Heme

Question 1

Types of HIT

Answer 1

Type I- mild, not immune mediated, first 2 days
TypeII- severe, immune-mediated, 5-10 days
Thrombotic complications (odd, arterial, venous)

Question 2

Cryo contains

Answer 2

Fibrinogen
Factor VIII
Factor XIII
vWF

Question 3

Contraindications to lytics for PE (8)

Answer 3

1. Intracranial AVM
2. Prior intracranial hemorrhage
3. Ischemic stroke within 3 months
4. Active bleeding
5. Recent brain or spinal surgery
6. Recent head trauma with fracture or brain injury
7. Known intracranial neoplasm
8. Bleeding diathesis

Question 4

Relative contraindication to lytics for PE (11)

Answer 4

1. SBP >180
2. DBP >110
3. Recent bleed
4. Surg within 3 weeks
5. Ischemic stroke within 3mos
6. on anticoag
7. Traumatic CPR
8. Pericarditis
9. Pregnancy
10. Age >75
11. BW <60kg

Question 5

4T score component:
1. Timing
2. Thrombocytopenia
3. Thrombosis
4. AlTernative
(6)

Answer 5

1. 0- fall <30k or nadir <10, 1 fall is 30-50% and nadir 10-19, 2 fall >50% and nadir is 20-100
2. 0- fall within 1d and no previous exposure, 1 fall after day 10 or within 1d and prior exosure, 2 fall 5-10d or within 1d and prior exposure to heparin
3. 0 no sx, 1 progression or recurrence of prior thrombosis, 2 proven thrombosis, skin necrosis
4. 0 definite alternative cause, 1 possible alt cause, 2 no alternative cause

Question 6

Evidence based uses of tranexamic acid:

Answer 6

1. Trauma- within 3h, decr mortality
2. mild/mod TBI, within 3h, improved mortality
3. postpartum hemorrhage, improved survival from hemorrhage
4. ATACAS- no improved mortality after CABG, less bleeding but more seizures

Question 7

PTT measures

Answer 7

Common pathway (X, V, II [thrombin], and I [fibrin])
and contact activation pathway (XII, XI, IX, and VIII)

Question 8

PT/INR

Answer 8

Measure of VII and 
Common pathway (X, V, II [thrombin], and I [fibrin])

Question 9

Common Pathway

Answer 9

X, V, II [thrombin], and I [fibrin]

Question 10

Processes that affect common pathway (and thus PT and PTT)

Answer 10

DIC, supratherapeutic heparin, DTI, warfarin, Vit K defic, and hepatic insuffic, dilutional coag

Question 11

Factor Xa inhibitors effect

Answer 11

PT normal or prolonged, PTT normal or minimally prolonged

Question 12

DTI

Answer 12

PT prolonged, PTT prolonged

Question 13

vWD vs lupus anticoagulant

Answer 13

Both prolong just PTT, VWD has prolonged bleeding time, not lupus anticoagulant

Question 14

5 NOACs

Answer 14

1. Dabigatran- DTI
   - prolong PTT and TT
   - reversal- Idaruciaumab (Fab fragment)

Rest prolong PT to variable degree

2. Apixaban- Xa inhib
3. Betrixaban
4. Edoxaban
5. Ribvaroxaban

Question 15

Reversal of dabigatran

Answer 15

Idarucizumab

Question 16

Reverasal of Xa inhibitor

Answer 16

Andexanet alpha or PCC (only 69%)

Question 17

PCC contains

Answer 17

four factor formulation (II, VII, IX, X)

3-factor, missing VII

Question 18

Adexanet

Answer 18

Reverse rivaroxaban and apixaban

Question 19

Dabigatran action

Answer 19

Blocks factor IIa (thrombin)

Question 20

O2 Content

Answer 20

O2 Content=[Hg x O2 sat x 1.34]+0.003xPO2

Question 21

O2 Delivery

Answer 21

02 delivery= CO x{[Hg x O2 sat x 1.34]+0.003xPO2}