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87 Cards in this Set
- Front
- Back
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what is the average age of dx of NHL and what are the age ranges?
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avg 65
ranges from 40-70 |
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What is the most common neoplasm in age group 20-40?
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NHL
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What are risk factors for NHL?
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H pylori and gastric MALT
HIV, HCV, EBV |
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presents with painless lymphadenopathy
fever night sweats and weight loss |
NHL
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how do you dx NHL?
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lymph node excision
PET/ CT for prognosis |
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What are useful prognostic markers for NHL?
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serum LDH evelate
low hgb ann arbor stage 3-4 more than 1 nodal site age over 60 |
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What is the most common myeloproliferative disorder?
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polycythemia vera
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Who is most likely to get PV?
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60 year old me
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what cause PV?
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genetic mutation in the JAk-2 gene (janus kinase) whcih regulates erythropoietin and thromopoeitin
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someone presents with dizziness, HA, feeling of head fullness
lethargy, weakness puritis after bathing splenomegaly hepatomygaly distended retinal vessels |
PV
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What is hallmark for PV?
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hematocrit of >54% for men and >51% in women
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What labs are seen in PV?
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elevated RBC, WBC, and platelets
high hemoglobin and B12 Hypercellular marrow with low iron stores increased megakaryocytes FISH analysis |
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what are major complications of PV?
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erythomelalgia
arterial thrombosis |
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What is tx for PV?
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phlebotomy
daily ASA hydrea JAK inhibitor |
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What is the average onset of CML?
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67 but can be seen in younger adults
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What is the etiology of CML?
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philadelphia chromosome (BCR/ABL)
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what are some clinical presentations for CML?
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can be asymptomatic
fever, bone pain, swollen spleen causing early satiety |
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who gets hodgkins?
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bi-modal
20s and then 50s but young children in developing countries |
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what could be causes of hodgkins?
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EBV
redd-sternberg Cd95+ |
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someone presents with:
painless adenopathy mediastinal mass that spreads in an orderly fashion constitutional symptoms anemai splenomegaly and hepatomegaly |
hodgkins
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what is hallmark of hodgkins?
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young adults + reed sternberg + mediastinal mass
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what is the most common malignancy in children?
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ALL
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who gets ALL?
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ages 2-5 then over 39
hispanic males |
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what is the hallmark of ALL and AML?
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pancytopenia with circulating blasts
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what are critical lab findings in ALL?
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hypercellular bone marrow
mediastinal mass on CXR anemia and thrombocytopenia without reticulocytosis cytogentics |
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what is the most common leukemia in adults and when does it present?
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AML
age 60 |
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what are labs for AML?
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packed marrow dry tap
cytometry auer rods peroxidase adn butyrate esterase |
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aka small cleaved lymphoma
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CLL
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what is the cause of CLL?
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clonal malignancy of B cells
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what is the hallmark of CLL?
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isolated lymphocytosis
lymphocyte more than 5,000 and small lymphocytes (may see CD19 with CD5) |
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where do you see smudge cells?
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CLL
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what are complications of CLL
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felty syndrome ( RA + neutropenia + splenomegaly)
large granular lymphocyte syndrome (neutropenia and anemia and RA) hypergammaglobulinemia |
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What is DIC?
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bleeding and clotting at the same time
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what are causes of DIC?
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sepsis
pregnancy cancer AA cavernous hemangioma snake bite, burn, trauma |
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what is hallmark of DIC?
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thrombocytopenia and decreased fibrinogen
prolonged PTT and PT!! |
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when do you see elevated D dime
low platelets possible schitocytes? |
DIC
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what sndromes are associated with DIC?
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HELLP - peripartum women
trousseau syndrome |
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how do you tx DIC?
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tx underlying cause
FFP, pRBCs, platelets cyroprecipitate is active bleeding heparin for refractory bleeding |
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hemophilia A is a decrease in what factor?
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VIII
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what is the hallmark of Hemophilia A?
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hemarthrosis of knees, ankles and elbows
( also will bruise easily) |
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what labs are seen in Hemophilia A and B?
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PTT is prolonged but PT is normal
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how do you tx hemophilia A and B?
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give the concentrated factor
can give DDVAp for mild bleeding |
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what is the most common inherited bleeding disorder ( autosomal dominant)?
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Von willebrand disease
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a person presents with easy bruising, epistaxis, bleeding easly, heavy menstrual bleeds,
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vWF
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what are the labs in vW disease?
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platelet count normal
prolonged PTT but normal PT factor 8 may be reduced low vWF |
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how do you tx vW?
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none needed unless mild bleeding give DDVAP and vWF concentrate
cryoprecipitate for severe bleed avoid ASA |
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person presents with:
wide spread purpura bleeding at multiple sites petechiae ecchymosis renal failure thombosis |
DIC
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what is the most common cause of venous thrombosis?
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factor V leiden
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in factor V leiden there is a resistance to what?
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protein C and its cofactor S
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what are risk factors for factor V?
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contraception, hormone replacement
pregnancy |
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who gets factor V?
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white men and women in the late teens early 20s
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how to dx factor V?
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DNA test
ultrasound for DVT |
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how do you tx factor V?
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low heparin or warfarin is 1st tx
is recurrent then anticoag indefinielty compression stockings |
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what is the cause of hemophilia C?
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def in factor XI
autosomal recessive ( instead of x-linked recessive like A and B) |
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who gets hem C?
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jewish and european
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what is tx for hem c?
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FFP is mainstay!
aminocaproic acid for procedures or episodes |
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what is the most common transfusion reaction?
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febrile NH TR
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what causes febrile NH TR?
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HLA antibody against donor WBC
ctokines cause immune response |
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presents with fever
chills HA vomiting following transfusion |
febrile NH TR
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what labs in febrile NH TR?
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negative DAT
samples are correct |
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how do you tx febrile NH TR?
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antipyretics
stop transfuiosn luekoreduced blood |
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most common cause of acute hemolytic TR
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ABO incompatibily
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what does lab show for acute hemolytic TR?
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post transfusion tube shows hemolysis
DAT positve dark urine and bilirubin decreased haptoglobin increased renal fx test |
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how to tx acute hemolytic TR?
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stope tranfusion
supportive care analgeisvs pressors |
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how to tx for anaphylactic TR?
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Trendelengerg position
antihistamines corticosteroids epinephrine check for IGA immediate and severe |
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cause of bacterial TR?
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platelets
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dx of bacteria Tr?
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culture and gram stain
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tx of bacteria TR?
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supportive care
BS abx increase renal output |
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cause of delayed hemoltic TR?
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antibody to antigen groups like kidd and Rh
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what labs do you see with delayed hemolytic TR?
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negative antibody screen is now positive
DAt positve low hemoglobin |
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tx of delayed hemolytic TR?
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identify antibody causing problem
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pt presents with erythroderma
maculopapular rash fever vomiting diarrhea PANCYTOPENIA |
transfusion associated graft vs host disease
(need to irradiate fatal 90%) |
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presents with thrombocytopenia and purpura 8-10 days after transfusion
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post transfusion purpura caused by platelet antibodies in recipeinct destroying platelets
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how to tx post transfusion purpura?
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IVIG and crossmatched platelets
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pt presents with dyspnea, cough, cyanosis, HA, chest disocmfort, and tacycardia during a transfusion
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transfusion associated circulatory overload
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how to tx TA circulatory overload
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stop transfusion
put in sitting postiion therapuetic phlebotomy |
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pt presetnts with resp distress, cough, fever chills, hyptoension, cyanosis
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TR acute lung injury
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what should be ruled out be dx TRALI?
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heart failure
MI volume overload sepsis |
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what cause TR acute lung inuury
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multiparous female dones have leukocyte antibodies that cause problems
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what 5 things for TTP and HUS?
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microaniopathic hemolytic anemia
thrombocytopenia with purpura fever neuro renal function problems |
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how to tx HUS and TTP
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steroids and plasma exchange
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ADAMST13
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TTP (brain)
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ecol and diarrheal illness in childre
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HUS (kidney )
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what labs are seen in ITP?
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megakaryocytes
normal coaguation studies platelet count <10,000 |
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tx of chronic ITP
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prednison
IV IG splenectomy rituximab transfusion only for active bleeding |
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labs for HITT
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PF4 assay
revered if take away heparine exclude others thrombocytopenia |
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Pv and HITT both have...
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aterial thombosis complications
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