Heme/Onc - Week 2 Review - Part 2

Question 1

LDH - Lab Value Meaning

Answer 1

Indicates Tumor or Hemolysis

Question 2

Acute Leukemia Differentiation

Answer 2

AML - Auer Rods + MPO + CD33

ALL - TdT + Lymph (B=CD19/20/23 vs. T=2/7)

Question 3

AML-M3 - Alternative Name + Genetics + Treatment + Associated Disease

Answer 3

Acute Promyelocytic Leukemia

t(17:15) - RAR Activated - Treatment = ARTA, vitamin will activate the receptor and force differentiation

Associated with DIC

Question 4

Multiple Myeloma Labs (7)

Answer 4

1) Leukopenia
2) Thrombocytopenia
3) Low Hb
4) Low Hct
5) Elevated Total Protein with Low Albumin
6) High Creatine
7) Hypercalcemia

Question 5

Multiple Myeloma Finds + Causes (6)

Answer 5

All due to Monoclonal Plasma Cells

1) Bone Break Down with Lytic Lesions - Osteoclast Activating Factor
2) Hypercalcemia - Osteoclast Activating Factor
3) Monoclonal Spike - Increased Ig
4) Infection - Monoclonal Ig
5) Proteinuria (with kidney damage) - Bence Jones Proteins - Light Chain
6) Roulox Formation on Smear - Spherocyte RBC Linking

Question 6

Nodular Sclerosisng HL - Classic Case + Histology

Answer 6

Young Female with Medistinal/Cervical Mass

Reed Sternberg Cells - CD 15/30+

Question 7

Nodular Sclerosing HL - ABVD Treatment

Answer 7

1) Adriamycin (Doxorubicin - Cardiotoxicity)
2) Belomycin (Anti-Tumor Abs - Pulm. Fibrosis
3) Vinblastine (Microtubule Inhibitor - Peripheral Neuropathy
4) Dacarbazine (Alkylating Agent)

Question 8

Mechanisms of Drug Resistance (7)

Answer 8

1) Mutation
2) Gene Amplifaction (Overproduction of the drug’s target)
3) Efflux Pumps
4) Lack of Transport into cancer
5) DNA Repair - Cancer can learn DNA Repair
6) Drug Inactivation - Oxidation of the rug
7) Presence of Cancer Stem Cells (Hide)

Question 9

Imatinib - Mechanism + Use (2) + Resistance Method (2)

Answer 9

Inhibits BCR-Abl and C-Kit

Use - CML (BCR) + Gastrointestinal Stromal Tumor (GIST) - C-Kit

Resistance - BCR-Amplication + Mutation in the drug binding site

Question 10

hENT1-2 - Role In Resistance

Answer 10

Normally at the blood brain barrier to remove unwanted substance

Development elsewhere - Become drug efflux pumps

Question 11

BRCA2 - Resistance Mechanism

Answer 11

BCRA2 - Mutation in DNA Repair Enzyme

Give drugs - it will mutate back and it can repair the DNA Again

Question 12

Alkylating Agent Resistance (Platinums)

Answer 12

Gutathion S-Transferase Metabolizes Platinums and triggers their efflux

Increasing the GST System increases the efflux of the platinums

Question 13

Atripimod - Mechanism + Resistance

Answer 13

JAK2 Inhibitor (works great in vivo)

In the body the cancer cells (SET2) are protected via the stromal cells

Question 14

ABO Blood Groups - Sugars + Chromosome

Answer 14

Chromosome 9

A Antigen - N-Acetyl-Galactosamine
B Antigen - Galactose
O Antigen - None

Type O = Least vWF = Most Bleeding
Type AB = Most vWF = Least Bleading

Question 15

Anti-ABO Antibodies - Key Points (3)

Answer 15

IgM - Warm Agglutanin - React at Normal Body Temperatures (key for transfusion)

IgM - Triggers Compliment Cascade - Rapid Intravascular Hemolysis - Why Matching Is Key

Question 16

Anti-Rh Antibodies - Key Points (3)

Answer 16

IgG - Made in response to exposure

To small for compliment - bind and trigger splenic macrophage destruction (extravascular hemolysis)

Hemolytic Disease of Newborn (Small enough to cross placenta)

Question 17

Hemolytic Disease of the Newborn

Answer 17

IgG for Rh+ Crosses from baby #1 to mom (Rh(-)) - Not an issue for the first child

During second pregnancy mom has built anti Rh+ IgG which goes into the new Rh+ baby and attacks - Worse with each pregnancy

Question 18

Transfusion Implications of ABO (2)

Answer 18

Type O - Universal Donor - Won’t be attacked by any antibodies the person may have (E.g. Type A with Anti-B antibodies won’t get the Type O)

Type AB - Universal Recipient - No antibodies - can receive any type

Question 19

Rh-Immune Globulin - Mechanism + Use

Answer 19

Prevents hemolytic disease of the newborn

Give IgG Ab’s to the RhD Antibody - and newborn blood that escapes in the mom is knocked out before it has time to trigger mom’s Ab response

Question 20

Mycoplasma Pneumonia - Impact on Blood (3)

Answer 20

I Antigen - Triggers IgM and IgG after infection

IgM - Agglutinante in Cold Temps
IgG - Compliment Activation - Donath-Landstiener Anemia

Question 21

Blood Transfusion Components (4)

Answer 21

1) Packed RBCs
2) Platelets (HLA)
3) FFP
4) Cryopercipitate

Question 22

Packed RBCs - Key Points (3)

Answer 22

1) ABO Compitability
2) Expiration 3-6 Weeks (fridge)
3) Stored to long - low pH = hemolysis + 2,3 BPG drop (left shift)

Question 23

Platelets - Key Points (2)

Answer 23

1) HLA Matching if Possible

2) Expiration = 5 Days (then bacterial infection

Question 24

FFP - Uses (3) + Keys (2)

Answer 24

1) DIC
2) TTP
3) Warfarin Overdose

1) Stored Frozen (Expiration after 24 Hours)
2) Storage Factors V and VIII lost first

Question 25

Cryopercipitatie - Keys (3)

Answer 25

1) Thawed FFP 2) Fibrinogen + Factor VIII + vWF 3) Used for DIC

Question 26

Complications of Transfusion (6)

Answer 26

1) Infection 2) Febrile Reactions 3) Allergic Reaction 4) Acute Immune Mediated Hemolytic Reaction 5) Transfusion Associated Circulatory Overload (TACO) 6) Transfusion Related Acute Lung Injury (TRALI)

Question 27

Febrile Transfusion Reaction - Key Point

Answer 27

Reaction to donor HLA - Mild Fever

Question 28

Allergic Transfusion Reaction - Key Points (3)

Answer 28

1-3% of Transfusions - Circulating Ab's Against Donor Proteins KEY FOR EXAM IgA Deficient Recipient - Receives Blood with IgA - Recipient Anti-IgA Ab's attack the IgA from the donor causing sever anaphalxis Classic Presentation - Family Hx. of anaphlaxis with a "matched" patient (e.g. anaphalaxis not due to clerical error)

Question 29

Acute Immune Mediated Hemolytic Reaction - Key Points (2)

Answer 29

Un-matached ABO Donor/Recipient #1 Cause = Clerical Error - Also Cross and Type

Question 30

Transfusion Associated Circulatory Overload - Key Point

Answer 30

TACO Transfusion alters hemodynamic state - HTN + Pulm Edema

Question 31

Transfusion Related Acute Lung Injury (TRALI) - Key Points (4)

Answer 31

1) 1-2 Hours After Transfusion 2) Severe Hypotension + Pulmonary Edema 3) Antibodies against donor HLA - Antibodies cause massive immune reaction with endothelial damage and fluid leak (pulm. edema) 4) #1 Cause of Transfusion Death