heme Flashcards by wallace M

mechanism of polycythemia vera

EPO: high/low

jak2 mutation causing proliferation of bone marrow stem cells

EPO low( jak2 mutation don’t care about EPO

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high Hb, pain in fingertips, pruritus with exposure to hot water: Dx & treatment

Phlebotomy
Polycythemia vera

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old, fatigue, Hb low: cause

GI bleed

diverticular bleed
colorectal cancer
angiodysplasia

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smoker, COPD+high Hb mechanism?

EPO level?

2nd polycythemia

high EPO d/t low O2

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smoker, Polycythemia , hypercalcemia, high creatinine

Renal cell carcinoma
d/t paraneoplastic PTHrP secretion

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Bleed Time increase (2-7min)
Bleeding on surfaces

vWF
platelet adhesion

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school age kids with viral infection
+epistaxis, bruising/petechiae, low platelet.

ITP

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Low platelet, high bleeding Time, random bruising 30-40F

ITP

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30F random bruise+BT 6,

domestic abuse

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40F bruise +BT 9

ITP(idiopathic/immune thrombocytopenia purpura

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35F +viral infection+epistaxis ITP DX confirm with:

low platelet

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13M + epistaxis +BT 9

ITP

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Teen cough, coryza, epistaxis

antibodies against
glycoproteins IIB/IIIA
HS type II

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Teen nose bleed, very low platelet manage with
Initial treatment?
No response?

steroid
Non responsive: IVIG

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Teen nose bleed, very low platelet , effective way to decrease recurrence

splenectomy
NOT steroid (only initial treatment)

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Teen +viral infection+ low neutrophil

next best step

viral induced neutropenia

immediate IV broad-spectrum antibiotic

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Teen +viral infect. Neutropenia, fever +antibiotics. Restore Neutrophill with?

GM-CSF (IL3)

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child +pancytopenia+low platelet+viral DX

B19
aplastic anemia

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32F+ arthritis+ Hb 9+WBC 3k+ Platelet 90k mechanism

note no viral infection

increased peripheral destruction
autoantibodies
antiphospholid

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overactive thyroid treatment low WBC(neutrophil 5%

Drug-induced neutropenia
methimazole & propylthiouracil

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drug causing agranulocytosis

ganciclovire (CMV)
Clozapine (anti-psychotic0)
methortrexat(DMARD)
ticlopidine(anti-platelet )

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child with absent or hypo plastic thumb low Hb, WBC, platelet

falconi anemia
AR aplastic anemia

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pure RBC aplasia

triphalangeal thumb (Diamond-blackfan anemia

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Thymoma associated with anemia

pure RBC aplasia

(myasthenia gravis)

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daycare worker with lacy rash, no aplastic anemia, check

Parvo IgM titers

44F chemotherapy low RBC, WBC, platelets next step

bone marrow aspiration

chemo with all cell line low (neutropenia)

IG broad spectrum antibiotic

PT high PTT high BOTH high

extrinsic (III, 7,5,10 intrinsic( 12,9,8, 10 common (10,5, prothrombin(II), thrombin(IIa)-->fibrinogen(1)-->fibrin(1a)

Bleeding time high with aspirin why?

lower platelet function inhibit CoX1/2 decrease thromboxane A2 production

Increase fibrin degradation product seen with

DIC and PE

treatment for BT9, petechiae, PTT 42 , Normal platelet

DDAVP (desmopressin) increases vWF

Hemarthrosis in school age boy

Hemophilia A/B

the child with hemarthrosis, PTT 90

Hemophilia A/B

inheritance pattern for vWF

hemophilia inheritance

X-LR

cause of Hemophilia A/B

deficient production of factor 8/9 Hemophilia A mc

Hemophilia A treatment

IV desmopressin/factor 8 replacement

Hemophilia B

factor 9 replacement

repeated factor replacement(like repeated antibody venom treatment)

PTT very high factor 8/9 less effective

Low HbA, high HBA2 and HbF in 8 month old boy

Insufficient production of Beta globin symptomatic after 6 month

How is Nephrotic syndrome associated with acquired clotting state

loss of natural anticoagulants antithrombin III

antithrombin III function

natural anticoagulant inhibit factors IIa (thrombin) and 10a

Restocitin neg dz , normal platelet

vWF and Bernard-Soulier ds

BT high with pos Restocitin, Normal platelet

Glanzmann thrombasthenia

AoCD mechanism inflammatory state -->high IL6 liver-->___hepcidin-->dec ferroportin activity-->___iron released by gut enterocytes and macrophages---> iron transport___---->ferritin level____----->Transferrin and TIBC____

elevated hepcidin decrease all others

12F+chronic renal failure +epistaxis, Hb low? explain epistaxis

renal failure cause uremic platelet dysfunction high BUN Note: epistaxis is seen with platelet dysfunction

82M+ M spike IgG+epistaxis. explain epistaxis?

uremic platelet dysfunction 2nd to MM(renal amyloidosis)

effect of imatinib and dihydropyridine Calcium channel blocker(nifedipine, amlodipine)

fluid retention Imatinib treats CML(9:22 bcr/abl)

10M + lytic bone lesion with pos CD1a,S100

Langerhan Cell histiocytosis Birbeck granules

MOA of rituximab Indication

CD20 inhibitor on B cells RA, ITP, MS, AIHA, B cell Non-hodgkin(CLL)

Rituximab reactivate

JC virus

Toxicity of ___________ mitigated with saline (NaCl-) infusion and amifostine

cisplatin

important side effect with cisplatin

Oto and Neurotoxicity

decrease IL-2 responsiveness+ no effect on calcineurin

Sirolimus

decrease calcineurin

cyclosporine +tacrolimus

MOA of cyclosporine and tacrolimus

dec calcineurin+dec IL-2 transcription +nephrotosic

Sirolimus(mTOR) is save in

kidney failure, not nephrotoxic

gingival hyperplasia +nephrotoxicity +BP

cyclosporine

antagonist at cyclophilin receptor

cyclosporine

antagonist at FK506 receptor to decrease calcineurin important side effect

Tacrolimus Type II diabetes

Mesna is use to

reduce cyclophosphamide toxicity using thiol-SH group

hemorrhagic cystic due to acrolein

cyclophosphamide

guanine N7 alkylating agent

MOA of cyclophosphamide

inhibitor topo I Topo II

irinotecan/topotecan etoposide/teniposide

HER-2/New(ERBB2) treatment

trastuzumab

trasTUzumab toxicity

Cardio

partial agonist in endometrium increasing endometrial cancer

tamoxifen

SERMs

Tamoxifene and raloxifene Both antagonists at ER receptors in the breast agonist on bone

fluid retention in CML treatment

Imatinib

bar/abl tyrosine kinase inhibitor for CML

inmatinib

Ab against EGFR

cetuximab

MOA of erlotinib

EGFR tyrosine kinase inhibitor

Notable indicator of erlotinib

non-small cell lung cancer

dexrazoxane chelation of free radicals

toxicity of doxorubicin/daunorubicin

dilated cardiomyopathy with a DNA intercalator

doxorubicin/daunorubicin

DNA intercalates + cause free radical

doxorubicin(Adriamycin)/daunorubicin

pulmonary fibrosis Drug? Free radical formation

Bleomycine

vincristine toxicity

neuro

hyper stabilize microtubules

paclitaxel/docetaxel

inhibit microtubules formation

cochicine, -bendazoles (mebendazole, albendazole) vincristine vinblastine, griseofulvin

Inhibits IMP dehydrogenase (purine synthesis)

mycophenolate mofetil

pyrimidine synthesis inhibitor (ribonucleotide reductase inhibitor

hydroxyurea produces more fetal Hb sickle cell pt

converted to 6-MP

inhibits purine synthesis azothioprine

MOA of 6-mercaptopurine

PRPP amidotransferase inhibitor(purine synthesis inhibitor)

MOA of 5- fluorouracil

thymidylate synthase inhibitor

leucovorin rescue use in

methotrexate toxicity

reversible, competitive inhibitor of dihydrofolate reductase; 1st line DMARD for RA

Methotrexate

Methotrexate side effect

pulmonary fibrosis, hepatotoxicity, neutropenia

antifibrinolytic drugs (tPA: stroke)

tranexamic acid, aminocaproic acid

tPA fibrinolytic should be given

in ischemic stroke within 3-4.5 hr

MOA of apixaban

factor Xa inhibitor(band)

MoA of fondaparinux

inhibits factor Xa (activate antithrombin)

treatment for heparin induce thrombocytopenia

Bivalirudin, lepirudin dabigatran argatroban

Both anti-platelet agents and vasodilators

dipyridamole +cilostazol, both cAMP and cGMP phosphodiesterase inhibitors

Gp2b/3a inhibitor

abciximab eptifibatide tirofiban

MOA of clopidogrel prasugrel ticagrelor ticlopidine

ADP2Y 12 receptor blockers inhibit aggregation by dec expression of Gp2b/3a

heme Flashcards

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