Heme/Onc

Question 1

What are the macrocytic anemias? What would we see on a blood smear with these anemias?

Answer 1

B12 and Folate deficiency

Megaloblastic (hypersegmented neutrophils)

Question 2

What would a pt have with B12 deficiency?

Answer 2

Peripheral neuropathy

Question 3

What type of anemia may be secondary to alcoholism?

Answer 3

Folate deficiency

Question 4

What type of anemia is associated with glossitis?

Answer 4

Folate (can also occur in B12)

Question 5

What are the microcytic anemias? What consititues as microcytic?

Answer 5

*TICS* MCV is less than 80
Anemia or chronic disease
Iron def anemia
Thalassemia
Sideroblastic

Question 6

What are the differences between Anemia of chronic dz and iron def anemia?

Answer 6

Both have LOW Serum Iron
Ferritin is NORMAL in ACD
Ferritin is LOW in IDA
IDA will also have a high iron binding capacity

Question 7

What is the max amount of ferrous sulfate a person absorb/day?

Answer 7

Max = 4mg
Males require 1mg
Females require 2mg (more if preggo)

Question 8

If the iron levels are normal but the MCV is still less than 80, what should you think of?

Answer 8

Thalassemia or sideroblastic

Question 9

What is thalassemia?

Answer 9

Reduced or absent beta or alpha chain

*Normal hemoglobin is made up of two alpha globin & two beta globin chains

Question 10

How do you diagnose a thalassemia?

Answer 10

Electrophoresis (Hgb A2 and F)

Question 11

When would we see Beta thalassemia diagnosed?

Answer 11

Intermediate and Major occur between 4-6months when the switch from fetal hemoglobin to adult occurs

Minor is asymptomatic

Question 12

How do we treat alpha vs beta thalassemia?

Answer 12

Alpha H – folic acid supplements, avoid iron supplements

Beta = transfusions, iron chelation

Question 13

What is the MC cause of sideroblastic anemia? Dx?

Answer 13

Lead toxicity

Lead level followed by bone marrow biopsy

Question 14

What would normocytic anemia be caused from? What are the MCV levels?

Answer 14

Acute blood loss, organ failure, or impaired marrow function.

MCV 80-100

Question 15

What is hemolytic anemia?

Answer 15

HIT (hereditary, immune attack, and trauma to the RBCs); characterized by decreased RBC survival and increased cell lysis

Question 16

What are some of the causes of hemolytic anemias?

Answer 16

spherocytosis, elliptocytosis, G6PD, thalassemias, and sickle cell

Question 17

How might a patient present with hemolytic anemia?

Answer 17

Jaundice, delayed puberty (from sickle cell), hepatosplenomegaly, and petechiae and purapura

Question 18

Target cells are associated with what?

Answer 18

Thalassemias

Question 19

Heinz body or bite cells are associated with what?

Answer 19

G6PD

Question 20

What would we see on labs for G6PD?

Answer 20

Increased indirect bilirubin, reticulocyte count, LDH

Decreased Haptoglobin

Question 21

What causes G6PD?

Answer 21

oxidative stress = Infection, meds, and fava beans

Question 22

What meds have to be avoided with G6PD?

Answer 22

oxidant drugs = nitrofurantoine, sulfa, TMP-SMX, antimalarials

Question 23

Howell-Jolly cells are associated with what?

Answer 23

Folate def (can also be seen in a Sickle cell smear)

Question 24

What is the classification system for leukemias?

Answer 24

Acute or Chronic

Myelocytic or Lymphocytic

Question 25

What do you see on labs in a pt with leukemia?

Answer 25

Pancytopenia (decreased RBC, platelets, and WBC) OR elevated WBC               Blasts seen on smear = Acute Leukemia               Flow cytometry distinguishes the classification of acute leukemia

Question 26

What type of leukemia MC occurs in young children?

Answer 26

ALL – MC form of childhood cancer

Question 27

What type of leukemia typically occurs in adults over the age of 60?

Answer 27

AML

Question 28

What type of leukemia presents in young to middle aged adults?        

Answer 28

CML

Question 29

What type of leukemia has the worst prognosis and occurs in those over the age of 70?

Answer 29

CLL

Question 30

Auer rods are associated with what type of leukemia?

Answer 30

AML

Question 31

The Philadelphia chromosome is associated with what?

Answer 31

CML

Question 32

Smudge cells are associated with what?          

Answer 32

CLL

Question 33

What is the standard of treatment for acute leukemias?         

Answer 33

Chemotherapy |               *better prognosis in AML if under the age of 60

Question 34

How do we treat CML?  CLL?

Answer 34

CML = tyrosine kinase inhibitors Imatinib and allogeneic bone marrow transplantation               CLL is palliative care

Question 35

Reed-Sternberg cells are associated with what?

Answer 35

Hodgkin disease (along with enlarged spleen and liver)

Question 36

What type of hodgkin’s is found in patients aged 15-45?

Answer 36

Hodgkin’s disease

Question 37

How do we treat Hodgkin’s?

Answer 37

chemo and radiation

Question 38

Which type of hodgkin’s has a better prognosis?         

Answer 38

Hodgkin’s

Question 39

What are the B symptoms?

Answer 39

Fever, night sweats, weight loss

Question 40

A pt presents with bone pain and anemia – what dx?  Workup?

Answer 40

``` Multiple myeloma               Monoclonic spike on serum protein electrophoresis               *Bence-Jones protein in urine               Lytic lesions on xray  ```

Question 41

How do we treat multiple myeloma?

Answer 41

chemotherapy, dexamethasone

Question 42

What is the cause of sickle cell anemia?

Answer 42

abnormal hemoglobin S

Question 43

What’s worse – sickle cell homozygous or heterozygous?

Answer 43

homozygous (heterozygous means they carry the trait)

Question 44

What are some risk factors to vasoocclusive disease in sickle cell?

Answer 44

infection with parvovirus B19               COLD, dehydration, hypoxia, stress, menses, and alcohol

Question 45

What are the sxs of vaso-occlusion in sickle cell?

Answer 45

sudden pain, commonly chest, back, abdomen, and extremities

Question 46

What are some of the complications of sickle cell?

Answer 46

growth issues, Asplenia + recurrent infection, increased risk of stroke, retinopathy

Question 47

How do we diagnose sickle cell?

Answer 47

CBC shows hemolysis               Confirmed with hemoglobin electrophoresis

Question 48

How do we treat the chronic form of sickle cell?

Answer 48

Folic Acid for ALL!!!               Vaccines: pneumococcal, influenza, and meningococcus               Children under 5: Prophylactic PCN to prevent infection               Hydroxyurea (to increase level of HgF)

Question 49

How do we treat an acute vaso-occlusive episode?

Answer 49

O2, hydration, and opioids               If a fever is present give ceftriaxone (cephalosporin allergy = clinda or levo)

Question 50

If a pregnant woman has a DVT can you give warfarin?

Answer 50

NO