CA Heme/Onc: Key Terms & Definitions in Medicine

fatigue

nonspecific

sense of weariness or loss of energy

investigate fully

weight change

loss of 5+% of body weight over 6mo period

b symptoms

lymphoma

fever, drenching night sweats, weight loss >10% of prior body weight

concerning skin changes

new onset generalized itching (malignancy (Hodgkins, lung, breast), CKD, liver disease)

increase bleeding and bruising

Pallor (paleness)

lesar-trelat

tripe palm

lesar-trelat

new onset of multiple is concern for GI CA, lymphoid, Breast, lung & other CAs

tripe palm

swollen fingers - GI or lung CA

interpret CBC with automated differential

see screenshot

corpuscle

cell

CBC panel components

hemoglobin

hematocrit

total RBC count

total WBC count

total platelet count

MCV, MCH, MCHC

when is a CBC w/ diff ordered?

major surgeries, surveillance, <1yo, before starting biologics, to differentiate source of infection

WBC prevelance

never let monkeys eat bananas

what measures help you evaluate anemia in a CBC?

mean corpuscle volume, hemoglobin & hemoglobin concentration

mcv

mean cellular corpuscular volume

average size of RBCs

CMP components

partial thromboplastin time (PTT)

when would you order a PTT?

prothrombin time and international normalized ratio (PT & INR)

when do you order a PT & INR?

when would you obtain a peripheral blood smear?

what is included in a peripheral blood smear?

acanthocytes

dacrocytes

elliptocytes

schistocytes

helmet cells - fragmented RBCs in various shapes

indicate hemolytic anemia

what anemia may present with jaundice?

hemolytic

spherocytes

seen in spherocytosis

spleen destructs cells

dark red, lack central pallor, dense

Howell-jolly body

target cells

heinz bodies

clumps of damaged hemoglobin attached to RBC

hemolytic anemia finding, G6PD deficiency

bite or blister cells

seen in G6PD deficiency

auer rods

hyperhsegmented neutrophils

reed Sternberg cells

philadelphia chromosomes

IDA

low Hgb, Hct

low MCV

low/normal reticulocyte

microcytic, hypo chromic

pica

thalassemia

intrinsic, hereditary hemolytic anemia

microcytic, hypochromic

normal iron, ferritin, TIBC

high reticulocytes, bilirubin

low haptoglobin

lab values: anemia of chronic disease

ferritin increased or normal

low iron (because it is moved out of serum)

TIBC low

normocytic early then microcytic

lab values: vitamin b12 deficiency

*concern for demyelination

tired, irritable, depressed, sleep problems, poor reflexes, sore tongue, unsteady gait, stocking glove paresthesias, impaired proprioception, CHF

dx: low b12, nl folate, anti-intrinsic factor antibodies, macrocytic, elevated ldh maybe

folic acid deficiency

weakness, fatigue, loss of appetite, weight loss, HA< glossitis, low birth weight, neural tube defects

anemia = late finding

serum b12 normal

folate low

Howell-jolly bodies

autoimmune hemolytic anemia

result of autoimmune condition

dx: Coombs test - clump

anemia lab values

Hgb & Hct Low

microcytic anemias

iron deficiency

anemia chronic disease

thalassemia

macrocytic anemias

vitamin b12 deficiency

folic acid deficiency

normocytic anemia

autoimmune hemolytic anemia

lab values: thrombocytopenia

lab values: thrombocytosis

lab values: leukopenia

lab values: leukocytosis

lab values: neutropenia

decreased neutrophils; many things: drugs, viral

neutrophilia

increased neutrophils - bacterial infections

lab values: lymphocytosis

increase lymphocytes; viral infections, acute infectious lymphocytosis in children, acute & chronic lymphocytic leukemia

lab values: pancytopenia

indicates aplastic anemia

disseminated intravascular coagulation (DIC)

idiopathic thrombocytopenia (ITP)

thrombotic thrombocytopenia (TTP)

von willebrands disease

factor V leiden

hemophilia

myelodysplastic syndrome

Acute Myelogenous Leukemia (AML)

acute lymphocytic leukemia (ALL)

chronic lymphocytic leukemia (CLL)

chronic myelogenous leukemia (CML)

Non-Hodgkin's Lymphoma

Hodgkin's lymphoma

multiple myeloma

polycythemia vera

increased RBC mass, big RBCs

elevated RBC count, Hgb, Hct, epo

Bone marrow bx for confirmation dx

pruritis after bathing, burning hands & feet; red or blue discoloration, epistaxis, thrombosis + more

peptic ulcer disease

aplastic anemia

malaise, pallor, palpitations, bruising, increased infection, chills, fever, petechiae

pancytopenia

confirm dx with bone marrow bx

phlebotomy: risk & benefit

phlebotomy: equipment

injections: risk/benefits (subQ, intraderm, IM)

subcutaneous injection equipment

intradermal injection equipment

IM injection equipment

IV catheter risk/benefits

IV catheter equipment

bone marrow biopsy: risk/benefits & equipment

lymph node biopsy: risk/benefits & equipment

nuclear testing (like PET scan): risk/benefits & equipment

injection indications

medical diagnoses

vaccine administration

therapeutics

injection contraindications

allergy

coagulopathy

pregnancy (no live vaccines)

active infection or atrophy at site

injection complications

pain, burning at site

infection

lipodystrophy/atrophy with repeated injections

injury to surrounding structures

allergic rxn

medical error

injection angles

Intradermal: 10-15°

IV: 15-30°

Subcu: 45° or 90*

IM: 90°

common needle sizes

intradermal 25-27gauge, 1/2-5/8 inch

subcutaneous: 25-27, 3/8-5/8in

IM: 20-25, 1.5in

intradermal optimal location

10cm distal to antecubital fossa on ventral forearm

subcutaneous locations

anterior or posterior thigh

upper buttocks

lateral lower back

lateral upper extremity

IM locations

deltoid (2.5cm below acromion)

ventrogluteal site (prone or supine, palm over greater trochanter, extended index and middle finger, insert between)

vastus lateralis (front thigh Into 9 sections, outer middle is where you inject; supine or standing)

IM injection rate

10s/mL

MCH

mean cellular corpuscular hemoglobin

amount of hemoglobin in average RBC

MCHC

mean cellular corpuscular hemoglobin concentration

= hemoglobin/hematocrit

hypo- normo- or hyper- chromic

RDW

red cell distribution width - measures degree of anisosocytoskis (variation in RBC size)