Exam 1: Must know Flashcards
What is considered severe aplastic anemia? (want lab values)
Neutrophils: (ANC) less than 500
Platelets less than 20K
Retic (ARC) less than 60K
What is considered VERY severe aplastic anemia? (want lab values)
Neutrophils: (ANC) less than 200
Platelets less than 20K
Retic (ARC) less than 60K
What are the SE of Epoetin / Darbepoetin? What is the CI?
HTN and thrombosis
uncontrolled HTN
What is the most form of inherited sideroblastic anemia?
x-linked
What are some common ways for acquired sideroblastic anemia? What syndrome is it associated with?
Often part of a general myelodysplastic syndrome
Chronic alcoholism
Lead poisoning
Copper deficiency
Chronic infection/inflammation
Medications - mostly antimicrobials
isoniazid, linezolid, chloramphenicol
What does erythroid hyperplasia indicate?
ineffective erythropoiesis
You must order ____ to diagnosis sideroblastic anemia
bone marrow aspirate
What are the ringed sideroblasts made up of?
erythroid cells with IRON deposits in mitochondria encircling the nucleus
What is the MC cause of anemia worldwide?
Iron deficiency anemia
What is Plummer-Vinson Syndrome? What is it associated with?
esophageal webs leading to dysphagia
iron deficiency anemia
What is the recommended oral iron replacement dose? What is the alternative?
Ferrous sulfate 325 mg orally three times per day on an empty stomach
Ferrous gluconate
When would you want to give parenteral iron?
If pt cannot tolerate or absorb oral iron, or anemia is refractory to it
Hx of bariatric surgery, GI malabsorption
May also be used for late-stage renal disease, later in pregnancy
Name a way you can differentiate Iron def. anemia from anemia of chronic disease
iron def anemia: ferritin is DECREASED
anemia of chronic disease: ferritin is normal or INCREASED
What is the anemia of endocrine disorders caused by?
Decreased EPO secretion → normocytic, normochromic anemia
What is anemia of chronic liver disease caused by?
Cholesterol deposits in RBC membrane → shortened RBC survival and inadequate EPO secretion to compensate
What is anemia of starvation caused by?
Decreased protein intake → decreased metabolism → decreased EPO
What is anemia of the elderly caused by?
resistance to EPO, decreased EPO secretion, and chronic low-level inflammation
____ is the cyanide anitdote
Hydroxocobalamin
When can you use oral B12 therapy?
May use oral or sublingual B12 if mild (Hgb >8) and no neuro s/s, or for maintenance
and if absorption is adequate orally
What is the MC of folic acid deficiency?
Anorexia, alcoholism, no fruits/vegetables, overcooked fruits/vegetables
What is the classic difference between B12 and folate def?
B12 will have NUERO s/s and folate will not
When will B12 and folate deficiency begin to respond to treatment?
retic: 1 week
CBC: approx. 2 months
______ excessive production of all hematopoietic cells, especially RBCs
Polycythemia vera
_____ excessive platelet production
essential thrombocytosis
_____ excessive production of collagen or fibrous tissue in the marrow
myelofibrosis
_____ excessive production of granulocytes
Chronic myelogenous leukemia (CML)
In what condition does the patient have ruddy facial features?
polycythemia vera
What is the classic traid of hemochromatosis?
hyperpigmentation, DM, cirrhosis
What is the most common x-Linked genetic disease?
Hemophilia A
Should give hemophilia patients ____ for mild pain relief
Celebrex
____ is the most common inherited bleeding disorder
vWD
What are the platelets counts associated with bleeding risks?
<10,000 = spontaneous hemorrhage
<50,000 = increased bleeding during invasive procedures and in trauma (non-CNS)
<100,000 = increased bleeding/complications during invasive procedures in closed spaces (CNS, eye)
You have a pt with ITP, when is it necessary to start pharmcotherapy?
Severe thrombocytopenia (platelets <10,000/microL) with signs of substantial cutaneous bleeding
Moderate thrombocytopenia (platelets <20,000/microL) with mucosal bleeding
Past or anticipated factors that increase bleeding risk (such as recent head trauma)
You have a pt with ITP, when do they need to go the hospital?
Patients with major bleeding or very severe thrombocytopenia (<10,000) should be admitted to the hospital for management/monitoring
When is a splenectomy indicated for a pt with ITP?
thrombocytopenia persists for 6 months or more with medical therapy
qualitative PLT disorders manifest as _____
mucous membrane bleeding
How do you stop the bleeding caused by qualitative plt disorders?
transfusion of normal donor platelets
severe deficiency of enzyme ADAMTS13 molecule what disease are you thinking?
Thrombotic Thrombocytopenic Purpura
What is the role of ADAMTS13?
breaks down vWF when it is no longer needed
aka small blood clots form more frequently
____ is the most common cause of acute renal failure in children
HUS
_____ is the most common cause of inherited thrombophilia, accounting for 40 to 50 percent of cases
Factor V Leiden
____ pts are at risk for warfarin-induced skin necrosis. What is the treatment?
Protein C deficiency
stop warfarin, start vit K, heparin and protein C concentrate/FFP
The probability of a DVT Wells score, what is high?
3 or greater
moderate: 1-2
low: 0 or less
The probability of a PE Wells score, what is high?
hight is greater than 4
low: 0-4
_____ you cannot use if the CrCl >95`
Savaysa
What DOACs should if you avoid if your patient LOVES grapefruits juice?
Eliquis and Xarelto
What are the dosing instructions for a pt who is on ASA and NSAIDs at the same time?
take ASA 60 minutes before or 8 hours after taking NSAIDs
Name all the IRREVERSIBLE P2Y12
Plavix
Effient
Ticlid
Is ASA reversible or irreversible?
irreversible
Do not give ___ and omeprazole together
Plavix
What are the CI of Effient?
Hx of TIA or CVA
What is the major SE of Ticlid?
life threating hematologic reaction
must monitor CBC every 2 weeks for the first 3 months
What are the REVERSIBLE P2Y12 medications?
Brilinta: Ticagrelor
Kengreal: cangrelor
What is a major SE shown in clinical trials with Brilinta?
dypsnea
What is the BBW with Brilinta?
CI when taking ASA 100mg or higher daily
____ is the IV only form of P2Y12 class of medication.
Kengreal : Cangrelor
normally found in the cath lab
