hematology

Question 1

M-spike <1.5, free light chain negative, evaluate?
what is MGUS-level of M protein?
urine FLC?
plasma clonal cells?

smoldering MM:

Answer 1

f/u 6 months-MGUS-when <1.5-not need BM biopsy
values: should be less than 3
less than 500
less than 10%
no signs symptoms of end organ damage

> 3
500
10%
with signs of symptoms of end organ damage
MRI is gold standard to look for osteolytic lesion
1 lesion>5 mm-considered symptomatic and requires treatment
equivocal small lesions: repeat MRI in 3-6 months and treat if progressing

Question 2

prophylaxis or treatment:
acquired hypogammaglobulinemia
bortezumib chemo
anti-resorptive therapy in MM vs smoldering vs MGUS

Answer 2

treat with IVIG, vaccine against influenza, H. inf, pneumococcus
prevent herpes with acyclovir
MM-treat with zoledronnic acid (indefinite every 3-4 weeks)or pamidronate
-dexa in others

Question 3

when to measure serum viscosity

Answer 3

IgM >4 g/dl

Question 4

PNH:
def?
diagnose?
complications:

Answer 4

1-CD55, CD59
2-flow cytometry
3-Bone marrpow aplasia, myelodysplastic->acute leukemia, weird clots like portal vein thrombosis

Question 5

cold agglutinin anemia

Answer 5

c3 positive on direct anti globulin test
treat with rituximab and cold avoidance
check for mycoplasma, EBV
also can be waldenstroms, B cell non Hodgkin, IgM MGUS
IgM antibody mediated hemolysis