Flashcards in Onc - MDS and Leukemias Deck (22):
Features of polycythemia vera?
#Headache, blurred vision, tinnitus
#Thrombosis and bleeding
Distinguishing between polycythemia vera and renal cell carcinoma as a cause for increased hematocrit?
Low versus high erythropoietin
Suspected polycythemia vera – non-CBC lab findings? Most accurate test? Increased risk to develop which cancer?
Conversion to AML
Treatment for polycythemia vera?
#Phlebotomy and aspirin (to prevent thrombosis)
#Hydroxyurea (to lower cell count)
#allopurinol or rasburicase (to protect against uric acid rise)
#Antihistamines (to prevent pruritis following warm showers)
Essential thrombocytosis – clinical sign? Treatment?
Erythromelalgia – Painful red hands
If under 60, asymptomatic, and platelet count under 1.5 million no treatment
If patients over 60, thromboses or platelet count over 1.5 million:
#aspirin for Erythromelalgia
Patient with essential thrombocytosis presents after beginning hydroxyurea – now has red blood cell suppression. Switch to which medication?
Anagrelide (inhibits platelet maturation)
Teardrop shaped cells and nucleated RBCs suggest what diagnosis? Treatment?
Thalidomide and Lenalidomide (TNF-a inhibitors that increase bone marrow production)
Patient presents with infection and pancytopenia after a long history of myelodysplastic syndrome – need to rule out? Best initial test? Most accurate test?
Blood smear will show blasts
Leukemia patient presents with Eosinophilic inclusions in white blood cells – type of leukemia? Associated associated with what genetic mutation?
AML (auer rods)
Translocation between chromosomes 15 and 17
Best indicator of prognosis in acute leukemia?
Cytogenetics (specific chromosomal characteristics)
Treatment for patients with promyelocytic leukemia?
Complication of promyelocytic (M3) leukemia?
Chemotherapy + intrathecal methotrexate to prevent CNS relapse
Patient presents with pruritis, splenomegaly, night sweats, fever and high WBC count with increased basophils - suspected diagnosis? Most accurate test? Best initial treatment? Can be cured with? If untreated, can result in?
PCR or FISH for BCR-ABL
Tyrosine kinase inhibitors (imantinib)
Bone marrow transplant
Patient presents with acute leukostasis reaction (extremely high white blood cell count) – Next step?
Leukapheresis to remove excess WBCs (more important than getting a diagnosis)
Patient over 60 presents with asymptomatic pancytopenia on CBC. CBC shows bi-lobed neutrophils – suspected diagnosis? Other lab findings? Usual cause of death?
Myelodysplastic syndrome (pre- leukemia disorder)
Bleeding and infection
Myelodysplastic syndrome – treatment?
#Transfusions (azacitadine decreases transfusion dependence)
#lenalidomide if patients have 5Q deletion (better prognosis)
Smudge cell seen on smear – suspected diagnosis? Clonal proliferation of?
Stages of CLL? (And treatment?)
Stage 0 – elevated WBC (none)
Stage 1 – lymphadenopathy. (None)
Stage 2 – Hepatosplenomegaly (fludarabine + rituximab)
Stage 3 – anemia (fludarabine + rituximab)
Stage 4 – thrombocytopenia (fludarabine + rituximab)
Patient with refractory CLL – treat with?
Autoimmune thrombocytopenia or hemolysis?
Antibiotic prophylaxis in CLL?