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Study Guides:

Acute Myeloid Leukemia (AML)

Background: Proliferation of immature myeloid blasts with differentiation arrest The median age at diagnosis is late ~60s May present with pancytopenia, hyperleukocytosis (>100K), leukostasis, DIC, TLS Symptoms of leukostasis: Lung: SOB, DAH, respiratory failure CNS: Confusion, coma, delirium, focal neurologic deficits Eye: Impaired vision, retinal hemorrhage Vascular: Priapism Work up: Peripheral blood: CBC with diff, PBS, coagulation panel (DIC risk in APL) BMBx: A marrow o

Anal Carcinoma

Background: Risk factor: HPV (high risk) > HIV, smoking Mostl y SCC Work-up: DRE Anoscopy LN biopsy/FNA HIV test Chest/abd CT scan Staging: T1: ≤ 2cm T2: 2-5 cm T3: > 5cm T4: Any tumor size invaded to adjacent organs Perianal SCC Non-metastatic disease (M0): Local excision/surgery: Indications: T1 N0 well/moderately differentiated T2 N0 with no sphincter involvement ChemoRT: Indications: T1 N0 poorly differentiated T2-4 N0 Any T N+ ChemoRT can cure without requiring an abdomi

Anticoagulants

Vitamin K antagonist (VKA): Warfarin Mechanism: Inhibit hepatic synthesis of vitamin K–dependent clotting factors (II, VII, IX, X) Decreases proteins C and S Eliminated by hepatic metabolism Requires close INR monitoring INR interpretation may be challenging in significant hepatic dysfunction because liver disease can elevate the baseline INR Consider if other agents are contraindicated Direct oral anticoagulants (DOAC): Classes: Direct thrombin (IIa) inhibitors Dabigatran Di

Anemia

Anemia of chronic disease: Mediated by IL-6 Promotes hepcidin expression → decreased intestinal absorption and storage of ferritin in macrophages Transferrin downregulated Erythropoiesis becomes iron restricted (since iron not accessible) May eventually lead to iron deficiency due to lack of GI absorption Hemolytic anemia (Separate section below) Iron deficiency anemia (Separate post " Iron Metabolism and Diseases ") Iron refractory iron deficiency anemia (IRIDA): Inherit

Adverse Events

Anthracyclines: Myelosuppression (esp neutropenia ) Nausea, vomiting Total alopecia Mucositis Red-colored urine Cardiomyopathy (mostly with Doxorubicin, risk increases with cumulative dose) Secondary malignancies (AML, MDS) Topoisomerase I inhibitors: Irinotecan: Severe diarrhea , nausea, vomiting Neutropenia Top otecan: Myelosuppression Less GI toxicity Interstitial lung disease (rare but serious) Topoisomerase II inhibitors: Doxorubicin: Discussed in Anthracyclines secti

Acute Lymphoblastic Leukemia (ALL)

Background: Second most common acute leukemia in adults 75% of cases are B-cell lineage, 25% are T-cell lineage Diagnosis requires ≥20% bone marrow lymphoblasts Work up: CBC with diff, CMP, LFT DIC panel TLS panel Hepatitis B/C and HIV serologies BMBx: Cytogenetics, Molecular analyses To identify if philadelphia chromosome/ philadelphia-like chromosome is present Philadelphia-like chromosome: Lacks the BCR-ABL1 gene Associated with poor prognosis Consider use of TKIs and earl

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