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295 Cards in this Set
- Front
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what disease:
normal platlet increased bleeding time normal PT increased PTT |
VWD
|
|
what disease:
decreased platlet increased bleeding time normal PT normal PTT |
thombocytopenia (ITP, TIP, HUS)
|
|
what disease:
normal platlet normal bleeding time normal PT increased PTT |
hemophilia A
|
|
what disease:
decreased platlet increased bleeding time increased PT increased PTT |
DIC
|
|
what disease:
normal platlet increased bleeding time normal PT normal PTT |
aspirin/NSAID therapy
|
|
what disease:
normal platlet normal bleeding time increased PT increased PTT |
warfarin/heparin use
|
|
thrombohemorraghic disorder
increased PT and PTT thrombocytopenia increased bleeding time d-dimers normocyctic anemia with schistocytes and reticulocycitosis |
DIC
|
|
txt of DIC
|
treat disease
transfuse blood components FFP, packed RBC, platlet concentrates |
|
DVT and pulmonary emboli at early age
most common |
factor V leiden
|
|
no prolongation of PTT after standard dose of heparin -- what is deficient?
|
antithrombin III
|
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hemorrhagic skin necrosis from warfarni therapy, def in what?
|
protein C
|
|
decreased factor VIII could be from what 2 diseases?
|
Hemophilia A and VWD
|
|
ristocetin cofactor assay is to detect what?
|
to detect VWF antigen
|
|
most common cause of childhood thrombocytopenia
after resp tract infection NO lymphadenopathy or splenomegaly |
acute idiopathic thomrbocytopenic purpura (ITP)
|
|
IgG Abs againsted GpIIb:IIIa receptor is what?
|
thrombocytopenic purpura
|
|
adult female
presents with: fever, thrombocyopenia, renal failure, microangiopathic hemolytic anemia with schistocytes, and CNS defects |
TTP
|
|
excess vWF is defect in what enzyme and what can it be treated with?
|
metalloprotease in endotheilial cells
txt: plasmapheresis |
|
what does d-dimer assay detect, and what diseases?
|
only cross linked insoluable fibrin monmers in fibrin clot (NOT fibrinogen)
screaning for pulm embolism DIC and coronary artery thrombosis |
|
causes of thrombocytopenia
|
1. decreased production (aplastic anemia, leukemia)
2. Increased destruction (ITP, TTP, DIC) 3. sequestion in spleen |
|
causes of thrombocytosis
|
1. increased platlet cuont -- essential thrombocythemia, PV
2. reactive - iron def, ifnection, splenectomy |
|
absent GpIb platlet receptor for vWF
platlet adhesion defect |
bernard'soulier syndrome
life long bleeding problem auto recessive |
|
platlet aggregation defect
absent GPIIb-IIIa fribinogen receptor |
glanzmann's
auto recessive |
|
IgA mediated vasculitis
child post acute infection |
henoch-schonlein syndrome
|
|
drugs that cause immune thrombocytopenia
|
1. quinine
2. quinidine 3. heparin |
|
women 15-50, children post vaccination
present with thrombocytopenia |
ITP
|
|
thrombocytopenia with neurological Sx
helmet cells |
TTP
use FFP |
|
child post e.coli ifnection
increased splenic pooling renal trouble |
HUS,
do NOT transfuse with platlets |
|
factor IX def
|
hemo B
|
|
txt of vWD
|
vasopressin
factor VIII concentrates with vWF |
|
txt of DIC
|
FFP, platlet concentrates, cryoprecipitate, ATIII and protein C concentrates
|
|
contraindications of DIC
|
NEVER give heparin or antiplatlet drugs, or fibrinolytic inhibitors
|
|
young pt presents with DVT and prolonged PTT
|
factor V leiden
|
|
arterial thrombosis
recurrent venous thrombosis in early adult life deficient in what? hereditary? |
antithrombin def
auto dom |
|
increased thrombotic risk
increased plasma prothomrbin levels is what? |
prothomrbin G20210
|
|
increasd risk of both venous and arterial thrombosis
|
hyperhomocystinemia
|
|
venous and arterial thrombosis
lupus PT lots of miscarriages prolonged PTT that does NOT correct with mixture study (50:50 with normal plasma) |
antiphospholipid syndrome
|
|
what blood type is the mother if there is HDN ABO?
|
mother is type O
|
|
HDN presents in 1st pregnancy, is it ABO or Rh related?
|
ABO occurs in 1st preggo only
|
|
clinical presentation of infant with HDN ABO
|
mild jaundice, slight anemia -- correct with phototherapy
|
|
RH (-) mother has what kind of Abs cross over placenta to the Rh (+) fetus?
|
IgG anti-D
|
|
what does the cord blood test show from an HDN?
|
increased bilirubin
increased blasts + direct coombs anemia reticulocytosis |
|
what does the kleihauer betke test used for?
|
to determine what dose of Rh Ig to give to the mother, based on + screening of resistance of fetal cells to acid hemolysis
|
|
txt of srs HDN Rh
|
exchange transfusion, remvoes Abs and bilirubin
replaces incompatable RBC with compatible ones lowers bilirubin levels corrects anemia must be compatible with mother's blood |
|
what can cause thrombocytopenia in fetus?
|
alloimmune neonatal thrombcytopenia
mother does not have HPA platlet Ab, IgG abs cross placenta and bleeding can result |
|
examples of malignant localized lymphadenopathy (2)
|
1. HL
2. NHL |
|
examples of generalized malignancies (>3 non-contguous areas of enlargment)
|
1. CLL/ALL
2. NHL/HL 3. WM |
|
ex of lymphocytosis
|
1. CLL
2. ALL |
|
examples of lymphopenia
|
1. HL:
2. chemo 3. HIV 4. SLE |
|
is CLL B or T cell?
|
B cell
|
|
elderly female presents with:
lymphadenopathy recurrent infections AIHA thrombocytopenia hypogamaglobinemia |
CLL
|
|
small mature looking lymphocytes (can't distinguish from normal), found with smudge cells... what is it?
|
CLL
|
|
can transform to diffuse large cell lymphoma ... what is this syndrome called?
|
richter's found in CLL
|
|
when do you txt CLL?
|
when there are signs of:
lympadenopathy or organomegaly BM failure constitution B sx |
|
SIg + (weak)
CD5 + CD 23 + CD 10 - FMC7 - what is this? |
CLL
|
|
agents to txt CLL...
|
1. cytotoxic: chlorambucil, cyclophosphamide, purine analogues
2. corticosteroids 3. monoclona Abs - CD20 and CD52 |
|
CLL pt comes in with adenopathy and splenomgaly, what do you txt for?
|
pallitive only
|
|
CLL pt comes in thrombocytopenia and anemia, with organomegaly ... what do you txt for?
|
start txt for chemo
|
|
PLL is what kind of cell, B or T?
|
B cell
|
|
pt presents with:
massive splenomegaly no lymphadenopathy SIg + (bright) CD5 - CD23 - FMC7 + what does pt have? |
PLL
|
|
hairy cell leukemia is what kind of cell? B or T?
|
B cell
|
|
older male with fatigue and infections presents with splenomegaly, what is it?
|
hairy cell leukemia
|
|
TRAP + is what?
|
HCL
|
|
what do you treat HCL with?
|
2-CDA
|
|
large granular lymhocytic leukemia is what kind, T or B cell?
|
T cell
|
|
50 yo pt presents with arthropathy and rheumatoid arthritis, anemia, neutropenia, increased WBC. BM has large cells with azurophilic granules.
|
LGLL
Txt not normally needed |
|
CD 3+
CD 56 + CD4 - CD 8 + what is it? |
LGLL
|
|
adult t cell leukemia/lymphoma is ass'd with what virus? where is this virus common?
|
HLTV, japan/caribbean
|
|
pt comes in and presents with:
lymphadenopathy hepatosplenomegaly skin lesions bone pain hyper calcemia what is it? |
ATLL
|
|
clover-leaf nuclei with
CD3 + CD4 + CD8 - what is it? |
ATLL
|
|
what is the most common form of HL?
|
nodular sclerosis
|
|
reed sternberg cell = what?
|
HL
|
|
32 yo pt presents with painless cervical lymphadenopathy, weight loss, and night sweats... what does he have?
|
HL
|
|
survivors of HL are at increased risk for what kind of malignancies?
|
AML, NHL, epitheliam tumors, malignant melanoma
|
|
what is the prognosis of HL and txt?
|
curable, use ABVD
sensitive to BOTH chemo and radiation |
|
CD 15 +
CD 30 + LCA - neutrophilia eosinophilia lymphopenia increased ESR and C reactive protein increased LDH |
NH, increased LDH = poor prognosis
|
|
is LDH routine in NHL or NH?
|
NHL
|
|
pt presents with painless lymphadenopathy, SOB/DOE, fullness, jaundice, anemia, neutropenia, thrombocytopenia == what??
|
NHL
|
|
txt of NHL
|
use CHOP and anti-CD20 (R-CHOP)
|
|
follicular lymphoma is what grade of NHL? (high, intermediate or low) is it curable?
|
Low grade, not curable
|
|
older pt with destroyed lymph node and cleaved lymphocytes... what is it?
|
NHL - FL
|
|
t(14;18) is ass'd with?
|
FL
|
|
BLC2 overexpression is linked to what NHL?
|
FL
|
|
t(11;14) and overexpression of BCL1 and Cyclin D is ass'd with what?
|
mantle cell lymphoma
|
|
CD 19 +
CD5 + CD23 - FMC7 + CD22 + what disease? |
Mantle cell
|
|
t(8;14) is add'd with what disease and overexpression of what>?
|
C-myc overexpression
ass'd with burkitt's lymphonma |
|
for burkitt's fill in blank:
endemic is found in the ____ and is/is NOT ass'd with EBV sporadic is found in the ___ and is/ISNOT ass'd with EBV |
endemic = jaw with EBV assosciation
sporadic = abdominal pain NOT EBV ass'd |
|
starry sky = what?
|
burkitt's
|
|
is burkitt's curable and if so, with what?
|
yes, CHOP
|
|
an intermediate NHL with large cells and diffuse growth is what?
|
diffuse large cell lymphoma
|
|
what NHL curability depends on age as a determination of prognosis?
|
DLCL
also on LDH, performance status, stage, and # of extranodal sites |
|
pt comes in with pruitic, psorasis like plague... what is it?
|
mycosis fungoides -- T cell, CD4+
|
|
circulating lymphoma cells that look like folder cerebriform nuclei
|
sezary syndrome
|
|
73 yo pt presents with backache and frequent infections, what is it?
|
MM
|
|
bence jones proteins found = what?
|
MM
|
|
is MM curable?
|
no, pallitve txt only
|
|
plasma cell with an eccentric nuclei, deep blue cytoplasm and perinuclar halo is related to what??
|
MM
|
|
i say lytic bone lesions, you say...
|
MM
|
|
what chromosome deletion and gene is affected in MM?
|
del 13, and Rb gene
|
|
contraindication in MM
|
IV contrast agents!!
|
|
pt presents with:
huge tongue CHF, cardiomegaly neuropathy renal failure carpal tunnel... what is it related to? |
amyloidosis
|
|
amyloidosis is present in what?
|
anything with increased proteins
MM MGUS WM |
|
pt comes in with:
changes in vision lethargy confusion headache nose bleed and CHF what is this syndrome? |
hypervisocity syndrome
|
|
hyperviscocity syndrome is related can be caused by what?
|
1. PV
2. acute leukemia 3. MM 4. WM 5. hyperfibrinogemia |
|
M protein <3mg/dl
normal: serum Ca, renal fxn NO bone lesions NO anemia... is what? |
MGUS.. can evolve into MM
|
|
lymphoplasmacytoid cell found in what?
|
WM
|
|
pt presents with:
fatigue, bleeding, weight loss hepatosplenomegaly lymphadenopathy hyperviscovisity increased IgM NO bone lesions what is it? |
WM
|
|
t(9;22) is related to what malignancy?
|
ALL -- unfavorable prognosis
BCR/ABL |
|
a 4 year old presents with anemia, thrombocytiopenia, neutropenia
PAS is + TdT is + what is it? |
ALL, B cell
|
|
child pt presents with mediastinal mass, anemia, neutropenia, thrombocytopenia..
PAS + + for CD4, 5, 8 what is it? |
ALL, T cell
|
|
pt presents with spontaneous bleeding and easy bruising with dilated swellings that started in childhood. pt has frequent recurrent GI bleeds... what is it?
|
hereditary hemorrhagic telangiectasia
|
|
is HHT auto dom, recessive, or x-linked?
|
auto dom
|
|
↓ MCV
↓ serum Fe ↓ RBC count ↓ ferritin ↑ TIBC ↑ RDW what is it? |
Fe defiency
|
|
↓ MCV
↓ serum Fe ↓ RBC count ↑ ferritin ↓ TIBC normal RDW what is it? |
ACD
|
|
↓ MCV
NORMAL serum Fe ↑ RBC count normal ferritin normal TIBC what is it? |
alpha thal trait
|
|
↓ MCV
↑ serum Fe ↓ RBC count ↓ ferritin ↓ TIBC normal RDW ringed sideorblasts present basophilic stippling what is it? |
lead poisoning
|
|
↓ HbA
↓ HbA2 ↓ HbF ↑ RBC count normal electropherisis what is it? |
alpha thal trait
|
|
4 beta chains is called what and has how many gene deletions?
|
HbH and has 3 genes deleted
|
|
HbH presents as with?
|
severe hemolytic anemia
|
|
Four deletions is called?
|
HbBart -- incompatible with life
4x gamma chains |
|
pt presents with:
microcytic anemia decreased MCV, Hb, and Hct INCREASED RBC normal RDW and ferritin Hb electrophersis shows: ↓ HbA ↑ HbA2, and HbF with RBC count |
beta thal minor
|
|
pt has severe hemolytic anemia with extramedullary hematopoesis, with the following electropherisis:
NO HbA ↑ HbA2, and HbF increased RBC and reticulocytes what is ti? |
beta thal major
|
|
causes of sideroblastic anemia
|
1. chronic alcoholism
2. B6 defiency 3. lead posoning |
|
loss of vibration sense is seen in what?
|
B12 def
|
|
macrocytic anemia + neuro defects =?
|
B12 def
|
|
most common cause of ACD?
|
pneumonia
|
|
hemochromatosis can occur from frequent transufions, chronic hemolytic diseases or from a missense mutation in this gene?
|
HFE gene
|
|
PK deficiency pt comes in with bronze skin ... what do you think?
|
hemocrhoamtosis, oh shiz we need to chelate her bitchass
|
|
hypersegmented PMN == ?
|
megaloblastic anemia
|
|
hereditary spherocytosis is a..
extra or intravasclar? intrinsic or extrinsic? |
extravasuclar intrinsic with auto domin and poor penetrance
|
|
pt has a viral infection from a parvovirus, with gallstones... what do you suspect?
pt has osmotic fragility and spherocytes on smear |
hereditary spherocytosis
|
|
defect in:
spectrin ankyrin band 4.2 is ass'd with what? |
hereditary spherocytosis
|
|
you say heinz bodies and bite cell... i say...
|
G6PD def
|
|
pt has rapid drop in Hb after eating fava beans, pt has what?
|
G6PD
|
|
G6PD is... auto dom/recessive or xlinked?
|
x-linked
|
|
pt has splenomegaly and evan's syndrome.. what test do you order? and will it be + or - ?
what is the pt presenting with? |
+ direct Coombs
AIHA |
|
warm reactive is ass'd with idiopathic, complement specific... to what type of Ig?
|
IgG
|
|
cold reactive is ass'd with mycoplasma, mono, and lymphomas... what type of Ig?
|
IgM
|
|
you see helmet cells, you suspect what?? (3)
|
1. DIC
2. HUS 3. TTP |
|
missing CD55 and CD59
|
PNH
|
|
acid ham test is done in what? what does it test for?
|
PNH, suspectibility to sucrose soltuion
|
|
pt presents with thrombosis, recurrent abdominal pain, and interrcurent infections... what do you suspect?
|
PNH
|
|
BM has hypoplasia
decreased LAP score hemosideruria what is it? |
PNH
|
|
txt for PNH
|
immunosuprresion, BMT, supportive care
|
|
hbH can be demo'd with what stain?
|
cresyle blue stain, looking for inclusions
|
|
what thal presents with at birth??
|
alpha
|
|
severe anemia at 4-6 months
jaundice hair on end appearance on xray target cells Howell Jolly bodies |
beta thal
|
|
sickle cell is...
intra/extravascular intrinsic or extrinsic |
extravascular, intrinsic defect
|
|
what does the blood smear look like in a pt with sickle trait?
|
TOTALLY NORMAL
|
|
rhomboidal RBC
target cells microsphercytes are common in what Hb subtype of sickle cell? |
HbC
|
|
child with sickle cell presents with what hallmark?
|
dactylitis
|
|
adult with sickle cell presents with what hallmark?
|
acute chest syndrome
|
|
what prophylaxis do you give a sickle cell pt?
|
penicillin
|
|
pt has:
hemolytic anemia heinz bodies heat preciptation test crisis after taking oxidative drugs |
unstable Hb
|
|
HbEE = ?
HbE beta thal =? HbAE = ?? |
HbEE = mild hypochromia and microcytosis
HbE beta thal = SEVERE transfusion dept hemolytic disease like beta thal major HbAE = mild thal phenotype with microcytosis and hypocrhomia |
|
Hb with high O2 affinity have an increase in what?
|
erythopoeitin
|
|
Hb with high O2 affinity is RIGHT or LEFT shift on dissosciation curve?
|
LEFT shift
|
|
pt has cyanosis and a R shift on diss curve, what do they have?
|
Hb with LOW O2 affinity
|
|
pt has cyanosis and you draw blood -- it's brown, what do they have?
|
HbM
|
|
what Hb phenotype has mild target cells but no anemia?
|
HbAC
|
|
what Hb phenotype presents with target cells, hemoglobin crystal,s microspherocytes, mild splenomegaly, mild hemolytic anemia
|
HbCC
|
|
HbE is common to what region of the world?
|
far east, West coast US
|
|
62 yo woman presents with sharp back pain, rouleaux, hyper Ca, neuropathy, and decreased in normal immunoglobins
what does she have? |
plasma cell myeloma
|
|
12 yo girl has lower abdominal pain, fever, and is CD20+ with vaculoated cells on a starry sky... what translocation is common and what does she have?
|
t(8;14), burkitt's
|
|
55yo male has cough, chest pain, DOE, fever, pruitis, supraclavicular lymphnode enlargment.
RBC are normocytic, normochromic 15cm mediastinal mass with PLEURAL effusion RS cell is present CD30 + |
HL - nodular sclerosising
|
|
72 yo female presents with lymphadenopathy in neck and axilla, weight loss, and fatigue.
see cleaved lymophocytes what is it and what translocation is common? |
follicular lymphoma
t(14;18) |
|
65yo male with a swollen neck, splenomegaly, with small mature lymophocytes on biopsy. CD20+, serum hypoglobulimea... what doe she have?
|
CLL
|
|
68 yo presents with indigestion, no infection or bleeding or organmegaly. Pt has hypercell BM, with increase # of megakaryoctyes, no fibrosis, - for philly chrom, normal Fe... what does he have?
|
essential thrombocytothemia
txt with platletpharesis, hydroxyurea |
|
53 yo male with fatigue, weight loss, no appetite, and gets fully quickly. he has hepatosplenomegaly, no lymphadenopathy, eosinophilia/basophilia, with normochromic normocytic anemia, increased WBC... what does he have?
|
CML, txt with gleevac and BMT
|
|
40 white woman with increased menses, gum bleeding, and small purple spots on legs, with fatigue.
macrocytic anemia, neutropenia, and thrombocytopenia with <5% blasts in blood. hypercell BM with 17% blasts what does she have? txt? |
MDS -- RAEB
BMT |
|
42 yo male with gum bleeding and prolonged oozing, no lymphadenopathy, large bruise. he has a prolonged PT, normal PTT, and increased d-dimers. LOTS of auer rods, +for MPO... what is common trans, txt, and dx?
|
t(15;17)
promylocytic leukemia txt with ATRA |
|
26yo male has severe rectal pain, fatigue, hemorroids, with increase in LDH, normal retic, an increase in blasts (eosinophils noted). what does he have?
|
inv 16 with M4 AML
mylemonocytic leukemia |
|
6 yo boy with fatigue, headaches, palable lymph nodes in supraclavicular region, SPLENOMEG, no edema, bruises. incrased blasts and LDH, MPO is NEGATIVE
trans location? dx? |
t(9;22) ALL B cell
|
|
> 20% blasts in blood or BM is automatically...
|
AML
|
|
MPO is + in what cell type?
|
myeloid
|
|
sudan black is + in what cell type?
|
myloblasts and monoblasts
|
|
NSE is + in what cell time?
|
monocytes
|
|
CD13, CD33, CD 117 are Ag for what?
|
meyloid
|
|
CD2, 3, 4, 8, 19 and 20 are for fhwat cell type?
|
lymphoid
|
|
t(15;17)
|
acute promylocytic leukemia
|
|
11q23
|
AML with MLL
|
|
MPO, SB -
CD13, 33, 34, 117 + |
AML with min diff
|
|
MPO, SB +
CD13, 33, 34, 117 + |
AML withOUT maturation
|
|
auer rods are in what?
|
M3 and M2
|
|
auer rods
CD13, 33, 34, 117 + mature PMN |
M2 AML with maturation
|
|
+NSE
3% blasts are MPO + CD13, 33 11b, 11c, 14, 36, 64 + |
M4
acute mylomonocytic |
|
CD13, 33
CD14, 11b, 11c, 36, 64 80% or more are monocytic lineage young pt extramedullary sarcoma |
acute monoblastic/monocytic leukemia
M5 |
|
>80% blasts are erythroid precurosers, MPO-, no dysplasia
or >50% erythroid precurors >20% myloblasts |
acute erythroid leukemia
M6 |
|
cytopenia, psudeopod formation, BM fibrosis
CD13, 333 CD 41, 61 (megakaryocytic) |
acute megakaryblastic leukemia
M7 |
|
difference between acute vs chronic leukemia?
|
acute > 20% blasts
chronic: <10% blasts evidence of maturation |
|
what disease:
increased RBC decreased EPO hypercell BM with fibrosis (later) |
polycythemia vera
|
|
BCR-ABL fusion in 100% of what cases?
|
CML
|
|
massive fibrosis of BM
splenomegaly portal HTN L side pleural effusion tear drop cells lerukoertyhroblastic rxn extramedullary hematopoiesis what condition? |
myelofibrsis and myeloid metaplasia
|
|
5q- and trisomy 8 related to what?
|
MDS
|
|
pancytopenia
leukoertythroblastic rxn ringed sideroblasts blasts <20% |
MDS "preleukemia"
|
|
CD10 -
TdT + = ? |
T cell ALL
|
|
CD10+
TdT + = ? |
B Cell ALL
|
|
>60 yo pt
generalized lymphadenopathy immune hemolytic anemia lymphoblasts <10% "smudge cells" neutropenia *hypogammaglob* |
CLL
|
|
what is the only leukemia without lympahdenopathy?
|
hairy cell
|
|
for type and crossmatch, IgM detection, if it is negative what does that mean? if it is positive, what do you do next?
|
it rules out an ABO incompatibility
if pos, do an indirect coombs |
|
delayd hemolytic transfusion rxn takes how long to manifest? is it intra or extravascular?
|
3-7 days, extra
|
|
how do you manage HTR?
|
1. hydration, diruesis
2. txt DIC with FFP 3. txt shock with steroids |
|
in a febrile rxn what is increased?
|
IL1beta
IL6 TFN alpha |
|
in febrile rxn, what is the pt reacting to?
|
donor leukocyte
|
|
after transfusion, pt presents with VERY high fever. describe etiology and txt.
|
prolly gram + coci from skin, txt with broad spec abx
|
|
what is the usual rate of transufion for a non bleeding pt? what rate do you transfuse at for a pt at high risk for circulatory overload?
|
normal: 2ml/kg/hr
risk: 1ml/kg/hr |
|
tranfusion related acute lung injury is reacting to what?
|
HLA specifci abs
|
|
ARD, pulm edema, hypoexmia, chills and fevers are characteristics of what?
|
TRALI
|
|
how can you prevent transfusion assosciated graft v host disease? what ags are present?
|
irritated blood, HLA ag
|
|
who is at risk for transfusion related GvHD?
|
premie infants, immunocomp'd
|
|
you store RBC, what happens to them?
|
1. increase in plasma K
2. loss of 23 DPG 3. need to maintain ATP level |
|
what is crytoprecipitate made up of?
|
from FFP, thawing, and collecting that precipitate
|
|
if you remove the leukocytes, what are you decreasing the incidence of?
|
alloimmunization to HLA ag, and some viral infections CMV
|
|
what pts would be harmed from a platlet transfusion?
|
ITP, TTP
|
|
what does cyroprecipitate contain?
|
factor VIII and vWF
|
|
factors that worsen coagulopathy in massive transfusion (3), and how do you correct it?
|
1. hypovolemia
2. DIC 3. Acidosis correct with transfusion of FFP |
|
what do platlet dense granules container? (3)
|
1. ADP
2. Calcium 3. serotonin |
|
what do platlet alpha granules cotnain? (6)
|
1. fibrinogen
2. factor V 3. vWF 4. fibronectin 5. PF4 6. thrombospondin |
|
indications for use of thrombolytics
|
1. MI
2. pulm emoblism 3. ischemic stroke |
|
indication for use of ASA
|
1. acute coronary syndrome
2. ischemic stroke 3. stent replacement |
|
you can use what within 3 hours of ischemic stroke?
|
t-PA
|
|
antifibrinolytics are contra-indicated in what?
|
anything to do with the head:
intracranial bleed, hematoma, stroke, hydrocephalus |
|
demopressin is used in...
|
vWD, hemophilia A, uremic bleeding
|
|
side effect of demopressin
|
tachyphylaxis
|
|
txt of CML
|
imatinib-gleevac, TK inhibitor
|
|
true or false
nilotanib causes a rash |
true
|
|
true or false
dasatinib causes peripheral edema? |
FALSE
dasatinib causes pleural edema imatinib caues peripheral edema |
|
fludarabine + clycophophamide +/- rituximab is 1st line for what?
|
CLL
|
|
what can be treated with ATRA?
|
APL
|
|
hydroxyurea, anangrelide, interferon alpha is used to treat what?
|
MDS
|
|
do you give hyrdoxyurea in PV?
|
NO, only in ET
|
|
low grade NHL can be treated with what?
|
CVP and anti-20 rituximab
|
|
CHOP up what?
|
Diffuse large b cell lymphoma
|
|
cuntaneous t cell is treated with what?
|
vorinostat
|
|
mantle cell is treate with what?
|
hyper CVAD
|
|
CBV regiment takes care of what?
|
lymphoma
|
|
Cy/TBI treats what?
|
lymphoma, acute leukemia
|
|
VP-16 and TBI treats?
|
acute leukemia
|
|
BAC
Bu/Cy BEAM all treat? |
lymphoma
|
|
true/false
melphalan treats MGUS |
FALSE
treats MM |
|
you see helmet cells (schistocytes) on blood smear, this could mean:
|
1. DIC
2. microangiopathic hemolytic anemia 3. SLE 4. HUS 5. thrombocytopenia purpura 6. malignant HTN |
|
you see tear drop cells on blood smear, this could mean:
|
Dacrocytes are found in myelofibrosis, myeloid metaplasia, pernicious anemia, thalassemia, and some hemolytic anemias.
|
|
you see howell jolly bodies, this means that the ____ is absent
|
SPLEEN gone when you see HJ bodies
|
|
you see target cells on smear, this means...
|
HbC disease
or severe liver disease |
|
you see helmet cells, this means...
|
auto immune hemolytic anemia
or traumatic anemia |
|
you see spur cells...
|
PNH
|
|
you see howell jolly bodies, this could mean the pt has (3):
|
1. hemolytic anemia
2. megaloblastic anemia 3. hyposplenism |
|
pt has heinz bodies which occurs post oxidative stress, this could mean the pt has: (4)
|
1. G6PD def
2. alpha thal 3. unstable Hb 4. splenectomized pt |
|
Is this indirect or direct coombs?
1. cross matching the donor RBC with pt serum 2. detection of Ab to RBC in pt's serum |
indirect coombs
|
|
direct or indirect coombs?
used in diagnosis of: 1. HDN 2. AHIA and drug induced hemolytic anemia 3. hemolytic transfusion rxns |
direct coombs
|
|
What is tested before RBC transfusions?
|
1. ABO and Rh
2. Ab screen to detect clinically sig Abs 3. in vitro compatibility of pt's serum with donor'[s RBC |
|
cross matching means...
|
adding pt serum to ABO, Rh, matched donor RBC
MANDATORY in pt with sig Abs |
|
true or false
extravascular hemolysis does not activate complement |
TRUE
|
|
upon transfusion pt has dyspnea, headache, heart failure, and distention of jugular veins... what happened??
|
circulatory overload
occurs in children, old people and severely anemic |
|
what is citrate used for in blood products?
|
used as an anticoagulant, chelates calcium
|
|
what coagulation factors does FFP contain? and what do you txt with it?
|
contains ALL coag factors
txt: DIC, massive transfusion, liver failure, reversal of coumadin, TTP, HUS, reversal of warfarin |
|
what do you use albumin for?
|
volume expansion! use to replace blood volume in blood loss, for plasmaphersis procedures
|
|
what day does reticulocytosis start? what day does it reach its max?
|
starts 2 days later, maxes at day 8
|
|
in massive transfusion, what should you measure?
|
PT and PTT
|
|
is coagulopathy more or less predictable than thrombocytopenia in massive transfusion?
|
coagulopathy is LESS predictable than thrombocytopenia
|
|
what is richter's syndrome?
|
transformation of CLL to diffuse large cell lymphoma
|
|
monoclonal B cell markers (CD19, CD20, SIg +) with CD 5+ is diagnostic of what 2 diseases?
|
CLL or mantle cell lymphoma
|
|
large lymphocytes with azurophilic granules would imply...
|
large granular lymphocytic leukemia
|
|
every pt with diagnosis of lymphoma should do what?
|
CT and PET scan
bilat BM aspiration biopsy blood chemistries |
|
true or false
MM is curable |
FALSE
txt with chemo and radiation, steroids, autologus stem cell transplantation = all pallitive |
|
you see a monoclonal Ab spike (M-protein_ what is your differential?
|
1. MM
2. WM 3. MGUS |
|
if you have roulaeux formation of the RBC what does this mean?
|
hypergammaglobulinemia
|
|
large platlets with not glycoprotein Ib, platlets wont aggregate to ristocetin -- what is this?
|
bernard soulier
|
|
there are no alpha granules in large platlets
|
grey platlet syndrome
|
|
what is the most common cause of defective platlet function?
|
aspirin therapy
|
|
why do you do immunosupression therapy in a person with hemophilia?
|
because they can form Abs to infused factor VIII
|
|
neck lymphadenopathy, hepatosplenomegaly, and bilateral axillary adenopathy are clinical features of what malignancy?
|
chronic lymphoid leukemias
|
|
treatments of hyperviscosity syndrome
|
plasmapheresis
venesection leurkopheris txt underlying disease! |
|
myeloid sarcoma with monocytic diff and an increase in eospinophils is due to what gene alteration in AML?
|
inv(16)
|
|
if you treat acute promyelocytic leukemia with ATRA what could happen?
|
DIC due to release of granules
|
|
-7q and -5q are seen in what 2 diseases?
|
AML and MDS
|
|
pt has a parvovirus infection and presents with pancytopenia, hypocellular BM, without abnormal cells in blood or bone... what is it?
|
aplastic anemia
|
|
hematopoietic stem cell is id'd via what CD marker?
|
CD34
|
|
what hematologic malignancies can be treated by autologous transplant? (4)
|
1. HL
2. NHL 3. MM 4. leukemias |
|
what hematologic malignancies can be traeted b y allogenic transplantation?
|
AML
ALL CML MDS HL NHL Aplastic Anemia Thalassemias Sickle cell SCID |
|
if you needed a transplant, what is the likelihood that your sibling is an HLA match?
|
25%
|
|
which refractory anemia presents with:
dimorphic RBC pappenheimer bodies erythroid hyperplasia anemia >15% ringed sideroblasts |
refractory anemia with ringed sideroblasts
|
|
which refractory anemia?
blasts 5-19% in BM blasts <20% in blood anemia macroovaloycytes nucleated RBC neuropenia, and thrombocytopenia immature neutrophils in blood |
RA with excess blasts
|
|
which refractory anemia:
no increase inblasts, monocytes or auer rods dysplasia of 2 or more myeloid cell lines BM is hypercell |
RA with multilineage dysplasia
|
|
what kind of refractory anemia is this:
after iron therapy macrocytic cells no blasts in blood BM is hypercell with <5% blasts |
just plain old refractory anemia (without ringed sideroblasts)
|
|
what are good prognosis for MDS? what about poor?
|
normal, 5q-, 20q-
poor: chrom 7 |
|
you see pseudo pelger huet nuclei and cytoplasmic vacuoles... what deltion is this ass'd with?
|
17p deletion, high p53 mutation -- UNBALANCED
|
|
monosomy 7 is ass'd with what? and when does it present?
|
childhood, median 10 months, ass'd with NF type 1 in males
|
|
what are high grade MDS?
|
RAEB1 and 2, 40-60% chance of evolution to AL
|
|
how to treat RAEB?
|
combo therapy of topotectan and cytoarabine, BMT
|
|
pt is 50 yo presents with B sx and splenomegaly. Was exposed to radiation, ,2% blasts in blood, baso and eosinophilia, platlet is INCREASED, BM is hypercell
|
CML chronic phase
|
|
CML pt has 10-19% blasts in blood or BM, with basophils >20%, increases WBC and spleen -- what phase?
|
accelerated
|
|
CML pt with >20% blasts in blood or BM, extramedullary prolif of blasts, clusters of blasts in BM - what phase?
|
blast phase
|
|
reticulin and collagen fbrosis of the BM, with splen enlargeent, taer drop cells, and immature myeloid/erythroid cells in blood. extramedullary hematopoesis is present. what is this?
|
spent phase of PV
|
|
low EPO and high RBC, splenomegaly, high platlet and WBC = what?
|
PV
|
|
what has reticulin and collagen fibrosis in BM with new bone formation??
|
fibrotic stage of chronic idiopathic myelofibrosis
|