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Hematology_Oncology (Rosh Review)
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Hematology/Oncology (Rosh Review)(HIT) Heparin Induced Thrombocytopenia - ANS-Type 1: PLT recovery with or without
heparin cessation
Type 2: autoimmune, venous/arterial thromboses
↓ in PLTs by 50%
Stop heparin, use direct thrombin inhibitor ==>(lepirudin, argatroban), factor *Xa
inhibitors (fondaparinux)* or heparinoids (danaproid)
AML - Acute Myeloid Leukemia - ANS-Patient will be an adult
Complaining of fever, fatigue, anemia, easy bruising or bleeding, petechiae, bone and
joint pain, and persistent or frequent infections
PE will show hepatosplenomegaly
Labs will show *Auer rods, normocytic, normochromic anemia*
The majority of patients will have a
*platelet count < 100 x 109/L* while the leukocyte count may be low, normal, or
elevated.
*Diagnosis is confirmed by bone marrow biopsy.*
Antiphospholipid Antibody Syndrome - ANS-Patient with a history of lupus or other
rheumatic diseases
Complaining of repeated spontaneous abortions
Labs will show thrombocytopenia
Most commonly caused by autoimmune
Treatment is anti-coagulation
B12 Deficiency (Cobalamin) - macrocytic - ANS-B12 is essential for DNA synthesis. If
deficient, nuclear maturation and cell division fails to occur cells are abnormally large
ETIOLOGIES
• Pernicious anemia is m/c/c: diminished intestinal absorption of B12 secondary to lack
of intrinsic factor.
o Gastric cells are responsible for secreting intrinsic factor so pts. s/p gastric bypass are
@ risk.
• Vegans: B12 is found in meat, fish, eggs, milk
S/S: all regular s/s of anemia (glossitis/ stomatitis) + neurologic s/s
, • Parasthesias, memory loss, dementia, confusion
DX: CBC/ peripheral smear
• High MCV
• Hypersegmented neutrophils + Ovalocytes
• High Homocysteine & Methylmalonic acid
• (+) Shilling Test in pernicious anemia.
TX: B12 replacement, watch for signs of hypokalemia
Chronic Lymphocytic Leukemia (CLL) - ANS-Patient will be > 60 years old
PE will show generalized lymphadenopathy
Labs will show isolated lymphocytosis, *smudge cells*
Comments: Most common adult leukemia in western world and generalized
lymphadenopathy > 60 years old
• TX: palliative for early disease, chemo once disease becomes symptomatic
• Classified w/ Rai, Binet
Different type of cells - ANS-*Codocyte* (target cell):
Thalasemia, Hemoglobin C Disease, Post splenectomy/Autosplenectomy
*Downey Cell* (Atypical lymphocyte):
Infectious Mononucleosis, EBV, CMV
*Echinocyte* (Burr Cell):
Artifact produced by EDTA (anticoagulant), Uremia, Pyruvate kinase deficiency,
Hemolytic anemia, Hypomagnesemia & hypophosphatemia
*Smudge Cell* (Basket cell): Chronic Lymphocytic Leukemia (CLL)
Factor V Leiden - ANS-Most commonly caused by an autosomal dominant genetic
disorder
Comments: *Most common inherited hypercoagulability disorder*
TX: FFP, anticoagulation*
G6PD Defficiency - ANS-X-linked recessive
Macrocytic anemia w/ increased reticulocytes and Heinz Bodies
Asymptomatic until exposed to oxidative stress
Antimalarials, sulfonamides (TMP-SMX), nitrofurantoin, methylene blue, fava beans,
vitamin K
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