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Flashcards in Hematology/Oncology Deck (209):
1

compensatory mechanisms in anemia

increased CO
increased extraction ratio
RIGHT shift on Oxy-Hb dissociation curve (increased 2,3 BPG)
expansion of plasma volume

2

general indications for blood transfusion

1. Hb < 7 g/dL
2. pt requires increased O2 carrying capacity - i.e. pt with CAD or cardiopulm dz

3

what is pseudoanemia?

decrease in Hb and Hct secondary to dilution (acute volume infusion or overload)

4

MCC of death due to anemia

myocardial ischemia

5

formula for converting Hb to Hct

Hb x 3 = Hct

6

how does 1 Unit of packed RBCs affect Hb and Hct levels?

increases Hb level by 1 point and Hct by 3 points

7

if pt has low Hb and Hct, what are the next tests to determine cause of anemia?

reticulocyte count
mean corpuscular volume

8

reticulocyte index > 2%

excessive RBC destruction and blood loss - the BM is responding to increased RBC requirements

9

reticulocyte index < 2%

inadequate RBC production by BM

10

how do you administer Packed RBCs?

mixed with Normal Saline and infuse 1 unit over 90-120 minutes; check CBCs once complete

11

what does fresh frozen plasma contain?

all of the clotting factors - no WBCs, RBCs or platelets

12

what is FFP given for ? (3)

1. high PT/PTT
2. coagulopathy
3. deficiency of clotting factors

13

how do you assess response of FFP?

look at PT and PTT

14

what is cryoprecipitate and what is it used for?

- contains factor VIII and fibrinogen
- used for: hemophilia A, DIC and vWD

15

1 unit of platelets raises platelet count by how much?

10 000

16

what is the ONLY time you use whole blood?

massive blood loss
- in a ratio of 1:1:1 of platelets:FFP:PRBCs and warmed

17

a pt who recently received a blood transfusion suddenly develops fever, chills, NV, flank pain, chest pain and dyspnea - what should you be worried about?

intravascular hemolysis due to ABO-mismatched blood

18

management of acute hemolytic reaction due to ABO-mismatched blood

1. stop transfusion
2. aggressive fluid replacement to avoid shock/renal failure
3. Epi. for anaphylaxis
4. dopamine/NE to maintain BP

19

a pt who received a blood transfusion 2 weeks ago develops mild fever, jaundice and anemia - what should you consider?

delayed hemolytic transfusion reaction (Extravascular hemolysis) due to mismatched minor RBC antigens

20

what is the next step in assessing anemia if the reticulocyte index is < 2?

exam smear and RBC indices- ie. MCV

21

differential diagnosis of microcytic anemia (MCV < 80)

iron deficiency
anemia of chronic disease
thalassemias
ring sideroblastic anemias

22

differential diagnosis of macrocytic anemia (MCV > 80)

vit B12 /folate deficiency
liver disease
stimulated erythopoiesis

23

differential diagnosis of normocytic anemia (MCV 80-100)

aplastic anemia
BM fibrosis
tumor
anemia of chronic disease
renal failure

24

what do you need to R/O in elderly pt with iron deficiency anemia?

colon cancer

25

major causes of iron deficiency anemia

1. chronic blood loss - menstrual or GI loss
2. dietary deficiency
3. increased requirements - i.e. growth, pregnancy, lactation

26

what is the most reliable test for diagnosing iron deficiency anemia?

decreased serum ferritin (below 10 ng/ml)

27

what lab findings are characteristic of iron deficiency anemia?

low serum ferritin
low serum iron
high TIBC and low TIBC saturation
high RDW

28

what can cause a falsely elevated serum ferritin

malignancy and inflammatory states - ferritin is also an acute phase reactant

29

what is the gold standard for dx. iron deficiency anemia?

bone marrow biopsy
- rarely performed unless no

30

first step in tx. of iron deficiency anemia?

oral iron replacement w/ ferrous sulfate
- give trial to menstruating woman but in everyone else, attempt to determine point of chronic blood loss

31

young patient is brought in with massive hepatosplenomegaly, expansion of marrow space, growth retardation and failure to thrive; CBC reveals microcytic anemia - dx?

B-thalessemia major (aka. Cooley's anemia)

32

how do you dx. B-thalassemia major?

hemoglobin electrophoresis --> HbF and HbA2 are elevated

33

Tx. of B-thalessemia major?

frequent PRBCs transfusios with desferrioxamine to prevent iron overload

34

if you suspect iron deficiency anemia, but it does not respond to iron - what should you do next?

Hb electrophoresis to R/O thalassemias

35

what happens if you have deletion of 2 alpha globin loci?

mild, microcytic hypochromic anemia
common in African-Americans
usually asx. w/ no tx. needed

36

pt comes in with hemolytic anemia, splenomegaly, and significant microcytic hypochromic anemia; Hb electrophoresis shows Hb H - what should you consider?

Hb H disease - mutation/deletion of 3 alpha globlin loci

37

what is Hb H

tetrads of B-globin chains

38

what is Hb-Barts?

tetrads of Y-globin chains form when there is deletion or mutationof all four alpha-globin loci resulting in fatal hydrops fetalis

39

which alpha-thalassemia requires tx and what is the tx?

HbH disease - tx. w/ frequent PRBC transfusions w/ desferrioxamine

40

what are the iron studies findings in thalassemia pts?

normal/high serum ferritin
normal/high serum iron
normal TIBC
normal/high RDW

41

what are the iron studies findings in sideroblastic anemia pts?

increased serum iron and ferritin
normal/low TIBC
TIBC saturation is normal/high

42

what are some acquired causes of sideroblastic anemia?

drugs - chloramphenicol, alcohol, INH
lead exposure
collagen vascular disease
myelodysplastic syndromes

43

what are the hereditary causes of sideroblastic anemia?

defect in ALA synthase
abnormal vit B6 metabolism

44

what are the iron studies findings in anemia of chronic disease?

low serum Fe
low TIBC
low serum transferrin
high serum ferritin

45

characteristic finding in aplastic anemia

BM is empty with no precursor cells leading to pancytopenia (anemia, neutropenia and thrombocytopenia)

46

causes of aplastic anemia

idiopathic
radiation exposure
drugs - chloramphenicol, NSAIDs, alcohol, sulfonamides, gold, carbamazepine
viral infection
chemicals - benzene, insecticides

47

how do you definitively dx. aplastic anemia?

bone marrow biopsy

48

what is the definitive tx. of aplastic anemia?

bone marrow transplantation

49

what two reactions is vit B12 necessary for?

conversion of homocysteine to methionine
conversion of methylmalonyl CoA to succinyl CoA

50

what is the characteristic neuropathy in vit B12 deficiency?

demyelination of posterior columns, lateral corticospinal tracts and spinocerebellar tracts

51

what kind of cancer are pts with pernicious anemia at higher risk for?

intestinal type - gastric ca.
gastric carcinoid
- perform periodic stool testing for FOB

52

diagnostic findings in vit. B12 deficiency

- hypersegmented neutrophils
- serum vit B12 level < 100
- serum methylmalonic acid and homocysteine levels elevated
- ab's against IF

53

what Schilling test result implies dietary deficiency of vit B12

after giving radioactive Vit B12, if urine levels are > 5%

54

what do you do if in the Schilling test, urine levels are below normal (<5%)?

give radioactive vit B12 w/ IF --> if they go up after, then you know you have IF deficiency; if they do not go up, it is due to malabsorption

55

tx. of vit B12 deficiency

cyanocobalamin IM once per month

56

serum methylmalonic acid levels are only increased in what deficiency?

vit B12
- this test allows you to tell it apart from folate deficiency

57

what general lab findings do you see in hemolytic anemia?

elevated reticulocyte count
elevated LDH and bilirubin
decreased haptoglobin
decreased Hb/Hct

58

what kind of cells can be seen on PB smear in thalasemia?

target cells

59

what kind of cells on smear are characteristic of TTP, DIC, prosthetic heart valves and hemolytic anemias?

schistocytes
helmet cells

60

what characteristic clinical features (in addition to those of anemia) can be seen in hemolytic anemias?

jaundice
dark urine - esp. IV processes

61

what kind of cells are seen on smear in intravascular hemolysis)

schistocytes

62

which cells suggest extravascular hemolysis?

spherocytes
helmet cells

63

what types of cells characterize G6PD deficiency?

heinz bodies

64

what vitamin should be supplemented in hemolytic anemia?

folate

65

sudden drops in Hct are usually due to..

parvovirus B19 infection
folate deficiency - acute aplasia

66

what should you suspect in a young blank male who presents to you with painless hematuria?

sickle cell trait

67

what is really the only clinical feature seen in sickle cell trait?

isosthenuria and increased rate of UTIs

68

what does the prognosis of sickle cell disease depend on?

the frequency of vaso-occlusive crises

69

MC clinical manifestation of sickle cell disease vasoocclusive crises

painful crises involving bone - multiple sites

70

what is usually the first manifestation of sickle cell disease?

hand-foot syndrome (dactylitis) - painful swelling of dorsa of hands and feet seen in infancy

71

splenic sequestration crises

in sickle cell dz, sudden pooling of blood into spleen results in rapid development of splenomegaly and hypovolemic shock; potentially fatal

72

what is priapism due to in sickle cell crises?

infarction of prostatic plexus of veins

73

tx. that can potentially prevent recurrence of priapism in sickle cell dz

hydralazine
nifedipine OR
antiandrogen (stilbestrol)

74

what types of infections are sickle cell pts susceptible to?

encapsulated bacterias - SHiNS
salmonella osteomyelitis

75

screening test for sickle cell trait/disease

sickle cell prep - blood smear with chemical added to remove O2 from hemoglobin - looks for sickled cells

76

diagnostic test for sickle cell dz

hemoglobin electrophoresis

77

what should sickle cell pts receive prophylactically until age 6?

penicillin
folic acid supplments in definitely

78

which drug is used to enhance HbF levels and reduce incidence of painful crises in sickle cell dz?

hydroxyurea

79

which conditions in sickle cell dz warrant consideration for blood transfusion?

acute chest syndrome
priapism unresponsive to other measures
cardiac decompensation
stroke

80

causes of spherocytosis

hereditary
G6PD deficiency
ABO incompatability
hyperthermia
autoimmune hemolytic anemia

81

diagnostic test for hereditary spherocytosis

osmotic fragility test - RBC burst in hypotonic saline

82

lab findings in hereditary spherocytosis

elevated reticulocyte count
elevated MCHC
direct Coombs test result is negative

83

what is the Tx. for hereditary spherocytosis?

splenectomy
- vaccinate against pneumo, H.flu and meningococcus several weeks before

84

what nationality of people are primarily affected by G6PD deficiency?

African-Americans - mild form
Mediterranean descent - severe form

85

precipitants of hemolytic episode in G6PD deficiency?

sulfonamides/sulfur containing drugs - TMP/SMX
primaquine (antimalarials)
nitrofurantoin
dimercaprol
fava beans
infections (MCC)

86

CF of G6PD deficient pts

hemolytic episodes marked by jaundice and dark urine that is induced by either an infection or a drug

87

characteristic cells seen in G6PD pts

Heinz bodies - Hb precipitates
Bite cells

88

how do you diagnose G6PD deficiency?

measurement of G6PD levels - do not do this during a crises but rather when pt is asymptomatic

89

what is the "Warm" autoimmune hemolytic anemia?

IgG ab that binds to RBC mbs resulting in extravascular hemolysis in the spleen

90

what is "cold" autoimmune hemolytic anemia?

IgM ab binds to RBC mb at temp. between 0-5 C producing complement activation and intravascular hemolysis primarily in liver

91

which infections are associated with cold AIHA?

mycoplasma pneumonia
infectious mononucleosis

92

cold agglutinin disease

cyanosis of ears, nose, fingers and toes in cold temperatures

93

how do you diagnose autoimmune hemolytic anemia?

Direct Coomb's test

94

Tx. of warm AIHA

steroids - prednisone in divided doses
- splenectomy if pt doesnt respond to steroids

95

Tx. of cold AIHA

avoid exposure to cold
RBC transfusion if absolutely necessary

96

what is the deficiency in paroxysmal nocturnal hemoglobinuria?

deficiency of anchor proteins that link complement inactivating proteins to RBC mbs resulting in unusual susceptibility to complement mediated lysis of RBCs, WBCs and platelets

97

in addition to anemia (pancytopenia) and hemolysis, what CF can be seen in paroxysmal nocturnal hemoglobinuria?

thrombosis of venous systems ex. Budd Chiari

98

most sensitive and specific test for PNH

flow cytometry of anchored cell surface proteins - CD55 and CD59 } DAF

99

Ham's test

test for PNH - cells incubated in acidic serum, triggers alternative complement pathway resulting in lysis of PNH cells

100

sugar water test

test for PNH - PNH cells lyse in sucrose

101

Tx of PNH

glucocorticoids - prednisone (DOC)
- alternates: BM transplant, eculizumab

102

CF of idiopathic thrombocytopenic purpura

minimal cutaneous and mucosal bleeding
low platelet counts
generally healthy

103

what do you suspect in a young female whose CBC shows a platelet count of 15 000; she reports no symptoms.

idiopathic thrombocytopenic purpura

104

definite dx. of ITP

BM biopsy - shows increased megakaryocytes

105

first line tx. in ITP

steroids -prednisone

106

how can you tx. pts with ITP who have platelet count < 10 000 or develop a life threatening bleed?

IVIG

107

two new drugs approved for ITP in splenectomy-resistant pts?

romiplastim
eltrombopag

108

Type 1 HIT

heparin causes platelet aggregation within 48 hrs of starting heparin tx; no tx is needed

109

Type 2 HIT

heparin induces antibody-mediated injury to platelet; seen in 3-12 days after heparin tx; d/c heparin immediately

110

pt comes in with signs of hemolytic anemia, thrombocytopenia, a rising Creatinine level, fever and fluctuating neurologic signs - what should you consider?

TTP

111

How do you Tx. TTP?

plasmaphoresis (large volume)

112

decrease in platelet count by 50% after heparin suggests ?

HIT

113

main complication of HIT

venous thrombosis with DVT and PE

114

diagnostic tests for HIT

antiplatelet factor IV antibody
serotonin release assay

115

Tx. of HIT

stop heparin

116

disorder of platelet adhesion due to deficiency of platelet glycoprotein GP1b-IX

Bernard Soulier disease

117

disorder of platelet aggregation due to deficiency in platelet glycoprotein GPIIb/IIIa

Glanzmann's thrombasthenia

118

what is the role of vWF?

1. mediates adhesion of platelets to injured vessel wall (GP1b/IX and subendothelium)
2. carrier of factor VIII in blood

119

MC inherited bleeding disorder

vW disease

120

how can you diagnose vW disease?

prolonged bleeding time but normal platelets
aPTT may be prolonged
decreased plasma vWF and factor VIII
reduced ristocetin-induced platelet aggregation

121

how can you tell vW dz apart from hemophilia A?

bleeding in vWD is much milder than in hemophilia, factor VIII levels are not reduced as much and spontaneous hemarthrosis do not occur

122

first line tx. for vWD

desmopressin (DDAVP) - induces endothelial cells to secrete vWF

123

what do you do if pt with vWD does not respond to DDAVP?

try factor VIII concentrates
- also given during major trauma or surgery

124

how much factor VIII do you need before signs of bleeding appear?

> 10% of normal factor VIII and patients are asymptomatic

125

lab findings in hemophilia A

prolonged PTT
low factor VIII levels
- everything else is normal

126

mixing study results in hemophilia A

if plasma from a hemophiliac pt is mixed with normal plasma, the PTT normalizes --> this is indicative of a factor deficiency

127

how can you prevent recurrent hemarthroses in hemophilia?

prophylactic factor VIII concentrates
synovectomy / radiosynovectomy

128

Tx of acute hemarthrosis in hemophilia

analgesia - codeine +/- acetaminophen (avoid NSAIDS and aspirin)
immobilization, ice packs etc

129

mainstay of therapy for hemophilia

factor VIII concentrate
- for acute bleeding episodes and before surgery/dental work

130

what drug may be helpful in mild hemophilia A?

DDAVP - can increase factor VIII level four-fold

131

what is the defect in hemophilia B?

factor IX

132

(1) normal PT
(2) normal PTT
(3) normal bleeding time

(1) 11-15 sec
(2) 25-40 sec
(3) 2-7 min

133

lab findings in DIC

Increased:
- PT, PTT, bleeding time and thrombin time
- high d-dimers
Decreased:
- fibrinogen level
- platelet count

134

coagulopathy due to liver disease

PT and PTT are elevated
- all else is normal

135

coagulopathy due to vitamin K deficiency

PT is initially prolonged, PTT prolongation follows

136

how do you Tx. DIC?

must take care of underlying cause
- things like FFP, platelet transfusions and cryoprecipitate can buy you time

137

how can you confirm the diagnosis of vitamin K deficiency?

correction of PT/PTT after admin for vit. K

138

how do you correct vitamin K deficiency coagulopathy?

oral or parenteral vitamin K
FFP if severe bleeding is present

139

what type of bleeding is most common in coagulopathy due to liver disease?

GI bleeding - ex. varices

140

tx for coagulopathy due to liver disease if there is prolonged PT/PTT or bleeding..

FFP

141

what is the role of protein C

inhibitor of factors V and VIII
- deficiency leads to unregulated fibrin synthesis

142

what is the role of protein S

protein S is a cofactor for protein C - so a deficiency leads to decreased protein C activity

143

factor V leiden mutation

activated protein C resistance - protein C can no longer inactivate factor V

144

MOA of heparin

potentiates antithrombin III to inhibit clotting factors IIa and Xa; prolongs PTT (intrinsic pathway)

145

adverse effects of heparin

bleeding
transient alopecia
osteoporosis
HIT
rebound hypercoagulability

146

C/I to heparin

previous HIT
active bleeding
recent surgery on eyes, spine or brain
hemophilia/thrombocytopenia
severe HTN

147

how can you reverse the effects of heparin?

standard hep has short half life, so its effects stop w/in like 4 hours; but if you need to you can give PROTAMINE SULFATE

148

benefits of LMWH

given subcutaneously (not IV)
no monitoring needed
less side effects
- better for outpatient use

149

MOA of LMWH

inhibit factor Xa (less IIa and platelet inhibition)

150

what is the therapeutic INR you want on warfarin?

2-3

151

adverse effects of warfarin

hemorrhage
skin necrosis
teratogenic
should not give to alcoholics or pts prone to falls (risk of IC bleed)

152

mechanism of warfarin skin necrosis

inhibits protein C and S first, leading to hypercoagulable state with thrombus formation in first few days of admin; MC in pts with congenital protein C and S deficiency to start

153

what do you do if your INR is too high while pt is on warfarin?

lower/omit dose; if very high, give vitamin K
- if severe bleeding, give pt FFP

154

MOA of clopidogrel

blocks binding of ADP to platelet receptor P2Y12; reduces platelet activation and aggregation

155

indications for use of clopidogrel

pretreatment for pts before PCI (600 mg)
after PCI w/ stend placement for 12 mths (75 mg)
peripheral artery disease
acute coronary syndromes

156

if a patient is taking clopidogrel, which other drugs should you avoid?

PPIs

157

what should you do in any women over age 30 presenting with a breast mass?

biopsy - conservative approach

158

a young woman presents with a round, moveable breast mass which changes in size over course of menstrual cycle - what is this most likely?

fibroadenoma

159

a woman presents with bilateral breast pain that cycles with hormonal changes...

fibrocystic changes

160

what should you always order before beginning tamoxifen therapy for breast cancer?

echocardiogram - high risk of cardiotoxicity (esp. if EF < 55%)

161

diagnostic criteria of MGUS

IgG spike < 3 g/dL
< 10% plasma cells in BM
Bence-Jones proteinuria < 1 g/24 hrs
no end organ damage

162

a pt presents with low Hb, high calcium, high serum protein and poor renal function - what should you suspect?

multiple myeloma

163

CRAB mnemonic for multiple myeloma

hyperCalcemia
Renal failure
Anemia
lytic Bone lesions

164

diagnostic criteria for mutliple myeloma

- >10% plasma cells in BM
- one of the following:
- M protein in serum or urine
- lytic bone lesions

165

what does a peripheral smear look like in someone with multiple myeloma?

RBCs in rouleaux formation

166

lab findings in multiple myeloma

hypercalcemia
elevated total protein, but lower albumin
elevated ESR
elevated BUN/Cr
pancytopenia may be present

167

Tx. of choice for mutliple myeloma

autologous hematopoietic stem cell transplantation

168

how do you tx. multiple myeloma pts who are not transplant candidates?

systemic chemotx with alkylating agents: melphalon, prednisone, thalidomide

169

a pt comes in fatigue, weight loss, LAD, splenomegaly, anemia; lab tests show IgM > 5 g/dL and Bence Jones proteinuria - dx?

Waldenstrom's macroglobulinemia

170

Tx. of hyperviscosity syndromes

plasmaphoresis
chemotherapy

171

pt presents with painless LAD of the cervical LNs along with fever, night sweats and recent weight loss; he also notes pruritus - dx to consider?

Hodgkin's lymphoma

172

how do you diagnose Hodgkin's lymphoma?

LN biopsy showing Reed-Sternberg cells surrounded by inflammatory cells

173

what tests do you do to determine staging in HL?

CT scan, CXR and BM biopsy

174

tx. of stage 1, 2 and 3A Hodgkin's lymphoma

radiation therapy only

175

tx. of stage 3B and 4 Hodgkin lymphoma

chemotherapy = ABVD
- adriamycin, bleomycin, vincristine, dacarbazine

176

what lab test can sometimes correspond with disease activity in Hodgkin's lymphoma?

elevated ESR
increased LDH = adverse prognosis

177

RFs for NHL

HIV/AIDs
immunosuppression
viral infections - EBV, HTLV1, HCV
h.pylori gastritis
autoimmune disease

178

what type of NHL presents are peripheral LAD and a t(14:18) translocation

follicular NHL

179

what infection and what translocation are associated with Burkitt's lymphoma?

African variety = EBV infection
t(8:14)

180

pt presents with eczematoid skin lesions that progress to generalize erythroderma; his lymphocytes are cribiform shape

mycosis fungoides (T cell lymphoma of skin)

181

Sezary syndrome

disseminated form of mycosis fungoides

182

what are indirect indicators of tumor burden in NHL?

serum LDH and B2-microglobulin

183

chemotherapy used in NHL

CHOP - multiple courses
- cyclophosphamide
- hydroxydaunomycin (doxorubicin)
- oncovin (vincristine)
- prednisone

184

RFs for AML

radiation exposure
myeloproliferative syndromes
Down's syndrome
chemotherapy - alkylating agents

185

poor prognostic indicators in ALL

age 9
WBC count > 100 000/mm3
CNS involvement

186

testicular involvement is common in what hematologic malignancy?

ALL

187

which leukemia presents with an anterior mediastinal mass?

T cell ALL

188

pt recently tx with chemotherapy for acute leukemia presents with hyperkalemia, hyperphosphatemia and hyperuricemia - dx?

tumor lysis syndrome - rapid cell death with release of intracellular contents

189

what study is needed for diagnosis of leukemia?

BM biopsy

190

chemotx. for AML

cystosine arabinoside AND either daunorubicin or idarubicin

191

chemotx. for ALL

vincristine
predniosone
daunorubicin

192

in which leukemia should you give prophylaxis for CNS involvement?

ALL - give MTX intrathecally

193

when does BMT come into play in tx. of acute leukemia?

any pt who relapses after chemotherapy

194

what disease is characterized by monoclonal proliferation of lymphocytes that are morphologically mature but functionally defective?

CLL
- usually in pts > 60

195

an elderly man comes in complaining he frequently gets respiratory and skin infections that are long lasting and difficult to tx. On exam you notice, painless LAD - what test should you do?

CBC - to diagnose CLL

196

lab findings in CLL

WBC 50,000-200,000 (80-90% lymphocytes)
smudge smells on PB smear
may have pancytopenia

197

what test is used to confirm CLL?

flow cytometry of peripheral blood - shows clonal population of B cells (CD19)

198

how do you tx. CLL?

usually observe patients until they become symptomatic (may take years)
Chemo = RFC (rituximab, fludarabine, cyclophosphamide)

199

standard of care for CML

imatinib
- tyrosine kinase inhibitors (also: dasatinib, nilotinib)

200

Lab findings in CML

WBCs 50,000-200,000 (left shift toward granulocytes)
eosinophilia/basophilia
leukemic cells in peripheral blood
decreased leukocyte ALP

201

pt comes in complaining of severe pruritus after a hot bath or shower - what should you consider?

polycythemia vera

202

CF of polycythemia vera

hyperviscosity sx
thrombotic phenomena
bleeding
splenomegaly/hepatomegaly

203

lab findings in polycythemia vera

elevated RBC count, hemoglobin/Hct > 50
reduced serum EPO levels
elevated vit B12 levels
thrombocytosis/ leukocytosis

204

Tx. of polycythemia

repeated phlebotomy

205

major criteria for dx. polycythemia vera

1. elevated RBC mass (men > 36, women > 32)
2. arterial O2 sat > 92%
3. splenomegaly

206

minor criteria for dx. polycythemia vera

1. thrombocytosis (plts > 400,000)
2. leukocytosis (WBC > 120,000)
3. leukocyte ALP > 100
4. serum vit B12 > 900

207

essential thrombocythemia

Platelets > 600,000/mm3 with findings of splenomegaly, pseudohyperkalemia, elevated bleeding time and erythromelalgia

208

BM biopsy finding in essential thrombocytemia

increased number of megakaryocytes

209

Tx. of essential thrombocytemia

antiplatelet agents - anagrelide, aspirin
hydroxyurea if severe