Hematology

Question 1

What vitamin is essential for factors II, VII, IX, X and proteins C, S?

Answer 1

Vitamin K

Limited placental transfer, sterile neonatal gut, limited stores at birth.

Question 2

What is VKDB and when does early VKDB occur?

Answer 2

Vitamin K Deficiency Bleeding; within 24 hours

Caused by maternal warfarin or anticonvulsants.

Question 3

What are the classical symptoms of VKDB?

Answer 3

Umbilical, GI, circumcision bleeding; occurs days 2–7

Classical VKDB symptoms appear during this timeframe.

Question 4

What are the symptoms of late VKDB?

Answer 4

Intracranial, GI, skin bleeding; occurs weeks 3–8

Question 5

What lab findings indicate VKDB?

Answer 5

Prolonged PT → PTT

Question 6

How is VKDB treated?

Answer 6

Vitamin K IV/IM; consider fresh frozen plasma (FFP)

Question 7

What should be monitored for bleeding when using drugs that affect hemostasis?

Answer 7

Bruising, petechiae, bleeding gums, blood in urine/stool

Question 8

What types of anticoagulants are mentioned?

Answer 8

Heparin, LMWH, Warfarin

Question 9

What is the mechanism of action of Heparin?

Answer 9

Potentiates antithrombin on thrombin/factor Xa

Question 10

What is the dosing for Heparin in treatment?

Answer 10

~25 units/kg/hr

Question 11

What is the dosing for Heparin in prophylaxis?

Answer 11

10 units/kg/hr

Question 12

What tests are used to monitor Heparin?

Answer 12

PTT and anti-factor Xa (target: 0.3–0.7)

Question 13

What is a key advantage of Low Molecular Weight Heparins (LMWH)?

Answer 13

Better bioavailability, longer half-life

Question 14

What are the indications for Warfarin?

Answer 14

DVT, PE, mechanical valves, AFib

Question 15

What is the half-life range of Warfarin?

Answer 15

6 hrs–2.5 days

Question 16

What is the INR target for Warfarin therapy?

Answer 16

2.0–3.0 (↑ with embolism history)

Question 17

What are examples of antiplatelet drugs?

Answer 17

Aspirin, Clopidogrel, Tirofiban

Question 18

What is the typical use of antiplatelets?

Answer 18

MI, stroke prevention

Question 19

What is the chronic dosing for Aspirin?

Answer 19

81 mg/day

Question 20

What is the acute dosing for Aspirin in MI?

Answer 20

325 mg

Question 21

What is the first-line thrombolytic agent?

Answer 21

tPA

Question 22

What is a contraindication for thrombolytics?

Answer 22

Bleeding risk

Question 23

What should be monitored when using thrombolytics?

Answer 23

PT, aPTT, fibrinogen, D-dimer, platelets

Question 24

What is the dose of PRBCs?

Answer 24

10–20 mL/kg over 3–4 hrs

Question 25

What are the indications for PRBCs?

Answer 25

Anemia, blood loss

Question 26

What is the dose of platelets?

Answer 26

10–15 mL/kg

Question 27

What is the threshold for platelet transfusion in the absence of IVH risk?

Answer 27

<30K

Question 28

What is the dose for Fresh Frozen Plasma (FFP)?

Answer 28

10–15 mL/kg

Question 29

What conditions is FFP used for?

Answer 29

DIC, liver failure, vit K deficiency

Question 30

What is the purpose of recombinant human EPO?

Answer 30

May reduce PRBC transfusions

Question 31

What is a concern with EPO in VLBW neonates?

Answer 31

↑ ROP

Question 32

What is being studied for neuroprotection in neonates?

Answer 32

Darbepoetin

Question 33

What were the findings in Case 1?

Answer 33

Term C-section infant, pallor, boggy scalp; Hct drop from 31% to 21%

Question 34

What were the lab findings in Case 1?

Answer 34

Prolonged PT/PTT/INR (INR 10)

Question 35

What was the diagnosis in Case 2?

Answer 35

VKDB; given IV vitamin K but coags abnormal

Question 36

What was the treatment for Case 2?

Answer 36

Coagadex (250 units IV); improved labs

Question 37

What was the treatment plan for Case 2?

Answer 37

Coagadex q1–2 weeks

Question 38

What were the findings in Case 3?

Answer 38

Cranial US negative; family history of bleeding disorders

Question 39

What social determinants were noted in Case 3?

Answer 39

Undocumented worker, SSO