HemOnc - Revision history

Aesetholephews at 22:35, 30 June 2023

2023-06-30T22:35:20Z

2023-01-17T02:59:57Z

Anemia

2023-01-16T18:04:04Z

HIT

2023-01-15T04:19:26Z

Missed Concepts

2023-01-15T04:16:04Z

Missed Concepts

2023-01-15T04:13:38Z

HIT

2023-01-15T04:09:33Z

2023-01-14T17:30:27Z

HIT

2023-01-14T06:06:49Z

2023-01-14T06:06:24Z

Missed Concepts

← Older revision		Revision as of 22:35, 30 June 2023
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	*Dx: Bone marrow biopsy showing >10% clonal plasma cells + end organ damage (CRAB) OR >60% clonal plasma cells without end organ damage. M-spike on SPEP (also shows up in smoldering myeloma). Bone scan shows punched out lesions. Hyperviscosity syndrome when there is monoclonal IgM, this leads to impaired platelet function and epistaxis/gingival bleeding (overall more common in Waldenstrom's macroglobulinemia). β2 microglobulin is a prognostic marker.		*Dx: Bone marrow biopsy showing >10% clonal plasma cells + end organ damage (CRAB) OR >60% clonal plasma cells without end organ damage. M-spike on SPEP (also shows up in smoldering myeloma). Bone scan shows punched out lesions. Hyperviscosity syndrome when there is monoclonal IgM, this leads to impaired platelet function and epistaxis/gingival bleeding (overall more common in Waldenstrom's macroglobulinemia). β2 microglobulin is a prognostic marker.
	*Tx: Autologous Stem Cell Transplant or chemotherapy		*Tx: Autologous Stem Cell Transplant or chemotherapy
		+
		+
		+	https://www.ohsu.edu/knight-cancer-institute/thomas-deloughery-mds-famous-handouts

← Older revision		Revision as of 02:59, 17 January 2023
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	=[[Anemia]]=		=[[Anemia]]=
		+	*Micro: Thalassemia (Mentzer Index < 13: MCV/RBC), Iron (RDW high), Chronic inflammation (ESR, CRP), Lead (serum level), Sideroblastic
		+	*Normo:
		+	** Non-Hemolytic (retic count ≤ 2%, normal LDH/haptoglobin/RDW): Chronic inflammation, Iron, CKD, Aplastic
		+	** Hemolytic (retic count > 2%, elevated LDH, low haptoglobin, elevated RDW):
		+	*** Intrinsic: MEH (HS/PNH, G6PD/Pyruvate kinase, SCD/HbC)
		+	*** Extrinsic: MAMI
		+	*Macro:
		+	** Megaloblastic: B12 Folate Fanconi
		+	** Non-Megaloblastic: Alcohol Liver disease

	=Thrombocytopenia=		=Thrombocytopenia=

@@ Line 22: / Line 22: @@
 ==HIT==
 *Dx: T score (timing, thrombocytopenia, thrombosis, alTernate causes)
-*Tx: Discontinuation of heparin and transition to a DOAC if anticoagulation is still required (Warfarin causes transient hyper coagulable state due to '''depletion of protein of C'''). '''Avoidance of heparin for life'''
+*Tx: Discontinuation of heparin and '''transition to a DOAC if anticoagulation is still required (usually is immediately)''' (Warfarin causes transient hyper coagulable state due to '''depletion of protein of C'''). '''Avoidance of heparin for life'''
 =Multiple Myeloma=

@@ Line 4: / Line 4: @@
 *Factor V Leiden accounts for about 50% of hereditary thrombophilia.
 *Technetium-99 bone scan detects plastic lesions, CT detects lytic lesions.
-*Tumor lysis syndrome causes release of K, Phos, and Urea, this leads to uremic syndrome, stones, hypocalcemia, [[Renal|AKI]], and cardiac arrhythmias.
+*Tumor lysis syndrome causes '''release of K, Phos, and Urea''' leading to '''uremic syndrome, stones, hypocalcemia, [[Renal|AKI]], and cardiac arrhythmias'''. Treatment is with '''IV fluids and rasburicase'''
 =[[Anemia]]=

@@ Line 4: / Line 4: @@
 *Factor V Leiden accounts for about 50% of hereditary thrombophilia.
 *Technetium-99 bone scan detects plastic lesions, CT detects lytic lesions.
 =[[Anemia]]=

@@ Line 20: / Line 20: @@
 *Dx: Low platelets plus elevated d-dimer, prolonged PT/PTT, low fibrinogen
 ==HIT==
 *Tx: Discontinuation of heparin and transition to a DOAC if anticoagulation is still required (Warfarin causes transient hyper coagulable state due to '''depletion of protein of C'''). '''Avoidance of heparin for life'''

@@ Line 1: / Line 1: @@
 =Thrombocytopenia=
 ==ITP==
@@ Line 18: / Line 26: @@
 *Dx: Bone marrow biopsy showing >10% clonal plasma cells + end organ damage (CRAB) OR >60% clonal plasma cells without end organ damage. M-spike on SPEP (also shows up in smoldering myeloma). Bone scan shows punched out lesions. Hyperviscosity syndrome when there is monoclonal IgM, this leads to impaired platelet function and epistaxis/gingival bleeding (overall more common in Waldenstrom's macroglobulinemia). β2 microglobulin is a prognostic marker.
 *Tx: Autologous Stem Cell Transplant or chemotherapy

← Older revision		Revision as of 17:30, 14 January 2023
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−	=HIT=	+	=Thrombocytopenia=
		+	==ITP==
		+	*H&P: Caused by autoantibodies against platelet membrane proteins.
		+	*Dx: Low platelets with otherwise normal labs. Petechiae and purpura.
		+	*Tx: Corticosteroids if Plt < 30k
		+	==TTP==
		+	*H&P:
		+	*Dx: Low platelets plus microangiopathic hemolytic anemia with low Hgb, shistocytes on smear, elevated LDH. Sometimes associated with acute renal failure (hemolytic uremic syndrome)
		+	*Tx: Treat HUS with plasma exchange
		+	==DIC==
		+	*H&P: Spontaneous bleeding due to widespread intravascular coagulation and consumption of clotting factors.
		+	*Dx: Low platelets plus elevated d-dimer, prolonged PT/PTT, low fibrinogen
		+	==HIT==
	*Tx: Discontinuation of heparin and transition to a DOAC if anticoagulation is still required (Warfarin causes transient hyper coagulable state due to '''depletion of protein of C'''). '''Avoidance of heparin for life'''		*Tx: Discontinuation of heparin and transition to a DOAC if anticoagulation is still required (Warfarin causes transient hyper coagulable state due to '''depletion of protein of C'''). '''Avoidance of heparin for life'''