Lecture 2 (hem/on)-Exam 1 Flashcards by Ashley Ruehle

What is hematopoiesis?

Normal cells can transform into malignant cells at any point in this process

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What are the 5 main categories of hematological malignancies?
What is the gold standard?

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Acute Leukemias
* Aggressive malignancies characterized by what?
* What are the labs?
* What are the sxs?

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What is this?

Auer rods

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Acute Myeloid Leukemia (AML)
* What are the risk factors?
* What is diagnostics?
* What is pathognomonic?
* What is the txt?

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Acute Lymphoid Leukemia (ALL)
* Most common what?
* Sxs as AML, except what?
* What is diagnostic?
* What lineage?
* As with AML, treatment is what?

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What is does the CSF?
What is ommaya reservoir?

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Chronic Myelogenous Leukemia (CML)
* Malignacy of what?
* What is average onset?
* What is sxs?
* What is it caused by?

Malignancy of mature granulocytes
Average onset 55-65 years old with mean WBC count of 150,000
Signs/symptoms: asymptomatic vs fatigue, low grade fever, splenomegaly
Caused by a translocation between chromosomes 9 & 22, t (9,22)- the Philadelphia (Ph) chromosome or BCR-ABL gene

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Chronic Myelogenous Leukemia (CML)
* How do you dx?
* What is txt?

Bone marrow biopsy with left shift/granulocytosis, blasts <20%, & BCR-ABL mutation
Treatment: oral tyrosine kinase inhibitors, which inhibit the bcr-abl oncogene, ie imatinib (Gleevec®) & dasatinib-> inhibts philadelphia

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Chronic Lymphocytic Leukemia (CLL/SLL)
* Malignancy of what?
* Average age?
* What is sxs?

Malignancy of mature lymphoid cells
Average onset 70 years with mean WBC >20,000- predominantly lymphocytes
Signs/symptoms: Asymptomatic vs fatigue, splenomegaly, lymphadenopathy, hemolytic anemia, ITP

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Chronic Lymphocytic Leukemia (CLL/SLL)
* what is dx?
* What is txt?

Diagnosed by peripheral blood flow cytometry, bone marrow biopsy, or lymph node biopsy. Smudge cells on peripheral blood smear.
Therapy: Observation vs Bruton’s TKIs (ie ibrutinib), monoclonal antibodies, chemotherapy (purine analogs, alkylating agents)

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What is this?

smudge cells in CLL

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Lymphomas
* Malignacies of what?
* What types?
* sxs?

Malignancies of mature lymphocytes in lymph tissue
Hodgkin’s vs Non-Hodgkin’s
Signs/symptoms: lymphadenopathy, splenomegaly, hepatomegaly, and “B” symptoms (fevers, drenching night sweats, unintentional weight loss >10% in 6 months)

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Lymphomas
* What are labs?
* some types are associated with what?
* What is needed for dx?

Labs: Lymphocytosis, anemia, thrombocytopenia, LDH elevation, & hypercalcemia
Some types are associated with viruses like EBV or HIV
Tissue biopsy required to confirm diagnosis

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PET/CT scan will show what in lymphoma?

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When to suspect lymphoma:
* What is the difference in lymphoma and benign?

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What is this?

Lymphoma

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Hodgkin’s Lymphoma
* Type of B-cell lymphoma with what?
* Peak age?
* Predom what?
* Presents with what?
* What staging system?
* What is the txt?

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What is this?

Reed sternberg cell

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Non-Hodgkin’s Lymphoma
* More or less common?
* What are examples?
* What is the staging system?

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Non-Hodgkin’s Lymphoma
* what is the txt?

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Multiple Myeloma
* What is it?
* What is the median age?
* What are the sxs?

Malignancy of plasma cells, mature B cells that produce immunoglobulins (antibodies)
Median age at diagnosis is 67 years
Signs/symptoms: CRAB criteria, Calcium, Renal insufficiency, Anemia, & Bone lesions

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Multiple Myeloma
* Dx?
* What staging system?
* What is the txt?

Diagnosed by bone marrow biopsy & M-spike in serum or urine; Rouleaux formation on peripheral blood smear
Durie-Salmon or International Staging System
Treated with chemotherapy +/- bone marrow transplant +/- palliative radiation or kyphoplasty. CAR-T cell therapy in some cases.

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What does this show?

Waldenstrom’s Macroglobulinemia * What is it? * Median age? * What are the sxs? * What is the txt?

Amyloidosis * What is type of disorder? * What are the signs? * Dx? * What is the txt?

Myelodysplastic Syndrome (MDS) * What type of disease? * More common in who? * What types of forms?

Myelodysplastic Syndrome (MDS) * What are the labs? * What are the sxs? * What are the dx?

Myelodysplastic Syndrome * What is the staging system? * What are the types? * Can evolve into what? * What is the txt?

Myeloproliferative Disorder/Neoplasm * Group of what? * Associated with what? * May evolve into waht? * What is the hallmark PE finidng? * With exception of primary myelofibrosis, presents as elevated what? * How do you dx?

Polycythemia Vera * Disorder of what? * What are the sxs? * What are the labs? * What do you need to rule out? * What is the txt?

Essential thrombocythemia * What is this? * What are the labs? * What do you need to rule out? * What are the sxs? * What is the txt?

Primary Myelofibrosis * disorder of what? * Gender? Age? * Sxs? * What are the labs? * What is the txt?

What does this show?

Primary myelofibrosis

* Myelodysplastic syndrome * Myeloproliferative neoplasms

* Myelodysplastic syndrome is a disorder of underproduction * Myeloproliferative neoplasms are disorders of overproduction

Summary: * Hematological malignancies and related disorders may present with what? * A peripheral blood smear may reveal what? * Lymphomas present with what? * Acute leukemias present with what? * Multiple myeloma presents with what? * what are are often found incidentally on routine CBC? * What is needed to rule in/out a hematological malignancy ?

What is cancer?

Cluster of diseases caused by genetic changes & result in unrestrained cellular growth

What are the 6 hallmarks of cancer?

1. Resisting apoptosis/cell death 2. Sustaining proliferative signaling 3. Evading growth suppressors (immune system)-> evade immune system 4. Activating invasion and metastasis 5. Enabling replicative immortality 6. Inducing angiogenesis-> | “Cancer” probably from Greek word for crab

Multi step process of discrete tissue and cellular changes * Include mutations of what (2)

1. Oncogenes, genes which increase growth when mutated or upregulated (growth of cancer), like K-RAS 2. Tumor suppressor genes, like P53 | Inflam ex IBD: higher risk of malignancy

Examples of pre-malignant lesions: * Skin: * Colonic mucosa: * Breast tissue: * Cervical tissue: * Bone marrow:

* Skin: actinic keratoses * Colonic mucosa: adenomatous polyps * Breast tissue: ductal papillomas * Cervical tissue: dysplasia * Bone marrow: MDS

What is the process of this * Colorectal cancer: * Pancreatic ductual adenocarcinoma:

Tumor Terminology: * Tumor: * Neoplasm: * Carcinoma: * Sarcoma: * Carcinogenic: * Cancer:

* Tumor: swelling or growth * Neoplasm: new growth, focal, non-functional * Carcinoma: cancer of epithelial origin * Sarcoma: cancer of mesenchymal origin * Carcinogenic: tendency to cause cancer * Cancer “in situ”: malignant, contained epithelial tumor

Tumor Terminology * Benign: * Malignant: * Dysplasia: * Dysplasia: * Metaplasia: * Exophytic: * Endophytic:

* Benign: upregulated growth without invasion * Malignant: upregulated growth with invasion * Dysplasia: abnormal, atypical cell growth * Metaplasia: change from one tissue type to another * Exophytic: growth outward from surface * Endophytic: growth downward from surface

Cancer screening: * Cervical Cancer: * Breat cancer: * Colorectal cancer:

* Cervical cancer: PAP smear (cytology), HPV testing * Breast cancer: mammograms, clinical or self examinations, Breast MRI * Colorectal cancer: colonoscopies, fecal occult blood testing, fecal DNA testin

Cancer screening: * Prostate exam: * Lung cancer: * Skin Cancer: * Ovarian Cancer:

* Prostate exam: PSA level, digital rectal exam * Lung cancer: low dose CT chest scan * Skin cancers: complete skin exam * Ovarian cancer: CA-125, transvaginal ultrasound

Multi-cancer detection (MCD) tests are what? * These signals are known as what? * What are they developed to screen for?

* Multi-cancer detection (MCD) tests are tests that measure biological signals in body fluids that may be shed by cancer cells. * These signals are also known as biomarkers or tumor markers. * MCD tests are being developed to screen for cancers from more than one organ site at the same time. ## Footnote Like all screening tests, the MCD assay itself does not diagnose cancer.

Current MCD tests measure different biological signals in blood plasma, such as: (5)

*Changes in DNA and/or RNA sequences, *Patterns of DNA methylation (a chemical change to DNA which changes how the gene product is expressed), *Patterns of DNA fragmentation (how the DNA is broken into smaller pieces) *Levels of protein biomarkers, and *Antibodies that a person may develop against components of growing cancer cells. Research scientists continue to search for new technological approaches that may expand this list to measure even more biological signals (e.g., what your body’s immune cells are actively searching for).

Diagnosing cancer: * What is the gold cancer? * Types of tissue samples? * What is the imaging? * What are the serum markers?

* Gold standard for diagnosis of any cancer is a **tissue sample** * Types of tissue samples: exfoliative cytology (ie PAP smear), fine needle aspiration, needle core biopsy, incisional biopsy, excisional biopsy * **Imaging**: radiographs, CT scan, MRI, nuclear medicine bone scans, PET scans * **Serum** markers: CEA, CD19-19, AFP, bHCG, M-spike

Staging cancer: * What is most widely used? * What contributes to prognosis?

* TNM (tumor, node, metastasis) most widely used * Increasingly, biologic features also contribute to prognosis

How do you do the TNM staging?

Metastases * What is it? * What are the routes?

* Migration of neoplastic cell of solid tumor to abnormal location * Routes include blood, lymph, CSF, and serous cavities (pleural, peritoneum, pericardium)

What are oncological complications?

Infections: * Skin * GI * CNS * Pulmonary

* Skin: Cellulitis, Ecthyma gangrenosum, abscesses, Sweet’s syndrome, erythema multiforme * Heme: bacteremia * GI: Oral/esophageal/hepatic candidiasis, HSV stomatitis, typhlitis, C diff colitis * CNS: meningitis, encephalitis, toxoplasmasmosis * Pulmonary: pneumonia (including PCP & aspergillus), pneumonitis, upper respiratory infections

Infections: * Cardiac * endocrine * MSK * Renal

* Cardiac: Endocarditis, infectious myo- or peri-carditis * Endocrine: candida of thyroid, CMV of adrenal glands * MSK: septic arthritis * Renal: UTIs, BK cystitis, pyelonephritis

Malnutrition: * occurs due to what? * May lead to what? * Assessment using labs and PE? * Requires what? * Consider what?

* Occurs due to combination of anorexia & hypermetabolism (due to cancer tx) * May lead to cachexia (severe protein and calorie malnut) * Assessment using labs (albumin, prealbumin, triglycerides) and physical exam (weight loss, temporal wasting) * Requires intervention if >10% weight loss from pre-cancer baseline * Consider appetite stimulants, protein shakes, or supplemental feedings

What is this?

Paraneoplastic Syndrome: * What is it? * tumor may express what? What are examples? * What is common wiht non small cell lung cancer? * What is also possible?

* Ectopic production of hormone by a tumor * Tumors may express protein encoded by DNA of normal glandular tissue * Examples: ADH, ACTH, PTH, and erythropoietin * SIADH common with non small-cell lung cancer * Paraneoplastic neurologic syndrome also possible (Lambert-Eaton, Myasthenia Gravis)

What are the branches of oncology?

Goals of therapy: * What are the two types? * Depends on what? * What are the performance scores?

* Palliative vs curative * Depends on curability of the cancer and patient’s ability to tolerate therapy (physiologic reserve) * Performance scores: Karnofsky and ECOG

Medical Oncology & Immunotherapy: * Broad types of treatments: * Classes of cytotoxic chemotherapy agents: (2) * Given in cycles

Bone Marrow Transplant * Most are what? * What are the different types? * What are the sources? * What are the indications? * Donors matched to recipients based on what? * What are complications?

What is the allogenic transplant process?

Radiation Oncology * Ionizing radiation causes what? * Described in what? * May be used as what? * How is usually applied?

## Footnote Goal: optimize cancer cell dealth with the least amount radiation

Common side effects of chemotherapy or radiation

What is this?

Surgical oncology: * What is the goal? * May be what? * What is adjuvant therapy? * What is neoadjuvant therapy? * What man be removed? * Outside of tumor biopsy or resection, cancer patients may require what?

* Goal is to excise entire tumor * May be curable (stage 1), palliative (make you feel comfortable), or prophylactic (bilateral mascectomy) * Adjuvant therapy: systemic treatment given after surgical resection * Neoadjuvant therapy: systemic treatment given before surgical excision * Regional lymph nodes may be removed in some cases to decrease chances of metastasis * Outside of tumor biopsy or resection, cancer patients may require surgical intervention for complications of their cancer

What are the different medical devices in cancer patients? (7)

Measuring Response to Therapy * By what? * What is complete remission/response? * What is the partial remission/response? * Progressive disease? * What is the cure?

What does this show?

What are the different oncological emergencies?

Neutropenic Fever/Sepsis * What is neutropenia? * Fever definition in neutropenic patient? * Cancer patients undergoing cytotoxic chemo are are at higher risk of what? * What is prophylaxis?

* Neutropenia definition: absolute neutrophil count of <1000 on WBC differential; severe neutropenia is ANC <500 * Fever definition in neutropenic patient: Single oral temperature of ≥38.3°C (101°F) or a temperature of ≥38.0°C (100.4°F) sustained over a one-hour period * Cancer patients undergoing cytotoxic chemotherapy are at high risk due to decrease in myelopoiesis and possible breakdown of mucosal linings * Prophylaxis: antimicrobial therapy given to patients at high risk of neutropenic fever/sepsis

Neutropenic Fever/Sepsis * Typically requires what? * Requires immediate what? * What are common pathogens? * What is the work up?

Hyperleukocytosis/Leukostasis/ “Blast Crisis” * Occurs to patients with what? * What is hyperleukocytosis? * What is leukostsis? * Requires?

Tumor Lysis Syndrome * What is it? * Occurs in patients with what?

* Massive tumor cell breakdown with the release of large amounts of potassium, phosphate, and nucleic acids into the systemic circulation * Occurs in patients with high tumor burden, high proliferative tumor rate, or high sensitivity to cytotoxic chemotherapy

Features of tumor lysis syndrome: * What is elevated? (2) * What is decreased?

* Elevated uric acid and phosphorus levels→ acute kidney injury * Elevated potassium level → cardiac arrythmia or arrest * Decreased calcium level → seizures or tetany

Tumor lysis syndrome: * More common with what? * Prophylaxis is to high risk patients: * What is the txt?

Hyperviscosity syndrome: * Common with what? * What are the sxs? * What are the labs? * What is the txt?

Superior Vena Cava Syndrome * Compression of what? * What is the sxs? * How do you dx? * What is the txt?

Summary: * Cancers what? * Healthy tissue changes to cancer by what? * The most common staging system is what? * Tissue sample is required for what? * What is the most common cause of mortality in cancer patients? * Fever in a neutropenic patient is always what?

What are the transfusable blood products?

Blood Product Donation * What are the sources? * What is the donor inclusion/exclusion criteria? * Methods? * What are the post collection testing?

Blood Typing * What system is the most important? * What are the types? * What is most common? * What is least common? * What is the universal donor and receipent? * What is trauma blood?

Rhesus (Rh) system * What is D antigen commonly referred to as? * Sensitization may occur from what? * What is given?

* ~50 antigens identified, but only D antigen is commonly referred to as “Rh positive” or “Rh negative” * Sensitization (alloimmunization) may occur from transfusions or pregnancy * Rh immunoglobulin, ie Rhogam®, is given to Rh neg pregnant women to prevent erythroblastosis fetalis

Indications for Transfusions * Not based on what alone? * Decisions also based on what? * Main goal of RBC transfusion is what? * What is the main goal of platelet?

Indications for Transfusions * What are the four causes of RBCs?

Indications for Transfusions * What are the four causes of platelets?

What is fresh frozen plasma or cryoprecipitate?

Preparing the patient for transfusion from a donor source Options for pre-transfusion testing: * What is the type and hold? * What is the type and screen? * What is the type and crossmatch? * No typing?

Autologous Transfusions * What is this? * Stored as what? * Often used when? * Other possible uses?

Transfusion Basics * A “unit” is what? * 1 unit RBCs (~300mL) raises Hgb by? * 1 pack of pooled platelets is what? How much does it raise the platelets? * Consider what?

Special Requests for RBCs: * Irradiated? * Washed? * Leukodeplete? * CMV negative? * Directed donor? * Same options with platelets plus:

Fresh frozen plasma: * Contains what? * Stored frozen for how long? * Thawed before what? * Increases coags by what? * Must be what?

Cryoprecipitate (“Cryo”) * Precipitate from thawed FFP, so what? * Indications?

Transfusion Reactions Introduction to Transfusion Reactions * Most are? * What are the types? * Typically to what? * The most common reactions are what? * When do transfusion reaction mc occur? * Whenever suspected, always do what?

Hemolytic Transfusion Reaction * Most often due to what? * Donor RBCs are lysed due to what? * What are the sxs?

Hemolytic Transfusion Reaction * What are the labs? * What are the txts?

Febrile Nonhemolytic Reaction * Common or rare? * What is the temp? * What are the sx? * Occurs due to what? * Increase risk when? * What is the txt?

Allergic Reaction * Spectrum of * Most are what? * What is the txt? * Anaphylactoid reaction or angioedema very rare?

Transfusion Related Lung Injury (TRALI) * Acute lung injury with what? * Due to what? * What are the sxs? * What are the dx? * What is the tx? * What needs to happen in future?

Delayed Immunologic Complications Delayed Hemolytic Reaction * Occurs when? * Causes what? * What is the tx? * What is txt?

Alloimmunization * Sensitization to RBC antigen with what? * Primary immunization occurs when? * With subsequent transfusions, patient may have what? * What will be positive?

GVHD due to Transfusion * Occurs when? * May present as what? * Dx made by what? * What is the txt

Transfusion Related Circulatory Overload (TACO) * Presents as what? * What are the sxs? * What are the labs? * What is there an increase risk of? * What is the management?

Transmission of Infectious Disease * Due to what? * Pt will present with what? * Clinically similar to what? * What maybe high? * Requires what? * May need what?

Hypothermia * What are the sxs? * What is the temp? * Highest with what? * What is recommended

Metabolic Disturbances/ Electrolyte Toxicity * What is hyperkaemia? * What is acidosis due to? What patient is at higher rate? * Hypocalcemia? * Iron overload/hemochromatosis? * Higher risk with what?

Summary: * Transfusion of blood products, such as RBCs or platelets, is what? * Blood product donors must meet what? * Blood products may be what? * Transfusions reactions are categorized as what? * A transfusion must immediately be stopped if what?

Lecture 2 (hem/on)-Exam 1 Flashcards

(111 cards)