Unit 12: Hematologic

Question 1

What are reversible risk factors for DVT and PE?

Answer 1

trauma, surgery, pregnancy, estrogen therapy, immobility, fractures, obesity

Question 2

What are acquired risk factors for DVT and PE?

Answer 2

age >40, malignancy, h/o thrombus, HF, CVA, nephrotic syndrome, spinal cord injury, varicose veins

Question 3

What are inherited factors for DVT and PE?

Answer 3

activated protein C resistance, antithrombin III deficiency, protein C deficiency, factor V Lieden

Question 4

What is Virchow’s triad and how is it significant?

Answer 4

Triad is venous stasis (sluggish blood flow), vascular endothelial wall injury, and hyper coagulability (propensity for increased blood clotting). It helps to categorize most common causes and risk factors for venous thromboembolism.

Question 5

What are cardioembolic causes of of CVA?

Answer 5

Afib, left atrial appendage, rheumatic heart disease, HF w/ LV thrombus, PFO, Myxoma, IE, DCM, Prosthetic valves

Question 6

what are two major categories of CVA?

Answer 6

ischemic 85% and hemorrhagic 15%

Question 7

what are antithrombin III, Activated protein C and activated protein S?

Answer 7

Natural anticoagulants–deficiencies in these can induce prothrombotic state corresponding to 5-10 fold increase in VTE risk.

Question 8

How are “massive” and “submissive” PEs defined?

Answer 8

Massive is >50% of pulmonary vasculature, submassive is <50%

Question 9

What d-dimer level indicates probably thrombosis?

Answer 9

> 500

Question 10

What drug class is Pradaxa? How is it eliminated?

Answer 10

Direct Thrombin Inhibitor. 80% really eliminated. NOT CYP450, so few interactions. QUINIDINE is one, however

Question 11

What drug class is Xarelto (rivaroxiban) and Eliquis (apixiban)? How are they metabolized?

Answer 11

Direct factor Xa inhibitor. CYP3A4.

Question 12

What is the starting dose of unfractionated heparin? What is the target aPTT?

Answer 12

80U/kg as IV bolus then 18U/kg/hr as continuous infusion. 1.5-2.5x control

Question 13

What anticoagulants produce effect through extrinsic pathway? Intrinsic?

Answer 13

Oral anticoagulants extrinsic, heparin intrinsic.

Question 14

When does the initial prolongation of bleeding time occur w/ warfarin therapy? When does it evert full effect?

Answer 14

1-3 days.

8-14 days, when factor II is depleted

Question 15

How does warfarin work?

Answer 15

Inhibits activation of clotting factors in the liver that depend on vitamin K for synthesis-II, VII, IX, and X.

Question 16

What is the half life of warfarin?

Answer 16

36-42 hours

Question 17

What is the time needed for peak plasma concentration of dabigitran (pradaxa)?

Answer 17

1.5-3 hours

Question 18

How long after dc’ing ASA are platelets still impaired?

Answer 18

7-10 days

Question 19

How are plavix and asa different?

Answer 19

asa affects COX, Plavix does not.

Question 20

What is the only PPI safe to take with Plavix?

Answer 20

Protonix

Question 21

What is first and second line therapy for DVT or PE?

Answer 21

Bolus of IV UFH with subsequent infusion/subcutaneous LMWHs/subcutaneous fondaparinux.

Question 22

What is first and second line therapy for prophylaxis of DVT and PE in ortho patients?

Answer 22

First line, LMWHs or warfarin, depending on institution. Second line, UFH started preop and SCDs.

Question 23

What is first and second line therapy for secondary stroke prevention (noncardioembolic ischemic stroke)?

Answer 23

First line, asa (or Plavix). Second line, Plavix or Aggrenox

Question 24

What is first and second line therapy for cardioembolic stroke prevention (AF)?

Answer 24

First line, warfarin (and now paradox). Second line, asa

Question 25

What is first line therapy for prevention of systemic embolism w/ patients with artificial valves?

Answer 25

First line, warfarin. Second, asa

Question 26

Where does RBC production start?

Answer 26

Starts with erythropoietin which is produced by kidneys

Question 27

What do reticulocytes in peripheral blood indicate?

Answer 27

RBC production is being stimulated

Question 28

How are anemias classified?

Answer 28

increased destruction as in blood loss, hemolysis, sickle cell or decreased production as in ion deficiency, thalassemia, anemia of chronic disease and aplastic anemia

Question 29

What are treatments for sickle cell?

Answer 29

hydroxurea and folic acid

Question 30

What is the earliest and most sensitive indication of iron deficiency?

Answer 30

ferritin level <0-12g/L

Question 31

What is the normal dose of iron supplementation in anemia?

Answer 31

2-3mg/kg/d in TID dosing

Question 32

what is expected increase in hub with iron supplementation?

Answer 32

Increase of 0.7-1.0 g/wk-continue 3-6 months

Question 33

What meds interact the most with iron?

Answer 33

tetracyclines and fluorquinolones

Question 34

What is usual dose of Epoetin?

Answer 34

50-100u/kg sc or iv 3x wkly

Question 35

What causes anemia of chronic disease?

Answer 35

chronic infection, subacute bacterial endocarditis, inflammation, TB, malignancies

Question 36

What affects can iron deficiency have on pediatric patients?

Answer 36

impaired mental/psychomotor development

Question 37

In treating anemia of chronic disease, what would indicate a good response?

Answer 37

increase of more than 0.5g/dL after 2 weeks

Question 38

What causes aplastic anemia?

Answer 38

NSAIDS, sulfas, quinidine, lithium, antiprotazoals

Question 39

What causes vitamin B12 deficiency?

Answer 39

inadequate intake, lack of intrinsic factor, H. Pylori, or malignancy.

Question 40

What B12 level is indicative of deficiency?

Answer 40

<200

Question 41

What folate level is indicative of deficiency?

Answer 41

<4ng/ml