, dx?
aplastic anemia 2/2 parvovirus B19
31
aplastic anemia 2/2 parvovirus B19 tx
IVIG
32
pregnant teacher worried about hepatitis A (or parvovirus B19, or hepatitis B) breakout in school, w/ which Ab titers can you reassure her?
IgM negative, IgG positive (already immune, no acute infection)
33
MCC of OM in SC disease
Salmonella > Staph (2:1)
34
pt w/ Hb 13 g/dL, MCV 70, Hb electrophoresis shows Hb A 75%, Hb S 25%, and Hb F 0.3%, dx?
SCT or alpha thalassemia
35
pt w/ SC disease and seizure d/o on phenytoin p/w severe anemia w/ Hb drop from 11 g/dL to 9 g/dL, MCV 110, reticulocyte count 0.7%, LDH 750, dx?
phenytoin-induced folate deficiency
36
55 yo chronic alcoholic w/ anemia, increased MCV, decreased folate, dx w/ folic acid deficiency anemia, started on folate PO daily, couple of weeks later, Plt count increases from 150,000 to 750,000, wtd?
c/w folate treatment (platelets known to increase w/ folate tx)
37
PCP started 60 yo pt w/ Hb 10 g/dL, MCV of 120 on folate, several years later, Hb is 11.2 g/dL, pt has dementia and gait problem, wtd?
check B12 level
38
PCP started 60 yo pt w/ Hb 10 g/dL, MCV of 120 on folate, several years later, Hb is 11.2 g/dL, pt has dementia and gait problem, if B12 level is 300, wtd?
check MMA level (if increased, B12 deficiency!!)
39
74 yo female p/w sxs of forgetfulness, exam shows Romberg sign positive, B12 level is 310, Hb 13 g/dL, MCV 103, wtd?
check MMA level
40
which meds decrease B12 absorption?
metformin and PPIs
41
best tx for B12 deficiency
cobalamin PO (even in pernicious anemia)
42
best way to differentiate between B12 and B6 deficiency
high MCV
- B6 def (high homocysteine, MMA WNL)
- folate def (high homocysteine, MMA WNL)
- B12 def (high homocysteine, MMA HIGH also)
43
in any chronic hemolytic anemia (SC anemia, HS, etc), pt should be tx'd w/?
folate
44
long time dock worker, now 80 yo, p/w c/o improper gait and forgetfulness, unable to remember names, exam shows Romberg sign positive, decreased vibration sense, Hb 10.5 g/dL, MCV 118, B12 275, homocysteine 22 (high), dx?
B12 deficiency
45
leukopenia, anemia, and thrombocytopenia is likely to be seen in which conditions?
DIC, ITP, and TTP (double check this answer)
46
elderly pt p/w anemia +/- thrombocytopenia +/- leukopenia w/ hypOsegmented PMNs, macrocytosis, megakaryocytes, hypercellular BM, 5q gene deletion, dx?
myelodysplastic syndrome
47
elderly pt p/w anemia +/- thrombocytopenia +/- leukopenia w/ hypOsegmented PMNs, macrocytosis, megakaryocytes, hypercellular BM, 5q gene deletion, tx if < 55 yo?
ALLOgenic BMT
48
elderly pt p/w anemia +/- thrombocytopenia +/- leukopenia w/ hypOsegmented PMNs, macrocytosis, megakaryocytes, hypercellular BM, 5q gene deletion, tx if > 55 yo?
azacitidine
49
myelodysplastic syndrome w/ 5q gene deletion tx
lenalidomide
50
best screening tool for hemochromatosis
serum transferrin saturation
51
diagnostic test for hemochromatosis
HFE gene test
52
to find out extent of Fe2+ overload, wtd?
liver bx
53
tx for hemochromatosis
phlebotomy
54
pt p/w fatigue, h/o PNA x 2 in past couple of months, exam shows petechiae, WBC 2000, Hb 6 g/dL, Plt count 62,000, reticulocyte count 1%, MCV 104, BM bx shows hypOcellularity and FAT cells, dx?
aplastic anemia
55
aplastic anemia tx if < 50 yo
ALLOgenic BMT
56
pt w/ uremia, low Hb, PBS w/ BURR cells, dx?
anemia of renal failure
57
etiology of anemia of renal failure
low EPO
58
anemia of renal failure tx
EPO w/ target Hb 10-11 g/dL
59
pt w/ alcoholic cirrhosis and worsening anemia, high bilirubin, high reticulocyte count, no evidence of bleeding, PBS shows RBCs w/ irregular spiculations, dx?
spur cell anemia of liver disease (bad prognosis)
60
pt w/ unstable angina is started on IV nitrates, or pt post EGD or post bronchoscopy, suddenly turns cyanotic and becomes SOB, EKG shows no acute ST/T wave changes, ABG shows PO2 96, and pulse ox 85%, dx?
methemoglobinemia
61
methemoglobinemia tx
methylene blue
62
- warm Ab (anti-IgG), cold Ab (anti-IgM), mixed, paroxysmal cold hemoglobinuria
- PCN/cephalosporin/methyldopa
warm Ab (anti-IgG)
63
- warm Ab (anti-IgG), cold Ab (anti-IgM), mixed, paroxysmal cold hemoglobinuria
- SLE
warm Ab (anti-IgG)
64
- warm Ab (anti-IgG), cold Ab (anti-IgM), mixed, paroxysmal cold hemoglobinuria
- CLL/lymphoma
mixed
65
- warm Ab (anti-IgG), cold Ab (anti-IgM), mixed, paroxysmal cold hemoglobinuria
- quinidine
cold Ab (anti-IgM)
66
- warm Ab (anti-IgG), cold Ab (anti-IgM), mixed, paroxysmal cold hemoglobinuria
- infection (Mycoplasma, infectious mononucleosis)
cold Ab (anti-IgM)
67
- warm Ab (anti-IgG), cold Ab (anti-IgM), mixed, paroxysmal cold hemoglobinuria
- can be treated w/ steroids
warm Ab (anti-IgG)
68
- warm Ab (anti-IgG), cold Ab (anti-IgM), mixed, paroxysmal cold hemoglobinuria
- influenza
cold Ab (anti-IgM) OR paroxysmal cold hemoglobinuria
69
43 yo pt on Bactrim for URI develops anemia, LDH and reticulocyte count increased, Mycoplasma titer positive, cold agglutinin positive, dx?
Mycoplasma induced hemolysis
70
48 yo male p/w colicky abd pain, UA shows blood positive, no RBCs, WBCs, and hemosiderin positive; Hb 8 g/dL, MCV 83, reticulocyte count 7%, LDH 210, amylase 16, lipase 35, PT 13, PTT 38, direct Coombs negative, indirect Coombs negative, abd US shows no gallstones, no renal stones, mesenteric vein thrombosis positive, dx?
paroxysmal nocturnal hemoglobinuria
71
paroxysmal nocturnal hemoglobinuria dx
DAF assay or flow cytometry positive for CD55 and CD59
72
paroxysmal nocturnal hemoglobinuria tx
ALLOgenic BMT or eculizumab
73
what should be given 2 weeks prior to treating PNH w/ eculizumab?
meningococcal vaccine
74
40 yo female w/ h/o smoking x 15 years, consumes 6 drinks per week, seizure d/o on barbiturates, takes progesterone OCP since she had a DVT 2 years ago, skips meals occaisonally, on exam BMI of 19, p/w acute onset abd pain, vomiting, pain/paresthesias in arms, constipated x 3 days, temperature 99, HR 100, WBC 8000, Hb 13 g/dL, AST 80, ALT 90, urine is dark red, blood negative, WBC negative, dx?
acute intermittent porphyria
75
acute intermittent porphyria etiology
decreased PBG deaminase activity
76
young female on routine exam found to have Hb of 9 g/dL, palpable spleen, family h/o anemia, MCV 86, MCHC 38, reticulocyte count 5%, direct Coombs test negative, esoin-5-maleimide binding test positive, dx and most etiology?
- hereditary spherocytosis
| - cytoskeletal spectrin membrane defect
77
hereditary spherocytosis tx
folate
78
35 yo female w/ recent URI, treated w/ amoxicillin or PCN, p/w fatigue and pallor, blood indices WNL 1 year ago, Hb now 9 g/dL, MCV 92, MCHC 39, reticulocyte count 12%, polychromasia positive, spherocytes positive, dx?
autoimmune hemolytic anemia
79
pt p/w hemolytic anemia, suspected to have G6PD deficiency, G6PD levels are normal, wtd?
recheck levels in 2-3 months (falsely normal)
80
18 yo p/w abd pain and bloody diarrhea, no fever or mental status change, Hb 10 g/dL, Plt 60,000, reticulocyte count 8%, LDH 650, PT/PTT normal, BUN 30, creatinine 2.2, PBS shows reticulocytes w/ polychromasia, schistocytes positive, dx?
HUS
81
25 yo female has normal labor, 7 days postpartum p/w fatigue, exam shows petechiae on arms, Hb 8 g/dL, Plt 20,000, reticulocyte count 7%, LDH 850, PT/PTT normal, BUN 30, creatinine 1.6, AST 120, ALT 250, PBS shows anisocytosis w/ polychromasia, schistocytes positive, dx?
HELLP syndrome
82
HELLP syndrome tx if < 32 weeks pregnant
steroids
83
HELLP syndrome tx if > 32 weeks pregnant
early delivery
84
young female is brought by family w/ mild confusion or headache for past 2 days, exam shows fallor, temp 100.4, Hb 9.5 g/dL, WBC 7000, Plt 25,000, PBS shows RBC fragments, polychromasia positive, BUN 40, creatinine 2.5, PT 12, PTT 25, tx?
plasmapheresis
85
tx for TTP if plasmapheresis machine is not available?
plasma infusion (give FFP)
86
pt w/ a Plt count of 50,000 w/ PNA, what will help establish dx of TTP?
PBS
87
which conditions will you see schistocytes?
DIC, HUS, HELLP, and TTP
88
pt is getting a blood transfusion, w/i 1 hour he becomes restless, dyspneic, c/o LBP, fevers, and chills, temp 101.5, HR increases from 80 to 110 bpm, urine is dark red, Hb drops from 9 g/dL to 7 g/dL, direct Coombs test is positive for IgG Abs, dx?
major hemolytic reaction d/t early ABO incompatibility
89
most likely cause of ABO incompatibility leading to hemolysis reaction?
clerical error w/ ABO mismatch
90
50 y/o alcoholic p/w GIB, 1 month ago was hospitalized w/ Mallory Weiss tear and had received 2 units of PRBCs, on exam BP is 80/60, HR 120 bpm, Hb 6.5 g/dL, pt receives vigorous IVF and 2 units of PRBCs and PPI, 2 days later on discharge planning pt c/o lightheadedness, temperature is 101.5, repeat Hb is 6.1 g/dL, best test to explain PE and lab findings?
Coombs test (will show delayed Rh incompatibility reaction)
91
pt receives blood transfusion 2 units PRBCs during surgery, is discharged, returns to office 1 week later w/ episode of dark urine and mild scleral icterus, dx?
late hemolytic reaction d/t Rh incompatibility
92
role of steroids in Rh incompatibility?
NONE
93
which electrolyte is most likely decreased after massive blood transfusion?
calcium
94
which electrolyte is most likely decreased after plasmapheresis?
calcium
95
most likely cause of seizures after massive blood transfusion?
citrate toxicity
96
pt w/ h/o urticaria and allergies needs blood transfusion, wtd?
transfuse washed PRBCs
97
pt has fevers and chills every time he is transfused, H/H does NOT drop, dx and wtd?
- febrile reaction to leukocytes from donor blood
| - leukocyte reduced PRBCs for future transfusions
98
blood transfusion is started, few minutes later, HR increases to 110 bpm, BP drops to 80/60, pt appears SOB w/ RR 28/min, lips are swollen, temperature 99, most likely cause?
IgA deficiency
99
pt w/ severe IgA deficiency requires blood transfusion, wtd?
washed PRBCs
100
pt receives Plt transfusion, 2 hours later has fevers, hypotension, headache, backache, chest pain, oliguria, but no red colored urine, dx?
bacterial contamination
