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Flashcards in Hematology Deck (136)
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91

What lab work is diagnostic for NAIT?

collect blood from mother and father; antigen testing HPA 1,3,5 will catch most cases; neonate can be screened for platelet antibodies that high false positive rate

92

What is the indicated treatment for NAIT?

1) brain MRI (most bleeding occurs where it cannot be seen)
2) random donor plt tx (if initial count is < 30k or < 100k with IVH)
3) IVIG if diagnosis is confirmed (helps to decrease rate of destruction)
4) if other tx is not effective in 1-2d: matched (antigen negative plts)- maternal tx or donor plt HPA matched

93

How do infants with Autoimmune Thrombocytopenia present?

- early onset
- mod- severe thrombocytopenia
- maternal h/o ITP or autoimmune disease
(all infants with maternal h/o autoimmune dz should be screened)- in OB pts with ITP, 25% of infants had low plt count at birth

94

What is the treatment for Autoimmune Thrombocytopenia?

1) IVIG
2) cranial imaging
3) plt tx
4) follow until stable

95

What are the risks a/w plt tx?

1) plt tx thresholds are highly variable
2) thresholds and effects in neonatal pop is poorly studied
3) GvHD
4) CMV
5) associated lung injury (hypoxemia and pulmonary infiltrates within 6h of plt tx)
6) bacterial contamination
7) strong association b/w the number of plt tx and risk for death

96

What is the current recommendation for plt tx threshold in an otherwise clinically stable newborn?

< 30k

97

What is Cushing's Triad?

indicator of increasing ICP
1) bradycardia
2) hypertension- progressively increasing systolic (or widened pulse pressures)
3) abnormal respiratory effort

98

What are anticlotting factors?

- Protein C
- Protein S
- Antithrombin
- Antithrombin III
- Thrombomodulin

99

Why are infants at an increased risk for thromobosis?

fibrinolysis decreased d/t low plasminogen levels

100

What are additional risk factors for thrombosis in neonates?

1) umbilical lines
2) asphyxia
3) sepsis
4) polycythemia (dehydration, IDM, CHD)
5) shock
6) Protein c or S deficiency
7) Antithrombin III deficiency
8) factor V Leiden

101

What clinical syndromes increase an infant's risk for thrombosis?

1) renal vein thrombosis (renal fx, renal mass, IDM, polycythemic)
2) renal artery thrombosis
3) sagittal sinus thrombosis
4) stroke (seizures)

102

What is the management for thrombosis?

antithrombolitic therapy; TPA controversial, heparin gtt

103

What is the PT test?

prothrombin time
- evaluation of the extrinsic pathway
- evaluation of vitamin K dependent factors (II, VII, IX, X)

104

What is the normal range for a PT test?

10-16 sec

105

When is a PT test elevated?

liver disease and DIC

106

What is the PTT test?

partial thromboplastin time
- evaluation of intrinsic pathway

107

What is the normal range for a PTT test?

FT: 25-60 secs; PT: up to 80 secs

108

When is a PTT test elevated?

1) vitamin K deficiency
2) liver failure
3) DIC

109

How should an INR be evaluated?

- if high: more likely to bleed
- if low: more likely to clot

110

When is an INR ordered?

to monitor efficacy of heparin therapy

111

What is the fibrinogen test?

fibrinogen is a protein produced in the liver to help in clot formation

112

When is a D Dimer or fibrin degredation product test indicated?

to evaluate the products in the blood that are needed to remodel and remove the clot

113

What would the lab work look like in a patient with Hemophilia A or B?

- very high PTT
- normal PT
- normal fibrinogen
- negative to high D dimer
- normal platelets

114

What would the lab work look like in a patient with thrombocytopenia?

- normal to high PTT
- normal PT
- normal fibrinogen
- negative to high D dimer
- low to very low platelets

115

What would the lab work look like in a patient with Vit K deficiency?

- high to very high PTT
- very to severely high PT (PT >PTT)
- normal fibrinogen
- negative to high D dimer
- normal platelets

116

What would the lab work look like in a septic pt?

- low to very high PTT
- high to very high PT
- normal to low fibrinogen
- high to very high D dimer
- low to very low platelets

117

What would the lab work look like in a hypoxic patient?

- high to very high PTT
- normal to very high PT
- normal to very low fibrinogen
- very high to severely high D dimer
- low to very low platelets

118

What would the lab work look like in a patient with DIC?

- high to severly high PTT
- high to severely high PT
- normal to severly low fibrinogen
- very high to severely high D dimer
- low to very low platelets

119

What is an APT test?

to evaluate "whose blood it is" MOB or babe; helpful in evaluating pseudohemorrhage in the newborn

120

What is the etiology of vitamin k deficiency in the first day of life?

1) refusing injection
2) maternal anticonvulsants
3) antibiotics