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Hematology > test 2 > Flashcards

test 2 Flashcards

1
Q

what are most cases of malaria caused by?

A

P. falciparum & P. vivax

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2
Q

what is the characertistic clinical feature of malaria?

A

malarial paroxysm

cold stage - hot stage - sweat stage

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3
Q

how often do cycles of paroxysm happen for each type of plasmodium? vivax/ovale? malariae? falciprium? knowlesi?

A

knowlesi: every 24 hrs, quotidian
vivax/ovale: every 48 hrs, tertian
falciprium: asyncrhonous, every ~48 hrs, tertian
malariae: every 72 hrs, quartan

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4
Q

which plasmodium is associated with cerebral malaria?

A

P. falciprium

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5
Q

which plasmodium is associated with splenic rupture?

A

P. vivax or P. ovale

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6
Q

which plasmodium is associated with persistent low level parasitemia?

A

P. malariae

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7
Q

during which stage of plasmodium are RBC destroyed?

A

asexual stage

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8
Q

what are the 3 mechanisms o pathogenesis of anemia in malaria infxn?

A
  • RBC lysis by mature asexual intra-erhtyrocytic parasites
  • Suppression of erythropoiesis by cytokines
  • Destruction of RBC by spleen
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9
Q

what type of plasmodium can only infect reticulocytes with duffy blood grp determinants?

A

P. vivax

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10
Q

causes of hypoglycemia in malaria?

A

decr oral intake
depletion of liver glycogen
parasite consumption of glu
inhibition of gluconeogenesis by elevated TNF-alpha

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11
Q

which plasmodium is associated with shuffner dots on PBS?

A

P. vivax & P.ovale

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12
Q

which plasmodium is associated with band form on PBS?

A

p. malariae

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13
Q

who is at risk for babesia infxns?

A

immunocompromised, hx of tick bite,

dx: maltese cross

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14
Q

which antimalarial has poor therapeutic to toxic ratio?

A

quinine

can cause cinchonism, hypoglycemia

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15
Q

which antimalarial can kill hypnozoites in the liver?

A

primaquine

useful for killing P. vivax, ovale

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16
Q

which deficiency must you screen for prior to administration of primaquine?

A

G6PD

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17
Q

how long should you dose antimalarials for areas where P. vivax and P. ovale are endemic?

A

terminal prophylaxis with primaquine

weekly doses for 8 weeks or daily doses for 2 weeks

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18
Q

which types of plasmodium warrant radical cure?

A

P. vivax & P. ovale

need to be completely cleared from body, incl liver

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19
Q

typically how quick do sx resolve after ppl are tx’d for malaria?

A

48-72 hrs

parasetemia reduced by 75%

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20
Q

general difference b/w Ag and Ab?

A

Ag sit on surface of RBC

Ab float around

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21
Q

which types of Ab are primarily made with transfusions?

A

IgM, IgG

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22
Q

contrast intravascular & extravascular hemolytic transfusion rxn?

A

intravascular: severe & immediate, IgM, renal dysfxn, DIC, shock
extravascular: delayed, IgG, jaundice several days later

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23
Q

which type of hemolytic transfusion releases free HbG directly into circulation?

A

intravascular

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24
Q

which type of hemolytic transfusion causes cytokine storm?

A

extravascular

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25
Q

which type of Ab crosses the placenta?

A

IgG crosses the placenta (IgM doesn’t)

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26
Q

Can lewis Ab cause hemolytic disease of the newborn?

A

NO, lewis Ag do not appear until several months after birth

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27
Q

when do ABO Ag develop?

A

6th week of fetal life

adult levels not reach until 3 yo

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28
Q

when do ABO Ab develop?

A

6 months after birth

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29
Q

what type of Ab would a person with type A blood have?

A

anti-B antibodies

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30
Q

What type of Ab would a person with type O blood have?

A

both anti-A and anti-B antibodies

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31
Q

what type of Ab would a person with type AB blood have?

A

none

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32
Q

50% of the population is what blood type?

A

type O

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33
Q

in the Rh system, what D do caucasians have?

A

caucasians: DCe-R1

Af Am: Dce-R0

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34
Q

Rh Ab are what type of Ab?

A

IgG

can cause extravascular and delayed HTR if mismatch

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35
Q

when are doses of Rhogam given?

A

28 weeks, another after delivery

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36
Q

what does direct antiglobulin test (DAT) look for?

A
  1. in vivo Ab sensitization, detects IgG or complement on RBC
  2. detect autoAb and alloAb
  3. process: uses patient red cells to determine what is already stuck on them
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37
Q

what does indirect antiglobulin test (IAT) look for?

A
  1. in vitro Ab sensitization
  2. screen for unexpected Ab, ID unexpected Ab, compatibility testing
  3. process: incubate serum with RBC under conditions favorable for Ab to attach to Ag
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38
Q

what are the 3 components of compatibility testing?

A
  1. blood type
  2. Ab screen
  3. crossmatch
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39
Q

what type of D blood should a D negative recipiient receive?

A

should ONLY receive D neg

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40
Q

when transfusing RBC, what is the universal donor?

A

type O

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41
Q

when transfusing plasma, what is the universal donor?

A

type AB

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42
Q

is there any problem with using older pRBC?

A

no difference in clinical outcome

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43
Q

what is the best transfusion strategy?

A

restrictive strategies with lower Hb thresholds

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44
Q

what virus carried in WBC can affect a transfusion recipient if no leukoreduction used?

A

CMV (eliminated with leukoreduction)

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45
Q

why is irradiation used?

A

prevent transfusion assc’d GVHD

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46
Q

when is volume reduction used to prepare pRBC?

A

when circulatory overload is a concern (CHF, renal failure)

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47
Q

when to administer plasma?

A
  1. coagulation factor replacement

2. massive transfusions

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48
Q

can patients who have already received platelets make Ab to transfused platelets?

A

yup, Anti-HLA & anti-HPA are present

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49
Q

what is platelet refractoriness?

A

in future platelet transfusions, the transfused platelets may become quickly destroyed (alloaimmune & non-alloimmune)

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50
Q

how to tx alloimmune platelet refractoriness?

A
  1. give random platelet units
  2. crossmathc
  3. find platelets that do not have Ag that the Ab is directed towards
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51
Q

what is in cryoprecipitate?

A

Factors 8 & 13, vWF, fibrinogen

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52
Q

why use cryoppt in a bleeding patient?

A

fibrinogen replacement

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53
Q

what are the contents of the prothrombin complex concentrate?

A

vit K dependent factors, IgG, albumin

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54
Q

types of plasma derivatives

A

prothrombin complex concentrate, recombinant factor 8,, IVIG, albumin

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55
Q

when to use a massive transfusion?

A

coagulation abnormalities

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56
Q

level of risk assc’d with directed donation?

A

more risky for donor & patient

57
Q

what type of blood product would be best for trauma?

A

whole blood

58
Q

when assessing if you have febrile transfusion rxn, what is important to assess?

A

no other etiology of the fevers

59
Q

incr bp & hr is seen with what transfusion rxn?

A

TACO

60
Q

which type of transfusion rxn is seen with the 2 hit mechanism?

A

TRALI

  1. neutrophil sequestration & priming–>lung microvascular endothelial injury
  2. neutrophil activation–>damage to pulmonary capillary endothelium
61
Q

which transfusion rxn presents within 6 hrs with Fevers, chills, dyspnea, cyanosis, hypotension, acute pulmonary edema?

A

TRALI

62
Q

what are the official dx criteria for TRALI?

A
  1. onset within 6 hrs

2. hypoxemia–>O2sat

63
Q

use diuretics to tx TACO or TRALI?

A

TACO

TRALI is not a fluid overload issue

64
Q

what is the classic Ab against a RBC Ag?

A

Anti-Kidd

65
Q

which transfusion rxns can present with fever?

A
  1. febrile
  2. TRALI
  3. acute hemolytic
  4. TA-GVHD
  5. TTBI
66
Q

Can you give Rhogam to a mother to prevent HDFN when the mother already has anti-D formed?

A

nope

67
Q

when to give rhogam?

A
  1. mother Rh-, father Rh+
  2. mother Rh-, father unk Rh
  3. infant Rh+
68
Q

contents of CBC include what?

A

RBC, platelets, WBC (lymphocyte, monocyte, eosinophil, basophil, neutrophil)

69
Q

when is the WBC highest?

A

in a newborn period

normal: 9k-30k

70
Q

what % of leukocytes do neutrophils account for at birth?

A
  1. 50-60% at birth
  2. followed by transient rise within 12 hrs
  3. decr b/w 1 month-1 yr
  4. slow increase to 59% during adulthood
71
Q

what immature forms of neutrophils may you see on slide?

A

myelocyte, metamyelocyte, band neutrophils

72
Q

which type of WBC is highest in he first 2 days of life?

A

band cells

73
Q

what is the I:T ratio used for?

A

presence of infxn

74
Q

how to calculate I:T?

A

Immature cells / total neutrophils

75
Q

an I:T ratio >0.2 would indicate what about sepsis?

A

high suspicion for sepsis

76
Q

normal % for lymphocytes in newborn?

A

30% in newborn
60% @ 2 yo
35% in adulthood (after 12 yo)

77
Q

what is true of HbG and HCT levels at birth?

A

much higher than during adulthood

78
Q

which CBC values are at high point in newborn?

A

neutrophil, white count, HbG, HCT

79
Q

what are normal HbG values for cord blood?

A

14-22

80
Q

a venous HCT >65% indicates what?

A

polycythemia (incr in RBC mass)

81
Q

does a capillary sample or a venous sample run a higher HCT?

A

capillary sample

82
Q

downstream effect of polycythemia?

A

hyperviscosity–>decr blood flow to heart, brain, lungs, intestines

83
Q

the following sx indicate what? ruddy complexion, irritability, jitteriness, tremors, feeding difficulties, lethargy, apnea, cyanosis, respiratory distress, and seizures

A

polycythemia

84
Q

best way to tx polycythemia?

A

if sx, then exchange transfusion

if no sx, then observation & adequate hydration

85
Q

what is the red cell life span in newborns?

A

80 days

86
Q

what is the nadir Hbg reached in newborns?

A

full term: 9 at 10-12 weeks post birth

preterm: 6 at 6-8 weeks post birth

87
Q

how to calculate lower limit of MCV in children

A

70 fL + age in years

88
Q

how to calculate upper limit of MCV until adult limit of 96 is reached?

A

84 fL + (0.6 x age)

89
Q

what is polychromatophilia?

A

the ability of bone marrow to produce retics in response to RBC loss or breakdown

90
Q

what are the normal platelet ranges for kids?

A

150k-450k

same as adults

91
Q

what is the most common leukemia in adults

A

AML

92
Q

which myeloproliferative neoplasm is represented by high levels of fxnal RBC + low survival?

A

polycyhtemia vera

93
Q

which myeloproliferative neoplasm is represented by overproduction of megakaryocytes and no sx?

A

essential thrombocythemia

94
Q

which myeloproliferative neoplasm is represented by fibrosis + atypical megakaryocytes?

A

primary myelofibrosis

95
Q

immature pre-B cells or B cells are the cell type for what malignancy?

A

ALL

96
Q

mature B cells are the cell type for which malignancies?

A

CLL and lymphoma

97
Q

plasma cells are the cell type for what malignancy?

A

multiple myeloma

98
Q

Reed sternberg cells characterize what type of cancer?

A

Hodgkin lymphoma

99
Q

which neoplasm results in incr # small, round lymphocytes + smudge cells?

A

CLL

100
Q

multiple myeloma originate from what and are composed of what?

A

originate from lymphoid lineage, composed of mature B cells (plasma cells)

101
Q

define induction tx

A

Initial treatment given for cancer. The goal is induce remission of the disease by reducing the number of cancer cells to an undetectable level

102
Q

define consolidation tx

A

Treatment given following induction therapy. The goal is to eliminate any undetectable cancer cells.

103
Q

define maintenence tx

A

Therapy given after patient has achieved remission. The goal is to maintain the remission and reduce the risk of relapse.

104
Q

what is anemia?

A

reduction in number, volume of RBC

reduction in quantity of Hgb

105
Q

what concurrent diseases do you need to evaluate when assessing for anemia?

A

juvenile idiopathic anemia, SLE, renal disorders, malignancy, immunodeficiency disorders

106
Q

when are evaluations for anemia recommended?

A

9-12 months, kindergarten, adolescents

107
Q

HCT: Hgb ratio?

A

3:1

108
Q

Is iron deficiency anemia or thalassemia characterized by large RDW?

A

iron deficiency anemia

109
Q

incr WBC, low platelets indicate what type of syndrome?

A

Hemolytic uremic syndrome

110
Q

normal WBC, low platelets indicate what type of syndrome?

A

ITP

111
Q

what type of anemia is common in 9-24 month olds?

A 
iron deficiency anemia
due to (1) excessive milk intake (2) early milk intake prior to 1 year (3) blood loss
112
Q

10 month old presents with mild anemia (Hgb 10), decr MCV, incr RDW, incr TIBC (ferritin, transferrin low), incr retic count - what type of anemia?

A

iron deficiency anemia

113
Q

when to start Fe supplementation in newborns?

A

4 months

114
Q

which type of anemia follows a viral illness, and presents after age 1, with normocytic MCV, decr retic?

A

TEC

115
Q

which anemia is dx

A

Diamond Blackfan

116
Q

sx of iron overload include?

A

liver damage, congestive cardiomyopathy, endocrine dysfxn, hyperpigmentation

117
Q

what are the 3 types of sickle crises?

A
  1. vaso-occlusive (pain)
  2. aplastic crisis (drop in HCT, Hgb, retics)
  3. hemolytic/splenic sequestration
118
Q

what drug can be used to tx vaso-occlusive pain in sickle cell anemia?

A

hydroxyurea (incr HbF)

119
Q

what is aplastic crisis normally accompanied by?

A

Parvovirus B19 infxn

120
Q

how to prevent & tx aplastic crisis?

A

prevent: folic acid supplementation
tx: transfusion

121
Q

how are aplastic crisis and hemolytic crisis different in sickle cell patients?

A

aplastic: drop in retics (w/ drop in HCT, HGB)
hemolytic: rise in retics (w/ drop in HCT, HGB)

122
Q

how to dx hemolytic crisis in sickle cell patients?

A

DAT

123
Q

sickle cell predisposes a child to infxn by what sort of bacteria?

A

encapsulated (ie. S. pneumoniae, H influenza, N meningitidis) + salmonella
can use prophylactic PCN

124
Q

what % of cases of hepatocellular carcinoma are due to HCV?

A

60%

125
Q

what % of cases of hepatocellular carcinoma are due to HBV?

A

50-55%; most prevalent in Asia

126
Q

what is non-alcoholic fatty liver disease associated with?

A

diabetes, obesity, metabolic syndrome

127
Q

what health condition doubles your risk for hepatocellular carcinoma?

A

diabetes

128
Q

what are the milan criteria for liver transplant?

A

1 lesion

129
Q

in which cancers does radiation therapy replace surgery?

A

anal cancer, limited small cell lung cancer, esophageal, stage IIIB NSCLC

130
Q

in which cancers is radiation tx used as adjuvant tx?

A

breast cancer, skin cancer, prostate cancer, uterine/endometial cancer

131
Q

what is the most common form of radiation therapy?

A

EBRT: daily external delivery of photons (x-ray) given over several weeks

132
Q

contrast radiosensitive & radioresponsive

A

radiosensitive: tumor melts with RT
radioresponsive: tumor melts quickly (O2 rich cells undergo dsDNA breaks better)

133
Q

particle linear accelerators (electrons) is good for what type of cancers?

A

superficial lesions

134
Q

what is the radiosensitive phase of the cell cycle?

A

M/G2

135
Q

what is the radioresistant phase of the cell cycle?

A

S

136
Q

is hyperfractionation or hypofractionation good fr rapidly dividing cancers?

A

hyperfractionation

137
Q

photons are good for what type of cancers?

A

tx deep cancers

138
Q

which types of cancer have a “long shoulder”?

A

melanoma, renal cell carcinoma, sarcoma require a larger dose to get to the cell kill line

Hematology (3 decks)

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