All subjects
Hematology & Oncology
Anemias, coagulation, leukemias and lymphomas with the chemotherapy toxicities that pair with them.
Exam weight 6–9% · 2 QBank items · 4 flashcards
Anemias
- Microcytic: iron deficiency, thalassemia, anemia of chronic disease, lead poisoning, sideroblastic.
- Iron studies: iron deficiency has low ferritin with high TIBC; chronic disease has high ferritin with low TIBC.
- Macrocytic megaloblastic anemia shows hypersegmented neutrophils — B12 or folate deficiency, or methotrexate.
- Hereditary spherocytosis: increased osmotic fragility and increased MCHC, positive eosin-5-maleimide test; splenectomy is curative.
Hemostasis & coagulation
- Platelet disorders bleed into skin and mucosa; coagulation factor disorders bleed into joints and muscle.
- ITP: isolated thrombocytopenia with large platelets, anti-GPIIb/IIIa; TTP: ADAMTS13 deficiency with schistocytes and neurologic signs.
- von Willebrand disease is the most common inherited bleeding disorder — prolonged bleeding time with normal platelets; treat with desmopressin.
- DIC prolongs PT and PTT with low fibrinogen and high D-dimer; triggered by sepsis, obstetric complication, malignancy and trauma.
Leukemias & lymphomas
- ALL in children: TdT positive, responds well, CNS and testes are sanctuary sites; t(12;21) has a good prognosis.
- CML: t(9;22) BCR-ABL, low leukocyte alkaline phosphatase, treat with imatinib.
- AML M3 (APL): t(15;17), Auer rods, DIC risk; treat with all-trans retinoic acid.
- Hodgkin lymphoma: Reed-Sternberg cells (CD15+, CD30+), contiguous spread, bimodal age distribution, B symptoms.
Oncologic pharmacology
- Doxorubicin: dilated cardiomyopathy — prevent with dexrazoxane; bleomycin: pulmonary fibrosis.
- Cisplatin: nephrotoxicity and ototoxicity — prevent with amifostine and saline hydration.
- Cyclophosphamide: hemorrhagic cystitis — prevent with mesna; vincristine: peripheral neuropathy.
- Methotrexate toxicity is rescued with leucovorin; 5-FU with uridine triacetate.