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Flashcards in Hemonc2 Deck (109):
1

Pt has fatigue and pallor- what lab should be run? What to expect?

suspect anemiaH&H- Hbg and Hct are low

2

What is the general rule for calculating hbg and hct?

hbgx3

3

What lab to do next if H&H are low?

retic index

4

What if retic is low/high, what does it mean and what is next step?

retic is high - bone marrow is able to compensate for blood loss --> check for blood loss or hemolytic anemiaretix is low - bone marrow is not making RBC --> MCV

5

What are the categories for MCV and what is next step?

microcytic check iron studiesnormocytic 100 --> aplastic anemia, tumor, renal failure, G6PDmacrocytic >100 --> check B12 and folate deficiency

6

What if Fe and TIBC is decreased? What should RDW and Ferritin be?

anemia of chronic dzRDW: normalferritin: normal

7

What if Fe is low but TIBC is high? What if older age-what to suspect? What should RDW and Ferritin be?

iron def. anemiacolon cancerRDW: high Ferritin: low

8

What if Fe if normal but TIBC is norm/low? What should RDW and Ferritin be?

lead poisoningthalassemiaRDW: high/norm Ferritin: high/norm

9

If pt has high TIBC and low Fe and ferritin - what PE to expect?

iron def anemiakoilnychiaglossitisplummer-vinson sx -thin tissue growth to blocks esophageal pipe

10

How to tx iron def anemia?

iron replacement - ferrous sulfate

11

Is MCV high or low in iron def. anemia?

low

12

How to dx B major thalassemia/Cooley's anemia and what to expect on PE?

electrophoresis: HbF elevatedblood smear: microcytic anemia + target cellsPE: chipmunk face; normal at birth

13

How many genes are affected in B major thalassemia?

2

14

Pt is mediterranean but Fe, Ferritin, TIBC, and RDW is normal and iron supplements don't help - what lab should be done and what to expect?

Beta minorblood smear- howell jolly bodieselctrophoresis- high A2 and F

15

What Beta thalassemias are entirely blood transfusion dependent?

intermediate and severeintermediate only needs after stressors

16

Pt has trouble exercising at school - what labs should be done and what to expect?

alpha thalassemiairon studies - low hct and MCV but normal RBCblood smear - Aconthocyteselectrophoresis - LOW HbA, HbA2 and Hb F

17

What dz have acanthocytes on blood smear - what is next step (what to expect on labs)?

alpha thalassemiahemoglobin Helectrophoresis- hemoglobin H: HbH; alpha thalassemia: low HbA, HbA2, and HbF

18

What is hydrops fetalis?

still born d/t all thalassemia being goofed up

19

How to differentiate anemia of chronic dz and iron def anemia via labs?

anemia of chronic dz has high ferritin but iron def has low ferritin

20

Pt is mediterranean and has chipmunk face - how to tx?

blood transfusion

21

What is the pathophys/cx of anemia of chronic dz? Tx?

anemia is secondary to some sort of underlying dz (TB)tx: self limiting-do not give iron

22

Pt has fatigue, recurrent infxn, easy bruising and seizures (carbamazepine)?

aplastic anemia

23

What can occur in aplastic anemia and what can this lead to eventually?

pancytopenia - anemia, neutropenia, thrombocytopeniaacute leukemia

24

What age does aplastic anemia affect?

15-30yo or >60yo

25

How to dx and tx aplastic anemia?

bone bxbone marrow transplant

26

Pt has Crohn's dz and had colon resected-what are they at risk for?

B12 def b/c it cannot be absorbed- resected out

27

Where is B12 absorbed and what does vit B12 bind to?

where: terminal ileumwhat: intrinsic factor

28

Pt has NO intrinsic factors? How should labs look like?

pernicious anemialabs: low MCV, low B12, HIGH methylmalonic acid

29

How to differentiate between B12 def and folate def? What can be the same in BOTH?

B12 has NEUROPATHY - numbness in extremitiesB12 has HIGH methylmalonic acid both: homocysteine

30

How to dx pernicious anemia?

schilling testEGD

31

How to tx B12 def?

supplemental shots: daily --> wkly --> monthly

32

Pt has seizures (phenytoin) + alcoholic-what PE should you expect?

folate defNO neurological probs

33

Which dz have howell-jolly on blood smear?

beta minorfolate def

34

What are indications for hemolysis (RBC)?

lack of haptoglobin (LOW) - if hbg is destroyed then haptoglobin that is attached to hbg is destroyed too!LDH is high (HIGH)- LDH is released from RBC during destructionDARK urine- suggesting intravascular hemolysis

35

What are the different blood smears re: hemolytic anemia and what dz could they suggest?

helmet cells/spherocytes - extravascular hemolysisheinz bodies - G6PDsickle cellschistocytes -intravascular

36

What is an autosomal recessive dz and what to expect on electrophoresis (why)?

sickle cellHb S - Hb S replaces Hb A

37

What supplement is crucial for pts w/ hemolytic anemia?

FOLATE

38

Sickle cell have anemia?

NO

39

Pt has splenomegaly, AA- what to expect on lab results? What to do w/ spleen?

leukocytosisthrombocytosishigh bilirubin sickle-dex testHb Ssplenectomy

40

Pt with sickle cell got infxd w/ parvovirusb19- tx?

aplastic crisis occurs - blood transfusion to tx

41

Pt w/ sickle cell - what haps to heart, bone, skin, lung?

heart- cardiomegalybone- pain crisis; avascular necrosisskin - non healing ulcers lung- acute chest syndrome - similar to pneumonia

42

How to tx sickle cell - acute vs chronic?

acute: O2, hydration, abx - NO TRANSFUSIONchronic: folic acid, vaccinate, bone marrow transplant, HDYROXYUREA

43

What are the 2 types of extravascular hemolytic dz?

hereditaroy spheroctyosisautoimmune hemolytic anemia

44

How to differentiate between hereditary spherocytosis and autoimmune hemolytic anemia?

direct coomb's test: hereditary spherocytosis is negative

45

Pt has splenomegaly, gallstone, jaundice, and high MCHC- what to expect on blood smear and what dx test?

hereditary spherocytosisblood smear: spherocytesosmotic fragility test - dx

46

How to tx hereditary spherocytosis?

folatesplenectomy

47

Pathophys of spheroctyosis?

autosomal dominant dz where the RBC size is defected and cannot go through the spleen --> EXPLODES!

48

Male mediterranean that ate fava beans + dark urine + jaundice- what to expect on blood smear?

G6PD defheinz body + bite cells

49

Male w/ MD that is recovering from UTI?

G6PD defcx: nitrofuratoin, bactrim, glipizide, NSAIDs

50

Pt has leukemia and went to Hawaii for summer vacation - fatigue + jaundice + splenomegaly?

warm autoimmune hemolytic anemia - extravascular IgG

51

What is happening in autoimmune hemolytic anemia?

depending on type of AIHA, antibody attacks RBC --> goes into spleen --> macrophage eat them --> spherocyte (defect on membrane occurs) --> splenomegly --> anemia sx

52

How to tx IgG vs IgM AIHA?

IgG responds to steroids b/c it is extravascularIgM does NOT respond to steroids b/c it is intravascular; use Riuximab

53

Pt has polycythemia vera- what to expect on labs?

HIGH:RBC, platelet, B12, uric acids

54

What is happening in polycythemia vera? Tx?

blood is too thick and getting sludgytx: drain blood out, PREVENT THROMOBSIS , splenectomy

55

Pt has hard time swallowing cold drinks?

cold autoimmune hemolytic anemia -intravascular IgM

56

Pt has lead poisoning-what to expect on blood smear?

BASOPHILIC STIPPLING

57

Pt has recurrent epitaxis - what are cx of this dz?

thrombocytopeniacx: bone marrow fails, invasion, injury; autoimmune destruction; exogenous destruction: HIV, HIT2

58

Pt is healthy and in for annual exam but labs show thrombocytopenia?

pseudothrombocytopenia

59

Child had flu and now has petechiae and ecchymoses- what to expect on lab?

immune thrombocytopenic purpuraisolated thromboctyopenia

60

What to expect in adults w/ immune thrombocytopenic purpura and how to tx?

mucocutaneous bleedingtx: PLASMAPHERESIS +/- steroids +/- splenectomy

61

Pt has HUS + fever + altered mental status? What is this a def of? What to expect on labs-why?

thrombotic thrombocytopenic purpuramicroangiopathic hemolytic anemia -MAHA --> def of ADAMTS13Labs show NORMAL PT and PTT b/c it is only platelets getting eaten NOT clotting factors!

62

Child has acute renal failure + thrombocytopenia-what to expect on blood smear?

hemolytic uremic syndrome (HUS)MAHA schistocytes

63

How to tx HUS?

self limiting+/-dialysis

64

What is CONTRAINDICIATED IN TTP?

platelet trasnfusion

65

Pt has DVT after heparin-what drug was probably used? How many days does it take to take effect?

heparin induced thrombocytopeniaunfractionated heparin5-14days

66

Pt has recurrent epitaxis, easy brusing since childhood-what to expect on labs?

von willebran dznormal platelet count and PT, PTT but b/c platelets are useless d/t lack of von wille bran --> bleeding time is LONG

67

How to tx von willebran dz?

ddAVP to help stimulate vWF from endotheliumavoid NSAIDs

68

Male pt has hemoarthrosis - what to expect on labs?

hemophilia Anormal bleeding time and normal platelet count but LONG PT

69

Defect of factor VIII can lead to what dz?

vWD and hemophilia A in males

70

How to tx hemophilia A?

cryoprecipitate

71

PT vs PTT vs bleeding time vs thrombin time?

PT: extrinsic pathway - prolonged by warfarinPTT: intrinsic pathway - prolonged by heparinthrombin time: how much fibrinogenbleeding time: fxn of platelet

72

Pt has coagulopathy, what to think of and how to differentiate the two?

vita K def and liver dzvia K def: PT is LONG but PTT is normalliver dz: PT AND PTT is LONG *both platelet ct is normal

73

Pt has a blood draw but cannot stop bleeding and has sepsis? What is going on? What are they at risk for?

Disseminated Intravascular Coagulationbody is clotting and bleeding at random placesrisk: organ failure, PE

74

What labs for DIC-increased and decreased?

increased: PTT, PT, bleeding time, d-dimerdecreased: platelet ct

75

Tx for DIC?

support pt

76

Pt took abx, on warfarin, and now cannot stop bleeding after cutting hand? What to expect on labs?

vita K def-cx: abx and wafarinlabs: long PT

77

Tx for vita K? Acute?

acute: FFP/cryo

78

What organ is responsible for making clotting factors?

liver

79

How to reverse heparin?

protamine

80

Pt has rash after taking herbal supplements? What is it?

drug induced thrombocytopenia - type II hypersensitivity

81

Platelet count for thrombocytosis? Risk for?

>400,000DVT, PE, stroke

82

What are the sx for multiple myeloma?

CRABCalcium (hypercalecmia)Renal failureAnemiaBone lesions

83

Pt is in ICU + NPO- at risk for?

vita K def

84

What dz have M spike on electrophoresis? What is the pathophys?

multiple myelomawaldenstrom macroglobulinemiasmonocolonal gammopathy of undetermined significance pathophys: monoclonal neoplasms of B cell line --> increase neoplastic cells

85

Pt has fever, night sweats, wt loss, 65yo and M spike on electrophoresis?

waldenstrom macroglobulinemias

86

Pt is asymptomatic but has monocolonal proteins in urine - may lead to?

monocolonal gammopathy of undetermined significancelead to: multiple myeloma

87

Pathophys in multiple myeloma?

bone marrow is replaced by malignant plasma cell

88

Pt has bone pain, anemia, renal failure - what do they die from and what to see in urine?

recurrent infxnfree light chains: bence jones + M-protein in urine

89

Tx for multiple myeloma?

hematopoietic cell transplantation - usually for the youngchemo/radiation

90

Pathophys for Waldenstrom macroglobulinemia?

hyperviscosity

91

Pt has painless lymphadenopathy w/ fever and wt loss? Labs-diagnostic?

Hodgkinlymph node bx- REED STERNBERG CELL CXR and CT to eval how much lymph nodes bone marrow bx- if bone is invaded

92

What staging is in Hodgkin lymphoma? What is it?

ann arbor stage I: ONE lymph nodestage II: involving 2+ lymph nodestage III - BOTH sides of diaphragm stage IV - extralymphatic sites A- no sxB - fever, wt loss, night sweats

93

Hodgkin has a strong association w/what virus?

EBV

94

How to tx Hodgkin?

Stage I, II, and IIIA - radiationStage IIB, IV - chemo

95

Pt has painless lymph node + abdominal pain/hepatosplenomegaly + anemia? Labs -diagnostic?

non hodgkin lyphoma labs: lymph node bx - 4wks-diagnostic

96

What is low, inter, and high grade non hodgkin? Which are B cell and T cell origin?

low: elderlyintermediate: middle agedHigh grade: kids B cell origin: low and intermedT cell origin: high

97

Rapid progressing tumor - non hodgkin? Common in? What to expect on bx?

burkitkidsstarry night

98

What is mycosis fungoides?

t cell lymphoma of the skin

99

Pt has acute renal failure after chemo? What to expect on labs?

tumor lysis syndromeHYPERkalemiaHYPERuricemiaHYPERphosHYPOcalcemia

100

Tx for acute lymphocytic leukemia?

chemo-good prognosis

101

What are the two types of acute leukemia?

acute myelogenous (AML)acute lymphoblastic (ALL)

102

Pt is adult (40-60yo) w/ pancytopenia after radiation? What to expect on labs?

acute myelogenous labs: aure rods

103

Pt is >60yo coming in for annual exam and find isolated increase in WBC? How is this staged?

Chronic lymphocytic leukemia stage 0- lymphocytosisstage I - lymphadenopathystage II - organomegalystage III - anemicstage IV - thrmboctopenic

104

How to dx chronic lymphocytic leukemia? Tx?

bone marrow bxsupportive

105

How phases are there in chronic myelogenous leukemia? What would you see on lab? Tx?

crhonic, accelerated, blast crisisphiladelphia chromosomeimatinib

106

Pt has severe prutitus after a hot bath or shower? What to see on lab?

polycythemia vera lab: high RBC ct, B12; low erythropoietin

107

Polycythemia vera tx?

phlebotomy

108

Polycythemia vera at risk for-life threatening?

thrmobitc (DVT, CVA, MI)bleeding- GI bleeding

109

Pt has exposure to radiation and now has anemia with pancytopenia? Tx?

myelodysplastic syndrome (MDS)supportive