Heme/Onc Part 1

Question 1

What will be seen on peripheral smear with a Macrocytic Anemia?

Answer 1

Hypersegmented Neutrophils (>5 lobes)

Question 2

What can differentiate a folate and B12 deficiency on lab value?

Answer 2

Methylmalonic Acid
– High with B12 deficiency

Question 3

Which occurs faster, Folate or B12 deficiency?

Answer 3

Folate

Question 4

Where is B12 found?

Answer 4

Animal products

Question 5

What 3 conditions may have a Vitamin B12 deficiency?

Answer 5

Vegan
Crohn’s
Gastric Bypass

Question 6

How is Vitamin B12 absorbed?

Answer 6

Parietal cells in the stomach secrete IF which binds B12 and helps it be absorbed in the terminal ILEUM

Question 7

What test can be used to assess if a Vitamin B12 deficiency is nutritional or an absorption problem?

Answer 7

Schilling’s Test

Question 8

Following a Schilling’s Test, if Vitamin B12 IS in the urine, what kind of deficiency does the patient have?

Answer 8

Nutritional deficiency

Question 9

If a patient has impaired absorption of Vitamin B12 due to Crohns or Gastric Bypass, what is the treatment?

Answer 9

IM Vitamin B12

Question 10

Vitamin B12 deficiency will have what symptoms that a Folate deficiency will not have?

Answer 10

Neuro Sx – loss of proprioception/vibratory/etc.
= Subacute Combined Degeneration

Question 11

What are the levels of Iron, Ferritin and TIBC with Iron Deficiency Anemia?

Answer 11

LOW iron and ferritin
HIGH TIBC

Question 12

What causes Anemia of Chronic Disease?

Answer 12

Chronic inflammation with cytokines, often autoimmune or malignancy

Question 13

What are the levels of Iron, Ferritin and TIBC with Anemic of Chronic Disease?

Answer 13

LOW iron and TIBC
HIGH Ferritin

Question 14

If you see a Microcytic Anemia with normal iron studies and a significantly low MCV, what may be the condition?

Answer 14

Alpha Thalassemia

Question 15

What are 3 Microcytic Anemias?

Answer 15

Iron deficiency
Anemia of Chronic Disease
Thalassemias

Question 16

If a Hemolytic Anemia is occurring, what 3 lab changes will be present?

Answer 16

Low Haptoglobin
HIGH LDH and bilirubin

Question 17

If a Hemolytic Anemia is occurring, what 3 lab changes will be present?

Answer 17

LOW Haptoglobin
HIGH LDH and bilirubin

Question 18

What are the signs of a Febrile Non-hemolytic transfusion reaction?

Answer 18

Fever, chills and malaise following transfusion

Question 19

What causes a Febrile Non-hemolytic transfusion reaction? What do you do?

Answer 19

Cytokines in the transfused blood
– Give Acetaminophen and stop the transfusion

Question 20

What are the signs of an Acute Hemolytic transfusion reaction?

Answer 20

Fever and chills
Hypotension
Flank pain and possible renal failure

Question 21

What causes an Acute Hemolytic transfusion reaction?

Answer 21

ABO incompatibility where recipient antibodies attack donor blood

Question 22

What will be seen with a Delayed Hemolytic transfusion reaction?

Answer 22

A week after a transfusion, the patient may have a fever

Question 23

If a patient has an allergic reaction with a transfusion it will occur in minutes. Why does it occur?

Answer 23

Recipient antibodies to plasma proteins
Ex. IgA Deficiency

Question 24

Signs of an Allergic reaction following a transfusion?

Answer 24

Urticaria and itching
Anaphylaxis

Question 25

What is the mutation with Sickle Cell Disease?

Answer 25

Glutamic acid replaced by Valine on Beta globin gene Chr. 16

Question 26

Under conditions of acidosis and hypoxemia, RBCs will sickle with sickle cell disease. In general, what 2 things does that cause?

Answer 26

Clot/Ischemia Hemolysis

Question 27

If you believe a Sickle Cell patient is having an Acute Chest Syndrome or a Cerebral infarction, what is the treatment?

Answer 27

Exchange transfusion

Question 28

If you believe a Sickle Cell patient is having a vaso-occlusive pain crisis, what are 3 things that they should be given?

Answer 28

IVF Oxygen Pain control

Question 29

If a Sickle Cell patient comes in with abdominal pain, what could be the cause?

Answer 29

Pigmented gallstones from chronic hemolysis

Question 30

Due to autoinfarction of the spleen, what should children with Sickle Cell be given until age 5? After that?

Answer 30

Penicillin until age 5 Pneumococcal vaccine after that

Question 31

Following the initiation of chemotherapy treatment, what may occur if patients are now sick or having arrhythmias?

Answer 31

Tumor Lysis syndrome

Question 32

Pneumonic to remember Tumor Lysis Syndrome electrolyte changes?

Answer 32

PUKE Calcium

Question 33

Electrolyte changes with Tumor Lysis Syndome?

Answer 33

PUKE Calcium - phosphorus - uric acid - potatssium = ELEVATED - Calcum LOW

Question 34

What is the treatment of Tumor Lysis Syndrome?

Answer 34

Normal saline and Uric acid inhibitors

Question 35

What is a Myelodysplastic Syndrome?

Answer 35

Disorder of the formation of 1 or more myeloid lines

Question 36

What will be seen with a Myelodysplastic Syndrome?

Answer 36

Cytopenias BM is < 20% blasts!

Question 37

What may be seen on peripheral smear with a Myelodysplastic Syndrome?

Answer 37

Oval Macrocytes

Question 38

What is the result of a BM biopsy with a Myelodysplastic Syndrome?

Answer 38

< 20% blasts!

Question 39

Side effect of Vincristine and Vinblastine?

Answer 39

Peripheral Neuropathy

Question 40

Side effects of Cisplastin/Carboplatin?

Answer 40

Ototoxicity Nephrotoxicity

Question 41

Side effect of Cyclophosphamide

Answer 41

Hemorrhagic Cystitis

Question 42

Side effect of Bleomycin?

Answer 42

Pulmonary Fibrosis

Question 43

Side effect of Adriamycin, Doxorubicin, Daunorubicin?

Answer 43

Cardiomyopathy

Question 44

How do you differentiate mature cells from blasts?

Answer 44

Mature cells have very little cytoplasm -- BLASTS = CYTOPLASM

Question 45

Exposed collagen on injured vasculature will expose vWF, which binds what platelet antigen?

Answer 45

GP1B