Difference between revisions of "HemOnc"
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| + | =Missed Concepts= | ||
| + | *For supratherapeutic INR in a patient on Warfarin, if INR <4.5, can hold Warfarin for 1-2 days then recheck and resume, if INR 4.5-10, give 1-2.5 mg PO vitamin K. | ||
| + | *The biggest drawback of IVC filters is that they '''double the risk of DVT''' | ||
| + | *Factor V Leiden accounts for about 50% of hereditary thrombophilia. | ||
| + | *Technetium-99 bone scan detects plastic lesions, CT detects lytic lesions. | ||
| + | |||
| + | =[[Anemia]]= | ||
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=Thrombocytopenia= | =Thrombocytopenia= | ||
==ITP== | ==ITP== | ||
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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 | ||
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Revision as of 04:09, 15 January 2023
Missed Concepts
- For supratherapeutic INR in a patient on Warfarin, if INR <4.5, can hold Warfarin for 1-2 days then recheck and resume, if INR 4.5-10, give 1-2.5 mg PO vitamin K.
- The biggest drawback of IVC filters is that they double the risk of DVT
- Factor V Leiden accounts for about 50% of hereditary thrombophilia.
- Technetium-99 bone scan detects plastic lesions, CT detects lytic lesions.
Anemia
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
Multiple Myeloma
- H&P: Often presents with CRAB symptoms (Calcium, Renal failure, Anemia, or Bone lesions) or frequent infections. Can be complicated by unstable bradycardia, osteoporosis, ATN (via IG light chain, an endogenous nephrotoxin), nephrotic syndrome secondary to renal (AL) amyloidosis, type II RTA
- 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