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Hema Flashcards

1
Q

Abnormal labs in hemochromatosis

A

High transferrin saturation

High ferritin

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2
Q

Best screen for hemochromatosis

A

Transferrin

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3
Q

Acute phase reactants

A

ESR
CRP
PLTs

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4
Q

Mechanism of aspirin

A

Permanent acetylation of platelet enzyme cyclooxygenase > inhibit PG

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5
Q

When to stop aspirin prior to surgery?

A

5 days

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6
Q

Labs in hemolytic anemia

A

High retic
High LDH
High unconjugated bilirubin

Low haptoglobin

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7
Q

Pathophysiology of HIT

A

Platelet aggregation from heparin induced antibodies

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8
Q

Rx of HIT

A

Stop heparin

Start lepirudin, argatroban, or desirudin

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9
Q

Healthy + clumped platelets ?

A

Repeat
Usually antibodies to anti coagulant in CBC tube

Repeat w/ citrate in tube.

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10
Q

Warfarin antidote

A

Vit K

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11
Q

Oral iron absorption is better w/ acidic or alkalic environment?

A

Acidic

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12
Q

Improve oral iron supplement?

A

Give Vit C

Take on empty stomach

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13
Q

Lower oral iron absorption?

A

PPI

H2 blockers

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14
Q

When to stop iron supplement? Why?

A

Months after reaching target Hgb

To replenish iron store

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15
Q

Causes of B12 deficiency

A

Strict vegetarian diet

Chronic pancreatitis

Pernicious anemia

Tapeworm (diphyllobothrium)

Ileum disease + gasterectomy / bypass

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16
Q

Hemochromatosis triad

A

Skin hyper pigmentation
DM
Cirrhosis

+ Cardiac disease
+ infertility
+ joint pain

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17
Q

Hemochromatosis pathophysiology

A

Single gene mutation (HFR)

Increased iron absorption > deposition in heart, liver, skin, pituitary, genitalia

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18
Q

What accelerate the expression of hemochromatosis

A

Hep C

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19
Q

Normal transferrin saturation

A

14-50%

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20
Q

Hemochromatosis gene

A

HEF gene Ch 6

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21
Q

Dx of iron deficiency anemia

A

Low ferritin

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22
Q

Rx of sickle cell crisis

A

IVF
Oxygen
Pain control (IV opiates)
If fever => Abx

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23
Q

Hgb electrophoresis in thalassemia trait

A

Hgb A2

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24
Q

MOA of warfarin

A

Inhibits epoxide reductase > low K > alters factors 2, 7, 9, 10

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25
Dx low B12?
High methylmalonic acid
26
Dx HIT
PLT low w/in 5-15 day oh heparin
27
In HIT antibodies are against what
Heparin-platelet factor 4 complex
28
Complication of HIT?
Thrombosis > bleeding albeit low platelet count
29
HIT Rx
Stop heparin Start danaparoid or fondaparinux If warfarin started = stop + add Vit K
30
Hemophilia A inheritance
XL
31
Serum iron in hemochromatosis
300 mg/dL
32
Indication of response to iron supplement in iron deficiency
Increase retic after 1 wk of replacement
33
Aplastic anemia labs
Normocytic anemia | Low retic
34
Dx aplastic anemia
Bone marrow biopsy
35
Type of ab in HIT
IgG
36
PLT level in HIT
< 50
37
Contraindicated in HIT
LMWH
38
T/F: 2-3 drinks / day of alcohol don't alter INR
True
39
Effect of alcohol on warfarin
Reduce its metabolism = increase INR
40
Active bleeding on warfarin
Stop warfarin 5-10 mg Vit K FFP Till INR < 5
41
High INR on warfarin + no bleeding
Stop warfarin INR q24hr Resume warfarin when INR is therapeutic range.
42
Risk of tea and toast diet
Low vitamin C
43
What's Vit C
Ascorbic acid
44
What's amyloidosis?
Extra cellular deposition of insoluble proteins
45
Dx amyloidosis
+ve Congo red dye Pink in H+E stain Apple green birefringence under polarized light.
46
What's Rivaroxban?
Factor Xa inhibitor
47
Advantages of rivaroxban
``` Fixed dose Acts in hours No monitoring No drug or food interaction Not metabolized by liver = not affected by P450 inducers / inhibitors. ```
48
Daily maintenance of Vit B12
1000 mg
49
Is Vit B12 supplement effective in pernicious anemia, gastrectomy, terminal ileum damage?
Yes
50
TTP classic
Easy bruising Fever Dark urine Low PLT High Bleeding time High bilirubin
51
Marker of liver dysfunction in bleeding
Abnormal INR + aPTT
52
Dx polycythemia Vera (1ry)
Erythropoietin low | O2 low
53
G6PD enzyme function
Catalyze the oxidation of glucose-6-phosphate to glucose-6-phosphogluconate And reduce NADP+ to NADPH (Nicotinamide adenine dinucleotide phosphate)
54
G6PD Dx
No fluorescent on rapid fluorescent spot test.
55
Drugs avoided in G6PD
Dapsone Sulfa TMP-SMX
56
MCC of anemia in elderly
Chronic disease esp renal
57
Normal Hct
40-50%
58
Normal MCv
80-100
59
Dx spherocytosis
Osmotic fragility
60
Coombs test in spherocytosis
Negative
61
Normal retic count
<2%
62
Rx of vW disease
Desmopressin | Transfusion of factor VIII or vW concentrate
63
Pathophysiology of TTP
Low ADAMS 13 | Plasma protease for vW factor.
64
TTP Rx
Plasmaphoresis | FFP transfusion
65
Advantage of LMWH
No monitor needed
66
aPTT used in monitoring what drug
Unfractionated heparin
67
TMP/SMX + warfarin
Bleeding risk
68
Criteria for polycythemia Vera
2 major or 1 major + 2 minor. Major: 1. Hgb >18.5 M or >16.5 F and RBC mass >25% 2. JAK2 mutation Minor: 1. Low erythropoietin (<30) 2. BM biopsy = hypercellularity + prominent erythroid, granulocyte, megakaryocyte 3. Endogenous erythroid colony formation
69
Normal PLT
130-400
70
Normal ESR
M: 1-13 F: 1-20
71
Serum albumin
35-50
72
Normal ferritin
15-200
73
Normal iron
60-160 ug/L or 11-29 umol/L
74
TIBC
250-460 ug/L or 45-82 umol/L
75
Most accurate Dx of iron deficiency anemia
Bone marrow aspiration for staining of iron
76
Complication of hemochromatosis
Liver cirrhosis (Portal HTN)
77
Dx portal HTN
``` Transjugular cath (dangerous) US or CT ```
78
Bleeding when on warfarin?
Hold warfarin FFP transfusion Vit K IV
79
Antidote of heparin, warfarin, ASA
Heparin = protamine Warfarin = FFP + Vit K ASA = platelet transfusion
80
Antidote of heparin, warfarin, ASA
Heparin = protamine Warfarin = FFP + Vit K ASA = platelet transfusion

CanQB (16 decks)

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