Benign and Thrombosis

Question 1

May Hegglin anomaly morphology

Answer 1

Large thrombocytes
Dohle bodies

Usually ASx

Question 2

Wiskot Aldreich syndrome PB morphology

Answer 2

Micro thrombocytopenia
X linked
Eczema

Question 3

When to start warfarin after HIT

Answer 3

When PLT normalize

Question 4

Temporary Tx of TTP if PEX is not available

Answer 4

FFP

Question 5

Tx of HELLP/Pre-eclampsia

Answer 5

Delivery at 34 weeks

Question 6

Clues for psychogenic pupura

Answer 6

Psychiatric illness
Areas that are accessible to pt

Question 7

Tx of MGUS associated VWD

Answer 7

IVIG
DDAVP

Question 8

Dosing of FIX

Answer 8

1U/kg for 1% change

Question 9

Dosing of FVIII

Answer 9

1U/kg for 2% change
(Half of FIX)

Question 10

Titer of Ab in hemophilia pts requiring bypassing agents

Answer 10

5 BU

Question 11

Immune tolerance therapy SE

Answer 11

Allergic reactions
Nephrotic syndrome

Question 12

Abciximab SE

Answer 12

Thrombocytopenia

Question 13

Dosing of DDAVP

Answer 13

Intranasal 150 mcg
IV/SC 0.3 mcg/kg max 20 mcg

Question 14

Goal of FEIBA Tx

Answer 14

To control bleeding
not to correct aPTT

Question 15

Superwarfarin PK

Answer 15

Longer half life

Question 16

Prolonged reptilase time

Answer 16

Dysfibrinogenemia

Question 17

Management of weak thrombophilias in pregnancy

Answer 17

No rule for antepartum AC
If FHx- Postpartum AC
w/o FHx no Tx

Question 18

Duration of AC after HIT without VTE

Answer 18

1 month

Question 19

Duration of AC after HIT with VTE

Answer 19

3 months

Question 20

Target INR in Mechanic vlaves

Answer 20

Aortic- 2.5
Mitral- 3

Question 21

When to consider dysfibrinogenemia

Answer 21

Hemmorhagic and thrombotic meinfistation

Question 22

Role of vitamin supplementation for MTHFR

Answer 22

No benefit
MTHFR mutation is probably not meaningful

Question 23

Management of PVT

Answer 23

Depending on bleeding and thrombosis risk
w&w may be appropriate if ASx
DOACs are effective

Question 24

Polycythemia effect on PT

Answer 24

Increases PT/INR
Check with less citrate to get the right result

Question 25

Tx of SVT proximal to junction with deep vein

Answer 25

Same as DVT

Question 26

Tx of SVT of >5 cm

Answer 26

Prophylactic AC for 45 days Fundaparinox 2.5/rivaroxaban 10

Question 27

Indications for phlebotomy in hemochromatosis

Answer 27

Ferittin > 200 or Organ damage

Question 28

DM drug affecting B12 metabolism

Answer 28

Metformin Supplement calcium to overcome

Question 29

Which test is more specific for spherocytosis

Answer 29

EMA More sensetive and specific than osmotic frgaility

Question 30

Test for eliptocytosis

Answer 30

Spectrin analysis

Question 31

Zinc excess effect

Answer 31

Copper and iron defficiency

Question 32

EPO ressistance in dialysis pts

Answer 32

Consider hyperparathyroidism PTH can cause BM fibrosis

Question 33

p50

Answer 33

Checks Hb affinity High (right shift) means less affinity Acidosis, 2,3 BPG, CO2

Question 34

Tx of methemoglobinemia

Answer 34

Methylene blue

Question 35

Problamatic mutation in hemochromatosis

Answer 35

C282Y H63D is usually benign

Question 36

McLeod phenotype

Answer 36

Absence of Kell group X linked Acanthocytosis and a compensated hemolytic state Progressive neurologic deterioration

Question 37

Passenger lymphocytes hemolysis

Answer 37

Can be delayed Usually due to ABO mismatch

Question 38

Tx of erythrocytosis post kidney transplant

Answer 38

ACEi

Question 39

Tx of Sideroblastic anemia

Answer 39

B6

Question 40

Tx of aplastic crisis due to Parvo in HS pts

Answer 40

Supportive care

Question 41

Emergent Tx of CAD

Answer 41

Plasmapheresis

Question 42

Prognosis of aplastic anemia during pregnancy

Answer 42

50% will recover spontaneously

Question 43

Predictors for response to IST in aplastic anemia

Answer 43

IFN-gamma on T cells

Question 44

VTE and ATE risk in cancer (timing)

Answer 44

VTE continuous ATE around diagnosis

Question 45

Which anti-PLT is resistant to Tx with PLT

Answer 45

Ticagrelor (Reversable inhibitor so less amendable to PLT transfusion)

Question 46

Transfusion of fresh vs stored RBC in critically ill patients

Answer 46

No decrease in 90 days mortality

Question 47

Presentation of partial D phenotype

Answer 47

D-positive patient with anti-D after transfusion

Question 48

Implications of partial D phenotype

Answer 48

As donor D+ As receipent (pregnancy) D-

Question 49

Presentation of weak D phenotype

Answer 49

D+ pt testing on occasions as D-

Question 50

P value

Answer 50

Probability of obtaining test results at least as extreme as the result actually observed, under the assumption that the **NULL HYPOTHESIS** is correct

Question 51

Highest risk Ab for HDFN

Answer 51

D, c, Kell, E c+E- very high risk

Question 52

Rivaroxaban dose adjustment

Answer 52

CrCL< 50

Question 53

Dabigatran dose adjustment

Answer 53

CrCL< 30 But caution in CrCL< 50

Question 54

Edoxaban dose adjustment

Answer 54

Weight < 60 kg CrCL< 50

Question 55

L-glutamine in SCD

Answer 55

As adjuvant to HU Prevention of vaso-occlusive pain in patients with frequent episodes

Question 56

Mesenteric venous thrombosis Tx benefit of AC

Answer 56

OS Recalnulization in most pts Lowers bleeding!

Question 57

Duraion of AC in Mesenteric venous thrombosis

Answer 57

3-6 months longer if thromophilia present

Question 58

Source of plasma transfusion in pts with unknown blood type

Answer 58

A

Question 59

CAD ab

Answer 59

Anti-I EBV related- anti-i (not present in adults)

Question 60

CAD hemolysis type

Answer 60

Usually extra-vascular in the liver May be intravascular if high titer

Question 61

Leukoreduction benefit

Answer 61

FNHTR CMV Alloimmunization TRIM

Question 62

Bernard Soulier vs Glazman defect

Answer 62

BS- GPIb-IX-V complex Glanzman- GPIIb/IIIa

Question 63

PLT adhesion vs aggregation

Answer 63

Adhesion- VWF and GPIb Aggregation- GPIIb-IIIa

Question 64

Upper vs lower limb DVT

Answer 64

Less PE with upper Same rate of PTS

Question 65

Hb goal in thalassemia major pts

Answer 65

Pretransfusion- 9-10 Post transfusion- 13-14

Question 66

Causes of ovarin vein thrombosis

Answer 66

Pelvic infection Surgery Ovarian cancer MPN

Question 67

A2 blood type

Answer 67

Can have anti-A1 in their serum May cause hemolysis after A transfusion

Question 68

Causes of reduction in ATIII

Answer 68

PEG-Asp Infection Liver failure Nephrotic syndrome

Question 69

Causes of reduction in protein C

Answer 69

Infection Liver failure CKD

Question 70

Factors effecting APCR test

Answer 70

Elevated FVIII Reduced PS Estogen Sepsis

Question 71

FXI inheritance

Answer 71

AR

Question 72

Periopertive management of mild hemophilia A

Answer 72

DDAVP If major surgery FVIII

Question 73

Blood components in cryoprecipitate

Answer 73

Fibrinogen Factor VIII vWF Factor XIII Fibronectin

Question 74

Complications of treatment with iron chelators

Answer 74

Deferoxamine: retinopathy and auditory toxicity Deferiprone- agranulocytosis Deferasirox- GI, rash, LFT

Question 75

Granulocytes storage time

Answer 75

24 hours

Question 76

p50

Answer 76

High means lower effinity to O2 (right shift) 2,3 BPG, acidosis- raise p50 Causing O2 to dissocate to the tissue

Question 77

Acute hemolysis after PLT transfusion

Answer 77

Usually ABO incompatibilty due to ab in plasma of transfused PLT Washing can reduce risk

Question 78

Dense granules of platelets compusition

Answer 78

ADP, ATP, Ca, serotonin

Question 79

EBV related CAD IgM

Answer 79

Anti-i

Question 80

Indications for transfusion in SCD

Answer 80

ACS not responding CVA prevention Preoperative

Question 81

Prothrombin mutation location

Answer 81

Non coding region

Question 82

Bashophilic stiplling

Answer 82

Aggregates of ribosomal RNA Seen in Lead poisoning, sideroblastic anemia

Question 83

Couagulation factor with shortest half life

Answer 83

FVII

Question 84

Weak A blood type

Answer 84

An impairement in the function of glycosyltransferase (Baby can be A even if both parents are O- bcs one of them is actually weak A)

Question 85

Storage lesions in stored blood products

Answer 85

Decreased 2,3DPG and ATP Decreased pH Increased K

Question 86

Risk of VTE among thrombophilia pts on estrogen

Answer 86

X35

Question 87

Protein defects in HS

Answer 87

Ankyrin, band 3, β-spectrin, α-spectrin, and protein 4.2

Question 88

Aspirin vs LMWH in orthopedic pts

Answer 88

Non inferior post fracture More VTE with aspirin after TKR and hip surgery

Question 89

Risks for post-splenectomy sepsis

Answer 89

Older age Hem condition (including thalassemia)

Question 90

Adsorption results interpetation

Answer 90

If positive- allo ab If negative- auto ab

Question 91

Elution results interpetation

Answer 91

If positive- auto ab If negative- allo ab

Question 92

Use of enzymes in adsoption technique

Answer 92

Removal of auto antigens while maintaining allo antigens on RBCs

Question 93

Plasmaphersis in myesthenia gravis solution

Answer 93

Albumin

Question 94

PLT refractoriness threshold

Answer 94

5K

Question 95

Refractoriness to oral iron therapy def.

Answer 95

Hb increment < 1 g% after 4 weeks of therapy

Question 96

Typical increment after PLT transfusion

Answer 96

30K

Question 97

Osmotic fragility curve in HS

Answer 97

Right shift Not stable in high osmolarity

Question 98

Lack of anti-A,B after transplant

Answer 98

May be due to donor-receipent mismatch in ABO Transfuse matched blood products Or O- Can try crossing after cooling of blood sample. Bcs IgM is more active at cold temperature.

Question 99

Splenectomy benefits and risk in thalassemia

Answer 99

Improves- Hb, PLT, decreases hemolysis and reduces extramedullary hematopoiesis Risks- VTE, worsening PHTN

Question 100

HIT without heparin Tx

Answer 100

Post COVID19 vaccine Post adenovirus infection

Question 101

Causes of methemoglobinemia

Answer 101

Dapsone, nirtrite

Question 102

FVIII trarget pre surgrey in Hem A pts

Answer 102

80-100%

Question 103

PCC dosage

Answer 103

25-50U/kg

Question 104

Andexanet alpha study

Answer 104

ANNEXA-I Composite outcome of hematoma volume and nuerologic det in 12 hours No advantage in long term neurologic outcomes 10% VTE vs 5%

Question 105

Prax-bind dosage

Answer 105

5 mg can repeat (2 separate doses of 2.5 in 15 minutes)

Question 106

Which cougulation factor does not change during pregnancy

Answer 106

ATIII PC FV

Question 107

Risk factors for catheter associated thrombosis in cancer patients

Answer 107

Type of cancer (HL, esophageal, ovrian)

Question 108

Risk factor for PTS

Answer 108

F Obesity Older age

Question 109

Factors to follow in PEX

Answer 109

Fibrinogen Ca

Question 110

Dosage of caplacizumab

Answer 110

11 mg (Practically 10 mg) First dose IV Then SC

Question 111

Management of distal DVT

Answer 111

FU can be exceptable

Question 112

Coumadin in cancer associated thrombosis

Answer 112

Was compared to LMWH Inferior

Question 113

DOAC after bariatric surgery

Answer 113

Not in the first month Apixaban is probably the safest

Question 114

Factors to prefer LMWH vs DOAC in CAT

Answer 114

GI/GU cancer Thrombocytopenia Absorption problems/vomiting Drug interactions Known planned procedures

Question 115

Cougulation factors that are elevated in pregnancy

Answer 115

F7-10 FV does not change

Question 116

INR for epidural

Answer 116

1.5

Question 117

Management of reccurent abortions in obstetric APLS

Answer 117

Increase dose to 1mg/kg qd Increase apirin to bid Add plaquenil IVIG Steroids

Question 118

Tx of superficial vein thrombosis > 5 cm

Answer 118

Fundaparinox 2.5 Rivaroxaban 10 LMWH? For 45 days

Question 119

Tx of congenital TTP

Answer 119

Recombinant ADAMTS13 IV cTTP Phase III vs SOC ADAMTS13 levels were 100% and TTP events were rare

Question 120

Andexanet alpha mechanism of action

Answer 120

Recombinant Xa that seaquesters anti-Xa

Question 121

Caplacizumab mechanism of action

Answer 121

Targets the A1-domain of vWF Inhibiting the interaction between vWF and platelets

Question 122

aHUS complement levels

Answer 122

Low c3 with normal c4

Question 123

aHUS special blood tests

Answer 123

Soluble c5b-9 Flow with CD46 positive Low Factor H and Factor I PEP IEP FLC

Question 124

What to do if aHUS pt does not improve his AKI even though hemolysos is better

Answer 124

Kidney biopsy to diagnose TMA vs other etiologies for CKD

Question 125

Duration of Tx of eculozumab in aHUS

Answer 125

3-4 months after hematologic count recovery

Question 126

What to do if aHUS pt is on continous dialysis

Answer 126

Stop eculizumab

Question 127

What differentiates aHUS and TTP presentation

Answer 127

aHUS- HTN, Renal TTP- Deep thrombocytopenia, fever

Question 128

Tx of HTN in aHUS

Answer 128

ACEi/ARB

Question 129

Dosing of andexanet-alpha

Answer 129

400-800 mg depeding on rtime from presentation and dosing

Question 130

Hemocysteine levels in MAHA

Answer 130

Cobalamin C deficiency HUS

Question 131

MGUS associated aHUS

Answer 131

Anti-factor H AI Treat with eculizumab+rituximab

Question 132

FVII deficiency ethnicty

Answer 132

Maroco Prasia

Question 133

Coagulation system prevalent in bleeding from endothel

Answer 133

Hyperfibrinolysis

Question 134

Pt with factor deficiency receiveing plasma

Answer 134

Always consider development of inhibitors

Question 135

FFP dosing

Answer 135

15-20 ml/kg

Question 136

rFVII dosing

Answer 136

15-30 mcg/kg

Question 137

Rexposure to heparin in HIT pts

Answer 137

In short exposure (CABG) Most will not develop antibodies