DI blood DO

Question 1

How is neutropenia vs agranulocytosis diagnosed?

Answer 1

ANC < 500 = neutropenia (severe) = expectant SE

ANC < 500 = Agranulocytosis = unintended AE

Question 2

What are the sx of neutropenia?

Answer 2

Chills
Fever
Infection (URI)
Mouth sores

Question 3

How is thrombocytopenia diagnosed?

Answer 3

Plt < 150,000
Moderate = 20,000-50,000
Severe < 20,000

Question 4

What is the clinical presentation of thrombocytopenia?

Answer 4

Easy bruising
Petechiae
Prolonged/spontaneous bleeding
Thrombosis

Question 5

How do we diagnose anemia?

Answer 5

Hgb < 12
Elevated reticulovytes > 2.5% of RBCs
Elevated reticulocytes
Coomb’s test

Question 6

What does the Coomb’s test detect?

Answer 6

Abs against RBC

Question 7

What are sx of anemia?

Answer 7

Fatigue
somnolence
Decreased concentration
Weakness
SOB
Tachycardia
Hypotension

Question 8

What is the diagnosis of aplastic anemia?

Answer 8

WBC
Plt
Hgb
Retic

Question 9

What is pancytopenia?

Answer 9

2 or more of aplastic anemia diagnostic criteria

Question 10

What are the results of intravascular hemolysis?

Answer 10

Decreased haptoglobin
Increased hemoglobinemia
Increased hemoglobinuria
Acute renal failure

Question 11

What are the results of extravascular hemolysis

Answer 11

Increased bilirubin (unconjugated)
Jaundice and bilirubinemia
Icteric sclera
Normal haptoglobin

Question 12

What drugs cause hapten type reactions?

Answer 12

PCN
Ceph
Tetracycline
NSAIDs

Question 13

What are RFs for hapten type reactions?

Answer 13

Dose

Renal insufficiency

Question 14

How long until presentaton of hapten type reactions?

Answer 14

7-10 days (1st event)

Question 15

What is the presentation of hapten type reactions?

Answer 15

+/- EV hemolysis

+ Coomb’s test

Question 16

Are any DI hemolytic anemias preventable?

Answer 16

No

Question 17

What are the drugs that cause auto-immune reactions?

Answer 17

NSAIDs

Methyldopa/levodopa

Question 18

What is the presentation of auto-immune reactions?

Answer 18

Months (3-12)
+/- EV hemolysis
+ Coomb’s test

Question 19

What drugs cause immune complex reactions?

Answer 19

PCN
Ceph
Tetracycline
NSAIDs

Question 20

What is a RF for immune complex reactions?

Answer 20

Previous exposure

Question 21

What is the presentation for immune complex reactions?

Answer 21

Hours-days
IV hemolysis
+ Coomb’s test

Question 22

What does G6PD lead to formation of?

Answer 22

Heinz bodies (denatured hgb)

Question 23

What do heinz bodies lead to?

Answer 23

Hemolysis

Question 24

What drugs cause G6PD deficiency?

Answer 24

Sulfa
Nitrofurantoin
Phenazopyridine
Dapsone
Primaquine

Question 25

What are RFs for G6PD deficiency?

Answer 25

G6PD deficiency severity Medication dose Concurrent stressors Diet (fava beans)

Question 26

What is the presentation of G6PD deficiency?

Answer 26

IV and EV hemolysis

Question 27

What is the prevention of immunologic DI hemolytic anemia?

Answer 27

Avoid recognized allergies

Question 28

What is the prevention of G6PD deficiency?

Answer 28

Avoid precipitating meds in type I-III deficiency

Question 29

What is the treatment of Hemolytic anemia?

Answer 29

Remove/treat precipitant Corticosteroids may be helpful in severe cases Transfusion (dependent of anemia/hemodynamic instability)

Question 30

What drugs cause DT thrombocytopenia?

Answer 30

``` PCN Ceph Sulfa Vanc Rifampin ```

Question 31

What are the RFs for DI thrombocytopenia?

Answer 31

Previous exposure

Question 32

What is the duration of hepatin?

Answer 32

5+ days

Question 33

What is the indication for heparin?

Answer 33

Surgery | Trauma

Question 34

Is UFH or LMWH worse for Type II heparin induced thrombocytopenia?

Answer 34

UFH

Question 35

What type of dose is the most likely to cause HIT?

Answer 35

Therapeutic dose > prophylactic dose > heparin flush

Question 36

If a patient has a 0-3 pre-test probability for HIT, what level is that?

Answer 36

Low

Question 37

If a patient has a 4-5 pre-test probability for HIT, what level is that?

Answer 37

Intermediate

Question 38

If a patient has a 6-8 pre-test probability for HIT, what level is that?

Answer 38

High

Question 39

What is the diagnosis of HIT?

Answer 39

Intermediate or High And Elisa +

Question 40

What level of thrombocytopenia is 2pts in the pre-test?

Answer 40

+50% drop or Nadir = 20-100,000

Question 41

What timing is 2 pts in the pre-test?

Answer 41

5-10 days

Question 42

What level of thrombosis is 2 pts in the pre-test?

Answer 42

New thrombosis/skin necrosis

Question 43

What causes receive 2 pts in the pre-test?

Answer 43

No other causes

Question 44

What level of thrombocytopenia receives 1 pt in the pre-test?

Answer 44

30-50% drop or Nadir = 10-19,000

Question 45

What timing for HIT receives 1pt in the pre-test?

Answer 45

10+ days

Question 46

What kind of thrombosis receives 1 pt in the pre-test?

Answer 46

Recurrent thrombosis | Erythematous skin lesions

Question 47

What causes receive 1 pt in the pre-test?

Answer 47

Possible other causes

Question 48

What level of thrombocytopenia receives 0 pts in the pre-test?

Answer 48

< 30% drop Or Nadir = < 10,000

Question 49

What is the timing that receives 0 pts in the pre-test?

Answer 49

Too early

Question 50

What type of thrombosis receives 0 pts in the pre-test?

Answer 50

None

Question 51

What types of causes receive 0 pts in the pre-test?

Answer 51

Definite other cause

Question 52

What is argatroban approved for?

Answer 52

Anticoagulant for prophylaxis or treatment of thrombosis d/t HIT

Question 53

What labs are used to monitor argatroban?

Answer 53

aPTT 1.5 - 3 times baseline | Check every 4 hours

Question 54

When do we start warfarin after HIT?

Answer 54

Once plt > 150K

Question 55

If the patient has a TEE and was started on warfarin, how many months of therapy should they receive?

Answer 55

2-3

Question 56

If the patient has no TEE and was started on warfarin, how many months of therapy should they receive?

Answer 56

5-6

Question 57

How should argatroban + warfarin be initiated?

Answer 57

Overlap by a minimum of 5 days (plt stable for 2+ days)

Question 58

Above what INR should we stop argatroban?

Answer 58

4+, recheck INR in 4-6 hours

Question 59

If INR is below 2 after discontinuing argatroban, what do we do?

Answer 59

Restart argatroban

Question 60

When do we start NOACs in HITT?

Answer 60

Once plt > 150K

Question 61

How soon after stopping argatroban should the NOAC be started?

Answer 61

w/in 2 hours

Question 62

Is the use of NOACs in HITT with or w/o TEE currently recommended?

Answer 62

No

Question 63

What is the prevention of neutropenia/agranulocytosis in anticonvulsants and abx?

Answer 63

Periodic WBCs

Question 64

What is the prevention of neutropenia/agranulocytosis in methimazole and PTU?

Answer 64

Periodic WBCs x 3 months

Question 65

What is the prevention of neutropenia/agranulocytosis in clozaril/ ticlopidine?

Answer 65

WBCs q2wks x 3 months