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'''
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*Factor V Leiden accounts for about 50% of hereditary thrombophilia.
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*Technetium-99 bone scan detects plastic lesions, CT detects lytic lesions.
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*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'''
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=[[Anemia]]=
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*Micro: Thalassemia (Mentzer Index < 13: MCV/RBC), Iron (RDW high), Chronic inflammation (ESR, CRP), Lead (serum level), Sideroblastic
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*Normo:
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** Non-Hemolytic (retic count ≤ 2%, normal LDH/haptoglobin/RDW): Chronic inflammation, Iron, CKD, Aplastic
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** Hemolytic (retic count > 2%, elevated LDH, low haptoglobin, elevated RDW):
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*** Intrinsic: MEH (HS/PNH, G6PD/Pyruvate kinase, SCD/HbC)
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*** Extrinsic: MAMI
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*Macro:
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** Megaloblastic: B12 Folate Fanconi
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** Non-Megaloblastic: Alcohol Liver disease
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=Thrombocytopenia=
 
=Thrombocytopenia=
 
==ITP==
 
==ITP==
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*Dx: Low platelets plus elevated d-dimer, prolonged PT/PTT, low fibrinogen
 
*Dx: Low platelets plus elevated d-dimer, prolonged PT/PTT, low fibrinogen
 
==HIT==
 
==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'''
+
*Dx: T score (timing, thrombocytopenia, thrombosis, alTernate causes)
 +
*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=
 
=Multiple Myeloma=
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*Tx: Autologous Stem Cell Transplant or chemotherapy
 
*Tx: Autologous Stem Cell Transplant or chemotherapy
  
−
=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.
+
https://www.ohsu.edu/knight-cancer-institute/thomas-deloughery-mds-famous-handouts
−
*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.
 

Latest revision as of 22:35, 30 June 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.
  • Tumor lysis syndrome causes release of K, Phos, and Urea leading to uremic syndrome, stones, hypocalcemia, AKI, and cardiac arrhythmias. Treatment is with IV fluids and rasburicase

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

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

  • Dx: T score (timing, thrombocytopenia, thrombosis, alTernate causes)
  • 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

  • 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


https://www.ohsu.edu/knight-cancer-institute/thomas-deloughery-mds-famous-handouts

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