Heme Onc

Question 1

Dabigatran(Pradaxa) reversal

Answer 1

idracizumab

Question 2

Dabigatran MOA

Answer 2

inhibits thrombin

Question 3

MOA of apixaban

Answer 3

inhibits factor Xa

Question 4

apixaban prolongs what coagulation study

Answer 4

prothrombin time, but it is the least of the anti Xa drugs

Question 5

Pradaxa prolongs?

Answer 5

aPTT, thrombin time

Question 6

half life of NOAC? prolonged by what?

Answer 6

out of system within 1-2 days, renally cleared so can take longer if decreased creatinine clearance

Question 7

reversal for Anti Xa drugs?

Answer 7

PCC

Question 8

HLH mechanism

Answer 8

extreme inflammation and upregulated immune activation, can be inherited(perforin gene) or acquired

Question 9

Signs of HLH

Answer 9

fever, HSM, cytopenia, very high ferritin, elevated LFT, low fibrinogen, and high bili. High levels of IL-2

Question 10

Adult onset stills disease dx with Yamaguchi criteria

Answer 10

fever >39 for a week, athritis for 2 weeks, nonpruritic salmon rash on trunk and ext, granulocytiuc leukocytosis >10000. Minor criteria with sore throat, lymphadenopathy, negative Rf and ANA

Question 11

TEG- R time- what is it, interpretation, treatment?

Answer 11

• time from reagent addition to fibrin formation
• prolonged R time is coagulation factor deficiency
• give FFP

Question 12

TEG- K time-what is it, interpretation, treatment?

Answer 12

• measurement of clot strength
• prolongation means dec coag factors and fibrinogen
• give FFP and cryo

Question 13

TEG- alpha angle-what is it, interpretation, treatment?

Answer 13

• rate of clot formation due to cross linking and fibrin buildup
• decreased angle means dec coag factors and fibrinogen
• give FFP and cryo

Question 14

TEG- MA-what is it, interpretation, treatment?

Answer 14

• reflects overall clot strength and fibrin and platelet bonding
• low means need platelet

Question 15

TEG- LY30-what is it, interpretation, treatment?

Answer 15

• reflects clot stability, breakdown
• if prolonged then increased fibrinolysis
• give TXA

Question 16

acquired perforating disorder

Answer 16

associated with cancer, renal dysfunction, DM, HIV

• lesions on body
• bx invagination with keratin plugs

Question 17

PLEVA

Answer 17

cutaneous T cell lymphoma, pretty much

Question 18

contact activation clotting pathway factors

Answer 18

VIII, IX, XI, XII

Question 19

common pathway clotting factors

Answer 19

X, V, II(thrombin), I(fibrin)

Question 20

APTT measures what?

Answer 20

both the contact activation and the common pathway

Question 21

PT measures what?

Answer 21

VII and the common pathway

Question 22

what is the INR a measurement of?

Answer 22

a means of standardizing the PT at multiple sites

Question 23

things that affect the common pathway can affect APTT, PT and INR. What are they?

Answer 23

DIC, heparin, Xa inhibitors, warfarin, vik K deficiency, hepatic insufficiency

Question 24

heparin lock concentration?

Answer 24

10000 u/ml and each lumen is locked with 1.5 to 2.5 ml, so it must be wasted before using the lumens

Question 25

DIC coag studies?

Answer 25

increased PT, PTT, INR decreased fibrinogen, low fibrin degradation products

Question 26

what does thrombin time measure?

Answer 26

how long it takes a clot to form in plasma, when thrombin is added. It measures a problem with a conversion of fibrinogen to fibrin

Question 27

type 1 HIT

Answer 27

small drop in plt in the first few days, non immune mediated, no need to stop heparin

Question 28

type II HIT

Answer 28

immune mediated against Pf4. usually occurs around day 5. heparin needs to be stopped an nees to be fully anticoagulated to prevent thrombosis

Question 29

HLH

Answer 29

- widespread macrophage activation due to failure of NK and t lymphs

Question 30

Criteria for HLH

Answer 30

5/8 - fever - splenomegaly - cytopenias in at least 2 cell lines - hypertriglyceridemia - hemophagocytosis - low or absent NK activity - ferritin >500 ng/mL, very specific if >3000 - increased solube CD25

Question 31

treatment for HLH

Answer 31

etoposide(VP-16) and dexamethasone

Question 32

Reason for argatroban over fondaparinux in HIT?

Answer 32

fondaparinux has a much longer half life

Question 33

Car T cell therapy, what is it?

Answer 33

patients own T lympho are harvested and modified with an external antigen domain , these new t cells are given back to patient and the external domain recognizes B lympho CD-19

Question 34

3 different side effects of Car T cell therapy?

Answer 34

cytokine release syndrome, CarT cell relate encephalopathy syndrome, HLH

Question 35

high grade CRS, 3 or 4? tx?

Answer 35

grade 3- IL6 receptor antagonist tocilizumab | grade 4- tocilizumab plus solumedrol at 1g.d

Question 36

when is the most likely time a patient will develop neutropenic enterocolitis?

Answer 36

following chemo for hematologic malignancies | - treat with abx and support

Question 37

hyperuricemia, hyperkalemia, hyperphos, hypocalcemia in a newly diagnosed cancer patient? what is the treatment? what is the most likely cancers to cause it?

Answer 37

tumor lysis syndrome - hydration and the initiation of rasburicase, fluids to maintain a relatively high urine output - non hodgkin lymphoma, ALL