Hematology

Question 1

Normal MCV, increased LDH, increased indirect bilirubin, decreased haptoglobin

Answer 1

Hemolysis

Question 2

sickle cell kid w/ sudden drop in hct?

Answer 2

aplastic crisis 2/2 sickle crisis from hypoxia, dehydration, or acidosis

Question 3

cyanosis of fingers, ears, nose + recent mycoplasma infxn?

Answer 3

Cold agglutinins. Destruction occurs in the liver. IgM mediated

Question 4

sudden onset after PCN, ceph, rifampin, or cancer

Answer 4

Warm agglutinins. Destruction in spleen. IgG. Tx w/ steroids then splenectomy

Question 5

Splenomegaly, +FH, bilirubin gallstones, increased MCHC

Answer 5

Hereditary spherocytosis. Tx w/ splenectomy

Question 6

Dark urine in AM, Budd-Chiari syndrome

Answer 6

Paroxysmal Nocturnal Hemoglobinuria. Lysis by complement

Question 7

Sudden onset after primaquine, sulfas, fava beans

Answer 7

G6PDH def. Heinz bodies, bite cells. Avoid oxidant stress

Question 8

Thrombocytopenia: 30 y/o F recurrent epistaxis, heavy menses, petechiae. Only decreased platelets

Answer 8

ITP (tx with prednisone). IVIG if <10,000K.

Question 9

Thrombocytopenia: 20yo F recurrent epistaxis, heavy menses, pethechiae, normal plts, increased bleeding time and PTT

Answer 9

VWD. DDAVP for bleeding. Replace factor VIII

Question 10

Thrombocytopenia: 20yo M recurrent bruising, hematuria, hemarthroses, increased PTT that corrected w/ mixing studies

Answer 10

hemophilia

Question 11

Thrombocytopenia: 50yo meat-a-tarian just finished 2 weeks clinda has hemarthroses and oozing at venipuncture sites

Answer 11

vitamin K def (decreased II, VII, IX, X), Tx with FFP + vit K

Question 12

Thrombocytopenia: 50yo beer -a-tarian w/ severe cirrhosis

Answer 12

liver disease causes factor VII depletion (PT increase)

Question 13

Thrombocytopenia, schistocytes on smear, PT and PTT increased, fibrinogen decreased, D-dimer and fibrin split products increased

Answer 13

DIC (tx with FFP, platelet transfusion)

Question 14

Thrombocytopenia, schistocytes on smear, PT and PTT are normal, fibrinogen decreased, D-dimer and fibrin split products increased

Answer 14

HUS or TTP (tx with plasmapheresis)

Question 15

increased PTT, multiple SABs, false + VDRL

Answer 15

lupus anticoagulant (antiphospholipid syndrome)

Question 16

skin necrosis after warfarin is started

Answer 16

protein C/S def

Question 17

MC inheritable pro-coagulable state.

Answer 17

Factor V Leiden

Question 18

Heparin won’t work. Clots on heparin

Answer 18

AT III Def

Question 19

Pee out ATIII protein C and S. At risk for renal vein thrombosis

Answer 19

Nephrotic syndrome