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Hematology – Awesome

Random heme associations

QuestionAnswer
ringed sideroblasts Pb toxicity or myelodysplastic syndrome with 6 years to live
anemia in a person who's worked with batteries or a person who lived in an old building Pb toxicity, microcytic
Heinz bodies in B thalassemia major, it's a precipitation of alpha chains
walking like a soldier B12 deficiency because they can't feel their feet
Things that can cause folate deficiency A FOLIC DROP. Alcohol, Folate antag like MTX and pyrimethamine, OCPs, Low in diet, Infection, Celiac, Dilantin/phenytoin, Relative folate deficiency, Old, Pregnant
see hypersegmented neutrophils on smear vs hypo segmented neutrophils B12 or folate deficiency; hypo is myelodysplastic syndrome
burr cells on peripheral smear anemia of uremia
spur cells liver disease, can't absorb dietary fats
mechanical valve on warfarin in the aortic position and without additional risk factors - what is the pre-procedural anticoagulation recommendation? periprocedural anticoagulation is to stop warfarin 48 to 72 hours before the procedure and restart it within 24 hours after the procedure; bridging with heparin is usually not necessary
factors that increase the risk of vte include afib, >1 mechanical valve, ejection fraction <30%, a hypercoagulable state, and previous thromboembolic event, including stroke or transient ischemic attack
what is the recommendation for pre-procedural anticoagulation for patients with a mechanical valve and an increased risk of a thromboembolic event unfractionated heparin is begun intravenously when INR falls below 2.0, stopped 4 to 5 hours before the procedure, and restarted as early after surgery as possible along with warfarin and continued until INR is therapeutic again
patients with a mechanical heart valve and therapeutic INR who require emergent surgery - what to do with the anticoagulation? reversal of anticoagulation with transfusion of fresh frozen plasma may be performed
Things you test for if you want an anti-coag workup activated protein C resistance, factor V Leiden, the prothrombin gene mutation, antiphospholipid antibodies, a lupus inhibitor, antithrombin deficiency, protein C deficiency, and protein S deficiency
The difference between MGUS, smoldering myeloma, and multiple myeloma MGUS <10% plasma cells, <3g M protein smoldering >10% plasma cells, >3g M protein with NO organ damage multiple myeloma >10% plasma cells, >3g M protein WITH organ damage
MCV in Hereditary spherocytosis normal to high
When to do FISH to find diagnosis FISH in t(9,22) in CML
When to do flow cytometry to diagnose? Flow cytometry of the peripheral blood would be useful if a hematologic malignancy characterized by a homogeneous population of cells (acute lymphoblastic leukemia, chronic lymphocytic leukemia, non-Hodgkin lymphoma, or acute myeloid leukemia
10% or more clonal plasma cells on bone marrow biopsy multiple myeloma
acute thrombosis, warfarin therapy, and pregnancy can cause transient declines or increases in functional protein S levels declines
decreased protein S levels cause what hypercoaguability. activated protein C and S block conversion of F8 and F5 to their active forms. Therefore, increased C+S means more bleeding. decreased C+S means less bleeding, more coagulability.
macroglossia, hepatomegaly, nephrotic syndrome, peripheral neuropathy, and the presence of an IgG lambda M-protein AL amyloidosis
how to dx AL amyloidosis combination of bone marrow biopsy and abdominal fat pad aspiration has a sensitivity of approximately 90%
splenomegaly, a personal and family history of anemia, leg ulcers, gallstones, and spherocytes on the peripheral blood smear Hereditary spherocytosis
Pregnant women with a history of idiopathic venous thromboembolism should receive what for ppx? prophylactic-dose or intermediate-dose low-molecular-weight heparin (LMWH) during pregnancy and for 6 weeks postpartum
ppx for women with recurrent fetal loss and the antiphospholipid syndrome? Prophylaxis with both low-dose aspirin and low- or moderate-dose unfractionated heparin or LMWH
inheritance pattern for von Willebrand disease autosomal dominant
initial therapy of patients with immune thrombocytopenic purpura if pt is bleeding or if plt < 10K Corticosteroids and intravenous immune globuli
thrombocytopenia, microangiopathic hemolytic anemia, neurologic deficits, kidney impairment, and fever TTP
25% lymphoblasts or more on bone marrow examination B-cell acute lymphoblastic leukemia (ALL)
TdT-positive cells marker for lymphoid cells
CD10 and CD20 B-cell markers
BCR-ABL inhibitor imatinib used in CML or Philadelphia chromosome-positive ALL
how to treat B-cell acute lymphoblastic leukemia induction chemotherapy consisting of daunorubicin, vincristine, L-asparaginase, and prednisone
when to use Erythrocyte transfusion and exchange transfusion in sickle cells patients acute management of stroke and acute chest syndrome
alloantibodies to antigens C, E, and K on blood typing and screening increase the risk for what? delayed hemolytic transfusion reaction
The peripheral blood smear shows increased platelet numbers and circulating megathrombocytes but is otherwise normal essential thrombocythemia
platelet counts greater than 1 million/µL (1000 × 109/L) strongly suggests essential thrombocythemia
presence of (1) microangiopathic hemolytic anemia, characterized by schistocytes on the peripheral smear and increased lactate dehydrogenase, and (2) thrombocytopenia. thrombotic thrombocytopenic purpura
thrombocytopenia, microangiopathic hemolytic anemia, neurologic deficits, kidney impairment, and fever thrombotic thrombocytopenic purpura
thrombocytopenia and microangiopathic hemolytic anemia thrombotic thrombocytopenic purpura
how to treat thrombotic thrombocytopenic purpura plasma exchange, which should be instituted emergently at diagnosis because 10% of patients die of this disease despite therapy, usually within the first 24 hours
ANCs between 1000/µL and 1500/µL (1.0-1.5 × 109/L) Mild congenital asymptomatic neutropenia, common in certain ethnic populations, including blacks, Yemenite Jews, and Jordanian Arabs. This condition is not associated with increased infections and requires no therapy.
antineutrophil antibody assay evaluation of autoimmune neutropenia if the patient's neutropenia were to worsen
neutrophil elastase gene mutated in patients with severe congenital neutropenia, which is characterized by onset early in life and life-threatening infections
how to treat secondary iron overload from β-thalassemia major iron chelation with Deferasirox
what is side effect of Deferasirox or other iron chelators agranulocytosis and kidney failure
unprovoked venous thrombosis at an unusual location, hemolytic anemia, and mild to moderate pancytopenia paroxysmal nocturnal hemoglobinuria (PNH)
how to diagnose PNH diagnosis of PNH is made by flow cytometry, which can identify a subpopulation of erythrocytes or leukocytes lacking specific glycosylphosphatidylinositol-anchored surface proteins, such as CD55 or CD59
IgM κ M-protein level Waldenström macroglobulinemia
lymphoplasmacytic lymphoma characterized by production of monoclonal IgM antibodies Waldenström macroglobulinemia
how to treat hyperviscoscity in Waldenström macroglobulinemia plasmapheresis
what can be helpful in estimating the prognosis of thrombotic thrombocytopenic purpura (TTP) ADAMTS-13
seeing what on the PBS makes warm or cold autoimmune hemolytic anemia less likely presence of schistocytes on the blood smear makes warm or cold autoimmune hemolytic anemia unlikely
viruses that can cause aplastic anemia Epstein-Barr virus and cytomegalovirus infection can cause aplastic anemia, also ParvoB19
how to treat HIT direct thrombin inhibitors lepirudin(don't use in CKD because cleared by kidney), argatroban, and danaparoid Argatroban, which is cleared through the liver, requires dose adjustments in patients with elevated liver chemistry test values.
hypoxia, and dyspnea, as well as fever and hypotension, occurring during or within hours of a transfusion and resembles noncardiac pulmonary edema TRALI
Very early in the transfusion, affected patients develop hypotension and disseminated intravascular coagulation acute hemolytic transfusion reaction (AHTR) is most commonly caused by a clerical error leading to ABO incompatibilit
high Hct and high Epo vs high Hct and Low Epo high Hct and high Epo is secondary erythrocytosis from hypoxia (like OSA). high Hct and low Epo is PV
macroovalocytes and hypersegmented polymorphonuclear cells on the peripheral blood smear and hemolysis. B12 deficiency
glossitis, weight loss, and pale yellow skin, loss of position or vibratory sense that can progress to spastic ataxia B12 deficiency
Hereditary spherocytosis associated with what types of stones calcium bilirubinate gallstones
Created by: christinapham