Hematology

Question 1

CML

Answer 1

BCL-ABL Tyrosine kinase fusion on chromosome 9/22

Tyrosine kinase inhibitor: imatinib

Question 2

Howel-Jolly Bodies

Answer 2

Found in patients with asplenia or functional asplenia. Remnants of RBCs nucleus that was not removed.

Question 3

Basophilic stipling

Answer 3

Found in patients with thalassemias or heavy metal poisoning.

Question 4

Heinz bodies

Answer 4

Found in patients with G6PD deficiency or thalassemia.. Aggregates of Hb. Sometimes removed by macrophages which will cause “Bite Cells”

Question 5

Sail Sign on CXR

Answer 5

Thymus can present in the right lung field in children up to three years old. This is a normal finding.

Question 6

Lead Screening

Answer 6

Must have venous blood for confirmation.
Tx if levels greater than 45ug 
Succimer if less than 75
Dimercaprol + EDTA if >75 or encephalopathic
Xray if suspicion for lead ingestion

Question 7

Acquired Sideroblastic Anemia

Answer 7

Microcytic hypochromic anemia with two distinct RBC populations mimics IDA but has increased ferritin and decreased TIBC.

Question 8

Uremic patients have ______ bleeding time

Answer 8

increased, high levels of uremia cause platelet dysfunctions.

Question 9

Diamond-Blackfan Anemia

Answer 9

Congenital erythroid aplasia

Craniofacial abnormalities, triphalangeal thumbs, increased risk of malignancy

Macrocytic, reticulopenic anemia
normal platelets and WBCs

Tx: steroids and transfusions

Question 10

Beta Thal Major

Answer 10

95% Fetal 5% A2, survival into 50s or 60s but will required chronic transfusions and chelation therapy.

Question 11

Hypocalcemia in massive transfusion

Answer 11

Citrate in RBC packs and other blood products chelates calcium.

Question 12

Spherocytes

Answer 12

Spherocytosis or AIHA (Coombs+)

Question 13

Tumor Lysis Syndrome

Answer 13

Hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia

Question 14

Causes of Acquired Sideroblastic Anemia

Answer 14

Seen in thalassemias and pyridoxine deficiency.

Question 15

ITP

Answer 15

Idiopathic thrombocytopenic purpura can present without the rash. Other cell lines should be normal. All those with ITP should have HIV and HepC screening.

Question 16

Lead Poisoning Symptoms

Answer 16

GI symptoms, cognitive deficits, peripheral neuropathy, Anemia

Question 17

HITT

Answer 17

Heparin induces a conformational change in platelets which exposes an antigen.

Serotonin release assay is the gold standard.

Question 18

CLL

Answer 18

Fatigue in an old person
Lymphadenopathy, HSM, often asymptomatic
mild anemia/thrombocytopenia
severe lymphocytosis and smudge cells

Question 19

Rouleaux Formations

Answer 19

MM

Question 20

PAD occlusive crisis

Answer 20

Heparin

Question 21

Spherocytosis

Answer 21

Increased indirect bilirubin, increased MCHC, decreased to normal MCV
Tx: Folate, transfusion, splenectomy

Question 22

Timing of anticoag in DVT vs PE

Answer 22

DVT symptoms only do not require empiric anticoagulation

Question 23

Macrocytosis in an alcoholic

Answer 23

Folate deficiency

Question 24

Most common complication of sickle cell trait

Answer 24

hematuria (papillary necrosis)

Question 25

ALL

Answer 25

Most common childhood cancer 2-5yo Lymphadenopathy, HSM, petechiae Dx: Bm Bx with >25% blasts

Question 26

Microangiopathic hemolytic anemia

Answer 26

Elevated LDH, reticulocyte count, and bilirubin Schistocytes Commonly occurs with DIC.

Question 27

CF associated bleeding pathology

Answer 27

Decreased fat soluble vitamin absorption (Vit K) Vit K is used to activate factors 2, 7, 9, 10. Prolonged PT

Question 28

Dx of CLL

Answer 28

Flowcytometry, lymph node biopsy is generally not needed

Question 29

PNH

Answer 29

Autoimmune hemolysis 2/2 lack of proteins (CD55/59) that prevent complement formation on RBCs Signs of hemolysis and hypercoagulability (portal vein thrombosis), 40yo Pancytopenia, Elevated LDH, and decreased haptoglobin Tx: Fe, Folate, Ecluzimab (inhibits complement fixation)

Question 30

Anemia of prematurity

Answer 30

impaired EPO production Usually asymptomatic Low Hb, low reticulocytes, normocytic/normochromic Tx: Fe

Question 31

Hereditary hemorrhagic telangiectasia

Answer 31

AKA Osler-Weber-Rendu Syndrome Autosomal dominant Diffuse telangiectasia, recurrent epistaxis, AVMs AVMs in the lungs can cause shunting and increased Hg

Question 32

Immune thrombocytopenic purpura

Answer 32

Autoantibodies to platelets shortly after a viral illness. Platelets are normal sized or enlarged.