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Heme/Onc > DI blood DO > Flashcards

DI blood DO Flashcards

1
Q

How is neutropenia vs agranulocytosis diagnosed?

A

ANC < 500 = neutropenia (severe) = expectant SE

ANC < 500 = Agranulocytosis = unintended AE

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2
Q

What are the sx of neutropenia?

A

Chills
Fever
Infection (URI)
Mouth sores

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3
Q

How is thrombocytopenia diagnosed?

A

Plt < 150,000
Moderate = 20,000-50,000
Severe < 20,000

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4
Q

What is the clinical presentation of thrombocytopenia?

A

Easy bruising
Petechiae
Prolonged/spontaneous bleeding
Thrombosis

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5
Q

How do we diagnose anemia?

A

Hgb < 12
Elevated reticulovytes > 2.5% of RBCs
Elevated reticulocytes
Coomb’s test

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6
Q

What does the Coomb’s test detect?

A

Abs against RBC

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7
Q

What are sx of anemia?

A 
Fatigue
somnolence
Decreased concentration
Weakness
SOB
Tachycardia
Hypotension
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8
Q

What is the diagnosis of aplastic anemia?

A

WBC
Plt
Hgb
Retic

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9
Q

What is pancytopenia?

A

2 or more of aplastic anemia diagnostic criteria

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10
Q

What are the results of intravascular hemolysis?

A

Decreased haptoglobin
Increased hemoglobinemia
Increased hemoglobinuria
Acute renal failure

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11
Q

What are the results of extravascular hemolysis

A

Increased bilirubin (unconjugated)
Jaundice and bilirubinemia
Icteric sclera
Normal haptoglobin

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12
Q

What drugs cause hapten type reactions?

A

PCN
Ceph
Tetracycline
NSAIDs

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13
Q

What are RFs for hapten type reactions?

A

Dose

Renal insufficiency

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14
Q

How long until presentaton of hapten type reactions?

A

7-10 days (1st event)

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15
Q

What is the presentation of hapten type reactions?

A

+/- EV hemolysis

+ Coomb’s test

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16
Q

Are any DI hemolytic anemias preventable?

A

No

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17
Q

What are the drugs that cause auto-immune reactions?

A

NSAIDs

Methyldopa/levodopa

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18
Q

What is the presentation of auto-immune reactions?

A

Months (3-12)
+/- EV hemolysis
+ Coomb’s test

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19
Q

What drugs cause immune complex reactions?

A

PCN
Ceph
Tetracycline
NSAIDs

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20
Q

What is a RF for immune complex reactions?

A

Previous exposure

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21
Q

What is the presentation for immune complex reactions?

A

Hours-days
IV hemolysis
+ Coomb’s test

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22
Q

What does G6PD lead to formation of?

A

Heinz bodies (denatured hgb)

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23
Q

What do heinz bodies lead to?

A

Hemolysis

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24
Q

What drugs cause G6PD deficiency?

A 
Sulfa
Nitrofurantoin
Phenazopyridine
Dapsone
Primaquine
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25
Q

What are RFs for G6PD deficiency?

A

G6PD deficiency severity
Medication dose
Concurrent stressors
Diet (fava beans)

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26
Q

What is the presentation of G6PD deficiency?

A

IV and EV hemolysis

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27
Q

What is the prevention of immunologic DI hemolytic anemia?

A

Avoid recognized allergies

28
Q

What is the prevention of G6PD deficiency?

A

Avoid precipitating meds in type I-III deficiency

29
Q

What is the treatment of Hemolytic anemia?

A

Remove/treat precipitant
Corticosteroids may be helpful in severe cases
Transfusion (dependent of anemia/hemodynamic instability)

30
Q

What drugs cause DT thrombocytopenia?

A 
PCN
Ceph
Sulfa
Vanc
Rifampin
31
Q

What are the RFs for DI thrombocytopenia?

A

Previous exposure

32
Q

What is the duration of hepatin?

A

5+ days

33
Q

What is the indication for heparin?

A

Surgery

Trauma

34
Q

Is UFH or LMWH worse for Type II heparin induced thrombocytopenia?

A

UFH

35
Q

What type of dose is the most likely to cause HIT?

A

Therapeutic dose > prophylactic dose > heparin flush

36
Q

If a patient has a 0-3 pre-test probability for HIT, what level is that?

A

Low

37
Q

If a patient has a 4-5 pre-test probability for HIT, what level is that?

A

Intermediate

38
Q

If a patient has a 6-8 pre-test probability for HIT, what level is that?

A

High

39
Q

What is the diagnosis of HIT?

A

Intermediate or High
And
Elisa +

40
Q

What level of thrombocytopenia is 2pts in the pre-test?

A

+50% drop
or
Nadir = 20-100,000

41
Q

What timing is 2 pts in the pre-test?

A

5-10 days

42
Q

What level of thrombosis is 2 pts in the pre-test?

A

New thrombosis/skin necrosis

43
Q

What causes receive 2 pts in the pre-test?

A

No other causes

44
Q

What level of thrombocytopenia receives 1 pt in the pre-test?

A

30-50% drop
or
Nadir = 10-19,000

45
Q

What timing for HIT receives 1pt in the pre-test?

A

10+ days

46
Q

What kind of thrombosis receives 1 pt in the pre-test?

A

Recurrent thrombosis

Erythematous skin lesions

47
Q

What causes receive 1 pt in the pre-test?

A

Possible other causes

48
Q

What level of thrombocytopenia receives 0 pts in the pre-test?

A

< 30% drop
Or
Nadir = < 10,000

49
Q

What is the timing that receives 0 pts in the pre-test?

A

Too early

50
Q

What type of thrombosis receives 0 pts in the pre-test?

A

None

51
Q

What types of causes receive 0 pts in the pre-test?

A

Definite other cause

52
Q

What is argatroban approved for?

A

Anticoagulant for prophylaxis or treatment of thrombosis d/t HIT

53
Q

What labs are used to monitor argatroban?

A

aPTT 1.5 - 3 times baseline

Check every 4 hours

54
Q

When do we start warfarin after HIT?

A

Once plt > 150K

55
Q

If the patient has a TEE and was started on warfarin, how many months of therapy should they receive?

A

2-3

56
Q

If the patient has no TEE and was started on warfarin, how many months of therapy should they receive?

A

5-6

57
Q

How should argatroban + warfarin be initiated?

A

Overlap by a minimum of 5 days (plt stable for 2+ days)

58
Q

Above what INR should we stop argatroban?

A

4+, recheck INR in 4-6 hours

59
Q

If INR is below 2 after discontinuing argatroban, what do we do?

A

Restart argatroban

60
Q

When do we start NOACs in HITT?

A

Once plt > 150K

61
Q

How soon after stopping argatroban should the NOAC be started?

A

w/in 2 hours

62
Q

Is the use of NOACs in HITT with or w/o TEE currently recommended?

A

No

63
Q

What is the prevention of neutropenia/agranulocytosis in anticonvulsants and abx?

A

Periodic WBCs

64
Q

What is the prevention of neutropenia/agranulocytosis in methimazole and PTU?

A

Periodic WBCs x 3 months

65
Q

What is the prevention of neutropenia/agranulocytosis in clozaril/ ticlopidine?

A

WBCs q2wks x 3 months

Heme/Onc (20 decks)

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