hematology/oncology diseases & the eye

most common form of anemia

iron deficiency anemia

iron deficiency anemia

-most common type (50% of anemias)

-adults MC reason is blood loss (PU disease or colon cancer)

-other causes: malabsorption or decreased iron intake

the MC cause of ID anemia in children: malnutrition

lab tests for iron deficiency anemia

-CBC

low HgB

decreased MCV

any iron under 12 (M or F)

signs of iron deficiency anemia

-fatigue

-pale skin

-leg cramps

-brittle hair

-nail spooning

-pica

tx for iron deficiency anemia

-iron supplementation

-ferrous sulfate: MC used for constipation

-GI disease management

anaplastic anemia

-pancytopenia

-fatigue, skin rash, HA, dizziness, tachycardia, uncontrolled bleeding from minor cuts

-chronically damage kidneys synthesize inadequate amounts of EPO (hormone that stimulates RBC production in bone marrow)

causes:

-infection, radiation and drugs (Chloramphenicol, Acetazolamide, Chemo drugs)

anaplastic anemia lab test

-low Hgb, platelet, RBC, WBC

-normal MCV

tx for anaplastic anemia

-#1 blood transfusions

-drugs (immunosuppressors, hematopoietic growth factors)

-bone marrow transplant

sickle cell anemia

-MC form is caused by a mutation in the beta globin gene

Valine is substituted for glutamic acid

-low Hgb, increased bilirubin and crescent shape cells

-crescent cells → occlude retinal vessels → ischemia → neovascularization

sea fan, salmon patch hemes and black sunburts

stage 1 for sickle cell anemia

peripheral arterial occlusion

stage 2 of SCA

-peripheral arteriovenous anastomoses, representing dilated pre-existing capillaries (hairpin loop)

stage 3 SCA

-neovascular and fibrous proliferation

-seafan: due to auto-infarction of the neovasculature

stage 4 SCA

vitreous heme

stage 5 SCA

tractional retinal detachment

tx for SCA

-antimetabolites: hydroxyurea

-opioid analgesics: acute crisis (morphine, oxycodonem phentanyl)

-blood transfusion

-hydration

vit b12 def

-inadequate intake or malabsorption of vitamin B12

-caused by pernicious anemia: autoantibodies against the parietal cells of the stomach (@ parietal cells of stomach which also produce HCl)

-decreased production of intrinsic factor

-glossitis, mood changes, dizziness, sensations of pins and needles

tx for vit b12 def

cyanocobalamin

nasal spray or SC MC

folic acid deficiency

-in OB can increase risk of neural tube defects → s

-fatigue, red tongue, miscarriages, diarrhea, pale skin

tx for folic acid def

400mcg/d PO and in OB 600 mcg/d PO

multiple myeloma

proliferation of a malignant clone of plasma cells in the bone marrow

-extensive skeletal bone destruction

-unexplained anemia

-hypercalcemia

-acute renal failure

lymphoma

proliferation of malignant lymph cells in solid tissues

@ lymph nodes, spleen and GI tract

40% hodgkins

60% non hodgkins

hodgkin’s lymphoma

two peak age groups:

-15-30yo

-50yo

-night sweats, enlarged lymph nodes, fever and itching

-red-sternberg cells (owl eyes)

-itching & enlarged lymph nodes

-good prognosis if dx early

50% associated with EBV (cause my mononucleosis virus)

non-hodgkins lymphoma

-enlarged lymph nodes and GI tumors

-abdominal pain

-variable prognosis depending on the type

-bone marrow bx to determine type (T or B cells)

intraocular lymphoma

non-hodgkin is the MC type

-orbital is the MC 55% in adults

-leopard spots, conjuctival lymphoma, orbital lymphoma

-metastatic from CNS

Tx for intraocular lymphoma

-chemoradiation

-survival rate 5 yrs

acute leukemia

-can affect all ages

-blast cells (immature cells) (B cells, T cells and Natural Killer cells)

Roth Spots

-retinal hem with a white spot in the middle

-also present in endocarditis

acute lymphoblastic leukemia (ALL)

-peak age is 2-10y

-normal WBC w. excessive lymphoblasts

-with tx: 75% remain disease free >5 yr

acute myeloblastic leukemia (AML)

-infants & middle age or older

-normal WBC with excessive myeloblasts

-Auer rods

chronic leukemia

-usually in older adults

-predominant cells are mature cells of the bone marrow

-often asymptomatic

-chronic myelocytic leukemia (CML) & chronic lymphocyte leukemia (CLL)

chronic myelocytic leukemia (CML)

-25-60yo

-poor prognosis 3 yr survival

-WBC 50,000 to 300,000 increased granulocytosis

-90% have the Philadelphia chromosome

chronic lymphocyte leukemia (CLL)

-age of onset is grater than 50yo

-M:F 2:1

-WBC 20,000 to 200,000

-5 to 10 yr survival rate

non-neoplastic disorders of blood cells

-leukopenia

-leukocytosis

-neutrophilia

-thrombocytosis

-pancytopenia

-thrombocytopenia

Leukopenia

-decreased number of WBC

-bone marrow injury, BM inactivation, #1 chemotherapy, antimetabolites (methotrexate)

leukocytosis

-#1 infections

-sx

-illness

-stress

-OB

neutrophilia

increase in absolute number of neutrophils

causes:

-stress

-exercise

-pain

-fever

-infections (typically bacterial)

thrombocytosis

-elevated platelet count

causes

-inflammation

-kidney disease

-spleen removal

pancytopenia

-decreased numbers of RBC and WBC

thrombocytopenia

-decreased platelets

causes

-infection

-lover failure

-BM disorders

metastatic intraocular tumors

only 5% of the eye tumors are primary to the eye → 95% occur by metastasis

matastases to the eye occur only in adults → in choroid bc it is the organ with the most vascularization

women MC: breast cancer

men MC: lung cancer

what is the most common tumor that metastasize to the eye?

carcinoma

what is the most common site in the eye for metastatic tumor involvement and what signs would they experience?

macula

-painless loss of vision, choroidal tumor in the PP

dx for metastatic intraocular tumors

-US #1

-FA

-Bx

tx for metastatic intraocular tumors

-external beam radiotherapy and chemotherapy

-good prognosis of the eye

most common primary cancers in choroidal metastasis

female: breast

male: lung