Heme Onc

Question 1

How to treat secondary iron overload from chronic transfusions

Answer 1

Iron chelation agent: deferasirox (PO) or deferoxamine (IV)
–>relatively toxic, leading to potential kidney and liver damage, agranulocytosis, or ocular and ophthalmic disorders

Use phlebotomy if you fix the underlying anemia

Question 2

chronic lead intoxication tx

Answer 2

lead chelator: succimer

Question 3

tx for supratherapeutic INR on Warfarin with bleeding

Answer 3

Vitamin K + four-factor prothrombin complex concentrate (4fPCC) – faster, less vol, and no thawing required (vs FFP)

Question 4

Dabigatran reversal tx

Answer 4

Idarucizumab– for life threatening bleeding or urgent/emergent surgeries.

Side effects: thromboembolism, bronchospasm, pruritis, hypersensitivity rxn

Question 5

peri-op Hgb goal for sickle cell anemia pts

Answer 5

10

1994, a landmark study was published showing that simple transfusion to a target hemoglobin level of 10 g/dL (100 g/L) was equivalent to exchange transfusion in low- to medium-risk surgeries (low-risk surgeries include adenoidectomy and inguinal-hernia repair; medium-risk surgeries include cholecystectomy and joint replacement) in reducing surgical complications in patients with SCD with less risk, reduced cost, and increased convenience.
More recently, guidelines have been published on the care of patients with SCD that strongly recommend simple transfusion to a target hemoglobin level of 10 g/dL (100 g/L) in patients requiring general anesthesia.

Question 6

when is exchange transfusion appropriate for sickle cell pts

Answer 6

acute stroke or retinal artery occlusion or in patients with severe acute chest syndrome. When indicated, the target hemoglobin S level should be less than 30%