12 articles Hematology/Oncology

Breast cancer

Breast cancer: Multidisciplinary approach: surgical oncology, radiation oncology, and medical oncology Breast cyst: US -> aspirate Breast mass: FNA or core needle biopsy -> excisional biopsy possibly needed Any mass palpated on exam needs to be evaluated with biopsy! Palpate mass -> Mammogram and/or US -> Biopsy (mass) or Aspirate (cyst) Ductal carcinoma in situ…

Immune thrombocytopenia (ITP)

Immune thrombocytopenia (ITP): (same as immune thrombocytopenic purpura) Diagnosis of exclusion characterized by isolated thrombocytopenia in an otherwise healthy young adult with lack of cause for thrombocytopenia or in child with viral illness. Clinical diagnosis: Do not need bone marrow biopsy for evaluation. Do not need antiplatelet antibodies, platelet survival times, or the degree of…

Chronic Lymphocytic Leukemia (CLL)

Chronic Lymphocytic Leukemia (CLL): Early-stage or asymptomatic CLL: Observation. No proven advantage to early treatment if asymptomatic. Indications for treatment: Bulky lymphadenopathy or organomegaly Constitutional symptoms (weakness, B symptoms) Bone marrow failure (anemia or thrombocytopenia) for progressive CLL Autoimmune hemolysis or autoimmune thrombocytopenia failing usual therapy Rapidly progressive disease or Richter transformation Richter syndrome: transformation…

Acute Promyelocytic Leukemia (APL)

Acute Promyelocytic Leukemia (APL): Biologically and clinically distinct variant of AML APL was classified as AML-M3 in the older French-American-British (FAB) classification system and is currently classified as Acute Promyelocytic Leukemia with t(15;17)(q24.1;q21.2); PML-RARA in the World Health Organization classification system. Induction: All-Trans Retinoic Acid (ATRA) Resulted in the highest cure rates of the AML…

Porphyria Cutanea Tarda

Porphyria Cutanea Tarda: Measure serum and urine porphyrin levels Associated with Hepatitis C Virus (HCV) – may have Cirrhosis Skin lesions: Plaques in sun-exposed areas such as the dorsa of the hands/face. Painless vesicles and bullae on the face and dorsa of the hands (light-exposed areas) Blistering skin lesions Facial hypertrichosis: increased hair growth Associated…

Hypercoagulability

Rule out genetic hypercoagulability: May need long term anticoagulation like Warfarin. Panel of labs to order: Antiphospholipid Antibody screening panel: Anti-Cardiolipin IgA,G,M. Only hypercoagulable state that causes thrombosis in both VEIN and ARTERY! Antinuclear Antibody (ANA) w/ reflex Recurrent pregnancy loss. CPK (CK) – Screening for Connective Tissue Disorder in general: Factor V Leiden mutation Protein…

Heparin Induced Thrombocytopenia (HIT)

HIT: (Heparin Induced Thrombocytopenia) Sx: Petechiae, hematuria, bleeding gums/nose, easy bruising Thrombocytopenia occurs after Heparin exposure (>50% drop) 2 types: Type I: idiopathic. Tx by stopping heparin Type II: immune mediated! Tx with Agatroban 4T score: http://www.mdcalc.com/4ts-score-heparin-induced-thrombocytopenia/ Most at risk: high dose Heparin CABG (give Heparin boluses:)> UFH > LMWH Thrombosis: venous vs arterial =…

Pseudothrombocytopenia

Pseudothrombocytopenia: Due to ethylenediaminetetraacetic acid (EDTA)-induced platelet clumping (EDTA: anticoagulant commonly used in tubes for routine CBC) Suspect in asymptomatic patient with low platelet count Repeat platelet count using an anticoagulant other than EDTA (heparin or sodium citrate) -> normal platelet count confirms diagnosis Peripheral smear: shows platelet clumping – results in artificially low platelet…