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Heme Flashcards

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1
Q

What is the only direct thrombin inhibitor?

A

Dabigatran (pradaxa)

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2
Q

How are factor Xa inhibitors cleared (renally/hepatically)? What is the significance of this?

A

Renall, thus dialysis patients or patients with renal disease will have altered clearance

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3
Q

How long does is take to clear the new Xa inhibitors?

A

12-24 hours

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4
Q

How do you reverse factor Xa inhibitors? (3)

A

TXA
4 factor PCC
IR consult if necessary

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5
Q

What is the reversal agent for dabigatran? What is the efficacy of this?

A
  • Idarucizumab

- Questionable efficacy

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6
Q

What is the reversal agent for apixaban and rivaroxaban? What is the efficacy of this?

A
  • Andexanet

- Questionable efficacy (rebound effect)

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7
Q

What is a febrile non-hemolytic transfusion reaction? Treatment?

A

Fever from blood products. Give tylenol and stop the transfusion temporarliy

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8
Q

What is the treatment for a simple allergic (urticarial) reaction to blood?

A

Benadryl. Continue to give product, but watch carefully.

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9
Q

What are the symptoms of a hemolytic transfusion reaction?

A

Fever
Flank pain/hematuria
Shock, DIC, death

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10
Q

What is the diagnostic test for a hemolytic transfusion reaction?

A

Coombs test

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11
Q

What is the treatment for a hemolytic transfusion reaction?

A
  • IVFs, and titrate to UOP of 100-200 cc/hr

- Treat hyperkalemia

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12
Q

What is in the differential for a patient presenting with shock and fever following a transfusion? Tests?

A

Sepsis vs hemolytic transfusion reaction

-Coombs test and blood cultures from pt and bag

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13
Q

What is the differential for a patient that presents with difficulty breathing following a transfusion?

A

Anaphylaxis
TRALI
TACO

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14
Q

What are the factors that lead to an increased risk for TRALI?

A
  • Massive transfusions
  • SIRS/Sepsis
  • Trauma pts
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15
Q

What is the role of lasix in the treatment of TRALI?

A

Do NOT give

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16
Q

What is the treatment for TACO?

A

Lasix, supoortive care (treat like CHF exacerbations)

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17
Q

What is the protein that is exposed on injured blood vessel walls that causes platelets to adhere?

A

vWF

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18
Q

What is the general role of the following:

  • Anti-thrombin III
  • Protein C
  • Protein S
A

All anticoagulants

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19
Q

What is the inheritance pattern of type A and B hemophilia respectively?

A

both AR

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20
Q

Which coag test will be elevated with hemophilias PT or PTT

A

PTT

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21
Q

What is the definitive test for a hemophilia?

A

Factor activity levels

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22
Q

What is the dosing of factor 8 and 9 for mild moderate and severe bleeding respectively?

A 
Mild = 12.5/25
Moderate = 25/50
Severe = 50/100
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23
Q

How does DDAVP work to improve clotting?

A

Releases extra vWF which carries factor 8

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24
Q

What is the alternative treatment for replacing lost factors?

A

DDAVP
Cryo
FFP

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25
What are types I, II, and III vWF disease?
``` I = decreased number of vWF II = non-functional vWF III = complete lack of vWF ```
26
Which type of vWF does DDAVP not work for?
III
27
What is the treatment for vWF?
DDAVP Non-recombinant VIII -cryo
28
What is the role of FFP in vWF?
Not used, since not much vWF in it
29
What is the antidote to heparin?
Protamine sulfate
30
What is the MOA of heparin?
Binds to and activates antithrombin III, which inhibits Xa
31
What is the MOA of protamine? Why is there a limit on the dose?
Binds heparin and prevents it from working, but it in itself is actually an anticoagulant
32
Why must protamine be given slowly?
Anaphylactoid rxn
33
What is the dosing scheme for protamine? Max dose?
1 mg for every 100 units of heparin over the last 4 hours with a max dose of 50 mg
34
What is the role of protamine in lovenox bleeding?
Reverses about 60% of lovenox
35
What are the three agents used to reverse coumadin?
FFP Vit K PCC
36
What is FFP?
All the coag factors and proteins in blood
37
What is PCC?
Factors 2, 7, 9, 10
38
What is the treatment for a supratherapeutic INR but less than 5 without bleeding?
Skip next dose of coumadin
39
What is the treatment for a supratherapeutic INR between 5 and 9 without bleeding?
Omit 1-2 warfarin doses, 5 mg vit K PO
40
What is the treatment for a supratherapeutic INR over 9 without bleeding?
Withhold warfarin, vit K 5-10 mg PO
41
What is the antidote to tPA?
Aminocaproic acid | TXA
42
What is the reversal agent for plavix?
Give platelets
43
What happens with anion gap with multiple myeloma?
Lower
44
What is the monoclonal protein that is found with multiple myeloma?
Bence Jones protein
45
What test is diagnostic of multiple myeloma?
SPEP/ UPEP
46
Why is ESR elevated with multiple myeloma?
Slow sedimentation rate due to rouleaux formation
47
Who is typically affected with follicular lymphoma? What is the natural history of the disease?
- Older adults | - Widespread and incurable, but pts live years
48
Who is typically affected with Diffuse large B-cell lymphoma? What is the natural history of the disease?
- Older adults | - Aggressive, 50% curable
49
How does Hodgkin's lymph nodes present?
Contiguous pattern of LAD
50
REed-sternberg cell = ?
HL
51
What are the two classes of lymphoid cells?
B cells and T cells
52
What are the classes of myeloid cells?
RBCs | WBCs
53
What are the s/sx of ALL?
- LAD - Fatigue/anemia - Bleeding/petechiae - Infxs
54
What are the s/sx of AML?
- NO LAD - fatigue/anemia - **Infiltration of gums**
55
Auer rods = ?
AML
56
How can you differentiate CLL vs CML on a CBC?
CML has increased platelets
57
How many WBCs are present with leukostasis?
over 100,000
58
What are the s/sx of leukostasis?
- Hypoxia | - HA/visual changes
59
What is the treatment for leukostasis? (4)
- Induction chemotherapy - Allopurinol - Hydroxyurea - Leukapheresis
60
What are the four major metabolic derangements with tumor lysis syndrome?
- Hyperuricemia - Hyperkalemia - Hypocalcemia - Hyperphosphatemia
61
What is the most important test to diagnose tumor lysis syndrome?
Uric acid
62
What are the two medications to treat tumor lysis syndrome?
Allopurinol | Rasburicase
63
What causes the hypocalcemia with tumor lysis syndrome?
hyperphosphatemia--phosphate binds to calcium
64
What is the difference in prognosis for ITP in kids vs adults?
Kids is self limiting disease, adults is usually chronic
65
What are the two major/broad pathophysiologic processes that lead to ITP?
- Immune mediated destruction of platelets | - Decreased production
66
What is the first line treatment for ITP? Second line?
Corticosteroids | IVIG
67
What are the components of the pentad of s/sx that make up TTP?
- AMS - Thrombocytopenia - Fever - Anemia - ARF
68
What is the role of platelets in the treatment of TTP?
Will make worse, do NOT give
69
What enzyme is deficient in TTP?
ADAMTS-13
70
What is the pathophysiology of TTP?
vWF untangles from intima, platelets bind. No ADAMTS-13 to cleave, so leave large sheets of platelets in blood vessels. RBC get sheared
71
What happens to bili with TTP? LDH? Fibrinogen?
- Unconjugated Bili increases - LDH increases - Normal fibrin
72
What is the treatment for TTP?
- FFP - IVIG - PET (plasma exchange trans)
73
Why does FFP work to treat TTP?
Replaces ADAMTS-13
74
What is the classic triad of HUS?
- MAHA - Thrombocytopenia - ARF
75
How do you diagnose HUS?
Send stool/urine for shiga toxin
76
Should you give platelets to HUS?
No
77
What is the treatment for HUS? What is not?
- Supportive care | - No Abx, causes release of toxins
78
Can you get HIT from lovenox?
Yes
79
What is the definition of HIT?
platelets less than 150 K OR 50% drop from baseline
80
What factor(s) does heparin vs lovenox work against?
- Heparin inhibits Xa and thrombin | - Lovenox only against Xa
81
What is the presentation of HIT?
clots everywhere
82
What are the 4 T's of HIT?
- Thrombocytopenia - Thrombosis - Timing (5-14 days) - no oTher cause
83
What is the treatment for HIT?
Stop heparin | Give Dabigatran
84
What is the role of platelets for the treatment of HIT?
Do NOT give
85
What happens to the following lab values with DIC: - platelet count - D-Dimer - PT - Fibrinogen
- Platelet goes down - Dimer elevated - PT prolonged - Fibrinogen decreases
86
Can you give DIC pts platelets?
Yes, but of variable efficacy
87
When is dialysis indicated for the treatment of HUS?
If patient becomes anuric.
88
What are the three major disease entities that you should not give platelets to?
TTP HUS HIT
89
Which of the following have decreased platelets: - ITP - TTP - HUS - HIT - DIC
All
90
Which of the following have increased PT/INR: - ITP - TTP - HUS - HIT - DIC
DIC | HIT +/-
91
Which of the following have microangiopathic hemolytic anemia: - ITP - TTP - HUS - HIT - DIC
TTP HUS DIC
92
Which of the following have low fibrinogen levels: - ITP - TTP - HUS - HIT - DIC
DIC
93
Which of the following are associated with splenomegaly: - ITP - TTP - HUS - HIT - DIC
TTP
94
Which of the following diseases cause the patient to look "sick": - ITP - TTP - HUS - HIT - DIC
TTP HUS DIC
95
Which of the following diseases is it okay to give platelets to: - ITP - TTP - HUS - HIT - DIC
ITP | DIC
96
Which of the following diseases commonly have clots: - ITP - TTP - HUS - HIT - DIC
HIT
97
What are the three major general etiologies of pancytopenia?
- Infections (HIV) - Medications - Leukemia
98
Microcytic or macrocytic: B12/folate deficiency?
Macro
99
Microcytic or macrocytic: Fe deficiency?
Micro
100
Microcytic or macrocytic: EtOH use
Macro
101
Microcytic or macrocytic: blood loss
normocytic
102
Microcytic or macrocytic: thalassemias
Microcytic
103
Microcytic or macrocytic: anemia of chronic disease
Microcytic
104
Microcytic or macrocytic: sideroblastic anemia?
Microcytic
105
What are the characteristics of iron deficiency anemia in terms of: - Reticulocytes - ferritin - Total Fe - TIBC
- Reticulocytes = low - ferritin = low - Total Fe = low - TIBC = high
106
What are the characteristics of thalassemias in terms of: - Reticulocytes - ferritin - Total Fe - TIBC
- Reticulocytes =high - ferritin = normal/high - Total Fe = normal/high - TIBC = normal
107
Target cells are usually associated with which anemia type?
Target cells
108
Pb poisoning has what characteristic microscopic appearance?
Basophilic stippling
109
What are the characteristics of anemia of chronic disease in terms of: - Reticulocytes - ferritin - Total Fe - TIBC
- Reticulocytes =low - ferritin = low - Total Fe = low - TIBC = low
110
Hypersegmented PMNs are seen with which anemia(s)?
Vit B12 and folate deficiency
111
Which causes neurologic changes: B12 or folate deficiency?
B12
112
What causes acute dactylitis?
Painful infarction of bone
113
Which virus causes an acute aplastic crisis with SCC?
Parvovirus B19

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