Heme/Onc Flashcards by Cassidy Ruocco

most common inherited cause of hyper coagulability

Factor V Lediden

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presence of kappa or lambda light chain proteins on urine electrophoresis

Multiple Myeloma

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Rouleaux formation of RBCs
punched out lesions on Xray
hypercalcemia

Multiple Myeloma

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medication that increases fetal Hgb levels, increases water content of RBCs and decreases sickling deformity of RBCs

Hydroxyurea

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hemolytic anemia
venous thrombosis of large vessels
pancytopenia
CLASSIC FOR…

Paroxysmal nocturnal hemoglobinuria

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Auer Rods seen, think..

AML

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What is prolonged in Hemophilia B (Christmas dz)

PTT

Hemophilia B effects factor IX, which is part of intrinsic pathway..therefor PTT prolonged

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10 yo African American male put on trimethoprim-sulfamethoxazole twice daily for a UTI. Comes back later with pallor, abdominal pain and back pain. Peripheral smear has SHISTOCYTES and HEINZ BODIES. Dx?

G6PD deficiency

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Which drug is the initial management of choice for heparin induce thrombocytopenia?

Argatroban

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Common presentation of sickle cell anemia in children under 2?

Dactylitis

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C282Y HFE genotype associated with

Hemochromatosis

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Thrombotic Thrombocytopenia Purpura is a disorder of ______

Platelets

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Platelets are part of the ______ pathway

Primary coagulation

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PTT and PT in Thrombotic Thrombocytopenia Purpura

Both normal!!

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Decreased ADAMTS13 serum levels found in…

Thrombotic Thrombocytopenia Purpura (TTP)

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Positive neurological symptoms

Schistocytes on periph smear

Thrombotic Thrombocytopenia Purpura (TTP)

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69 yo male develops HA, fevers, purpuric rash. CSF pos for gm neg bacteria. Few hours later, pt develops spontaneous bleeding @ venipuncture site. Initial labs.. elevated PT, PTT, INR. Also showed decreased fibrinogen levels. What is diagnosis?

disseminated intravascular coagulation (DIC)

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Pathological activation of coagulation system, leading to widespread microthombi and a subsequent phase of severe thrombocytopenia

DIC

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Associated w thrombosis, widespread hemorrhages

DIC

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Common after gm negative bacterial infections

DIC

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Can be brought on by malignancy, OB complications, massive tissue injury, rocky mountain spotted fever, liver dz, aortic aneurysm, acute respiratory syndrome

DIC

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PT, PTT, INR in ITP and TTP

should all be normal!

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Non contiguous, extra nodal spread

Non Hodgkins Lymphoma

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Bimodal distribution of increased incidence in 3rd and 6th decades
Reed Sternberg cells
Painful lymph nodes w ETOH ingestion

Hodgkins Lymphoma

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Associated w EBV

Burkitts Lymphoma

What happens to serum ferritin levels in Anemia of Chronic Dz

INCREASES!

Philadelphia Chromosome (translocation between chromosome 9 and 22) seen in..

CML

First line therapy for TTP

Plasmapheresis (plasma exchange therapy) ..this removes all excess ADAMTS 13 anitbodies and replaces ADADMTS 13

If AML pt is receiving chemo and develops tumor lysis syndrome as a complication, what drug can be given?

Allopurinol

Most useful diagnostic tool in patients with a negative Coombs test and periph smear showing microcytic, hyper chromic, sphere-shaped cells

Osmotic Fragility Test | Hereditary Spherocytosis

Due to defect in blood cell membrane, leading to sphere-shaped RBCs and increased cell fragility

Hereditary Spherocytosis

Treatment for moderate Type I von Willebrand Disease

Desmopressin | would also use for Hemophilia A

What is commonly seen as a consequence of thrombocytopenia?

Petechiae

What is the most common clinical presentation of pts with sickle cell trait?

Episodic hematuria | may also have isosthenuria, the inability to concentrate urine

Sickle cell trait is normally....

asymptomatic

Hemophilia A lacks...

Factor VIII

Condition of increased arterial and venous thrombi formation as well as frequent miscarriages

Antiphospholipid syndrome

34 yo female has an increased PTT. a mixing study is performed and there is no correction of the increased PTT. what does she have

Antiphospholipid syndrome

Chemotherapeutic agent that can also be used intrapleurally for pleurodesis

Bleomycin

What organism is most commonly associated with the development of Hemolytic Uremic Syndrome (HUS)

Enterohemorrhagic E. Coli 0157:H7 | Shigella and Salmonella can also cause

Hemophilia B pt sprains ankle (grade 3), what is routine management of this patient?

Factor IX concentrates

JAK2 mutation is associated with

Polycythemia Vera

Headache, dizzniess, tinnitus, blurred vision and increasing pruritus of the last 2 weeks that worsens after hot showers...

Polycythemia Vera (JAK2 mutation)

PE shows flushed face, engorged retinal veins w no evidence of papilledema. Increased hemoglobin and hematocrit

Polycythemia Vera (JAK2 mutation)

What is the treatment of refractory immune/idiopathic thrombocytopenic purpura (ITP)

Splenectomy ...removal of the spleen is the definitive management of the splenic destruction of the platelets

Management of severe thrombocytopenia (platelet count of

Platelet transfusion

``` Increase in: Basophils Platelets RBCS Hematocrit ```

Polycythemia Vera | NO INCREASE IN LYMPHOCYTES!!!

First line management of sickle cell crisis?

IV hydration and oxygen. Pain medication is also administered

Long term management to reduce frequency of crisis. Also can be used in SEVERE pain crisis

Hydroxyurea

Positive Coombs test is associated with..

autoimmune hemolytic anemia

``` Folate deficiency B12 deficiency Alcoholism Liver dz Hypothyroidism ``` ..all cause?

Macrocytic Anemia

In addition to G6PD deficiency, where else can Heinz Bodies be seen in a peripheral smear?

Alpha Thalassemia Intermedia

6 mo year old male is brought into pediatric ER when his mom noticed he was "pale and yellow". CBC showed severe anemia and hypo chromic microcytosis. A peripheral smear shows: numerous target cells and teardrop cells (dacrocytes). Hgb electrophoresis shows: Hgb A: decreased Hgb A2: increased Hgb F: increased (90%) What does he have?

Beta Thalassemia Major (Cooley's Anemia)

In children, this is most commonly seen after a viral infections (such as the flu)

Idiopathic (Immune) Thrombocytopenic Purpura (ITP)

The development of antibodies against platelets with associated splenic destruction of platelets

Idiopathic (Immune) Thrombocytopenic Purpura (ITP)

Management of Idiopathic Thrombocytopenia Purpura (ITP) in children

Observation OR | IV immunoglobulin

First line management of Idiopathic Thrombocytopenia Purpura (ITP) in adults

Corticosteroids

``` In children, classic presentation is: abdominal pain w constipation varying neurologic symptoms (ie difficulty concentrating) anemia metabolic acidosis ```

Lead poisoning

CBC showing/Periph smear show: Anemia Microcytosis Basophilic stippling

Lead poisoning

Antibodies against ADAMTS 13 leading to large vonWillebrand multimers, causing platelet activation

Thrombolic Thrombocytopenic Purpura (TTP)

Auto antibodies against glycoprotein IIb/IIIa receptor on platelets commonly following a viral infection

Idiopathic Thrombocytopenic Purpura (ITP)

Mutated Factor V that is resistant to breakdown by activated protein C

Factor V Leiden

Pathologic activation of the coagulation system causing micro thrombi and subsequent thrombocytopenia

Disseminated intravascular coagulation (DIC)

Platelet activation by exotoxins (such as Shigella toxin or Shigella like toxin released from Enterohemorrhagic E. Coli)

Hemolytic Uremic Syndrome (HUS)

Aplastic crisis in sickle cell anemia patients can be precipitated by ____ infections

Parovirus B-19

``` Ice/clay cravings progressive dysphagia pallor of conjunctiva atrophic glossitis angular chelitis spooning of nails esophageal webs upon endoscopy ```

Iron deficiency anemia

large B cells with bilobed or multi lobar nuclei giving it an "owl eye" appearance due to eosinophilic inclusions in the nuclei

Reed-Sternberg cells, found in Hodgkins Lymphoma

First line management of warm antibody type autoimmune hemolytic anemia in a patient with SLE?

Corticosteroids

Treatment for cold antibody hemolytic anemia

Avoid the cold

Argatroban is what kind of drug?

direct thrombin inhibitor

First line management of polycythemia vera?

Phlebotomy

First line management of Heparin overdose?

Protamine sulfate

A patient with severe B12 deficiency is being treated with IM B12 supplementation. Which electrolyte abnormality is a common complication of B12 replacement therapy?

HYPOKALEMIA With IM B12 replacement, hypokalemia may result as new blood cells are being formed, since most of the body's potassium is found intracellularly.

Heme/Onc Flashcards

(73 cards)