Heme-Onc

Question 1

Blood donations are collected in plastic bags containing the anticoagulants:

Answer 1

ACD (Acid-Citrate-Dextrose) or CPD (Citrate-Phosphate-Dextrose)

Question 2

PRBCs are stored at what temperature? How long is the shelf life?

Answer 2

0 - 6 degrees, 42 days

Question 3

At what temperature are platelets stored? Shelf life?

Answer 3

Room temperature with 5 day shelf life.

Question 4

RBC transfusions generally indicated when Hb drops below

Answer 4

7

Question 5

The restrictive RBC transfusion policy aims at a lower target Hb around:

Answer 5

7 - 8 Gms

Question 6

In an actively bleeding patient, goal of platelet transfusion is to keep platelets:

Answer 6

Above 50k in most cases, above 100k if evidence of DIC or CNS bleeding

Question 7

Platelet transfusions are also given to patients in preparation for invasive procedures. Major surgery and endoscopies aim for __k while a spinal tap with a heme malignancy aims for __k.

Answer 7

50k

20k

Question 8

Prophylactic platelet transfusions are generally above 10k, but may be higher in patients with:

Answer 8

Fever, sepsis, APL

Question 9

Prophylactic platelet transfusions should not be given to patients with

Answer 9

TTP/HIT

Question 10

For a massive transfusion, a 1:1:1 ratio of what should be given?

Answer 10

PRBCs:FFP:Platelets

Question 11

What are some major concerns with a massive transfusion?

Answer 11

Citrate toxicity, hypothermia, hyperkalemia, hypocalcemia, metabolic alkalosis, coagulation parameters

Question 12

A transfusion reaction wherein antibodies to donor leukocytes cause a release of cytokines and result in symptoms of fever, chills, dyspnea

Answer 12

Febrile, nonhemolytic RBC or platelet transfusion reaction

Question 13

A transfusion reaction wherein ABO incompatibility leads to rapid destruction of donor erythrocytes and results in DIC, shock, acute renal failure, fever, bakc pain, hemoglobinuria.. May only see fever and chills in comatose or anesthetized pt!

Answer 13

Acute hemolytic transfusion reaction

Question 14

What is the appropriate response to an AHTR?

Answer 14

Stop transfusion, ABCs, saline, diuretics, blood sample for DAT, Hb, type and cross

Question 15

A transfusion reaction wherein ABO incompatibility results in shock, hypotension, angioedema, respiratory distress. IgA deficient patients at high risk.

Answer 15

Anaphylactic transfusion reaction to RBCs, platelets, cryoppt, granulocytes, or gamma globulin.

Question 16

A transfusion reaction wherein allergenic substances in donor plasma react with recipient antibodies with mast cell and basophil histamine release.

Answer 16

Urticarial transfusion reaction, give benadryl

Question 17

A transfusion complication more common in elderly patients, pediatric patients, patients with compromised cardiac function (seen in ICU)

Answer 17

Transfusion associated circulatory overload

Question 18

A transfusion complicated associated with two hit theory of neutrophil sequestration, priming, and activation paired with donor Abs vs HLA1, 2, and human neutrophil antigens.

Answer 18

Transfusion related acute lung injury

Question 19

TRALI occurs how long after transfusion?

Answer 19

1 - 6 hours

Question 20

A transfusion complication occurring days or weeks after transfusion, presenting with anemia, hyperbilirubinemia as a result of extravascular hemolysis.

Answer 20

Delayed hemolytic transfusion reaction

Question 21

A transfusion complication that occurs days to weeks after transfusion and presents with fever, rash, anorexia, vomitting, abd pain, diarrhea, pancytopenia, abnormal LFTs

Answer 21

Graft vs Host disease

Question 22

Most common mortality in travelers:

Answer 22

Cardiovascular disease

Question 23

What percentage of travelers will develop some type of diarrhea?

Answer 23

20 - 60%

Question 24

What questions might you want to ask someone who is planning to travel?

Answer 24

Country, duration, accommodations, purpose, travel history, allergies, current illnesses

Question 25

What treatment is recommended for altitude sickness?

Answer 25

Descent, oxygen. Prevention: avoid alcohol and sedatives, high carb diet, sildenafil and acetazolamide.

Question 26

Catfish that ascends the urethra, attracted by urea.

Answer 26

Candiru

Question 27

Prophylaxis for traveler's diarrhea is not recommended, but may recommend _____ before a high-risk meal

Answer 27

Peptobismol

Question 28

Treatment for traveler's diarrhea with blood in stool:

Answer 28

Fluids, zithromax

Question 29

Three R's of travel immunization

Answer 29

Routine childhood Required for crossing borders Recommended: according to risk (Hep A, typhoid, etc)

Question 30

Routine travel immunizations:

Answer 30

Diphtheria, tetanus, Polio, MMR, Influenza, Pneumococcal

Question 31

Recommended travel vaccines:

Answer 31

Hep A, Hep B, typhoid, japanese encephalitis, rabies

Question 32

DEET concentration that is sufficient for repellent for travelers:

Answer 32

40%

Question 33

Clotting in the arterial system generally results in ____ clots of platelets.

Answer 33

White

Question 34

Clotting in the venous system generally results in ____ clots of red blood cells.

Answer 34

Red

Question 35

Risk factors for arterial thrombosis include:

Answer 35

Vascular injury (#1), lipoproteins decreasing fibrinolysis, inflammatory changes, homocysteine

Question 36

An anti-coagulant that decreases thromboxane and lasts for the lifespan of a platelet

Answer 36

Aspirin

Question 37

Most commonly used inhibitor of ADP-induced platelet aggregation

Answer 37

Clopidogrel (Plavix)

Question 38

Thrombin inhibitors for VTE prophylaxis and atrial fib

Answer 38

Dabigatran (Pradaxa) and Apixaban (Eliquis)

Question 39

Bone marrow has the capacity to increase production ______ x the normal production

Answer 39

5 - 10

Question 40

RBC lifespan can reach as low as __ days before marrow cannot compensate and anemia develops.

Answer 40

18 days

Question 41

A person can lose up to __% of their blood without clinical signs at rest.

Answer 41

20%

Question 42

A loss of __ - __% of blood can lead to circulatory collapse and shock

Answer 42

30 - 40%

Question 43

Anemia as a result of _______ may present with signs of malnutrition and neurological changes

Answer 43

B12 deficiency

Question 44

Anemia as a result of _______ may present with severe pallor, a smooth tongue, and esophageal webs.

Answer 44

Iron deficiency

Question 45

Anemia as a results of ______ may present with jaundice

Answer 45

Hemolysis

Question 46

A CBC includes:

Answer 46

``` RBC count (n = 3.8-5.2, 3.9-5.9) Hct/PCV (n = 38-46%, 41-53%) Hb (n = 12 0 16, 13.5-17.5) RBC indices ```

Question 47

RBC indices on a CBC are:

Answer 47

MCV (mean corpuscular volume) MCHC (Mean corpuscular hb concentration) MCH (Mean corpuscular hb) RDW (Red cell distribution width)

Question 48

MCV =

Answer 48

(Hct%/RBC) x 10 | n = 80 - 100 fL

Question 49

MCHC =

Answer 49

(Hb/Hct%)x100 | n = 31 - 37

Question 50

MCH =

Answer 50

(Hb/RBC) x 10 | n = 26 - 34

Question 51

RDW =

Answer 51

(Standard dev/mean MCV) x 100 | n = 11.5 - 14.5%

Question 52

What stain is used on PBS to visualize remaining ribosomes and ER of reticulocytes?

Answer 52

Methylene blue

Question 53

Special considerations in treating a patient for HIV include:

Answer 53

Adolescents, pregnant patients, IV drug users, older patients, HIV-2, coinfection with HBV/HCV/TB

Question 54

The best predictor of disease progression, indicator of immune function, and key factor in determining urgency of ART:

Answer 54

CD4+ cell count

Question 55

An adequate response to ART is

Answer 55

Increase in CD4 cells by 50 - 1500 /uL/year

Question 56

How often should a patient have their CD4 count checked during first two years of ART?

Answer 56

Every 3 - 6 months

Question 57

How often should a patient have their CD4 count checked after two years of adequate and consistent suppression? (300 - 500 cells/uL)

Answer 57

Every 12 months

Question 58

A factor to consider in the decision to start ART and the goal of art with regard to this factor:

Answer 58

HIV RNA, goal to achieve undetectable levels (

Question 59

How often should HIV RNA be checked?

Answer 59

Every 2 - 4 weeks after starting or changing the ART regimen, then every 4 - 8 weeks until levels are

Question 60

Drug resistance testing is indicated in HIV patients with:

Answer 60

Acute HIV infection, chronic infection at entry into care, virologic failure during ART, suboptimal suppression, pregnancy

Question 61

Drug resistance testing is not usually indicated in HIV patients:

Answer 61

After discontinuation of ARVs, if plasma HIV RNA

Question 62

Patients with this HLA should not receive ABC and should be recorded as an ABC allergy.

Answer 62

HLA-B*5701

Question 63

Current recommendations for initiating ART with the intention of preventing transmission:

Answer 63

HIV infected pregnant women, patients at risk of transmitting HIV to a sexual partner

Question 64

Current 6 categories of ARV medications:

Answer 64

NRTI, NNRTI, PI, Integrase inhibitors, fusion inhibitors, PK boosters

Question 65

3 categories of regimens for ART:

Answer 65

1 Integrase inhibitor + 2 NRTIs 1 PK-boosted PI + 2 NRTIs 1 NNRTI + 2 NRTIs

Question 66

In the 3 main categories for ART regimens, each includes 2 NRTIs, one of which should include:

Answer 66

3TC (Lamivudine) or FTC (Emtricitabine)

Question 67

In patients with CD4

Answer 67

RPV-based | DRV/r +RAL

Question 68

In patients with HIV RNA >100k, it is not recommended to use _____, _____, or _____ due to high rate of virologic failure.

Answer 68

RPV-based ABC/3TC + EFC or ATV/r DRV/r + RAL

Question 69

In patients with chronic kidney disease and ostoporosis, one should avoid ____ in ART regimen:

Answer 69

TDF

Question 70

In patients with a psychiatric illness, one should consider avoiding ____ in ART regimen

Answer 70

EFV