Hematology / Oncology Flashcards
(39 cards)
Transfusion targets in sickle cell disease
Hgb < 50 unless heart failure, dyspnea, hypotension
Hgb ~ 100 in acute chest syndrome
3 causes of acute drop in hemoglobin in sickle cell disease
Splenic Sequestration
Aplastic Crisis - First test is RETICS (Low in aplastic)
Hemolysis / MAHA
Causes of sickle cell disease
HgbS + HgbS
HgbS + Hgb BThal
HgbS + HgbC
- Usual first presentation of dactylitis
Acute Chest Syndrome Diagnosis and Mgmt
Rehydration
Analgesia
Incentive spirometry
02 > 92%
Empiric antibiotics -
Consider exchange transfusion
treatment of vaso-occlusive crisis
Can be triggered by cold, humidity, stress, EtOH
+++ Pain meds. i.e 1 Dilaudid IV Q15 mins
O2 and IV fluids PRN
Hydroxyurea can prevent reduce incidence.
CLL Diagnosis
Lymphocytes > 5 on repeat test without underlying illness
Blast Crisis definition / mgmt
Hyperviscocity syndrome
- WBC > 100, blasts > 20
- Mucosal bleeding
- Headaches and ataxia
- Visual changes
Tx: Dilute: hydration, oxygen and supportive care. Hematology consult
- Phlebotomy: withdraw 2U of blood.
TTP Presentation and treatment and Mimics
Fever (rare)
Anemia
Thrombocytopenia
Renal failure
Neurologic Sx
Mgmt: Supportive care, Plex, FFP as a temporization
Mimics:
SLE - APLA
Vasculitis
Malignant Hypertension
Compliment mediated HUS
DIC
Pre-eclampsia / HELLP
Disseminated Malignancy
ITP
Look for “wet puppura” in oral mucosa
Usually do ok - low rates of bleeding
Plts < 30, call heme
If > 30, observe ensure f/u
Tx: steroid, IVIG, rituximab (down the road), consult heme
If severe bleed: IVIG 1g/kg. Methylpred 1g IV,, TXA 1g over 15 plus 1g over 8 hrs, call heme, transfuse
Platelet transfusion threshold
Chemotherapy: < 10
Chemo + Fever: < 20
ITP: 30 with bleeding
DIC with bleeding: 50
Life threating bleeding: 50
ICH: 100
LP: 50
Paracentesis: Doesn’t matter
Central Venous: <20
Transfusion fever dx and management
Stop transfusion
- Acute hemoltyic
- Sepsis
- Febrile, non-hemolytic transfusion reaction
- TRALI (resp distress, usually several hours later)
Stop
Full set vitals
RE-check: Call transfusion medicine - clerical check
Hemolytic workup
If mild: give acetaminophen and continue
Transfusion fever dx and management
Stop transfusion
- Acute hemoltyic
- Sepsis
- Febrile, non-hemolytic transfusion reaction
- TRALI (resp distress, usually several hours later)
Stop
Full set vitals
RE-check: Call transfusion medicine - clerical check
Hemolytic workup
If mild: give acetaminophen and continue
Hemolytic Anemia Diagnosis and DDx
Diagnosis:
- CBC, smear, retics, haptoglobin, LDH, bili (total and direct), DAT, fibrinogen
DDx:
-Hereditary: Sickle, G6PD, Spherocytosis
-Acquired: Autoimmune warm / cold (IgG, bind at body temp, usually a malignancy caused / EBV or Mycoplasma pneumonia, lymphoma or Waldenstroms), Alloimmune (newborn, transfuse), drug induced (cephalosproins, sulfa, levodopa, penicillin..)
-Framentation:
DIC - sepsis, meningococcemia, bacteremia, trauma, etc. - Supportive mgmt
TTP - Congenital or acquired ADAMSTS13 deficiency. Bicytopenia, ALTERED MENTAL STATUS, renal failure, neuro issues). Treatment: PLEX +/- steroids
HUS - Post β hemolytic (Shiga toxin producing) E.coli.
Pregnancy
Malignant HTN
Malignancies
Anemia causes by MCV
Microcytic < 80
- Thalassemia
- Anemia of chronic disease
- Iron Deficiency
- Lead poisoning
- Sideroblastic
Normocytic 80-100
- Hemolysis (sometimes macro)
- Bleeding (sometimes macro)
- Anemia of chronic disease (sometimes micro)
- Marrow failure (aplastic anemia, myeloproliferative disorders)
- Infectious (EBV)
- Hypothyroid
- Hypoadrenal / Hypopit
- Renal failure
Macrocytic:
- B12
- Folate
- Reticulocytosis
- EtOH
- Hypothyroisd
What is sideroblastic anemia
Disorder of porphyrin leads to iron deposition in mitochondria of RBC precursors
- Genetic in kids
- Acquired in adults: infections, carcinoma, leukemia, RA, EtOH, lead poisoning
Drugs that can trigger hemolysis in G6OD
Aspirin
Antimalarials (Quinine, Plaquenil)
Nitrofurans
Sulfa
FAVA beans
6 Diagnostic lab tests for hemolytic anemia
Peripheral smear
DAT
Haptoglobin
unconjugated bili
LDH
Serum free Hgb
Types of intravascular hemolysis
Intra: MAHA(s), burn, infections, autoimmune, transfusion
Extra: Malignancy, enzyme deficiency, hemoglobin defects, hypersplenism, toxins
Causes of Leukocytosis / Lymphocytosis
Leuko:
- Infection
- Medications - Steroids
- Trauma
- Pregnancy
- Lymphoproliferative (CML, PV)
- hereditary neutrophilia
- Eosinophilia
- DKA
- Thyrotoxicosis
- Seizures
Lymphocytosis:
- Viral (mono, rubeola, rubella, varicella), CLL, graft rejection
Things affecting O2 dissociation curve
Right shift: acidosis, increased CO2, fever/hyperthermai, increased 2,3 BPG
Left Shift: alkalosis, cold,
Hemostasis steps
Endothelial injury
Platelet plug
Activation of cascade
Clot formation
Fibrinolysis
10 causes of thrombocytopenia
Production:
- Aplastic anemia / Marrow failure
- Liver failure
- Drugs: chemo, EtOH, septra, digoxin, ASA
Destruction:
- ITP
- Collagen vascular disease
- Transfusion reactions
- TTP
- HIT
- DIC
- HUS
- Vasculitis
- Massive transfusion
- Infection - Rubeola, Varicella
Sequestration:
- Hypersplenism
6 causes of thrombocytosis
Reactive:
- Infection
- Iron deficiency
- Trauma
- Non heme malignancy
- Post splenectomy
- Rebound from deficiency
PV
Primary
HIT vs ITP
HIT:
- Usually 5-7 days post exposure
- Present with bleeding and thrombocytopenia or thrombosis
- Isolated thrombocytopenia
ITP:
Acute: usually in age 2-6.
- Preceded by viral prodrome-
- Self limited
- Can use IVIG, steroids and plamapheresis
- Platelets < 20
Chronic: Women>men, insidious onset
- Plt 30-100 k
