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[h] Hematology & Oncology System Flashcards

[i] Master this session in just 5 minutes.

[q] What is the most likely diagnosis?

20 years old patient presenting with Weakness, fatigue, and dyspnea + Laboratory findings include: Hb: 9.2 g/dL, MCV: 75, ↑ ferritin, ↓ TIBC, ↑ serum iron, and ↑ % saturation (iron-overloaded state). Ringed sideroblasts (with iron-laden, Prussian blue-stained mitochondria) seen in bone marrow?

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[f]IFNpZGVyb2JsYXN0aWMgYW5lbWlhLiBBbmVtaWEgZHVlIHRvIGRlZmVjdGl2ZSBwcm90b3BvcnBoeXJpbiBzeW50aGVzaXMu

SXJvbiBpcyB0cmFuc2ZlcnJlZCB0byBlcnl0aHJvaWQgcHJlY3Vyc29ycyBhbmQgZW50ZXJzIHRoZSBtaXRvY2hvbmRyaWEgdG8gZm9ybSBoZW1lLiBJZiBwcm90b3BvcnBoeXJpbiBpcyBkZWZpY2llbnQsIGlyb24gcmVtYWlucyB0cmFwcGVkIGluIG1pdG9jaG9uZHJpYS4=

Iron-laden mitochondria form a ring around the nucleus of erythroid precursors; these cells are called ringed sideroblasts (hence, the term sideroblastic anemia).

[q] What is the most likely diagnosis?

1 years old child presenting with Weakness, fatigue, and dyspnea, Encephalopathy (cognitive impairment), Abdominal colic and constipation + History of moving recently to old house +  Laboratory findings include: Hb: 9.2 g/dL, MCV: 75. Peripheral blood smear is coarse basophilic stippling on a background of hypochromic microcytic anemia?

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[f]IExlYWQgcG9pc29uaW5nLiBMZWFkIGluaGliaXRzIEFMQSBkZWh5ZHJhdGFzZSBhbmQgZmVycm9jaGVsYXRhc2UgJiM4MjExOyZndDsg4oaTIGhlbWUgc3ludGhlc2lzLg==

QmFzb3BoaWxpYyBzdGlwcGxpbmcgcmVzdWx0cyBmcm9tIHRoZSBhYm5vcm1hbCBhZ2dyZWdhdGlvbiBvZiByaWJvc29tZXMgKGxlYWQgaW5oaWJpdHMgclJOQSBkZWdyYWRhdGlvbiku

Diagnosis is made by measuring the patient’s blood lead level.

Dimercaprol and EDTA are 1st line of treatment. Succimer used for chelation for kids (It “sucks” to be a kid who eats lead).

[q] α-Thalassemia is usually due to gene deletion; normally, 4 alpha genes are present on chromosome 16. How many genes is deleted in the following cases?

1. Type of  α-Thalassemia which is usually asymptomatic?

2. Type of  α-Thalassemia which is presented with mild anemia with ↑ RBC count; can be due to Cis or trans deletion?

3. Type of  α-Thalassemia which is presented with severe anemia; β chains form tetramers (HbH) that damage RBCs; HbH is seen on electrophoresis?

4. Type of  α-Thalassemia which is lethal in utero (hydrops fetalis); γ chains form tetramers (Hb Barts) that damage RBCs; Hb Barts is seen on electrophoresis?

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[f]

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3. Three genes deleted

4. Four genes deleted.

[q] What is the most likely diagnosis?

2 years old child presenting with severe anemia that started 6 months after birth with prominent facial bones that looks like chipmunk facies and skull x-rays show ‘crewcut’ appearance + Laboratory findings include: Hb: 9.2 g/dL, MCV: 75 + Blood Smear shows microcytic, hypochromic RBCs with target cells and nucleated red blood cells + Electrophoresis shows little or no HbA1 with increased HbA2, and HbF.

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[f]IFRoYWxhc3NlbWlhIG1ham9yICjOsjDOsjApLg==

SXQgaXMgdGhlIG1vc3Qgc2V2ZXJlIGZvcm0gb2YgZGlzZWFzZSBhbmQgcHJlc2VudHMgd2l0aCBzZXZlcmUgYW5lbWlhIGEgZmV3IG1vbnRocyBhZnRlciBiaXJ0aDsgaGlnaCBIYkYgKM6xMs6zMikgYXQgYmlydGggaXMgdGVtcG9yYXJpbHkgcHJvdGVjdGl2ZSAoc3ltcHRvbWF0aWMgb25seSBhZnRlciA2IG1vbnRocywgd2hlbiBmZXRhbCBoZW1vZ2xvYmluIGRlY2xpbmVzKS4=

α Tetramers aggregate and damage RBCs, resulting in ineffective erythropoiesis and extravascular hemolysis (removal of circulating RBCs by the spleen).

[q] Target cells form when erythrocytes have …….. or ……

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[f]IHJlZHVjZWQgY2VsbCB2b2x1bWUgKHRoYWxhc3NlbWlhLCBpcm9uIGRlZmljaWVuY3kpLCBleGNlc3NpdmUgbWVtYnJhbmUgKG9ic3RydWN0aXZlIGxpdmVyIGRpc2Vhc2UsIHBvc3RzcGxlbmVjdG9teSku[Qq]

[q] What is the most likely diagnosis?

36 years old patient with a long history of alcohol use presenting with Weakness, fatigue, and dyspnea + laboratory findings include: Macrocytic RBCs and hypersegmented neutrophils (> 5 lobes), ↓ serum folate, ↑ serum homocysteine, Normal methylmalonic acid.

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[f]IEZvbGF0ZSBkZWZpY2llbmN5Lg==[Qq]

[q] What is the most likely diagnosis?

36 years old patient with a long history of crohns disease presenting with Weakness, fatigue, dyspnea, ataxia and parathesia + laboratory findings include: Macrocytic RBCs with hypersegmented neutrophils, ↑ serum homocysteine (similar to folate deficiency), ↑ methylmalonic acid (unlike folate deficiency).

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[q] ….. is a megaloblastic anemia that is refractory to folate and B12 supplementation.

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[f]IE9yb3RpYyBhY2lkdXJpYS4gVXJpZGluZSBtb25vcGhvc3BoYXRlIHRvIGJ5cGFzcyBtdXRhdGVkIGVuenltZS4=[Qq]

[q] What is the most likely diagnosis?

6 months child presenting with Rapid-onset anemia,↑ % HbF, craniofacial abnormalities, and triphalangeal thumbs.

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