question

Delivery of oxygen equation

answer

DiO2 = Cardiac Output * Hgb *%Sat

question

Next step (2) 1. Anterior rim/skin pallor 2. Syncope 3. Dyspnea on Exertion 4. Hgb <13

answer

Anemia 1. Mean Corpuscular Volume - Micro vs. Normo vs. Macro 2. Reticulocyte Index - Production (2%)

question

Next step (4) 1. Anterior rim/skin pallor 2. DOE 3. Syncope 4. Hgb <13 5. MCV <80

answer

Microcytic Anemia Iron Studies: 1. Ferritin 2. Iron 3. TIBC 4. %Sat

question

Destruction vs. Production Anemia test

answer

Reticulocyte Index 1. Increased Destruction >2% 2. Decreased Production <2%

question

Causes of (4) 1. Anterior rim/Skin pallor 2. DOE 3. Syncope 4. Hgb <13 5. MCV <80

answer

Microcytic Anemia 1. Iron Deficiency Anemia 2. Anemia of Chronic Disease 3. Thalassemia 4. Sideroblastic Anemia

question

Definition Macrocytic Anemia

answer

Cells are big

question

Definition Megaloblastic Anemia

answer

Impaired DNA synthesis - 5+ lobes on PMN cells

question

Next step 1. DOE 2. Anterior rim/skin pallor 3. Syncope 4. Hgb 100

answer

Macrocytic vs. Megaloblastic Anemia Blood Smear

question

Next step 1. DOE 2. Anterior rim/skin pallor 3. Syncope 4. Hgb 100 6. Blood smear = >5 lobes PMN

answer

Megaloblastic Anemia 1. B12 levels 2. Folate levels

question

Diagnosis 1. DOE 2. Anterior rim/skin pallor 3. Syncope 4. Hgb 100 6. Blood smear = >5 lobes on PMN 7. B12 and Folate levels equivocal 8. Methylmalonic Acid Elevated

answer

B12 Deficiency

question

Diagnosis 1. DOE 2. Syncope 3. Anterior rim pallor 4. Hgb 100 6. Blood smear = >5 lobe PMN 7. Folate/B12 equivocal 8. MMA normal

answer

Folic acid deficiency

question

Causes 1. DOE 2. Syncope 3. Anterior rim pallor 4. Hgb 100 6. Blood smear = <5 lobes PMN

answer

Nonmegaloblastic Macrocytic Anemia 1. Liver 2. EtOH 3. Drugs - chemo and retroviral (Zidovudine) 4. Metabolic - Leisch Nyhan

question

Next step (5) 1. DOE 2. Syncope 3. Anterior rim pallor 4. Hgb <13 5. MCV = 80-100

answer

Normocytic Anemia 1. LDH 2. Haptoglobin 3. Total Bili 4. Direct Bili 5. Smear

question

Diagnosis and Next Step 1. DOE 2. Anterior rim pallor 3. Syncope 4. Hgb <13 5. MCV = 80-100 6. LDH = Elevated, TBili = Elevated, Haptoglobin = Decreased

answer

Hemolysis Blood Smear

question

Diagnosis and Next Step 1. Anterior Rim Pallor 2. DOE 3. Syncope 4. Hgb <13 5. MCV = 80-100 6. LDH = Normal, Haptoglobin = Normal, TBili = Normal

answer

Hemorrhage Find the hole Plug Give blood

question

Causes (3) 1. Anterior Rim Pallor 2. DOE 3. Syncope 4. Hgb <13 5. MCV = 80-100 6. LDH = Normal, Hapto = Normal, TBili = Normal 7. Not bleeding 8. Reticulocyte Index <2%

answer

Normocytic Anemia Cancer - Leukemia, Myelodysplastic Syndrome Chronic Kidney Disease

question

Pathology (3) and Time Frame 1. Anemia 2. MCV > 100 3. Blood smear = >5 lobes neutrophils 4. Folate levels low

answer

Folate deficiency Pathology: 1. Dec Leafy greens - Chronic Alcoholic, Old depressed person 2. Pregnancy Time Frame: 3-6 week store

question

Treatment Chronic alcoholic 1. Hgb 100 3. Smear = >5 lobes on PMN 4. Folate low/equiv 5. MMA normal

answer

Folate deficiency 1mg PO folate

question

Patient pathology (4) and Time Storage 1. Hgb 100 3. Smear = >5 lobes on PMN 4. B12 level low or equiv 5. MMA level high

answer

B12 Deficiency Pathology: Animal products 1. Strict uneducated long term vegan Absorption Problem: 2. Pernicious Anemia 3. Crohn's Disease 4. Gastric Bypass Time Span: 3-10 years storage

question

Symptoms 1. Hgb 100 3. Smear >5 lobes/pmn 4. Low or equiv B12 5. High MMA

answer

B12 Deficiency Neuro symptoms: - Dorsal Column Medial Lemniscus 1. Two point discrimination 2. Proprioception - stomping foot, banging into things 3. Vibratory

question

B12 is absorbed

answer

Terminal Ileum

question

Treatment 1. Hgb 100 3. Smear >5 lobe PMN 4. Low B12 5. High MMA 6. IV B12 --> PO B12 --> Urine + for B12

answer

B12 Deficiency - Megalo Anemia Cause is: Strict uneducated vegan - PO B12

question

Treatment 1. Hgb 100 3. Smear >5 lobes/pmn 4. Vit b12 low 5. MMA high 6. IV B12 --> PO B12 --> Urine negative for B12

answer

B12 Deficiency - Impaired Absorption Cause is: Gastric bypass, crohn's, pernicious anemia - IV B12

question

Pathology and patient Hgb <13 MCV <80 Fe: Low Ferritin: Low TIBC: Elevated

answer

Iron Deficiency Anemia Pathology: Decreased Fe Patient: Slow bleeds 1. Old guy with colon cancer 2. Young woman with menometorrhagia *Not acute hemorrhage*

question

Next possibly step Hgb <13 MCV <80 Fe: Low Ferritin: Low TIBC: Elevated

answer

Iron Deficiency Anemia Bone Marrow Biopsy *Don't need to do this if you have labs*

question

Treatment (2) Hbg <13 MCV <80 Fe: Low Ferritin: Low TIBC: Elevated

answer

Iron Deficiency Anemia 1. Iron 324 mg 3x/Day 2. Stool softeners

question

Pathology and Person (3) Hgb <13 MCV <80 Fe: Low Ferritin: High TIBC: Low

answer

Anemia of Chronic Inflammatory Disease Pathology: Inflammation Person: Chronic Autoinflammatory, asymptomatic, Hg >8

question

Treatment (2) Hgb <13 MCV <80 Fe: Low Ferritin: High TIBC: Low

answer

Anemia of Chronic Inflammatory Disease 1. Nothing (don't need treatment for anemia just control disease) 2. Can use EPO

question

Pathology and Patient Hgb<13 MCV <80 Fe: Normal Ferritin: Normal TIBC: Normal

answer

Thalassemia Pathology: Globin Thalassemia Minor - Asx Thalassemia Major - Transfusion dependent

question

Alpha thalassemia mutations

answer

1 - asymptomatic (never see dont know have anemia) 2 - mild 3 - severe - transfusion dependent 4 - hydrops fetalis (never see - die)

question

Beta thalassemia mutations

answer

1 - mild 2 - severe - constant transfusion

question

Next step Hgb <13 MCV <80 Fe: Normal Ferritin: Normal TIBC: Normal

answer

Thalassemia Hgb Electrophoresis

question

Treatment and Follow-Up Hgb <13 MCV <80 Fe: Normal Ferritin: Normal TIBC: Normal Hgb Electrophoresis: Increased A2Y2 (HgF) and A282 (HgA2)

answer

Beta Thalassemia Minor - Asx Major - Transfusion F/u: Iron overload Hemosiderosis: Deferoxamine, desafarox *Not phlebotomy*

question

Pathology Hgb <13 MCV <80 Fe: Increased Ferritin: Doesn't matter TIBC: Doesn't matter Ringed sideroblasts (RBC with dark circle in it)

answer

Sideroblastic Anemia Path: Iron can't get out of mitochondria

question

Causes (3) Reversible sideroblastic anemia

answer

Alcohol Drugs Lead

question

Causes (2) Irreversible sideroblastic anemia

answer

B6 (pyridoxine) Deficiency (can't correct w/ B6) Myelodysplastic syndrome

question

Hemolytic anemia labs

answer

Decreased haptoglobin Indirect hyperbilirubinemia

question

Treatment (3) HbSS Hypoxia, infection, DKA, dehydration Acute pain

answer

Sickle cell acute crisis - oxidant stress IVF O2 Nsaids

question

Treatment HbSS Hypoxia, infection Chest pain

answer

Sickle cell acute chest - also for priapism or ARDS Exchange transfusion *not cath*

question

Vaccinations Autosomal Recessive African American Chronic Pain Anemia

answer

Sickle Cell Anemia 1. PCV 2. Meningococcus 3. H. flu 4. HBV

question

Next step Autosomal Recessive African American HgSS Aseptic necrosis of hip or fever

answer

Sickle Cell Dexa Scan

question

Complications Autosomal Recessive African American HgSS

answer

1. Vasoocclusive crisis 2. Splenic autoinfarction 3. Encapsulated organisms 4. Aseptic necrosis 5. Salmonella osteomyelitis

question

Daily treatment sickle cell

answer

1. Daily folate 2. Daily iron 3. Hydroxyurea 4. Hydration 5. Analgesia

question

Carrier state sickles ...

answer

1. Extreme conditions (mount everest) 2. Renal vein (increased risk for renal vein thrombosis)

question

G6PD genetics

answer

x-linked genetic disorder

question

Causes (5) Mediterranean man Hemolytic anemia

answer

G6PD Deficiency 1. Drugs - dapsone, primaquine 2. Infection 3. DKA 4. Foods - Fava beans

question

Diagnose with (3) Mediterranean man Hemolytic anemia

answer

G6PD Deficiency Blood smear: 1. Heinz bodies (inclusions in RBC) 2. Bite cells G-6-PD level weeks after the attack (too soon might be artificially normal)

question

Diagnose with Hgb <13 MCV 80-100 Decreased haptoglobin Increased indirect bilirubin Enlarged spleen Blood smear: Smooth, red, very round RBC Coombs test negative

answer

Hereditary spherocytosis Osmotic fragility test

question

Treatment Hgb <13 MCV 80-100 Decreased haptoglobin Increased indirect bilirubin Enlarged spleen Smear: Smooth, red, very round RBC Coombs test negative

answer

Hereditary spherocytosis 1. Severe HS: Splenectomy 2. Chill HS: Folate supplements

question

Causes (2) Hgb <13 MCV 80-100 Decreased haptoglobin Increased indirect bilirubin Cough, fever, chills Coombs test positive

answer

Cold Autoimmune hemolysis (IgM) 1. Mycoplasma 2. Mono

question

Antibody produced Hgb < 13 MCV 80-100 Decreased haptoglobin Increased indirect bilirubin Cough fever chills Coombs test positive

answer

Cold autoimmune hemolysis IgM against RBC at cold temperatures

question

Causes (5) Hgb < 13 MCV 80-100 Decreased haptoglobin Increased indirect bilirubin Pt with cancer Smear: smooth red very round rbc Osmotic fragility - Coombs test +

answer

Warm autoimmune anemia 1. Cancer 2. Autoimmune 3. Drugs - Penicillin, sulfa drugs, rifampin

question

Treatment (3) Hgb < 13 MCV 80-100 Decreased haptoglobin Increased indirect bilirubin Pt with cancer Smear: smooth red very round rbc Osmotic fragility - Coombs test +

answer

Warm autoimmune anemia Treat like autoimmune disease: 1. Steroids 2. Acute: IVIg 3. Refractory: Splenectomy

question

Cause Pt wake up with hematuria Abdominal pain: Venous thrombosis in intra-abdominal veins

answer

Paroxysmal Nocturnal Hematuria 1. PIG-A gene mutation 2. No GPI anchor (can't inhibit complement from fixation)

question

Diagnose with (2) 1. Morning hematuria 2. Abdominal pain

answer

Paroxysmal Nocturnal Hematuria 1. Steroids 2. Flow cytometry

question

Treatment (1) 1. Morning hematuria 2. Abdominal pain

answer

Paroxysmal nocturnal hematuria Anti-Ab Drugs: 1. Eculizumab

question

Symptoms Acute leukemia

answer

1. Fever 2. Night sweats 3. Bleeding 4. Infection

question

Cause Fever Night sweats Bleeding Bruising Petechiae Pallor Infection CBC: increase or decreased neutrophils Blasts on peripheral smear

answer

Acute myelogenous leukemia 1. Radiation 2. Benzene 3. Chemo 4. Transformation from other marrow cancers (CML, MDS)

question

Next step Fever Bruising Bleeding Petechiae Pallor CBC: increase or decrease in neutrophils

answer

Acute myelogenous leukemia Blood smear - blasts

question

Confirm diagnosis and requirement Bleeding Brusing Petechiae Fever CBC: increase or decrease in blasts Peripheral smear: blasts

answer

Acute myelogenous leukemia 1. Bone marrow biopsy = >20% blasts 2. Cytogenic analysis = neutrophils (myeloperoxidase)

question

Auer rods

answer

Acute myelogenous leukemia - M3 type (promyelocytic)

question

Treatment Fever Bruising Bleeding Petechiae Pallor CBC: increase or decrease neutrophils Peripheral smear: Blasts Cytogenic analysis: neutrophils (myeloperoxidase)

answer

Acute myelogenous leukemia 1. Idarubicin 2. Ara-C M3: Vitamin A

question

MOA Treatment of Fever Bleeding Bruising Petechiae CBC: increase/decrease PMN Peripheral smear: Blasts, auer rods Cytogenic analysis: neutrophls

answer

AML: M3 type (promyelocytic) 1. Vitamin A: all-trans retinoic acid induced development of blasts

question

Symptoms Acute lymphoid leukemia

answer

Pediatric patient (6 years old) Bleeding Bone pain

question

Next step 6 year old Bleeding Bone pain

answer

Acute lymphoid leukemia Peripheral smear: blasts (20% blasts make diagnosis)

question

Next step 6 year old Bleeding Bone pain Peripheral smear: blasts

answer

Acute lymphoid leukemia Bone marrow biopsy: >20% blasts Cytogenics

question

Treatment 6 year old Bone pain Bleeding Peripheral smear: blasts Bone marrow biopsy: >20% blasts Cytogenics

answer

Acute lymphoid leukemia 1. Chemotherapy (cyclophosphamide, doxorubicin, vincristine, and methotrexate) 2. Intrathecal prophylactic chemo-radiation with Ara-C or methotrexate

question

Gene associated with chronic myelogenous leukemia

answer

1. Philadelpha chromosome - 2. t(9,22) translocation 3. Overactivity of tyrosine kinase BCR-ABL

question

Presentation Chronic myelogenous leukemia

answer

1. Elevated white count 2. Abnormal percentage of neutrophils (>60% WBC, >90% PMNs)

question

Next step No symptoms Elevated WBC 60% WBC, 90% PMNs

answer

Chronic myelogenous leukemia Bone marrow biopsy

question

Treatment No symptoms Elevated WBC 60% WBC, 90% PMNs Bone marrow biopsy t(9,22)

answer

Chronic myelogenous leukemia Imatinib

question

Treatment Increase WBC Lymphocyte count >50 Bone marrow biopsy

answer

Chronic lymphoid leukemia Old: 1. NO symptoms: do nothing 2. Symptoms: chemo, fludarabine or rituximab-based Young <65: 1. Stem cell transplant

question

Symptoms Lymphoma

answer

1. Nontender lymphadenopathy 2. Fever 3. Night sweats 4. Weight loss 5. Pel-Epstein fevers (come and go over weeks)

question

Next step 1. Painless lymphadenopathy 2. Pel-Epstein Fever 3. Night sweats 4. Weight loss

answer

Possibly Lymphoma - Excisional biopsy 1. Lymph node biopsy 2. Reed-sternberg cells (abnormal B cells) *not Fine-Needle Aspiration*

question

Next step 1. Pel-Epstein fever 2. Nontender lymphadenopathy 3. Weight loss 4. Night sweats 5. Excisional biopsy: Reed-Sternberg cells

answer

Hodgkin's Lymphoma Stage: 1. Chest X-ray 2. PET/CT of chest/ab/pelvis 3. Bone marrow biopsy

question

Treatment 1. Pel-epstein fevers 2. night sweats 3. weight loss 4. Excisional biopsy: reed sternberg cells 5. Cxray, Pet/ct, Bone marrow biopsy

answer

Hodgkin's lymphoma ABVD: Adriamycin/Doxorubicin Bleomycin Vinblastine Dacarbazine

question

Symptoms (5) Multiple myeloma

answer

1. Old 2. Weird fractures 3. Renal failure 4. Hypercalcemia 5. Increased protein gap

question

Next step 1. Old 2. Weird fractures 3. Renal failure 4. Hypercalcemia 5. Elevated protein gap

answer

Multiple myeloma 1. Serum protein electrophoresis (Hgb electrophoresis) - M spike 2. Urine protein electrophoresis - Bence Jones

question

Next steps (2) 1. Old 2. Weird fracture 3. Renal failure 4. Hypercalcemia 5. Elevated protein gap 6. Serum protein electrophoresis - M-spike 7. Urine protein electrophoresis - Bence Jones

answer

Multiple Myeloma 1. Bone Marrow Biopsy - >10% Plasmacytosis 2. Skeletal Survey - Lytic lesions *not a bone scan*

question

Treatment 1. Old 2. Weird fracture 3. Hypercalcemia 4. Renal failure 5. Elevated protein gap 6. Spep - m spike 7. Upep - bence jones protein 8. Bone marrow - >10% plasmacytosis 9. Skeletal survey - lytic lesions

answer

Multiple Myeloma 1. >75: Just chemo 2. <75: Chemo and stem cell transplant (Melphalan + Prednisone and Thalidomide or Bortezomib)

question

Symptoms Monoclonal Gammopathy of Uncertain Significance

answer

1. + SPEP - M spike 2. Negative bence jones 3. Negative lytic lesions 4. Negative renal failure 5. Negative hypercalcemia 6. Plasmacytosis <10%

question

Symptoms Waldenstrom's Macroglobulinemia

answer

1. Peripheral Neuropathy 2. Hyperviscosity syndrome

question

Cause 1. Peripheral neuropathy 2. Hyperviscosity syndrome

answer

Waldenstrom's Macroglobulinemia - Plasma cell secretes IgM

question

Next step Peripheral neuropathy Hyperviscosity syndrome

answer

Waldenstrom's Macroglobulinemia 1. Spep: M-spike 2. Skeletal survey - no lytic lesions 3. Bone marrow biopsy - Lymphoplasmacytic lymphoma >10% of bone marrow

question

Treatment 1. Hyperviscosity syndrome also has peripheral neuropathy

answer

Waldenstrom's Macroglobulinemia Plasmapheresis

question

Treatment 1. Hyperviscoscity syndrome 2. Peripheral neuropathy 3. Spep - M-spike 4. Skeletal scan - no lytic lesion 5. Bone marrow biopsy - Lymphoplasmacytic lymphoma

answer

Waldenstrom's Macroglobulinemia 1. Rituximab

Hematology Oncology – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards