AWESOME HEME2 Flashcards
The finding on peripheral smear associated with uremia is _________
Echinocyte/Burr cell
BRAFV600E assoc with what 3-4 Dx?
Prob some that I am missing but in Hairy Cell Leukemia, Melanoma, and Histiocyte Disorders–Langerhans and Erdheim-Chester; recall it is Ras-Raf-Mek-Erk pathway
What is the best perioperative mgmt of a patient with hx of HIT who needs perioperative heparin for an elective surgery?
Delay surgery; if the PF4 abs are negative then ok to give during surgery followed by fondaparinux. Of note if important surgery people have done perioperative IVIG/PLEX
Dx for pt undergoing complicated CABG s/p xfusion of 12 units pRBC now w/ oozing, normal PT/PTT and platelets of 30 k
Likely dilutional thrombocytopenia; no dilutional coagulopathy as PT/PTT normal
Regarding giving TPA what should you do with giving with antiplatelets and anticoagulation?
Ok to give TPA with antiplatelet but not if on anticoagulation that is a contraindication
The platelet disorder with abnormalities of Gp IIb/IIIa is _________
Glanzmanns Thrombasthenia
What should you do for an incidentally noted elevated PTT that does not correct with 1:1 mixing study but does correct with addition of phospholipids but with no clot? With clot?
Nothing; then pt has APS and should start heparin then warfarin w/ goal 2-3 (if recurrent clot then make goal 3-4)
The platelet disorder with abnormalities of Gp1b/IX is _______
Bernard Soulier
In Essential Thrombocytosis you need to perform which test prior to starting aspirin when platelets are over 1 million?
Ristocetin Cofactor assay to ensure that the patient does not have an acquired VWD
Which disorder is often associated with a rather high PTT without any clinical history of bleeding?
Factor XII deficiency (Hageman Factor–I think)
In a patient scheduled for splenectomy what vaccines need to be given prior to splenectomy?
PCV13 and influenza then followed by PPSV23 8 weeks later; Haemophilus influenzae vaccine, and meningococcal vaccine (note meningococcus = droplet precautions, also need vaccine prior to eculizumab)
A patient presents with mucus membrane bleeding with total protein of 9.5 and gamma gap of 6, calcium 12.5 BUN is 80 w/ sCr of 4.5 and platelet count of 95k with normal PT/PTT. What is the most likely etiology?
Renal Failure secondary to MM with uremic platelet dysfunction
A patient is diagnosed with DVT and started on heparin and two days later the patient is hypotensive with sodium of 124 and K of 5.6. Dx?
Bilateral Adrenal Hemorrhage secondary to heparin; note that this can also occur in meningococcemia with Waterhouse-Freidreichson syndrome
When should you measure protein C after AC for a clot?
When patient no longer on AC and off of it for at least 2 weeks
All platelet disorders will cause an elevation of this ________
Bleeding Time (positive ristocetin in VWF, abnormal platelet aggregation in Glanzmanns, giant platelets in Bernard Soulier)
Dx for 1) Elevated bleeding time, normal PTT and positive ristocetin cofactor assay 2) Elevated BT, normal PTT, and giant platelets 3) increased BT, nl PTT, nl platelets but abnormal platelet aggregation
1) von Willebrand Disease 2) Bernard Soulier 3) Glanzmanns Thrombasthenia
Dx for 1) a patient with elevated PTT and bleeding corrects with 1:1 mixing study 2) pt with elevated PTT and bleeding does NOT correct 3) pt with elevated PTT and thrombosis does NOT correct
1) Factor Deficiency 2) Acquired Hemophilia 3) Antiphospholipid Syndrome
50 M with sudden onset of fever with leukocytosis and erythematous plaques and nodules on face with Bx showing dense neutrophilic infiltrate. Dx. Tx?
Sweet’s Syndrome–would give steroids but also need to perform BM Bx to r/o underlying leukemia
A patient with GIB and normal coags receives 8 units pRBCs now with rebleeding and elevated PT/PTT. Dx? WTD?
Dilutional Coagulopathy (Plasma Washout)–give FFP
What is the best agent to use for a patient with known HIT (platelet factor 4 abs positive) and requires urgent surgery what is the best AC?
Bivalrudin > Argatroban because lower half life
What are some issues with giving high dose IVIG for hypogammaglobulinemia (i.e. in CLL or CVID)?
Can cause hemolytic anemia and can also cause DVT/Stroke/MI
The finding on peripheral smear assoc with G6PD is _______
Blister cells and bite cells
Best mgmt for pt with ischemic stroke who is taking apixaban?
Thromboembolectomy as TPA contraindicated (ok if on antiplatelets)
When can you do an LP in a patient who received ppx dose lovnenox vs. therapeutic dose?
If only prophylactic then can do 12 hours later; if therapeutic then can do 24 hours later; after LP, can restart 4 hours later
What type of AIHA is often caused by CLL?
Warm AIHA w/ IgG + and C3 +/-; lots of other lymphomas cause colid agglutinin disease
Leukoreduced cells will aid in the prevention of which transfusion reaction?
Febrile Nonhemolytic
What have knee high compression stockings shown regarding post-phlebitis syndrome?
No change
Which other cell line may be affected after treatment for megaloblastic anemia?
Platelets. Tx for folate def anemia may lead to significant reactive thrombocytosis
The finding on peripheral smear assoc with liver disease and alcohol is __________
Acanthocyte/Spurr Cell
What is a renal issue that may be encountered on UA with TKIs
Phosphaturia
For a patient who needs CABG and has hx of HIT with current negative PF4 ab titers what is the best mgmt for perioperative a/c
Can give IV heparin during surgery followed by SQ fondaparinux post-operatively (Recall that fondaparinux also good in hyperkalemia)
Which drugs will cause abnormal platelet aggregation similar to Glanzmanns disease?
GP IIB/IIIa inhibitors such as abciximab (Reopro), Eptifibatide (Integrillin), and Tirofiban (Aggrastat)–of note Reopro can also cause thrombocytopenia
What is the Dx for a 25 F with hx of 3 vaginal births who presented one week ago for severe menorrhagia with anemia but normal platelets s/p several units of pRBCs now presenting with purpura and thrombocytopenia? Tx?
Post-Transfusion Purpura (due to platelet alloimmunization)–Tx is with IVIG (theoretically can check HPA-1a abs)
Regarding HIT how much would you expect the platelet count to drop and when? What if the platelets start to drop >14 days after heparin exposure?
Expect a 50% drop in 5-10 days but if >14 days later unlikely to be HIT
The PT/PTT in primary hemostasis disorders is ___________
Normal as this is a platelet plug formation issue (secondary hemostatic issues will have elevated PT/PTT depending)
Aspirin is used in adjunctive therapy of dissection of this vessel
Internal Carotid Artery Dissection–prevents in situ thrombosis
Regarding the presence of issues with primary hemostasis vs. issues with secondary hemostasis, when does bleeding tend to occur temporally?
Bleeding occurs immediately in issues with primary hemostasis and is mostly mucocutaneous (platelet issue) whereas secondary hemostasis is delayed and involves joint bleeds and hematomas
The finding on peripheral smear associated with splenectomy or functional asplenia is __________
Howell-Jolly Body
A 40 y/o F with hx of mildly elevated aPTT develops heavy menses after starting aspirin? Dx?
Von Willebrand Disease
Which often has HTN and elevated JVP–TACO or TRALI?
TACO because of the elevated oncotic pressure; next best step for all xfusion rxns is to stop the infusion; for future can slow infusion rate
A patient in her third trimester with platelets of 85k. Dx? Next steps?
Gestational Thrombocytopenia (ok as long as >70k), continue to monitor CBC or plt count q1-2w
A patient on isoniazid with abnormal bleeding but with normal PT and PTT likely has what
Factor XIII deficiency, may have abnromal clot retraction test
