Pance: Hematology And Oncology

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Auer rods on peripheral smear indicate...

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acute myeloblastic leukemia (AML)

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60 year old male with severe anemia, decreased neutrophil count, and small, abnormal B lymphocytes in the bone marrow (>30%) with levels at 90,000 per cubic millimeter. Has painless cervical lymphadenopathy and hepatosplenomegaly. Likely diagnosis?

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Chronic lymphocytic leukemia (CLL)

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Bone marrow aspiration and biopsy reveals the presence of the Philadelphia (Ph) chromosome in dividing marrow cells. Likely diagnosis?

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Chromic myeloblastic leukemia (CML)

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Follicular, cleaved cell, lymphocytic, histolytic

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Hodgkins Lymphoma

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Reed Sternberg cell

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Hodgkin's lymphoma

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Plasma cells, monoclonal protein

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Multiple myeloma

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What disease is characterized by abnormal monoclonal protein, anemia, and lytic bone lesions?

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Multiple myeloma

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30 year old white male with 3 month history of painless enlargement of bilateral cervical lymph nodes, fever, and night sweats. Likely diagnosis?

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Hodgkin's disease

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What hematologic measurement is abnormal in chronic heavy alcohol use?

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Mean corpuscular volume

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Most frequent cause of B12 deficiency in patients with classic pernicious anemia

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Lack of intrinsic factor

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In thalassemia anemia, what causes the anemia?

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Shortened lifespan of RBCs

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Teenage African American female presents with severe bone and joint pain. CBC shows severe anemia and elevate leukocyte and platelet counts. Most likely diagnosis?

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Sickle cell disease

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What 2 tests are used to confirm the diagnosis of homozygous sickle cell disease?

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Peripheral smear and hemoglobin electrophoresis

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The most helpful test to distinguish megaloblastic from nonmegaloblastic macrocytic anemia

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Peripheral smear

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What is the most common initial presentation of sickle cell disease?

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Failure to thrive in a child at risk

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4 year old with fever, bleeding, bone pain, generalized lymphadenopathy, splenomegaly, hepatomegaly. CBC shows anemia, leukocytosis (100,000 immature WBC) and thrombocytopenia. Prognosis is good. Likely diagnosis?

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Acute lymphocytic leukemia

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Type of anemia characterized by small red blood cells, MCV <76

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Microcytic anemia

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Name the classic types of microcytic anemia

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Iron deficiency anemia, thalassemia, sideroblastic anemia, anemia of chronic disease, lead poisoning

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Type of anemia characterized by large red blood cells, MCV >100

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Macrocytic anemia

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Causes of megaloblastic anemia

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B12 (cobalamine) deficiency, folate deficiency, and drugs. May be idiopathic.

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Type of anemia in which serum iron is decreased and TIBC is increased

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Iron deficiency anemia

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Basophilic stippling of RBCs is noted. Likely dx?

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Lead poisoning

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Classify the 2 types of macrocytic anemia

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Megaloblastic and nonmegaloblastic

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RBC with low hemoglobin and an enlarged area of central pallor

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Hypochromic

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RBC with a loss of central pallor, stains more densely, and is often microcytic.

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Spherocyte

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RBC that is hypochromic with a central darkening of hemoglobin. Seen in liver disease, thalassemia.

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Target cell

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Fragmented helmet or triangular-shaped RBC

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Schistocyte

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Elongated RBC with pointed ends

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Sickle cell

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Type microcytic hypochromic anemia that demonstrates low serum iron and low TIBC. Unresponsive to iron therapy.

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Anemia of chronic disease/inflammation

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3 possible etiologies of normocytic normochromic anemia

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Blood loss, hemolysis, decreased production

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In a patient presenting with normochromic normocytic anemia, what is the next test to classify the anemia according to marrow response?

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Reticulocyte count

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Low MCV, low RBC, high RDW, low serum Fe, high/nml TIBC

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Iron deficiency anemia

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Low MCV, normal/high RBC, normal RDW, high/norm serum Fe, normal TIBC

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Thalassemia

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Normal/low MCV, normal RBC, low serum Fe, low TIBC

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Anemia of chronic disease

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Pancytopenia, anemia, leukopenia, neutropenia, thrombocytopenia

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Aplastic anemia

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What is the best test to determine whether a patient as a hemolytic anemia?

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Reticulocyte count and blood smear

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A patient with a history of gastric carcinoma is pale and mildly icteric with a beefy, red, sore tongue. He presents with numbness in his feet, weakness, and ataxia. Peripheral blood smear shows macrocytosis and hypersegmented polymorphonuclear lymphocytes. This is due to deficiency of what vitamin?

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B12

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60 year old male with no symptoms and no abnormalities on physical exam has a CBC that shows hemoglobin of 9.0, leukocytes 40,000, and peripheral smear shows 97% small lymphocytes. Likely dx?

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Chronic lymphocytic leukemia

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What are the two most common histologic subtypes of Hodgkin's disease?

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Nodular sclerosing and mixed cellularity

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What are B symptoms?

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Fever, drenching night sweats, fatigue, weight loss

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What is the best test to determine whether a patient as a hemolytic anemia?

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Reticulocyte count and blood smear

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Increased ferritin, increased iron, decrease TIBC, hematocrit 20-30%

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Sideroblastic anemia

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59 year old African American with long-standing history of RA. Hemoglobin is 9, hematocrit 27. Iron and TIBC normal. Likely dx?

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Anemia of chronic disease

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A megaloblastic anaemia due to vitamin B12 deficiency dependent on impaired absorption of vitamin B12

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Pernicious anemia

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What test confirms the diagnosis of pernicious anemia?

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Schilling test

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What test is used to assess a patient's ability to absorb Vitamin B12 from the bowel?

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Schilling test

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What test will distinguish thalassemia minor from iron deficiency anemia?

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Serum ferritin determination

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Treatment for thalassemia minor

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Supportive

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Hypochromic microcytic anemia with increased serum iron, normal TIBC, increased ferritin, and normal HbA2

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Sideroblastic anemia

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Normal serum iron, normal TIBC, normal ferritin, elevated HbA2

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Beta-thalassemia trait

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What type of anemia requires a bone marrow aspiration for definitive diagnosis?

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Sideroblastic anemia

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Most likely vitamin deficiency related to pancytopenia

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Folate

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What factor is produced in the stomach and required for intestinal absorption of Vitamin B12?

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Intrinsic factor

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What is the most common cause of B12 deficiency?

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Pernicious anemia (lack of intrinsic factor)

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What is the most common cause of folate deficiency?

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Inadequate dietary intake

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What test is used to monitor progression of HIV infection and responses to therapy?

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Plasma viral load

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Most common presentation for Non-Hodgkin's lymphoma

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Painless lymphadenopathy

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What is the first step after finding a 1cm mobile, soft thyroid nodule with no associated lymphadenopathy?

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Fine needle aspiration

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Most common type of thyroid cancer

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Papillary

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What test excludes the diagnosis of polycythemia vera if it is suspected?

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Elevated plasma erythropoietin level

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What coagulation factor is NOT vitamin K dependent?

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Factor VIII

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What tumor marker is measured for testicular cancer?

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alpha-fetoprotein

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What tumor marker is measured for colon cancer?

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Carcinoembryonic antigen (CEA)

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What tumor marker is measured for ovarian cancer?

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CA 125

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What tumor marker is measured for prostate cancer?

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PSA

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What tumor marker is measured for carcinoid tumor?

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5-HIAA

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A Negri body is a pathognomonic sign of what disease?

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Rabies

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What type of megaloblastic anemia is associated with neurologic deficits?

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Vitamin B12 deficiency

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Headache, dizziness, visual disturbances, generalized itching, facial plethora, moderate splenomegaly. Likely diagnosis?

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Polycythemia vera

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The presence of Heinz bodies on peripheral smear indicates...

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G6PD deficiency

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What is the most common congenital hemolytic anemia in the white population?

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Hereditary spherocytosis

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What are the causes of microangiopathic hemolytic anemia?

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disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, and artificial heart valves

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Hemoglobin electrophoresis confirms the diagnosis of what 2 types of anemia?

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Thalassemia and sickle cell disease

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What viruses may cause aplastic anemia?

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Hepatitis and parvovirus B19

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What is the most common type of childhood leukemia?

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Acute lymphocytic leukemia. 75% of cases occur in children less than 15 years of age. The rest of the cases occur after age 50.

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What type of leukemia is most commonly seen in elderly men?

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Chronic lymphocytic leukemia

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What is the first-line chemotherapy agent for chronic lymphocytic leukemia?

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Chlorambucil

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Which ALL patient generally has a better prognosis: a child or an adult?

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98% of children achieve complete remission after 4 weeks of chemotherapy, and 70% of children will be cured. Only 30-40% of adults will be cured.

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What 2 types of leukemia may have the Philadelphia chromosome?

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Acute lymphocytic leukemia (its presence indicates a poorer prognosis) and Chronic myelogenous leukemia (present in 95% of cases)

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What is the most common form of adult leukemia in Western countries?

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Chronic lymphocytic leukemia

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Which type of leukemia will have smudge cells on the peripheral blood smear?

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Chronic lymphocytic leukemia

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What is the most deadly phase of chronic myelogenous leukemia?

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Acute blast crisis phase (>30% blasts in blood or bone marrow)

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What type of leukemia have lymphocytes with hairlike cytoplasmic projections?

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Hairy cell leukemia

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Hodgkin's lymphoma has a bimodal age distribution. When are they?

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The first peak is in the second and third decades of life, the second peak is after the age of 50

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What type of lymphoma may be linked with EBV?

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Hodgkins

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What does the presence of B symptoms in Hodgkins lymphoma indicate?

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Poor prognosis

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What test will confirm your diagnosis of multiple myeloma?

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Protein electrophoresis may show IgM proteins or Bence Jones proteins

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Hemophilia A is a deficiency of what coagulation factor?

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Factor VIII

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Hemophilia B is a deficiency of what coagulation factor?

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Factor IX

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What disease is an autoimmune bleeding disorder in which patients develop antibodies against their own platelets?

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Idiopathic Thrombocytopenic Purpura (ITP)

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Name some things that can cause disseminated intravascular coagulation.

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Obstetric complications (amniotic fluid embolism, retained dead fetus, abruptio placenta), transfusion reactions, malignancy, trauma (brain injury, crush injury, burns), infection or sepsis, acute pancreatitis, ARDS

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What lab test can be used to monitor effective response to treatment in patients with iron-deficiency anemia?

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Reticulocyte count