Hematology

Front 1

How much does each unit of blood increase hematocrit?

Back 1

3-4 pts

Front 2

What is contained in cryoprecipitate and FFP?

Back 2

FFP has all clotting factors
cryopreceipitate has factor VIII and fibrinogen
(also vWD, and factor XIII)

Front 3

Indications for FFP and cryoprecipitate?

Back 3

FFP- High PT/PTT, deficiency of factors (liver failure, Vit K deficiency)

Cryoprecipitate - hemophillia A, vWD, decreased fibrinogen (DIC)

Front 4

Fe and TIBC are decreased?

Back 4

Anemia of chronic disease

Front 5

Fe decreased TIBC increased?

Back 5

Fe deficiency

Front 6

Fe normal, TIBC normal or decreased?

Back 6

lead poisoning, thalassemia

Front 7

What condition should be considered if macrocytosis is up to 115? up to 110?

Back 7

Liver disease

Stimulated erythropoeisis

Front 8

Treatment of beta thalasemia major?

Back 8

frequent PRBC transfusions
splenectomy if splenomegaly

Front 9

Electrophoresis finding in beta thalasemia minor?

Back 9

elevated A2

Front 10

Treatment of HbH disease?

Back 10

splenectomy is sometimes helpful
Transfusions

Front 11

Pathophysiology of sideroblastic anemia?

Back 11

Red cell Fe metabolism is impaired

Front 12

Causes of acquired sideroblastic anemia?

Back 12

Drugs - chloramphenicol, INH, alcohol
Lead exposure
Autoimmune illness
Neoplastic disease (myelodysplastic syndrome)

Front 13

Increased iron, ferritin, normal TIBC with microcytic hypochromic RBCs?

Back 13

sideroblastic anemia

Front 14

Supplement in sideroblastic anemia?

Back 14

pyridoxine

Front 15

Which medications cause aplastic anemia?
What infectious agents may cause aplastic anemia?
Toxins?

Back 15

chloramphenicol, sulfonamides, gold, carbamazepine
Parvovirus, hep c, hep b, EBV, CMV, herpes zoster, HIV
Benzene, insectasides, radiation

Usually idiopathic

Front 16

Treatment of B12 deficiency?

Back 16

Cyanocobalmin IM once per month

Front 17

Most common cause of folate deficiency? Other causes?

Back 17

Tea and toast diet; Alchohol, long term antibiotic use, increased demand, methotrexate and other antagonists, anticonvulsants, hemodialysis

Front 18

Treatment of folic acid deficiency?

Back 18

daily oral folic acid replacement

Front 19

Acquired causes of hemolytic anemia excluding autoimmune?

Back 19

Malaria, clostridium, brown recluse, snake bites, burns

Front 20

What do spherocytes and helmet cells suggest in the context of hemolytic anemia?

Back 20

extravascular hemolysis

Front 21

What is hand-foot syndrome and what disease does it occur with?

Back 21

Sickle cell, painful swelling of dorsa of hands and feet; occurs in early childrhood, avascular necrosis of metacarpal and metatarsal bones associatated

Front 22

At what joints does sickle cell related avascular necrosis occur?

Back 22

shoulder, hip

Front 23

Prophylactic medication for sickle cell related priapism?

Back 23

hydralazine, nifedipine, antiandrogen

Front 24

How long must a priapism last before it is considered a medical emergency?

Back 24

3 hours

Front 25

What sort of renal anomaly does sickle cell typically cause?

Back 25

papillary necrosis

Front 26

Where do leg ulcers related to sickle cell tend to occur?

Back 26

lateral malleoli

Front 27

Antibiotic prophylaxis in sickle cell?

Back 27

penicillin from 4 months to 6 years

Front 28

Inheritance of spherocytosis?

Back 28

AD

Front 29

Treatment of hereditary spherocytosis?

Back 29

splenectomy

Front 30

Peripheral smear signs of G6PD deficiency?

Back 30

Bite cells, Heinz bodies

Front 31

Diagnosis of G6PD deficiency?

Back 31

G6PD levels, sometimes remeasuring is necessary due to lysis of cells that are especially deficient

Front 32

Primary site of extravascular hemolysis in Warm AIHA?

Back 32

spleen--> spenomegaly

Front 33

Causes of Warm AIHA?

Back 33

lymphoma, leukemia, malignancy, autoimmune illness, alpha methyl dopa

Front 34

Primary site of hemolysis in Cold AIHA?

Back 34

intravascular, liver is primary site of sequestration

Front 35

Treatment of warm AIHA?

Back 35

Glucocorticoids
Consider splenectomy if no response to glucocorticoids
immunosuppression (azathioprine, cyclophosphamide)
folic acid

Front 36

Treatment of cold AIHA?

Back 36

Chemotherapeutics, steroids

Front 37

What causes paroxysmal nocturnal hemoglobuinuria?

Back 37

deficiency of anchor proteins that link complment inactivation proteins

Front 38

Diagnostic tests used for paroxysmal nocturnal hemoglobuinuria?

Back 38

ham's test--> incubation in acidified serum triggering alternative complement pathway, lysis of PNH cells but not normal cells;
Sugar water test --> serum is mixed in sucrose, hemolysis in PNH;
Flow cytometry of CD55, CD 59

Front 39

Treatment of paroxysmal noctural hemolysis?

Back 39

glucocorticoids, bone marrow transplantation

Front 40

What is the difference between Type 1 and Type 2 HIT?

Back 40

Type 1 - Heparin directly causes platelet aggregation, seen <48 hours from initiation; Type 2: antibody mediated injury to platelet - 3-12 days after initiation

Front 41

In whom is the acute form and chronic form of ITP seen?

Back 41

Acute in children, chronic in adults (women between 20-40)

Front 42

Treatment of ITP

Back 42

Corticosteroids, IVIG, splenectomy for chronic ITP

Front 43

Treatment of TTP?

Back 43

Plasmapheresis from diagnosis, splenectomy and corticosteroids can be useful in some cases; Platelet transfusions contraindicated

Front 44

Causes of Reactive thrombocytosis?

Back 44

Iron deficiency, Splenectomy, IBD, malignancy, rebound thrombocytosis

Front 45

What common medications should be avoided in vWD?

Back 45

Aspirin, NSAIDs

Front 46

What are the most common sites of hemarthroses in hemophilia?

Back 46

knees

Front 47

How should acute hemarthrosis be treated in hemophilia?

Back 47

analgesia with codeine +/- acetaminophen (avoid ASA, NSAIDs)
Immobilization of joint, ice packs, don't bear weight on joint

Front 48

What is the most common cause of DIC?
Other causes?

Back 48

Infection
Obstetric complications due to high placenta, uterine concentration of tissue factor
Major tissue injury
Malignancy
shock, circulatory collapse
Rattle snake venom

Front 49

Production of which factors are dependent on vitamin K?

Back 49

II, VII, IX, X, C, S

Front 50

What are sources of Vit K?

Back 50

Intestinal microbe production
Leafy green vegetables

Front 51

Lab abnormalities in Vit K deficiency?

Back 51

PT is initally prolonged, PTT follows

Front 52

Side effects of heparin?

Back 52

transient alopecia, rebound hypercoagulabiltiy

HIT
osteoporosis

Front 53

Contraindications of heparin?

Back 53

hemophilia
thrombocytopenia
severe HTN
recent eye, spine, brain surgery

Front 54

Reversal of warfarin therapy?

Back 54

Give Vitamin K - correction of PT in 4-10 hours if normal liver function

Front 55

Primary cause of death in multiple myeloma?

Back 55

Infection usually of lung or urinary tract

Front 56

Diagnostic criteria for multiple myeloma?

Back 56

10% abnormal plasma cells in bone marrow and one of

M protein in serum
M protein in urine
Lytic bone regions in skull or axial skeleton

Front 57

Treatment guidelines for multiple myeloma?

Back 57

treat only symptomatic or advanced disease

Systemic chemo with alkylating agents
Rads if no response to chemo and debilitating pain
Transplatn by autologous peripheral blood stem cell is preferred to BMT

Front 58

Diagnosis of Waldenstrom's macroglobulinemia?

Back 58

IgM > 5 g/dL

Also bence jones proteinuria in 10%

Front 59

Treatment of Waldenstrom's macroglobulinemia?

Back 59

chemo and plasmapheresis for hyperviscosity syndromes

Front 60

Diagnosis of MGUS?

Back 60

IgG spike < 3.5 g
Less than 10% plasma cells in bone marrow
Bence Jones proteinuria < 1g/24 hours

Front 61

Age of onset of Hodgkin's disease?

Back 61

bimodal distribution
15-30; >50

Front 62

Types of hodgkin's disease?

Back 62

Lympocyte predominant - few reed sternberg cells, many B's
Nodular sclerosis - more frequent in women, bands of collagen envelop pools of reed sternberg cells
Mixed celllarlity - large numbers of Reed Sternberg cells in pleomorphic background
Lymphocyte depletion - lacking in mixed reactive cells

Front 63

How does Hodgkin's lymphoma spread primarily?

Back 63

local invasion to adjacent nodes

Front 64

What lab value tracks with activity of Hodgkin's disease?

Back 64

level of ESR

Front 65

Treatment of Hodgkin's disease?

Back 65

Stages I, II, IIIA can be treated with radiotherapy alone
Stages IIIB, IV are treated with chemo too

Front 66

Risk factors for Non Hodgkin's lymphoma?

Back 66

HIV
Immunosuppression
History of EBV., HTLV-1
Helicobacter pylori gastritis
Autoimmune disease

Front 67

What are the indolent or low grade non Hodgkin's lymphomas?

Back 67

Small lymphocytic lympoma - closely related to CLL

Follicular predominatly small, cleaved cell lymphoma
Most common form of NHL
T(14:18)
Painless peripheral lymphadenopathy

Front 68

What are the intermediate or mid grade non-Hodgkin's lymphoma?
Age of onset?
Spread?
Therapy?

Back 68

Diffuse large cell lymphoma - B cell origin, middle aged, elderly
locally invasive, presents as large extranodal mass
85% cure rate with CHOP

Front 69

High grade non-hodgkin's lymphoma types?

Back 69

Lymphoblastic lymphoma
May progress to T-ALL
aggressive with rapid dissemniation

Burkitt's (small noncleaved cell)
African - Jaw and facial bone disease - EBV link
American - abd organs - t(8:14) translocation

Front 70

Histology of mycosis fungoides?

Back 70

Cribiform lymphocytes

Front 71

Therapy for mycosis fungoides?

Back 71

Rads, topical chemo if limited to skin

Front 72

Smudge cells are present in what disease?

Back 72

CLL

Front 73

Major and minor criteria for polycythemia vera

Back 73

Elevated RBC mass
Arterial O2 sat > 92%
Splenomegaly

Thrombocytosis
Leukocytosis
Leukocyte alk phos > 100
Serum Vit B12 > 900

Front 74

Treatment for polycythemia vera?

Back 74

Repeated phlebotomy to lower hematocrit
Myelosuppression with hydroxyurea
Recombinant interferon alfa

Front 75

Treatment for essential thrombocythemia?

Back 75

anagrelide, low dose ASA
Hydroxyurea for severe thrombocytosis

Front 76

What conditions predispose you to clotting factor inhibitor?

Back 76

Lymphoma
Postpartum
Autoimmune illness

Front 77

How is clotting factor inhibitor diagnosed?

Back 77

With mixing study

Front 78

What are indications for daily hydroxyurea in SS?

Back 78

Three or more episodes of acute pain yearly requiring parenteral opioid therapy