Hematologic System

Question 0

Lymphoma and staging

Answer 0

• RFs: EBV, H. pylori, HIV, organ/stem cell transplant, autoimmune disease
• Imaging/tests: CT, PET, bone marrow bx
• Dx: cervical or axillary node excisional bx
• *Burkitt lymphoma**
• translocation of c-myc on chrom 8 to chrom 14 which leads to overexpression of c-myc and excess B cell proliferation
• *Follicular lymphoma**
• 14:18 translocation which leads to over expression of bcl-2 which prevents apoptosis
• *CLL**
• B-cell lineage
• Sx: fatigue, frequent infections, lymphadenopathy, splenomegaly, thrombocytopenia, increase in circulating mature lymphpcytes
• Tx: chemo, stem cell transplant
• *Hairy cell leukemia**
• B cell lymphoma in middle aged men
• Sx: pancytopenia, massive splenomegaly
• Hairy cells detected by TRAP stain (hairy monster in a trap)
• Flow cytometry
• *Non-Hodgkin Lymphoma**
• Sx: painless lymphadenopathy
• Dx: NEED TISSUE BX, flow cytometry, FNA bx
• Labs: CBC, LFTs, uric acid, Ca, serum protein electrophoresis, CXR, CT, bone marrow bx, LP, PET scan
• Tx: rituximab, chemo
• GI lymphoma: most commonly seen in stomach
  
  • RF= H. pylori
  • Sx: abdominal pain, obstruction, GI hemorrhage, GI tract perforation, fatigue
  • Tx: surgical resection with removal of draining LNs, chemo
• *Hodgkin Lymphoma**
• 20-30yo and >50yo
• Sx: nontender lymphadenopathy, fever, night sweats, wt loss
• Dx: LN bx (will see Reed-Sternberg cells)
• Tx: Low stage= radiotherapy. Advanced stage= chemotherapy.
• Good prognosis
• *Ann Arbor Staging**
• Stage 1: single LN region
• Stage 2: 2 or more LN regions on the same side of the diaphragm
• Stage 3: Both sides of the diaphragm are involved
• Stage 4: Involvement of extra-nodal sites (liver, bone marrow)
• A: asymtomatic
• B: Symptoms (wt loss, fever, night sweats)
• E: extralymphatic involvmement

Question 1

Anemia

Answer 1

• All women of childbearing age should have CBC done before any surgical procedure
• IDA in an elderly pt is colorectal carcinoma until proven otherwise
• anisocytosis=variation in size of RBCs
• poikilocytosis= variation in shape of RBCs
• Target cells: Thalassemia
• Howell Jolly bodies: sickle cell, hemolytic anemia
• Iron def is the most common cause of anemia
• Microcytic: iron def, anemia of chronic disease, sideroblastic anemia, thalassemia
• Macrocytic: Vit B12 def, Folate def
• Normocytic: hemolysis, acute blood loss
• Sx:HA, dyspnea, palpitations, dizziness, fatigue, dark urine, pallor, icterus, glossitis, koilonychia, angular cheilitis, tachypnea, tachycardia, pica (with IDA)
• Dx: gold standard is bone marrow bx, but this is rarely done.
• Labs: CBC, peripheral blood smear, reticulocyte count, UA, stool for occult blood, serum Fe(decreased in IDA), TIBC(increased in IDA), serum ferritin(decreased in IDA)
• Tx IDA: oral iron (ferrous sulfate), parenteral iron, blood transfusion if Hgb <6g/dL (generally if 6-7, possible if 7-8),