Heme/Onc Step Up

RBC Physiology

-RBCs serve to transport

-Normal Hgb ____ serves as

-Left shift vs Right shift DOC

-Circulating RBCs, myeloid cells and lymphoid cells all originate from

-RBCs become enucleated during

Next Step: If a patient presents with CO poisoning

CO poisoning includes signs of

mental status changes

cherry red lips

hypoxia despire normal pulse ox readings

Hgb-Ox disssociation curve

left shift

red shift

Normal Hgb concentrations and Hct

Micocytic anemia pneumonic

Classification of Anemias

Hemolytic Anemia

-defined by

-can be caused by

-SXS

-Workup

-Coombs Test

-Blood smear

Mean RBC lifespan is

Consider IDA in elderly patients caused by

IDA

-defined as

-results from

-SXS

IDA

-Workup

-Blood Smear

-Tx

Drug induced hemolytic anemia

-Pathophysiology

-Blood Smear

-Coombs Test

-Other Diagnostic Aids

-Treatment

Auto-Immune Hemolytic Anemia (AIHA)

-Pathophysiology

-Blood Smear

-Coombs Test

-Other Diagnostic Aids

-Treatment

Mechanical Hemolytic Anemia

-Pathophysiology

-Blood Smear

-Coombs Test

-Other Diagnostic Aids

-Treatment

Hereditary spherocytosis hemolytic anemia

-Pathophysiology

-Blood Smear

-Coombs Test

-Other Diagnostic Aids

-Treatment

G6PD hemolytic anemia

-Pathophysiology

-Blood Smear

-Coombs Test

-Other Diagnostic Aids

-Treatment

Labs

• Serum Iron

• Ferritin

• TIBC (transferrin)

• Iron: TIBC Ratio

• Blood smear

Type:

• IDA

• Chronic Dz

• Lead poisioning

• Sideroblastic

• Thalassemia

Lead Poisoning Anemia

-defined by

-similar presentation seen in

-SXS

-Workup

-Blood Smear

Folate deficiency is most common cause of

megaloblastic anemia

Folate Deficiency anemia

-SXS

Inadequate folate intake is seen with _____ and in the ____ because of poor nutrition

alcoholism and in the elderly

Vitamin B12 def anemia

-SXS

Inadequate B12 intake is usually only seen in

strict vegetarians/ vegans

Anemia of chronic disease

-defined by

-frequently assoicated with

-SXS

-Workup

-Blood smear

-TX

___caused by inadequate dietary intake develops ___ vs ____from inadequate intake

Aplastic Anemia

-Due to

-SXS

-Workup

-Tx

Aplastic anemia in Sickle cell patient is classically caused by

Sideroblastic anemia

-defined by

-can be a ___ or caused by ____

-Blood smear

-Tx

-Complications

Patients with alpha thalsaeemia minima usually have a

normal MCV

Thalassemia

-defined. by

-disease state arrises from

-normal Hgb

Types of thalassemias and characteristics

Alpha vs beta

-more prevalant in

-variants between

Thalassemia

-Workup

-Blood smear

-Tx

-Complications

Next Step: if microcytic anemia if found on blood smear

Heterozygous carriers of sickle cell defect (sickle cell trait) are

Presence of fetal hgb in newborns delays presentation of

Sickle cell disease

-___ cause Hgb S molecules to polymerize and distort RBCs into

Sickle Cell Disease

-Radiology

-Blood Smear

Radiology:

• Codfish vertebrae

• Lung infiltrates if acute chest syndrome 

Blood smear: 

• Target cells 

• Nucleated RBCs

• Deoxygenation of blood producing sickle cells 

Sickle Cell Disease

-Crisis treatment

-To decrease frequency of crises

-Asplenia patients need

Sickle cell crisis treatment: 

- hydration 

-supplemental O2 

-analgesics 

To decrease frequency of crises 

-hydroxyurea 

Asplenic patients: 

-pneumococcal vaccine reduced risk of infection in asplenic patients 

-Give prophylactic penicillin until age 5 if no spleen 

Patients with sickle cell disease are particularly susceptible to

Salmonella osteomyelitis 

Sepsis by NSH + klebsiella (encasuplated) 

Lymphopenia without Immune deficiency

-Def

-SXS

-Workup

-Tx

Eosinophilia

-Def

-SXS

-Workup

-Tx

Neutropenia

-def

-SXS

-Workup

-Tx

HSR reactions

-def

-Workup

-Tx

Types of HSR table

Anaphylaxsis

-Def

-SXS

-Workup

-Tx

Normal Clotting Functions: Platelets

Next Step: monitor heparin anticoagulation with

PTT

LWMH do NOT require

monitoring by PTT

Normal Clotting Function: Coagulation Cascade

Common Anticoagulant Drugs

• Mechanism

• Role

• Adverse Effects

Drugs:

• ASA

• Thienopyridines (ex.clopidogrel, ticlopidine)

• GP3b/2b inhibitors (abciximab, tirofiban, eptifibatide)

• Adenosine reuptake inhibitors (dipyridamole)

• Heparin

• LWMH/ enoxaparin/dalteparin

• Direct Thrombin inhibitors (apixaban, rivaroxaban)

• Direct XA inhibitors (-ban)

• Warfarin

Antithrombic drugs are used to ____; can affect ______

Next Step: Monitor warfarin anticoagulation with

Do not start warfarin therapy for _____ until _____ because _____

Thrombocytopenia

-Defined as

-may be caused by

-SXS

-Workup

-Blood smear

Causes of thrombocytopenia

• pathology

• Dx

• Tx

1. Impaired production

• drugs

• infection

• aplastic anemia

• folate/vitamin B 12 def

• alcohol

• cirrhosis

2. abnormal pooling

3. HIT

Causes of thrombocytopenia

• pathology

• Dx

• Tx

1. ITP

2. TTP-HUS

3. Antiphospholipid Syndrome

Causes of thrombocytopenia

• pathology

• Dx

• Tx

HELLP syndrome

vWD

-def

-SXS
-workup

-Tx

Administration of FFP is indicated in patients with

VWF and Factor8 are the only clotting factors not synthesized eclusively by

patients using warfarin can present with clinical picture similar to that of

Vitamin K deficiency

-definition

-Vitamin K is required in

-SXS

-Workup

-Tx

Hemophilia

-definition of

-SXS

-Workup

-Tx

-Complications

Hemophiliacs tend not to develop significant bleeds unless they have

DIC

-def and pathophysiology

-SXS

Workup

-Blood smear

-Treatment

-Complications

Bleeding in DIC occurs because

bleeding in other clotting disorders occurs because

Sepsis

-Defined by

-Dx criteria for SIRS

-Common community acquired pathogens include

-Common nosocomial pathogens include

-SXS

-Workup

-Radiology

-Staph aureus is most common cause of sepsis in

-Tx

-Complication

Sepsis: Next Step: Do not start abx until after

Malaria

-def

-SXS

-workup

-blood smear

-tx

although rare in US, malaria is common in ___

travers should take _____

Infectious mononucleosis

-def

-transmitted by

-SXS

-Workup

-Blood smear

-Tx

-Complications

Symptoms of mono do not appear until

HIV infection has greatest prevlance in

transmission typically through

HIV

-defined by

-Viruses use

-Transmitted via

HIV

-Following acute infection, patients enter

-Late SXS

Next Step: although rate of HIV transmission through needle sticks is very low, prophylactic ______ should be started immediately if there is an appreciable risk of transmission

_____ tests should be performed _____ after exposure to determine if transmission occured

-Tx should be continued for ____

Opportunistic infections, Neoplasms and Complications seen in AIDS:

• CD4 level when seen

• SXS

• Dx

• Tx

HSV

Kaposi Sarcoma

Parasitic Diarrhea (isopora, strongyloides, cryptosporidum)

Wasting syndrome

Opportunistic infections, Neoplasms and Complications seen in AIDS:

• CD4 level when seen

• SXS

• Dx

• Tx

Coccidiodomycosis

AIDS dementia

Bacterial PNA (S. PNA, H.flu, Nocardia)

Opportunistic infections, Neoplasms and Complications seen in AIDS:

• CD4 level when seen

• SXS

• Dx

• Tx

Candida esophagitis

Cervical Cancer

PJP

Opportunistic infections, Neoplasms and Complications seen in AIDS:

• CD4 level when seen

• SXS

• Dx

• Tx

TB

Histo

Cerebral Toxo

Opportunistic infections, Neoplasms and Complications seen in AIDS:

• CD4 level when seen

• SXS

• Dx

• Tx

Lymphoma (CNS or non Hodgkin)

PML/JC virus

Cryptococcal meningitis

Opportunistic infections, Neoplasms and Complications seen in AIDS:

• CD4 level when seen

• SXS

• Dx

• Tx

CMV

Mycobacterium avium complex

HIV

-W/U

1. ELIZA 

2. Repeat ELIZA if positive 

3. Western blot to r/o false positive 

4. Viral load and  CD4 count to track extent of disease progression 

It may take up to _____ for HIV abs to appear in the serum

6 months

Serologic profile of HIV

HIV

-Treatment

• ART should be initated for all HIV infected patients, regardless of

• Utility of starting ART in acute infection is

• Common initial HAART regimens

• Compliance with therapy is

• Indications for changing ART include

• Abx prophylaxis for opportunistic infections

• close following of serology is important for

• Pregnant mothers with HIV

-Complications

Mother to infant transmission of HIV is

rare when viral load <1000

ART for HIV

-Examples of drug

-Mechanism

-Adverse effects

• NRTIs

• NNRTis

• Protease Inhibitors

ART for HIV

-Examples of drug

-Mechanism

-Adverse effects

• INSTIs

• Fusion Inhibitor

• CCR5 antagonist

HIV positive mothers should NOT

DO NOT breastfeed their infants

Polycythemia Vera

-def

-tends to occur after age

-SXS
-Workup

-Tx

-Complications

The most common cause of increased RBC production is

chronic hypoxia

Multiple Myeloma

-defined by

-abnormal monoclonal protein ___ produced by

-SXS

-Radiology

-Tx

-Complications

Lymphoma

-def

-categorized as

ALL is the

Most ALL originates in

Hodgkin lymphoma vs Non Hodgkin Lymphoma

• cells of origin

• classification low to higher grade

• RF, patient population

• SXS

• Labs

• Tx

  • Prognosis

Leukemia

-defined as

-acute leukemia tends to involve

-Bone marrow involvement can cause

ALL

-epidemiology

-def

-SXS

-Workup

ALL

-Blood smear

-Tx

-Complications

AML

-def

-SXS

-Workup

Blood smear

-Tx

-Complications

CLL

-def

-SXS

-Workup

-Blood Smear

-Tx

Complications

lymphoma

ALL