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Heme_Onc

Hematology Oncology - Step 2 CK

QuestionAnswer
54 yo woman w/ (fatigue, decreased hematocrit, low MCV) + (elevated RDW and high platelet count) Microcytic Anemia - Fe def MCC (elevated RDW, thrombocytosis; Labs - low Fe, low ferritin, high TIBC)
54 yo woman w/ (fatigue, decreased hematocrit, low MCV) + (low serum Fe level, low TIBC, low retic ct, hx of RA) Anemia of Chronic Disease - (Labs - low serum Fe, normal ferritin, low TIBC), any chronic infectious or inflammatory diz can lead to this
54 yo woman w/ (fatigue, decreased hematocrit, low MCV) + (very low MCV, high RBCs, normal Fe studies) Thalassemia - normal iron studies; most accurate test is Hgb electrophoresis; do not tx pt w/ Fe
alcoholic w/ (fatigue, isoniazid tx, Hct 32%, high Fe, FOBT-) + (most likely dx) Sideroblastic Anemia - assoc w/ ALCHOHOLISM and LEAD poisoning (there are more drinkers than people exposed to lead); also assoc with isoniazid use and myelodysplasia
alcoholic w/ (fatigue, isoniazid tx, Hct 32%, high Fe, FOBT-) + (most likely dx, most ACCURATE dx test) Sideroblastic Anemia - Prussian blue stain; ringed sideroblasts - atypical, abnormal nucleated erythroblasts with granules of iron accumulated in perinuclear mitochondria
alcoholic w/ (fatigue, isoniazid tx, Hct 32%, high Fe, FOBT-) + (most likely dx, best INITIAL tx) Sideroblastic Anemia - no specific tx - remove toxic exposure or tx the myelodysplasia
pt w/ (fatigue, progressive dyspnea on exertion, low Hct, high MCV, hypersegmented neutrophils, high LDH, high INDIRECT bili) + (elderly pt, glossitis, peripheral neuropathy, high methylmalonic acid AND homocysteine levels) + (most likely dx) B12 def (megaloblastic anemia - high MCV) = (high homocysteine AND methylmalonic acid) + (NEUROLOGIC sx) - hypercellular bone marrow
pt w/ (fatigue, progressive dyspnea on exertion, low Hct, high MCV, hypersegmented neutrophils, high LDH, high INDIRECT bili) + (malnourished alcoholic, elevated homocysteine level) + (most likely dx) Folate def (megaloblastic anemia - high MCV) = high homocysteine ONLY - hypercellular bone marrow
pt w/ (sickle-cell, fatigue, low Hct, nl MCV, low retic ct) + (most likely dx) Parvovirus B19 - red-cell aplasia, low retic ct due to cessation of growth of RBC precursor cells (an otherwise non-infected sickle cell pt will have and increased retic ct)
pt w/ (sickle-cell, fatigue, low Hct, nl MCV, low retic ct) + (dx, most ACCURATE dx test) Parvovirus B19 infxn - PCR for DNA or IgM against the virus
pt w/ (sickle-cell, fatigue, low Hct, nl MCV, low retic ct) + (dx, best INITIAL tx) Parvovirus B19 infxn - tx w/ IVIG
pt w/ (sudden onset of fatigue, SOB, Hct 20%, high MCV, high retic ct, high LDH, high INDIRECT bili, low haptoglobin) + (hx of SLE, CLL, lymphoma or penicillin use) + (most likely dx) Autoimmune Warm Antibody Hemolytic Anemia; most ACCURATE test is a Coombs test; smear will be normal b/c hemolysis occurring in the spleen
pt w/ (sudden onset of fatigue, SOB, Hct 20%, high MCV, high retic ct, high LDH, high INDIRECT bili, low haptoglobin) + (recurrent episodes, large spleen, +FamHx, high MCHC) + (most likely dx) Hereditary Spherocytosis = (recurrent episodes, splenomegaly, high MCHC - b/c RBC membrane too tight to contain the amt of Hgb); most ACCURATE test = osmotic fragility test
pt w/ (sudden onset of fatigue, SOB, Hct 20%, high MCV, high retic ct, high LDH, high INDIRECT bili, low haptoglobin) + (MALE, sudden onset hemolysis, acute infxn, +/- sulfa drug use) + (most likely dx) G6PD def - X-linked; MCC of acute hemolysis is INFXN; assoc with primaquine, dapson, sulfa drugs and fava beens; best initial test - peripheral smear to look for Heinz bodies (inclusions w/i red blood cells composed of denatured Hgb) & bite cells
pt w/ (dark urine in the morning, U/A shows Hgb but no RBCs, CBC - dec RBC and low platelets, high LDH, high INDIRECT bili, high retic ct, hx of large-vessel thrombosis, low LAP) + (most likely dx) Paroxysmal Nocturnal Hemoglobinuria = (dark urine in the morning - overnight hemolysis, pancytopenia, signs of hemolysis)
pt w/ (dark urine in the morning, U/A shows Hgb but no RBCs, CBC - dec RBC and low platelets, high LDH, high INDIRECT bili, high retic ct, hx of large-vessel thrombosis, low LAP) + (most likely dx, most ACCURATE test) PNH Most ACCURATE dx test = CD55/59 Ag test which is low Other tests include the sugar/water and Ham's test - look for activation of complement
pt w/ (dark urine in the morning, U/A shows Hgb but no RBCs, CBC - dec RBC and low platelets, high LDH, high INDIRECT bili, high retic ct, hx of large-vessel thrombosis, low LAP) + (most likely dx, MCC death) PNH MCC of death is large-vessel thrombosis Less common complications - acute leukemia, aplastic anemia, myelodysplasia PNH is stem cell d/o
Created by: letmesee