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Flashcards in Heme/Onc Deck (67):
1

Management: TTP

Plasma exchange
Glucocorticoids
Rituximab

2

Pentad of TTP

Thrombocytopenia
Microangiopathic hemolytic anemia
Renal insufficiency
Neurologic changes
Fever

3

TTP is usually due to an acquired autoantibody to ___, a plasma protease that cleaves von Willebrand factor off the endothelial surface. As a result, vWF multimers accumulate on the endothelial wall, trapping platelets at areas of high shearing force and leading to formation of thrombi.

ADAMTS13

4

A manual ___ is a crucial test in diagnostic workup of TTP and would show sings of intravascular hemolysis (e.g., ___, ___, and ___)

Peripheral blood smear

Schistocytes
Helmet cells
Triangle cells

5

Common causes of macrocytic anemia [8]

Folate deficiency
B12 deficiency
Myelodysplastic syndrome
Acute myeloid leukemias
Drug-induced (hydroxyura, zidovudine, chemotherapy agents)
Liver disease
Alcohol abuse
Hypothyroidism

6

Megaloblastic anemia (folate and B12) is typically associated with a ___ reticulocyte count. Non-megaloblastic anemia can have increased, normal, or decreased reticulocyte count depending on etiology.

LOW

7

Basophilic stippling (nonspecific) can be associated with [3]

Lead poisoning
Thalassemias
Alcoholism

8

Loss of intrinsic factor, whether due to ___ or ___, is a common cause of B12 deficiency.

Gastric resection
Autoimmune gastritis

9

Direct factor Xa inhibitors are as effective as warfarin in treatment of acute CVT or PE and do not increase bleeding risk.
These drugs have what 3 major advantages?

Rapid onset of action
No requirement for monitoring
No requirement for overlap therapy with heparin

10

Direct factor Xa inhibitors should NOT be used in patients with ___ or ___

Severely impaired renal function
Patients with DVT or PE secondary to malignancy

11

Name 2 indications for IVC filter placement

Anticoagulation failure (e.g., VTE while fully anticoagulated)

Anticoagulation contraindication (e.g., active bleeding)

12

Treatment options for polycythemia vera

Phlebotomy
Hydroxyurea (if risk for thrombus)

13

Preconception counseling and testing of a patient of NON-AFRICAN DESCENT can help identify couples at risk for HEMOGLOBINOPATHIES that might affect their offspring. The most important INITIAL SCREEN in a female is a ___.

If a patient is of AFRICAN DESCENT, a ___ is usually obtained along with initial ___.

Based on the results, other appropriate screening tests should be obtained.

Complete blood count (CBC)

Hemoglobin electrophoresis
Complete blood count (CBC)

14

CRAB findings of Multiple Myeloma

Calcium high
Renal insufficiency
Anemia
Bone destruction/pain

15

Multiple myeloma is a plasma cell neoplasm that is characterized by the excessive production of ___ that can accumulate in the kidneys and cause renal insufficiency.

Monoclonal protein

16

Diagnosis of CO poisoning

ABG (carboxyhemoglobin level)
ECG
Cardiac enzymes (if ischemia or CAD)

17

Treatment of CO poisoning

High-flow 100% oxygen
Intubation/hyperbaric oxygen therapy (severe)

18

___ does not differentiate between carboxyhemoglobin and oxyhemoglobin; it cannot be used in diagnosis of CO poisoning. Diagnosis is made by ___.

Pulse oximetry

ABG with cooximetry

19

It is important to rule out ___ prior to starting folic acid replacement.

Cobalamin (B12) deficiency

20

Common drugs that cause PERIPHERAL NEUROPATHY

Chemotherapy agents:
- Vincristine
- Cisplatin
- Taxanes (Docetaxel and Paclitaxel)

Misc drugs:
- Phenytoin
- Isoniazid
- Amiodarone
- Hydralazine

21

Patients with paroxysmal nocturnal hemoglobinuria (PNH) have manifestations in the 4th decade of life resulting from one of the following [3]

Hemolysis (leading to hemoglobinuria)
Cytopenias (leading to fatigue and dyspnea from anemia)
Hypercoagulable state (e.g., portal vein thrombosis)

22

Diagnosis: Paroxysmal nocturnal hemoglobinuria (PNH)

Flow cytometry (absence of CD55 and CD59 [DAF])

23

Treatment: Paroxysmal nocturnal hemoglobinuria (PNH)

Iron and folate supplementation
Eculizumab (Ab that inhibits C' activation)

24

Suspect squamous cell carcinoma of the head and neck mucosa in an alcoholic smoker who presents with a palpable cervical lymph node. The best initial test is ___. Usually followed by a ___ when primary tumor is located.

Panendoscopy (triple endoscopy = esophagoscopy, bronchoscopy, laryngoscopy)

Biopsy

25

Treatment for hemophilia A

Factor VIII
Desmopressin (mild)

26

Treatment for hemophilia B

Factor IX

27

Genetics of hemophilia A and B

X-linked recessive

28

___ is the MCC of vitamin B12 deficiency in whites of northern European background. It is commonly seen with other autoimmune disorders (e.g., vitiligo, thyroid disease)

Pernicious anemia

29

Isoniazid is associated with 2 major side effects ___ and ___. It can also cause SIDEROBLASTIC ANEMIA.

Neuropathy
Hepatotoxicity

30

___ is seen primarily in the ELDERLY and presents with PANCYTOPENIA and MACROCYTOSIS. BM biopsy will reveal DYSPLASTIC CELLS.

Myelodysplastic syndrome

31

Electrolyte abnormalities of tumor lysis syndrome

Increase:
Phosphorus (intracellular ions liberated)
Potassium (intracellular ions liberated)
Uric Acid (nucleic acids metabolized into uric acid)

Decreased:
Calcium (phosphate binds and precipitates)

32

Manifestations of tumor lysis syndrome [3]

Severe electrolyte abnormalities
AKI
Cardiac arrhythmias

33

Treatment of tumor lysis syndrome

Continuous telemetry
Aggressive electrolyte monitoring/treatment

34

Prophylaxis of tumor lysis syndrome

IV fluids
Allopurinol (or Rasburicase)

35

Isoniazid is a ___ and can therefore be responsible for causing a sideroblastic anemia. Therefore administration of ___ is needed.

Pyridoxine (B6) antagonist

Pyridoxine (B6)

36

Beta-thalassemia minor (one gene defective) manifestations

Modest anemia (Hct 28-40%; MCV 55-75)

37

Beta-thalassemia major (two genes defective) manifestations

Severe anemia and transfusion dependence from an early age

38

DDX for patient with:
Microcytic/hypochromic anemia

Iron deficiency - decreased intake, blood loss

Defective utilization of iron storage - anemia of chronic disease

Reduced globin synthesis - thalassemia, other hemoglobinopathies

Reduced heme synthesis - lead poisoning, sideroblastic anemia

39

___ help confirm the diagnosis of iron-deficiency anemia, as well as rule out other causes of microcytic anemia

Iron studies

40

Iron studies: Iron-deficiency anemia
Serum iron
Serum ferritin
TIBC
% sat

Serum iron - low
Serum ferritin - low
TIBC - high
% sat - low

41

Iron studies: Thalassemias
Serum iron
Serum ferritin
TIBC
% sat

Serum iron - normal/high
Serum ferritin - normal/high
TIBC - normal
% sat - normal/high

42

Iron studies: Anemia of chronic disease
Serum iron
Serum ferritin
TIBC
% sat

Serum iron - low
Serum ferritin - normal/high
TIBC - low
% sat - low

43

Iron studies: Sideroblastic anemia
Serum iron
Serum ferritin
TIBC
% sat

Serum iron - normal/high
Serum ferritin - normal/high
TIBC - normal
% sat - normal/high

44

Warfarin doses to achieve a therapeutic INR of ___-___

2 - 3

45

Etiology: Warm agglutinin AIHA [5]

Drugs (penicillin)
Viral infections
Autoimmune (SLE)
Immunodeficiency
Lymphoproliferative (CLL)

46

Etiology: Cold agglutinin AIHA [2]

Infections (Mycoplasma pneumoniae, EBV)
Lymphoproliferative diseases

47

Treatment: Warm agglutinin AIHA

Corticosteroids
Splenectomy (refractory)

48

Treatment: Cold agglutinin AIHA

Avoidance of cold temperatures
Rituximab (anti-CD20) +/- Fludarabine

49

Dianosis: AIHA

Direct antiglobulin (Coomb's) test

Warm: anti-IgG, anti-C3
Cold: anti-IgM, anti-C3

50

Erytheopoiesis-stimulating agents (Erythropoietin and Darbepoetin) are the treatments of choice for anemia related to CKD. ___ is a common side effects. Patients who receive large doses or experience a rapid rise in Hb are at highest risk.

Hypertension

51

Late neutrophil precursors

Metamyelocytes
Bands

52

Early neutrophil precursors

Promyelocytes
Myelocytes

53

Leukemoid reaction is characterized by a ___ LAP

High (vs CML)

54

CML is characterized by a ___ LAP

Low (vs leukemoid reaction)

55

Hemochromatosis is associated with [4]

Cirrhosis
Increase incidence of HCC
Skin darkening
Insulin resistance

56

Most causes of hemolytic anemia are accompanied by a(n) ___ MCV.

Increased (larger premature RBCs)

57

Packed cells derived from whole blood collections (used for transfusions) contain ___, which can chelate serum calcium and magnesium, thus causing HYPOcalcemia and HYPOmagnesemia.

Most common after massive transfusions of the equivalent of more than one blood volume over 24 hours.

Citrate

58

Stored RBCs gradually lose intracellular ___ to the surrounding solution, thus causing ___.

Potassium
Hyperkalemia

59

Hypercoagulable disorder that usually presents with unexplained superficial venous thrombosis at unusual sites (e.g., arm, chest area).

The syndrome is usually diagnosed prior to (sometimes months to years before) or at the same time as an occult visceral malignancy.

Migratory superficial thrombophlebitis
(Trousseau's syndrome)

60

Next step: Patient with heavy smoking history, abdominal pain, migratory thrombophlebitis (Trousseau's syndrome)

CT scan of abd (evaluate for visceral malignancy)

61

Malignancies associated with migratory thrombophlebitis (Trousseau's syndrome)

Pancreas (MC)
Lung
Prostate
Stomach
Colon
Acute leukemias

62

One unique type of AML is APML, which is characterized by life-threatening coagulopathy due to ___. In APML, bone marrow biopsy would reveal ___.

DIC

Atypical promyelocytes

63

Independence of the underlying cause, homocysteine levels can usually be normalized by administration of ___ and ___. ___ should be added if deficiency is suspected.

Pyridoxine (B6)
Folate
B12

64

___ is pica for ICE and is quite specific for iron deficiency.

Pagophagia

65

Cancers that often metastasize to bone [4]

Prostate
Lung
Breast
Multiple myeloma

66

___ must be suspected in any patient with a history of malignancy who develops back pain with motor and sensory abnormalities. Bowel and bladder dysfunction are LATE neurologic findings.

Epidural spinal cord compression (ESCC)

67

Next 3 steps: Epidural spinal cord compression

IV glucocorticoids

MRI

Neurological consultation (if confirmed)