urinalysis for multiple myelomaFor urinalysis, use 24-hr urine protein electrophoresis (UPEP) to detect ☆light chain, as routine urine dipstick detects only albumin. hematologyUWorld HirotoShishido
what molecular findings suggest malignancy in the patient with lymphoma☆monoclonal T-cell receptor(TCR) gene rearrangements
The clonality of a T-cell population
can be assesed by molecular methods such as PCR. If a single allele for the V region of the TCR predominates in a lymphocytlc population, monoclonal proliferation is suspected. hematologyimmunologyUWorld HirotoShishido
how to test cold agglutinins
treatmentTesting for cold agglutinins can be done at the bedside by drawing blood into an edetate disodium-containing tube and placing it in a ☆cup of ice. Removing the tube after several seconds will reveal clumping/agglutination(turbidity) that resolves as the tube warms.
primary central nervous system lymphoma(PCNSL)non Hodgkin lymphoma of ☆B-cell origin that occurs as a late complication of HIV infection
needs to be distinguished from toxoplasmosis via CSF analysis→ positive EBV polymerase chain reaction analysis
+ in toxoplasmosis, ★multiple ring-enhancing lesions are usually present
age related changes in bone marrowhigher quantity of fat and a ☆reduced overall mass
→ older patients with acute traumatic blood loss have a much lower reticulocyte count and much longer time to recovery to pretrauma hemoglobin level compared to younger patients
heparin-induced trombocytopenia and thrombosis(HITT)
onset, mechanism of aggregation+thrombocytopenia5-10days following exposure to heparin products
the generation of IgG antibodies to ☆heparin and platelet factor 4(PF4) → Fc component of the IgG than binds to additional platelets→ widespread platelet activation
change in PTH for the patients with multiple myelomaosteolytic cytokines→
liberate calcium from bone→
hypercalcemia→
inhibits the release of PTH from parathyroid cells→
①increase urinary calcium excretion(☆hypercalciuria)
②reduce renal 1-alfa-hydroxylase→☆low 1,25 dihydroxyvitamine D endocrinologyhematologyUWorld HirotoShishido
blood smear of aplastic crisisInfection of erythroid progenitor cells prevents red blood cell maturation, leading to formation of
☆abnormal giant pronormoblasts (several times larger than surrounding red
blood cells) with glassy, intranuclear viral inclusions. hematologyUWorld HirotoShishido
when does therapeutic efficacy of warfarin take placeTherapeutic efficacy is delayed until ☆preexisting clotting factors in the plasma are consumed.
Although INR tends to slowly increase in the first few days of administration due to the short half-life of factor VII (4-6 hours), full therapeutic effect does not typically occur for 3 days due to the long half-life of factor II. hematologypharmacologyUWorld HirotoShishido
in sickle cell trait, ☆HbA is higher than HbS throughout the lifetime
β-thalassemia major become symptomatic only ☆after 6 months, when fetal hemoglobin declines (HbF is rather protective in the infant)
newborns wrth sickle cell disease is also asymptomatic hematologyUWorld HirotoShishido
hip and pelvic pain on exertion on the patient with sickle cell disease☆avascular necrosis
the second most common non-Hodgkin lymphoma
clinical coursefollicular lymphoma t(14;18)
(the most common→ DLBCL)
☆waxing and waning clinical course
in middle aged patients with painless(indolent) lymph node enlargement or abdominal discomfort from an abdominal mass hematologyUWorld HirotoShishido
