ITE Heme/Onc Flashcards by Laurence Lenz

What is PRCA caused by?

parvo typically

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How to treat PRCA?

IVIG

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Initial imaging modalities used for patients with monoclonal gammopathy ?

Low-dose CT

then PET-CT

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A whole-body low dose CT scan negative for smoldering myeloma should be followed by what?

whole-body MRI

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Guidelines state that patients treated for Multiple Myeloma with proteasome inhibitors (bortezomib) should receive what type of prophylaxis?

Antiviral (acyclovir, valacyclovir) to avoid herpes zoster

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What is acute chest syndrome?

SS anemia; where pulmonary vasculature is occluded by sickled cells

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What is the treatment for acute chest syndrome in SS patient’s?

erythrocyte exchange transfusion

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Most appropriate long-term treatment for high risk antiphospholipid syndrome?

Warfarin

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What should patients with diagnosed Polycythemia Vera (PV) always be treated with?

Phlebotomy and aspirin (goal hematocrit should be 45%)

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High Risk Polycythemia Vera with additional risk factors including older age (>60) or a hx of thromboembolic event should receive what?

cytoreductive therapy: hydroxyurea or interferon-alpha in addition to phlebotomy

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What is the treatment of choice for red blood cell aplasia related to parvovirus?

IVIG

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Should you always scan a pregnant patient that you suspect a PE in the setting of an elevated D-Dimer? Why or why not?

No. D-dimer elevation is common in pregnancy and you do not want to subject patient to unnecessary radiation

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What other drug would you want to add if patient was started on Bortezomib? (Hint: think prophylaxis)

Herpes Zoster prophylaxis: Valacyclovir

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If you suspect Acute Chest Syndrome (ACS) in someone with sickle cell anemia, what is the first thing to do for management?

Erythrocyte Exchange Transfusion

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What treatment should patients with anti-phospholipid be placed on?

Warfarin

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What is the most appropriate initial management for PV patients when first diagnosed (especially if they are not exhibiting signs/symptoms)?

Low dose aspirin and phlebotomy

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What are medicinal options for patients with PV and symptoms (or frequent phlebotomy)?

Hydroxyurea and interferon-alpha

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What agent is indicated in PV when patient is symptomatic and has resistant symptoms (1st line therapy failed)?

Ruxolitinib

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Characterized by anemia, reticulocytosis, elevated LDH, low haptoglobin and an indirect bilirubinemia

Hemolytic Anemia

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How to confirm diagnosis of Warm Autoimmune Hemolytic Anemia?

Direct Antiglobulin Test (DAT)

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How to reduce risk of febrile neutropenia when initiating chemotherapy?`

Start G-CSF at the time of chemotherapy

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Increased aPTT pathway in setting of common post-surgical bleeding could indicate what?

Factor level decrease (Factor 8, 9 and 12)

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Difference between alpha thal trait and carrie?

Alpha trait: elevated MCV and anemia

Alpha carrier: no anemia and normal or decreased MCV

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Difference between alpha-thal and beta-thal?

Alpha-thal: normal hemoglobin electrophoresis

Beta-thal: abnormal hemoglobin electrophoresis

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Difference between beta thal minor and Hemoglobin E trait?

Beta thal: decreased Hgb A components Hemoglobin E trait: elevated Hgb E (>50%)

Patients with mild forms of hereditary spherocytosis should be monitored and placed on what medication?

folate

If patient, who has hereditary spherocytosis, develops transfusion dependence, symptomatic anemia, and massive splenomegaly, what is the indicated treatment?

Splenectomy

Platelet levels of gestational thrombocytopenia and ITP?

Gestational: rare and rarely go under 100k ITP: first trimester low platelets and less than 70k

(9;22) mutation is associated with what cancer?

CML

What's the treatment for CML?

Imatinib which is a TKI

Fever, dyspnea, hypotension, flank pain, and pink colored urine appearing shortly after blood transfusion

Acute hemolytic transfusion reaction; tx is volume expansion and supportive care

Prolonged aPTT time should prompt what diagnostic test?

Mixing Study

How to additionally treat HIGH-RISK acute myeloid leukemia after completing induction chemotherapy?

Stem Cell transplant

How to treat anemia of chronic inflammation?

Treat the source; for instance, if PMR is suspected, start prednisone

How to manage minimally symptomatic ITP?

glucocorticoids; only give platelet transfusion if platelets are between 10-20k

Sepsis patient who then develops low platelets, prolonged coag studies, low fibrinogen, and elevated D-Dimer

DIC

What level of platelets require a transfusion if patient is about to undergo an invasive procedure?

less than 50,000

How much should one unit of platelets transfused increase the total count?

20-30k

What drugs cause neutropenia?

Methimazole and thionamides

In older patients with splanchnic vein thrombosis or Budd-Chiari syndrome, what should be tested?

Myeloproliferative disorders; order a JAK-2 tyrosine Kinase test

What should you do in a patient with supratherapeutic INR less than 10 and is asymptomatic?

just watch and wait; follow up with INR weekly

INR greater than 10

Vitamin K

INR greater than 10 and life-threatening BLEEDING

Vitamin K and PCC should be administered

Patients with essential thrombocythemia who have JAK2V617F mutation, what treatment regimen should be started?

aspirin and hydroyxurea

The initial tests you should order with immune thrombocytopenic purpura should include what?

HIV and Hep C = early signs are low platelets

What medication do you use for life-threatening bleeding on dabigatran?

Idarucizumab

What medication do you use to reverse Factor Xa inhibitors (Eliquis, Xarelto)?

Andexanet alfa

What vaccines are indicated for a patient starting chemotherapy for MM?

13-valent pneumococcal 23-valent pneumococcal yearly influenza vaccine

What are some underlying causes of erythrocytosis?

Hypoxia = smoking and OSA must be treated first

Young age onset of bleeding symptoms and family history of bleeding; typically mucocutaneous, and menorrhagia and bleeding after minor procedures; aPTT would be normal or prolonged

vWD disease

Macrocytic anemia with MCV of 110-115 would commonly include what differential?

1. B12/folate deficiency 2. treatment of HIV infection with anti-retrovirals 3. Hydroxyurea

How to treat DIC?

Treat the underlying disorder (ie. sepsis) Also, platelet transfusions, cryoprecipitate, and fresh frozen plasma are provided as needed

How to treat Warm autoimmune hemolytic anemia when patient has Hgb less than 7 and is symptomatic and hemodynamically unstable?

HAVE TO STABILIZE; use cross type erythrocyte transfusion therapies to get blood counts up; think about autoimmune treatments after

What disease causes an IgM monoclonal gammopathy?

Waldenstroms macroglobulinemia (hyper IgM syndrome); can cause hyperviscosity

How to immediately treat hyperviscosity syndrome associated with Waldenstrom?

Plasmapheresis

Middle aged patient with headache, altered mentation, change in vision and hearing, nystagmus and ataxia

Hyperviscosity syndrome

Patient with hemolytic anemia with a positive direct antiglobulin test to anticomplement (C3) but, not IgG

Cold agglutinin

Cold agglutinin can arise as a primary process or secondary to what?

infection, lymphoproliferative disorder, autoimmune disease

What is the management of upper extremity DVT associated with central venous catheter?

Left in: continue AC until cath is removed up to 3 months removed: 3 months of AC

Which anticoagulant has lowest renal elimination?

Eliquis

Treatment of acute TTP?

Plasma Exchange with rituximab and glucocorticoids

How to reverse warfarin bleeding?

4-factor PCC

Protamine sulfate is used to reverse what?

heparin

Heterozygous C282Y mutation of HFE gene without H63D or S65C in hemachromatosis

No treatment

Management of superficial DVT that measures greater than 5cm?

6 weeks of oral DOAC

Patients requiring chronic blood transfusions should be monitored for what?

evidence of iron overload with serial ferritin measurements; consider MRI to evaluate if iron deposition is suspected in heart/liver

Patients requiring chronic blood transfusions should be monitored for what?

evidence of iron overload with serial ferritin measurements; consider MRI to evaluate if iron deposition is suspected in heart/liver

What is the treatment for secondary iron overload?

iron chelation therapy

What is the treatment for secondary iron overload?

iron chelation therapy

What factor is most specific to the liver when evaluating for coagulopathy of liver disease?

Factor 8

What are one of the medications that can cause hemolytic anemia associated with G6PD deficiency?

Nitrofurantoin

Patient who has newly diagnosed triple positive anti-phospholipid disorder should be initiated with what therapy in the hospital? What oral medication should be initiated after discharge?

Heparin bridge to warfarin

In patients taking DAP following coronary revascularization with significant hemorrhage, the best strategy is what?

discontinue Plavix and continue aspirin at least

How to treat Hemophilia A patients who are bleeding?

Factor 7; PCC; or porcine derived factor 8 concentrate

What medication can you give patient with MDS with 5q-cytogenic abnormality who are transfusion dependent?

Lenalidomide