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Flashcards in Heme/Onc Deck (36)
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Most causes of microcytic anemia have what kind of reticulocyte count

Low reticulocyte count, implies production problem
Macrocytic anemia has a low reticulocyte count as well


Causes of macrocytic anemia

B 12/folate deficiency,Sideroblastic anemia, alcoholism, anti-metabolite medications, liver disease or hypothyroidism, zidovudine, phenytoin, Milo dysplastic syndrome, cold agglutinin's


FFP versus cryoprecipitate

FFP replace his clotting factors, used in those with elevated PT, PTT it, INR and bleeding, used as replacement with plasmapheresis
Cryoprecipitate is used to replace fibrinogen, used in DIC, provides clotting factors in smaller classroom about you, has high levels of factor 8 and VWF


Causes of sideroblastic anemia

Can be associated with Milo dysplasia, most common cause is alcohol – suppressing bone marrow, other causes: blood poisoning, INH, vitamin B6 deficiency


Unique features on iron studies of microcytic anemias:
Low ferritin
Hi iron

Low ferritin: iron def
Hi iron: sideroblastic
Normal: thalassemia


Difference between anemia of chronic disease and iron deficiency anemia

TIBC will be hi in iron deficiency, but low in anemia chronic disease


Thalassemia diagnosis

Alpha: DNA analysis
Beta: hemoglobin electrophoresis
RDW will be normal as well iron studies


Labs in vitamin B 12 and folate deficiency

Increased LDH and indirect Billy Rubin, decreased reticulocyte count, hypercellular bone marrow, increased homocysteine levels, only vitamin B 12 will have an elevated MMA
Both may cause pan cytopenia


Diagnosing sickle cell disease

Best initial test: peripheral smear
Most accurate test: hemoglobin electrophoresis


Sickle cell disease treatment

Oxygen, hydration, analgesia, if fever or high white count: antibiotics: ceftriaxone, Levofloxacin, moxifloxacin
Folate replacement, pneumococcal vaccination,
Exchange transfusion: ACS, Priya prism, stroke, visual disturbance from retinal infection


Features of sickle cell trait

Isothenuria: defect and ability to concentrate urine
Occasionally hemateria


Causes of autoimmune hemolysis – warm or IgG

CLL, lymphoma, SLE, penicillin, methyldopa, Ray famine, funny tone
Coombs test is most accurate, will have spherocytes on peripheral smear
Treat with steroids, if re current: splenectomy, severe/acute hemolysis not responding to steroids: I VIG
Rituximab, other immunosuppressant


Cold agglutinin disease

Most accurate test is cold agglutinin titer, direct Coombs' test was positive only for complement
Treat by staying warm, rituximab, sometimes plasmapheresis, anti-metabolites/immunosuppressive's – steroids in splenectomy do not work in cold


TTP is associated with?

Ticlodipine, cyclosporine, Plavix, AIDS, SLE


Episodic dark urine, pancytopenia, clots in unusual places think?

Paroxysmal nocturnal hemoglobinuria – PNH
MCC OD: thrombosis
Treat,with prednisones, eculizumab, bone marrow transplant, give folate


If a patient with a plastic anemia is too old for bone marrow transplant – about 50 or there's no match donor treat with?

Antithymocyte globulin and cyclosporine/tacrolimus


Treatment for polycythemia vera

Phlebotomy, aspirin: prevent thrombosis, hydroxyurea: lowers cell count, allopurinol, rasburicase: protects against Uric acid road, anti histamines


Essential thrombocytosis will have platelet count around? Very difficult to distinguish from?

Platelet count above 1 million, difficult to distinguish from reaction to another stress: infection, cancer, iron deficiency
Will have both bleeding and thrombosis
Treat with hydroxyurea


Treatment for myelo fibrosis

Thalidomide, lenalidonide, bone marrow transplant under age 50 to 55
ruxolitibib inhibits JAK2


Leukemia associated with the DAC

AML M3 subtype: acute promyelocytic leukemia
15:17 translocation
Best initial test: blood smear showing blast
Most accurate: flow cytometry
Myeloperoxidase characteristic of AML
Add all trans retinoic acid to Tx for M3
If ALL add mtx - intrathecal


Pruritis after shower, splenomegaly, high WBC think?

Diagnosed with BCR-ABL on pcr or fish
Most likely to transform into acute leukemia – blast crisis, differentiate from leukemoid reaction with low LAP


Myelodysplastic syndrome

Pre-leukemic disorder in older patients over 60 – pancytopenia with hypercellular bone marrow, increased MCV, nucleated red cells in small number of blasts, ring sideroblasts, severity based on percentage a blast, 5q deletion has excellent response to a lenalidomide
Pelger-Huet cells: bilobed nucleus


Treatment for CLL

Stage 3/4: fludarabine, cyclophosphamide, rituximab
Mild: chlorambucil
Infections: IVIG
Prednisone for autoimmune thrombocytopenia or hemolysis
PCP prophylaxis


Radiation increases the risk of?

Solid tumors: breast, direct, long, also increases chance of premature coronary artery disease
Chemotherapy increases the risk of acute leukemia, MDS, NHL


Best diagnostic test for MM

Bone marrow biopsy with greater than 10% plasma cells


Blurry vision, vertigo, engorge blood vessels in the eye, mucosal bleeding, Ray nods, think?

Walden Strom macroglobulinemia: hyperviscosity, no bone lesions, best therapy is plasmapheresis to remove the IgM and decrease viscosity


Immune thrombocytopenic Purpera will have? How to treat?

Isolated thrombocytopenia, normal sized spleen, Megakaryocytes are elevated, Platelets are large
If platelets under 30,000: steroids, if severe bleeding in less than 10,000: I VIG, anti-Rho, with recurrent episodes/steroid dependent: splenectomy, if still refactory: immunosuppressants
Give meningitis, pneumococcus, H. Flu vaccination before splenectomy


Superficial bleeding, elevated bleeding time with normal platelet count possibly elevated PTT, worsened after use of aspirin think?

No platelet aggregation with ristocetin assay
Treat with desmopressin


Hemophilia's have what PT/PTT?

Normal PT, elevated PTT implying intrinsic pathway defect, factor 8/9, May have prolonged bleeding time, treat with DDAVP or factor replacements


DIC risk factors and labs?

Risks: sepsis, burns, placenta abruption, amniotic fluid embolism, snakebites, trauma, cancer
Bleeding related to clotting factor deficiencies and thrombocytopenia
Elevated PT, PTT, BT, low platelets, elevated D dimer, decreased fibrinogen