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Hematology – Awesome
Random heme associations
| Question | Answer |
|---|---|
| ringed sideroblasts | Pb toxicity or myelodysplastic syndrome with 6 years to live |
| anemia in a person who's worked with batteries or a person who lived in an old building | Pb toxicity, microcytic |
| Heinz bodies | in B thalassemia major, it's a precipitation of alpha chains |
| walking like a soldier | B12 deficiency because they can't feel their feet |
| Things that can cause folate deficiency | A FOLIC DROP. Alcohol, Folate antag like MTX and pyrimethamine, OCPs, Low in diet, Infection, Celiac, Dilantin/phenytoin, Relative folate deficiency, Old, Pregnant |
| see hypersegmented neutrophils on smear vs hypo segmented neutrophils | B12 or folate deficiency; hypo is myelodysplastic syndrome |
| burr cells on peripheral smear | anemia of uremia |
| spur cells | liver disease, can't absorb dietary fats |
| mechanical valve on warfarin in the aortic position and without additional risk factors - what is the pre-procedural anticoagulation recommendation? | periprocedural anticoagulation is to stop warfarin 48 to 72 hours before the procedure and restart it within 24 hours after the procedure; bridging with heparin is usually not necessary |
| factors that increase the risk of vte | include afib, >1 mechanical valve, ejection fraction <30%, a hypercoagulable state, and previous thromboembolic event, including stroke or transient ischemic attack |
| what is the recommendation for pre-procedural anticoagulation for patients with a mechanical valve and an increased risk of a thromboembolic event | unfractionated heparin is begun intravenously when INR falls below 2.0, stopped 4 to 5 hours before the procedure, and restarted as early after surgery as possible along with warfarin and continued until INR is therapeutic again |
| patients with a mechanical heart valve and therapeutic INR who require emergent surgery - what to do with the anticoagulation? | reversal of anticoagulation with transfusion of fresh frozen plasma may be performed |
| Things you test for if you want an anti-coag workup | activated protein C resistance, factor V Leiden, the prothrombin gene mutation, antiphospholipid antibodies, a lupus inhibitor, antithrombin deficiency, protein C deficiency, and protein S deficiency |
| The difference between MGUS, smoldering myeloma, and multiple myeloma | MGUS <10% plasma cells, <3g M protein smoldering >10% plasma cells, >3g M protein with NO organ damage multiple myeloma >10% plasma cells, >3g M protein WITH organ damage |
| MCV in Hereditary spherocytosis | normal to high |
| When to do FISH to find diagnosis | FISH in t(9,22) in CML |
| When to do flow cytometry to diagnose? | Flow cytometry of the peripheral blood would be useful if a hematologic malignancy characterized by a homogeneous population of cells (acute lymphoblastic leukemia, chronic lymphocytic leukemia, non-Hodgkin lymphoma, or acute myeloid leukemia |
| 10% or more clonal plasma cells on bone marrow biopsy | multiple myeloma |
| acute thrombosis, warfarin therapy, and pregnancy can cause transient declines or increases in functional protein S levels | declines |
| decreased protein S levels cause what | hypercoaguability. activated protein C and S block conversion of F8 and F5 to their active forms. Therefore, increased C+S means more bleeding. decreased C+S means less bleeding, more coagulability. |
| macroglossia, hepatomegaly, nephrotic syndrome, peripheral neuropathy, and the presence of an IgG lambda M-protein | AL amyloidosis |
| how to dx AL amyloidosis | combination of bone marrow biopsy and abdominal fat pad aspiration has a sensitivity of approximately 90% |
| splenomegaly, a personal and family history of anemia, leg ulcers, gallstones, and spherocytes on the peripheral blood smear | Hereditary spherocytosis |
| Pregnant women with a history of idiopathic venous thromboembolism should receive what for ppx? | prophylactic-dose or intermediate-dose low-molecular-weight heparin (LMWH) during pregnancy and for 6 weeks postpartum |
| ppx for women with recurrent fetal loss and the antiphospholipid syndrome? | Prophylaxis with both low-dose aspirin and low- or moderate-dose unfractionated heparin or LMWH |
| inheritance pattern for von Willebrand disease | autosomal dominant |
| initial therapy of patients with immune thrombocytopenic purpura if pt is bleeding or if plt < 10K | Corticosteroids and intravenous immune globuli |
| thrombocytopenia, microangiopathic hemolytic anemia, neurologic deficits, kidney impairment, and fever | TTP |
| 25% lymphoblasts or more on bone marrow examination | B-cell acute lymphoblastic leukemia (ALL) |
| TdT-positive cells | marker for lymphoid cells |
| CD10 and CD20 | B-cell markers |
| BCR-ABL inhibitor | imatinib used in CML or Philadelphia chromosome-positive ALL |
| how to treat B-cell acute lymphoblastic leukemia | induction chemotherapy consisting of daunorubicin, vincristine, L-asparaginase, and prednisone |
| when to use Erythrocyte transfusion and exchange transfusion in sickle cells patients | acute management of stroke and acute chest syndrome |
| alloantibodies to antigens C, E, and K on blood typing and screening increase the risk for what? | delayed hemolytic transfusion reaction |
| The peripheral blood smear shows increased platelet numbers and circulating megathrombocytes but is otherwise normal | essential thrombocythemia |
| platelet counts greater than 1 million/µL (1000 × 109/L) strongly suggests | essential thrombocythemia |
| presence of (1) microangiopathic hemolytic anemia, characterized by schistocytes on the peripheral smear and increased lactate dehydrogenase, and (2) thrombocytopenia. | thrombotic thrombocytopenic purpura |
| thrombocytopenia, microangiopathic hemolytic anemia, neurologic deficits, kidney impairment, and fever | thrombotic thrombocytopenic purpura |
| thrombocytopenia and microangiopathic hemolytic anemia | thrombotic thrombocytopenic purpura |
| how to treat thrombotic thrombocytopenic purpura | plasma exchange, which should be instituted emergently at diagnosis because 10% of patients die of this disease despite therapy, usually within the first 24 hours |
| ANCs between 1000/µL and 1500/µL (1.0-1.5 × 109/L) | Mild congenital asymptomatic neutropenia, common in certain ethnic populations, including blacks, Yemenite Jews, and Jordanian Arabs. This condition is not associated with increased infections and requires no therapy. |
| antineutrophil antibody assay | evaluation of autoimmune neutropenia if the patient's neutropenia were to worsen |
| neutrophil elastase gene | mutated in patients with severe congenital neutropenia, which is characterized by onset early in life and life-threatening infections |
| how to treat secondary iron overload from β-thalassemia major | iron chelation with Deferasirox |
| what is side effect of Deferasirox or other iron chelators | agranulocytosis and kidney failure |
| unprovoked venous thrombosis at an unusual location, hemolytic anemia, and mild to moderate pancytopenia | paroxysmal nocturnal hemoglobinuria (PNH) |
| how to diagnose PNH | diagnosis of PNH is made by flow cytometry, which can identify a subpopulation of erythrocytes or leukocytes lacking specific glycosylphosphatidylinositol-anchored surface proteins, such as CD55 or CD59 |
| IgM κ M-protein level | Waldenström macroglobulinemia |
| lymphoplasmacytic lymphoma characterized by production of monoclonal IgM antibodies | Waldenström macroglobulinemia |
| how to treat hyperviscoscity in Waldenström macroglobulinemia | plasmapheresis |
| what can be helpful in estimating the prognosis of thrombotic thrombocytopenic purpura (TTP) | ADAMTS-13 |
| seeing what on the PBS makes warm or cold autoimmune hemolytic anemia less likely | presence of schistocytes on the blood smear makes warm or cold autoimmune hemolytic anemia unlikely |
| viruses that can cause aplastic anemia | Epstein-Barr virus and cytomegalovirus infection can cause aplastic anemia, also ParvoB19 |
| how to treat HIT | direct thrombin inhibitors lepirudin(don't use in CKD because cleared by kidney), argatroban, and danaparoid Argatroban, which is cleared through the liver, requires dose adjustments in patients with elevated liver chemistry test values. |
| hypoxia, and dyspnea, as well as fever and hypotension, occurring during or within hours of a transfusion and resembles noncardiac pulmonary edema | TRALI |
| Very early in the transfusion, affected patients develop hypotension and disseminated intravascular coagulation | acute hemolytic transfusion reaction (AHTR) is most commonly caused by a clerical error leading to ABO incompatibilit |
| high Hct and high Epo vs high Hct and Low Epo | high Hct and high Epo is secondary erythrocytosis from hypoxia (like OSA). high Hct and low Epo is PV |
| macroovalocytes and hypersegmented polymorphonuclear cells on the peripheral blood smear and hemolysis. | B12 deficiency |
| glossitis, weight loss, and pale yellow skin, loss of position or vibratory sense that can progress to spastic ataxia | B12 deficiency |
| Hereditary spherocytosis associated with what types of stones | calcium bilirubinate gallstones |
Created by:
christinapham
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