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RCE > Haematology > Flashcards

Haematology Flashcards

1
Q

CMML

A 
Monocytes >=10% total WBC and >=1E9
Blasts <20%
Dysplasia in >= 1 myeloid lineage
Other MPNs excluded
Usually JAK2 neg
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2
Q

Anticoagulants: Prophylactic Doses for VTE

A 
Apixaban 2.5 BID*
Riva 10 OD*
Dalteparin 5000-10000 U OD
Enox 40 (30) OD
Tinza 4500-10000 U OD
Fonda 2.5 OD

(DVT ppx for high risk ambulatory cancer: brain, lung, GI/GU)

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3
Q

DOACs: Treatment doses for VTE

A

Apixaban 10 BID x 7 days –> 5 BID x6-12 mo –> 2.5 BID
Riva 15 BID x 3 wks –> 20 OD x6-12 mo –> 10 OD
Dabi 150 BID (bridge with LMWH x5-10 days)
Edoxaban 60 OD (bridge with LMWH x5 days)

Warfarin - target INR 2-3 (use in APLA, ESRD with CrCl <15, VTE in breast-feeding women)

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4
Q

LMWH: Treatment doses for VTE

A

Enoxaparin 1mg/kg BID or 1.5mg/kg OD
Dalteparin 200 units/kg OD
Tinza 175 units/kg OD
Fonda = weight based OD (5 if wt <50 kg, 10 if wt >100, 7.5 if wt 50-100)

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5
Q

Wells Score DVT

A 
Active CA (within 6 mo) - 1 pt
Lower limb immobilization - 1 pt
Recent OR (within 4 wks) or bedbound >3 days - 1 pt
Unilateral calf swelling - 1 pt 
Unilateral leg swelling -1 pt
Collateral veins -1 pt
Deep vein tenderness - 1 pt
Pitting edema -1 pt
Non varicose superficial veins -1 pt
3+ = high prob
0= low
1-2 = intermed
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6
Q

Well’s Score for PE

A 
PE most likely dx -1 pt
Active CA (within 6 mo) -1 pt
Hemoptysis -1 pt
Hx VTE -1.5 points
Recent OR (within 4 wks) or bedbound >3 days - 1 pt
Signs and symptoms c/w DVT - 3 points
Tachycardia >100 - 1.5 point
No alt dx -3 pts

4+ high probability, otherwise low

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7
Q

When to use alternate anticoagulation > DOAC for VTE

A

C/I:
Pregnancy (LMWH) or Breastfeeding (LMWH/Warfarin)
Triple pos APLA (Warfarin)
Child Pugh B/C Cirrhosis
Plts <50
Drug interactions (doxorubicin, cyclosporine, dilantin)

Caution:
Intraluminal GI/GU/?intracranial Ca (LMWH)
HD or ESRD with CrCl <30 (Apix<25, up to <15; use Warfarin)
High clot burden - extensive/submassive PE, postTPA, iliofemoral DVT

Riva and Apix appropriate for any BMI/weight (except post bariatric sx)
Old?: Wt >120 kg or BMI >40 (LMWH, Warfarin)

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8
Q

Indications for VTE prophylaxis in CA patients

A

High risk score >= 3 –> start VTE PPX (LMWH, Apix, Riva)

2 pts- Brain, GI CA
1 pt- Lung, GU, Heme Ca
1 pt - BMI >= 35
1 pt for each CBC abN: Hgb <100, Plt >=350, WBC >11

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9
Q

Indications for thrombolysis

A

sBP <90 for >15 mins despite aggressive fluids + no high risk bleeding features

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10
Q

Indications to extend anticoagulation >6-12 months in unprovoked VTE

A 
MEN and HERDOO
Male - always continue Or Female with 2+ of:
-Hyperpigmented leg
-Edema leg
-Redness leg
- Dimer >=250
-Obesity: BMI >=30
-Older age >= 65
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11
Q

Treatment of breakthrough VTE

A

If on DOAC/Warfarin –> LMWH x 1 month

If on LMWH –> increase dose by 25-33%

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12
Q

VTE PPX after hip/knee replacement

A

LMWH or DOAC x 14-35 days

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13
Q

VTE PPX after hip Fracture

A

LMWH x14-35 days

No DOAC (compared to hip/knee replacement)

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14
Q

Indications to anticoagulate LE distal DVT

A 
Severe symptoms
Active CA / other irreversible RF
Dimer >=250
Multiple deep veins involved
>5 cm long
Close to popliteal vein
Progression on repeat US

*if high risk bleed: serial US instead

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15
Q

Indications to anticoagulate superficial vein thrombosis

A

1) <= 3 cm saphenofemoral junction (–>therapeutic AC x 3mo)
2) >3 cm saphenofem jcn but 5+cm long (–> ppx AC x 45d: fonda 2.5 or riva 10); if <5cm = NSAID + serial US
3) Hypercoag: Pregnant, Ca, Surgery, Trauma, Past VTE (Tx ppx AC x 45 days)

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16
Q

Indications to anticoagulate subsegmental PEs

A

Symptomatic (ie. pleuritic CP, hypoxia, SOB)
Silent DVT on bilateral leg Doppler
Active CA or other irreversible RF
Elevated D-dimer

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17
Q

Indications to AC mesenteric vein thrombosis

A
  • Worsening symptoms
  • Thrombophilia
  • Progression into larger veins or evidence bowel ischemia
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18
Q

Warfarin and LMWH Reversal

A

If non-bleeding:

  • INR >9: VitK 2.5-5 mg PO, hold dose, resume @ lower
  • INR 4.5-9: Hold dose, resume @ lower

If non life-threatening bleed: IV/PO Vitamin K, Hold warf

If life-threatening bleed: PCC (1000-3000 U based on INR) + Vit K IV

LMWH reversal = protamine 25-50mg

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19
Q

DOAC Reversal

A

If non-life threatening bleed: Hold

If life-threatening bleed:

  • Dabi: Idarucizumab, consider dialysis
  • Apix/Riva/Edox: PCC (1000-2000 units)
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20
Q

HIT 4T Score

A

Thrombocytopenia

  • 2= 50% drop NADIR >20
  • 1= 30-50% drop NADIR 10-19

Timing of heparin

  • 2= D5-14 or <1 d if exposed within 30d
  • 1= >14 ds or <1d if exp within 31-100 ds, or timing unclear

Thrombosis

  • 2= proven clot, necrosis, anaphylactoid rxn
  • 1=progressive thrombus, recurrent clot, skin redness

oTher cause

  • 2= no other cause
  • 1 = possible other cause

Score: <4 = low, 4-5= intermed, >5 = high

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21
Q

Treatment HIT

A

1 - STOP LMWH/ Heparin
2- START Argatroban/ Fonda/ Danaparoid (if preg)
3- B/L Leg Dopplers (silent DVT), UE doppler only if central venous line in situ
4- Once plts 150+ start warfarin overlap x5d (INR 2-3)
OR DOAC (riva 15BIDx3wk if VTE or 20daily until plt recovery if no VTE)
*no plt transfusion

Duration: no VTE = until plt >150 (max 3mo), if VTE 3-6mo

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22
Q

Diagnosis HIT

A

If 4T score = 4+ –> PF4/Heparin Assay

If Positive –> Fxnl Serotonin release assay to confirm

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23
Q

Coagulation cascade

A

Intrinsic: 12 –> 11 –> 9 –> 8 –>
Extrinsic: 7 +Tf –>
Common: 10 –> 5 –> 2 –> 1

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24
Q

VitK Dependent Coagulation Factors

A

10, 9, 7, 2

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25
Q

DDX Thrombocytopenia

A

Production Issue:

  • B12/Fe deficiency
  • Sepsis
  • Malignant Blood: Leukemia, lymphoma, MM, MPNs
  • Aplastic anemia
  • Myelofibrosis
  • Infiltration of BM: Mets, Tb, Sarcoid

Sequestration due to splenomegaly

Destruction:

1) Immune Mediated: Primary ITP, Secondary immune (Hep C, H. pylori, RA, SLE, APLA, ANCA), PTP, HIT
2) Non-immune (ie. TMAs): Mech valve, TTP, HUS, aTTP, HTN emerg, SRC, Vasculitis, DIC, HELLP, drugs (cyclo, tac, quinines)

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26
Q

Approach to isolated high INR

A

1 - confirm it is real, review meds (DOAC, warfarin)
2- 50:50 mixing study
a) Corrects= F deficiency (F7 defic, VitK defic, liver failure)
b) Does not correct = F7 inhib (order F7 + inhib) or LAC

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27
Q

Approach to isolated high PTT

A

1 - confirm it is real, review meds (LMWH, heparin, DOAC)
2- 50:50 mixing study
a) Corrects = F deficiency (8, 9, 11 >12) or T3 VWF (order these F levels and VWF assay)
b) Does not correct = F inhibitor or LAC (order above factor levels and inhibitor of those that are low)

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28
Q

Approach to combined elevated INR/PTT

A

1- Confirm it is real, review meds
2- Look at CBC + fibrinogen R/O DIC
3- 50:50 mixing study
a) Corrects = F defic in common pathway or multiple F deficiency (order F5,7,8 to determine)
- If all low = DIC
- If 5 and 7 low, 8 normal = liver failure
- If 7 low, 5 and 8 normal = Vit K defic
- If only 5 low = F5 defic
- If none low -> order F10, 2
b) Does not correct= F2/5/10 inhibitor or LAC

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29
Q

Types of vWD

-and factors that increase/decrease vwf

A

Type 1 = mild-mod quantitative (low Ag, low activ) *vwf<30% or vwf 30-50% + abn bleeding = diagnostic
Type 2 = qualitative (low/normal Ag, very low activ)
Type 3 = severe quantitative (low Ag, low activ, low F8) ~ to hemophilia A

vwf increase w/ stress/estrogen/preg; decrease in O blood group

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30
Q

Treatment of Bleeding in vWD

A

DDAVP (Type 1), vWF/VIII concentrate (=Humate P), cryoprecipitate
TXA+/-OCP if heavy menstrual bleeding

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31
Q

Treatment ITP

A

Not bleeding and plt >30 - observe

Not bleeding and plt <30

  • 1st line: Dex 40/Pred 0.5-2 mg/kg x 4 days (peak 2-14 d, dur 7-28 d) or IVIG (peak 1-3 d, dur 2-7 d)
  • 2nd line: Ritux (peak 7-56d, dur 180d), Splenectomy, TPO-R agonists

Pregnancy, treat if: bleed, plt <30, delivery or plt <50 + >=36GA
- IVIG or Prednisone > Dex bc it crosses placenta
(Pred for Preg)

Bleeding: Steroids + TXA +/- IVIG (+ Plt transfusion +/- splenectomy if life-threatening)

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32
Q

Treatment TTP

A

PLEX (send ADAMTS13 first)
+ FFP (4u then 1u q2hrs) + Solumedrol 1g + Folic acid +/- ASA if trop elevated
DVTp when plt>50 *no transfusion unless bleed
Caplacizumab or Ritux if refractory

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33
Q

DDX Hemolytic Anemia

A

Intravascular (schistocytes)

  • Mechanical: TMAs, heart valves, post-bypass
  • Complement mediated destruc: PNH, Cold AIHA
  • Acute hemolytic transfusion RXN

Extravascular (spherocytes)

  • Warm AIHA
  • Intrinsic RBC defects (hemoglobinopathies, membrane defectsm, enzyme defects)
  • Delayed hemolytic transfusion RXN
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34
Q

Warm AIHA

  • Causes
  • Blood film and bloodwork
A

CTD (SLE, RA)
LPD (eg CLL)
Drugs (NSAIDs, ABX, methyldopa)

spherocytes, IgG +/-C3d

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35
Q

Cold AIHA

  • Causes
  • Bloodwork
A

Waldenstrom’s, MGUS, lymphoma
Infectious: Mycoplasma, EBV

IgM, +C3d

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36
Q

Treatment Warm AIHA

A

Prednisone 1-1.5mg/kg
2nd line: Ritux or splenectomy (>8-12mo)
Folic acid

If requires transfusion: Ag matched blood

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37
Q

Treatment Cold AIHA

A 
Trigger avoidance, warm enviro
Plasmapharesis if very severe
Tx underlying cause
NO STEROIDS
Ritux if refractory
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38
Q

Acute Leukemia: Major manifestations

A

1) BM Failure: Anemia, Thrombocytopenia, Neutropenia
2) Blast-related issues: Leukostasis, DIC, TLS
3) End organ infiltration: CNS, Heart, Skin (rash), Mucosa (gum hypertrophy)

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39
Q

Diagnosis Acute Leukemia

A

> =20% Blasts in peripheral blood or BM

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40
Q

Diagnosis APL

A

> =20% Blasts in blood or BM + Auer Rods + DIC(!!!)

Or promyelocytes or PML-RARA mutation

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41
Q

Diagnosis TLS

A

Low Ca, High K/Phos/Uric Acid +/- AKI

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42
Q

Treatment TLS

A 
Fluids (UO 80-100cc/m2/h)
Allopurinol 
(Rasburicase (check G6PD) if AKI, urate >535, or refractory to allopurinol)
Manage lyte abn
PPX - allopurinol
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43
Q

Blast threshold for leukostasis

A

AML: 50-100
ALL: 100s
CML: 100s
CLL: high 100s

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44
Q

Treatment Leukostasis

A

Fluids, fluids, fluids
AVOID transfusion
Hydroxyurea
Allopurinol for TLS ppx

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45
Q

Treatment of DIC in APL

A

ATRA
Plt transfusion if <30-50
Cryoprecipitate if fibrinogen <1.5

46
Q

Treatment of DIC in non-APL acute leukemia

A

Supportive care
Plt transfusion if <10 or bleeding and <50
Cryo if bleeding and fibrinogen <1.5
FFP 15cc/kg if bleeding and PT/PTT >1.5x ULN

47
Q

Indications for irradiated blood

A

Prevent GVHD:

  • Allogenic-HSCT (always) or auto-HSCT within last 3 mo
  • Hodgkin’s Lymphoma (if ever)
  • Chemo with purine-based chemo (fludarabine) / ATG
  • T-cell deficiency (Congenital)
  • Previous transfusion GvHD
  • Intrauterine transfusions
48
Q

Indications for washed blood

A

Reduce allergies:

  1. IgA deficiency (documented anti-IgA)
  2. Anaphylactic transfusion rxn of unknown etiology.
  3. Recurrent/severe febrile or allergic transfusion reactions not ameliorated by pre-transfusion meds
49
Q

Treatment AML (not APL)

A

Induction chemo (3+7)

Consolidation chemo if low risk
Allo-HSCT if intermed/high risk

50
Q

Treatment APL

A

ATRA + Arsenic +/- chemo

51
Q

Treatment ALL

A

Chemo: Induction, consolidation, maintenance

High risk CNS involvement –> intrathecal chemo +/- intracranial radiation

+/- allogenic HSCT

52
Q

Phases of CML

A

1) CHRONIC (<10% blasts): Neutrophilia, Basophilia, Eosinophilia, anemia, high or low plts, splenomeg
2) ACCELERATED (10-19% blasts): worsening counts despite TKI (WBC >10, plts >1000 or plt<100), basophils >20%
3) BLAST: >=20% blasts = Acute Leuk (AML>ALL)

53
Q

Treatment CML

A

TKIs (ie. Imatinib)

iMatinib: M for CML

(Ibrutinib = CLL)

54
Q

Diagnosis Polycythemia Rubra Vera

A

3 Major or 2 major + 1 minor

Major:

  • Hgb > 165M/160F or Hct > 49%M/48%F
  • BM: Hypercellular, tri-lineage growth
    • JAK2

Minor: Low serum Epo

55
Q

Treatment Polycythemia Rubra Vera

A

For all: ASA 81 OD, Phlebotomy to target HCT <45%

If high risk (hx thrombosis or age >=60):

  • Add hydroxyurea –> Ruxolitinib (JAKi) if resistant
  • interferon if preg/young
56
Q

Diagnosis Essential Thrombocytosis

A

4 Major or 3 Major + 1 Minor

Major:

  • Plts >=450
  • BM: Increased mature hyperlobulated megakaryocytes
  • +JAK2/CALR/MPL
  • Other MPNs excluded

Minor:
- No secondary cause: CA, CTD, Infxn, Post-op, post-splenectomy, trauma, Fe defic

57
Q

Treatment Essential Thrombocytosis

A

For all: ASA 81 OD (up to BID if CV RFs), CV RF reduction

If high risk (hx thrombosis, Age>=60): Hydroxyurea (interferon if young/pregnant)

58
Q

Diagnosis Myelofibrosis

A

3 major + 1 minor

Major:

  • BM Bx: fibrosis, megakaryocyte proliferation, atypia
    • Mutation status: JAK2 >CALR> MPL
  • Other MPN/MDS excluded

Minor:

  • High LDH (>ULN)
  • Leukoerythroblastic film (L shift, teardrop, nuc RBC)
  • Palpable splenomegaly
  • Anemia
  • WBC >= 11
59
Q

Treatment Myelofibrosis

A

Supportive transfusions (eg EPO)
Ruxolitinib (JAKi) for splenomegaly/B-Sx
Allo-HSCT

60
Q

Diagnosis MDS

A

BM Bx/aspirate:

  • Hypercellular +/- ring sideroblasts (hypolobulated/ hypogranuloated neuts)
  • > 10% dysplasia
  • < 20% blasts
61
Q

Treatment MDS

A

Low risk:

  • Supportive transfusions +/- EPO, Fe chelation
  • Lenalidomide (5q deletion), immunosuppression, luspatercept (ring sideroblasts)

High risk:

  • Supportive (EPO, transfusions)
  • Cure: allogenic SCT
  • Ineligible for transplant: Azacytidine (hypomethlating agent)
62
Q

Diagnosis CLL

A

Periph blood: Lymphocytes >= 5 with consistent flow cytometry
*do not need BMBx

63
Q

Treatment CLL

A

If asymptomatic and no cytopenias: Watch and wait

Treat with TKI (Ibrutinib - afib/bleeding) if:

  • B-Sx,
  • BM failure: Cytopenias (Hb or plt <100)
  • Warm AIHA refractory to steroid,
  • Symptomatic LN or >10cm
  • Symptomatic splenomegaly or >6cm below CM
  • Extra-nodal sx: skin, lung, kidney, spinehod
64
Q

How to diagnose lymphoma

A

EXCISIONAL LN Biopsy

65
Q

Treatment Lymphoma

A

Hodgkin: Reed sternberg and aggressive
-Chemo (AVBD) +/- Rads

NHL: 
Indolent (follicular): Observe vs ritux + chemo
Aggressive: 
-DLBCL = ritux + chemo (RCHOP) 
-Burkitt's (Magrath)
66
Q

Staging lymphomas

A

CT Neck/C/A/P, PET, BMBx, +/- LP

1- 1 LN Region
2- >1 LN regions on same side of diaphragm
3- >1 LN regions on opposite sides of diaphragm
4- extra-nodal disease (skin, BM, CNS, kidney, spine)
A - no B-Sx; B - Yes B-Sx

67
Q

MGUS Definition

A

M-spike <30 g/L
BM Plasma cells <10%
No end organ damage
No biomarkers of MM

68
Q

Multiple Myeloma Dx

A

BM plasma cells >10% or plasmacytoma AND any SLIM CRAB

Biomarkers of Disease (SLIM)
Sixty: BM Plasma cells >= 60%
LIght chains: involved/uninvolved FLC Ratio >100 or <0.01
MRI: > 1 Focal osteolytic bone lesion on MRI that is >5mm

End Organ Damage: CRAB
C: Ca >2.75 or >0.25 above ULN
R: Renal - Cr >177 or CrCl <40 without other cause
A: Anemia - Hgb <100 or 20g/L below LLN
B: Bone - >=1 osteolytic lesion (skeletal survey, CT/PET)

*NO LYMPHADENOPATHY

69
Q

Smouldering Myeloma Definition

A

M-spike>=30 g/L or UPEP spike >=500/24hr
BM Plasma cells 10-60%
No SLIM CRAB or amyloidosis

70
Q

Criteria for high risk MGUS

-Ix/screening for high vs low risk

A

Any of:

  1. M-spike >=15
  2. Non-IgG M-spike
  3. Abnormal FLC ratio (normal = 0.26-1.65)

Need BMBx, whole body CT, CT abdo if IgM –> CBC, SPEP, FLC, Ca Cr in 6mo then q1y lifelong

If none of above = low risk: above BW in 6mo then q2-3y and NO imaging

71
Q

Treatment MM

A

Transplant eligible: Induction chemo –> Auto HSCT (<70yo and fit) –> maintenance
Tx ineligible: CyBorD –> maintenance therapy
Isolated plasmacytoma: Radiation

72
Q

Diagnosis AL Amyloidosis

A

Need all 4:

  1. M-spike or abn FLC or clonal plasma cell in BM
  2. Amyloid syndrome (liver, renal, GI, cardiac, neuro)
  3. Amyloid on tissue Bx or BM (apple green biefringence on Congo red stain)
  4. Amyloid light chain restricted (mass spectrometry or electron microscopy)
73
Q

Treatment Waldenstrom’s (lymphoplasmaytic lymphoma + monoclonal IgM in blood)

A

Watch and wait if Asx
Chemo + Ritux +/- auto-BMT for cytopenias or symptoms
Cold avoidance of cold AIHA
PLEX for hyperviscosity (removes IgM)

74
Q

Causes of Aplastic Anemia

A

Primary: Idiopathic

Secondary: Pregnancy, Autoimmune
Infxn: Parvo, Hepatitis B/C, EBV, CMV
Drugs: NSAIDs, PTU, carbemazapine, chemo

75
Q

Clues to PNH

A

Pancytopenia + intravascular hemolysis + VTE (arterial or venous; commonly hepatic)

76
Q

Diagnosis PNH

A

Peripheral flow cytometry: loss of CD55/59

77
Q

Treatment Vaso-occlussive crisis in Sickle Cell Disease

A

Fluids

Analgesia: Standing tylenol, nsaid, HM, + PRN HM

78
Q

Treatment acute chest crisis or CVA in sickle cell disease

A

Exchange transfusion to target HbS <30% and Hb <100

Simple transfusion ok if Hgb <100 and mild-mod chest sx

79
Q

Indications for pRBC transfusion (1 unit at a time)

A

Hgb <70 for most
Hgb <75 if CVSx
Hgb <80 if CVD/MI, non-cardiac surgery (eg ortho)
Hgb <60 if young pt at low risk ischemia

80
Q

Indications for Platelet transfusion (1 pool, 1 apharesed unit at a time)

A

<10 for all
<20 if low risk procedure (scope, central line)
<30 if AC can’t be held
<50 if LP, larger surgery, or bleeding, or DIC in APL
<80 neuraxial anesthesia
<100 if TBI, ICH, CNS surgery

Any plt count if plt dysfunction and marked bleeding

81
Q

Indications for FFP (all factors + fibrinogen)

A
  1. Bleeding or signif procedure
  2. Liver dz or DIC and: INR>1.8
  3. Warfarin reversal if prior HIT
  4. TTP pre-PLEX
82
Q

Indications for PCC (1000-3000 units) - vit k factors, prot c/s, heparin

A
  • Warfarin or DOAC reversal with life-threatening bleed

- Before A-case OR within 6 hrs

83
Q

Indications for cryoprecipitate (or fibrinogen concentrate) - 10 units at a time

A

Bleeding with fibrinogen <1.5
APML with fibrinogen <1.5
Intracranial bleed post tPA with fibrinogen <2
Bleeding in VWD/Hemophilia A if F8 conc not available

84
Q

Major Transfusion Reactions

A

Febrile non-hemolytic transfusion reaction - 1:20 plts - 1:300 RBC
TACO - 1:100
Minor allergic RXN - 1:100 -
Delayed hemolytic transfusion RXN - 1:7000
TRALI - 1:10000 plts 1:250000 RBC
Bacterial sepsis - 1:10000
Acute hemolytic transfusion RXN - 1:40000
Anaphylaxis - 1:40000
Hep B - 1: 7.5 Mil
Hep C - 1: 13 Mil
HIV - 1: 21 Mil

85
Q

Diagnosis of Acute Chest Crisis in Sickle Cell Disease

A

1) New segmental consolidation or infiltrate +
2) One of:
- Fever >= 38.5
- Hypoxia (>2% drop from baseline)
- Tachypnea
- Acces muscle use
- Cough
- Wheeze
- Rales
- CP

86
Q

Treatment proximal DVT & PE

A

DOAC if no contraindication for non-cancer:
Provoked: 3 mo (up to 6)
Unprovoked/Chronic RF: 3-6mo, continue indefinitely w/ regular risk/benefit ax, consider lower dose DOAC (caution if >120kg, symptomatic PH, post lysis, thrombophilia)

Cancer: indefinite while active cancer +6mo in remission
LMWH or DOAC (apix/riva; edox req 5d therapeutic LMWH)

87
Q

VTE recurrence risk

A

HERDOO and
DODS: Measure D-dimer on A/C
- Positive = resume AC
- Neg = stop AC and repeat D-dimer in 1 mo
- if positive in 1 mo - resume AC; if negative continue off AC

88
Q

Treatment VITT

A

DOAC + IVIG (No heparin - send HIT ELISA first)

*Avoid platelet transfusion unless bleed

89
Q

Primary vs Secondary Hemostasis manifestations

A

Primary:

  • mucocutaneous/menstrual bleeding/bruising eg petechiae
  • Low Plt quantity (eg ITP) or quality (eg ASA, uremia, congenital)

Secondary: intraarticular, muscular, retroperitoneal bleeding

90
Q

TMA Presentation and Ddx

A

MAHA (schistocytes) + low platelet + microvascular thrombi

Primary:

  • TTP (ADAMTS13 def; congenital/acquired),
  • HUS: atypical (complement mediated), typical (shiga toxin)

Secondary:

  • Preg (HELLP, preeclampsia),
  • Ca,
  • Infxn (HIV/HepC, H1N1),
  • Malignant HTN,
  • AI (scleroderma renal crisis, APLA, SLE, vasculitis),
  • Transplant (BMT+solid organ) assoc’d,
  • DIC,
  • Drugs (cocaine, calcineurin inhibitors, VEGFi)
91
Q

IDA dx and indications for IV replacement

A

Dx: Ferritin<30 or
Ferritin>30 + Tsat<20% + increased TIBC and sTFR

Venofer 300mg IVx3 or Monoferric 1gx1 for:

  • Mod/severe IDA (Hgb <80-100)
  • Intolerant to PO
  • Limited time (preop or preg <1mo from delivery)

PO: treat for 3mo after ferritin normalizes

92
Q

IDA clinical and blood film findings

A

S/S: anemia, RLS, pica, fatigue, glossitis, koilonychia

Film: hypochromia, pencil/target cells, thrombocytosis

93
Q

Plt transfusion refractoriness

A

Increased <10 after 1h = immune (HPA/HLA antibodies, ITP)

> 10 at 1h = nonimmune (sepsis, DIC, splenomegaly, bleeding/thrombosis, drugs)

94
Q

Indication for IVIG (pooled IgG)

A

Replacement: Hypogammaglobulinemia, CVID

Immunosuppression eg ITP

95
Q

MPN genes

A
  1. CML (granulocytes: neut, eos, baso) - BCR-ABL+ (Philadelph)
  2. PV (RBC) - JAK2
  3. ET (Plt) - JAK2
  4. MF (fibrosis) - JAK2 and Calreticulin
96
Q

MDS differential diagnoses

A

Deficiencies: Vit B12, Folate, Cu, Zn
Drugs: MTX, azathioprine, EtOH
Infxns: HIV

97
Q

Lymphoma RFs

A

Infections: HIV, Hep C, EBV, H pylori,

Immunosuppression:

  • DMARDs and biologics
  • Post-transplant lymphoproliferative disease

Autoimmune:

  • Sjögren’s (salivary gland MALT),
  • Celiac or Crohn’s (GI lymphoma),
  • SLE and RA associated with NHL
98
Q

Treatment aplastic anemia

A

If severe (ANC<0.5, Plt <20, Retic<60)

  • Supportive IRRADIATED transfusion
  • Immunosuppression (antithymocyte globulin or allo HSCT)
  • Stop offending drug
99
Q

Treatment PNH

A
  • Anticoag VTE (no ppx)
  • Eculizumab or pegcetacoplan (inhib complements)
  • Transfusions
100
Q

Teardrop cells

A

Myelofibrosis (B sx, high LDH, splenomegaly, cytopenias, leukoerythroblastosis)

101
Q

CLL blood smear

A

smudge cells and lymphocytes

102
Q

Rouleaux

A

MM, inflammation, pregnancy

103
Q

Spherocytes

A

immune mediated hemolysis (auto or allo immune)

104
Q

Hypersegmented neutrophils (>6lobes)

A

Megaloblastic anemia (folate or B12 deficiency)

105
Q

Schistocytes

A

TMA

106
Q

Indication for CMV negative blood

A

Intrauterine transfusion

107
Q

Nonmalignant causes of increased Hgb

A

Decreased O2: OSA, hypoventilation, smoking/CO poisoning, chonic lung disease, high altitude, cyanotic heart disease

Production: EPO, testosterone, tumors (RCC, hepatoma, uterine fibroids), renal artery stenosis,

108
Q

Nonmalignant causes of increased Plt

A
  • Iron deficiency
  • Infection/Inflammation
  • CTD
  • Malignancy, LPD
  • Surgery or Post-splenectomy
109
Q

Felty Syndrome

A

RA + Splenomegaly + Neutropenia

-Anemia/Thrombocytopenia can happen with sequestration

110
Q

Dabi vs Warfarin

A

Dabi 150mg BID vs Warfarin = superior efficacy, equivalent “major and minor bleeding”

Dabigatran 110mg BID vs Warfarin = equivalent efficacy, lower bleeding rates

Intracranial bleeding: Both Dabi doses = less intracranial bleeding vs warfarin
Extracranial bleeding: Both Dabi doses = less extracranial major bleeding vs warfarin in younger patients
-both doses = more major bleeding/extracranial major bleeding vs warfarin

RCE (18 decks)

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