Hem/Onc Flashcards by Nathaniel Guimont

cryoprecipitate for?

Hemophilia A
low fibrinogen (DIC
vWD

contains factor 8 and fibrinogen

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Tx for dintravascular hemolysis- wrong blood transfusion

stop the transfusion
replace fluids
EPi for anyphylaxis
dopamne/NE for pressures

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Extravascular homeless due to?

less sever, minor RBC antigens, Kell antibodies

see fever, jaundice and anemia

No mgmt

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Retic index =

Retic count (Pts Hct/35)

2% excessive RBC destruction

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macrocytic anemia that is not B12/foltate etiology

liver disease - altered plasma lipoproteins into membranes

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High Fe requirement age groups -> Fe deficiency concerns

Infants/ toddlers

Adolescents

Pregnant

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Dx of Beta thallesimia

HbF and Hb A2 are elevated

Peripheral smear - microcytic hypochromic anemia, Target cell

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Pancytopenia

bone marrow failure in aplastic anemia

low Ptls, rbcs and PMNs

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Pernicious anemia

special case of B12 def

autoimmune dosorder -> inadequate production of intrinsic factor -> impaired absorption of B12 in illium

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Hi methylmalonyl and homocristeine, may be deficient in?

B12

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Diagnose B12 vs folate b/c

replacement of flat can improve the symptoms but underlying B12 deficiency can lead to perm neuro deficits (demyelination of posterior columns, lateral corticospinal tract and spinocerebellar tracts)

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Hypersegmentes neutrophil in what anemia

B12

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Schilling test

Diagnose B12 def
- Give IM dose of unlabeled b12 to saturate site,
-Give oral dose radioactive B12
- measure B12 in urine and plasma
Redo w/ intirinsic factoe and then see if different

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homocysteine elv in both of which anemias?

methymalonic is only elv in>

Folate and B12 deficiency

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Lab tests in hemolytic anemia (4)

elv retic count, LDH

decreased haptoglobin and Hgb

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Schistocytes -intravascular

helmet cells- extravascular

seen on

TTP
DIC
prosthetic heart valves

hemolytic anemia in sickle cell can commonly lead to

gallstone disease -pigmentes

Aplastic crisis of sickle cell

human parvo virus precipitates -> lowers BM ability to compensate

Acute chest syndrome

seen in sickle cell

2/2 repeated episodes of pulm infarction
clinical presentation ~ pneumonia
associated w/ chest pain, resp distress and pulm infiltrates, hypoxia

First manifestation of sickle cell commonly is

hand foot syndrome - painful swelling of the dorsum of the hands and feet in infarct. and early childhood

Pain crisis in sickle cell2/2

pain in bone infarcion

Splenic sequestration crisis

sudden pooling of blood into the speed -: rapid splenomegaly and hypovoluemic shock

fatal complication of sickle cell and beta thalessima

Infections in sickle cell

SHiN
Strep pneumonia
Haemophlius influenza
Nesseiria

Salmonella osteomyolitis concerns

Spherocytosis causes (5)

hereditary spherocytosis (Coombs neg)
G6PD deficiency
ABO incompatability - but nor Rh
hyperthemia
autoimmune hemolytic anemia

Bite cells and heinz bodies seen in

G6PD deficency heinz = abnormal Hgb precipitates w/in RBCs

Warm AIHA

IgG binds to RBCs-> extravasculae hemolysis w/ sequestration in the spleen - primary or secondary to lymphomsa, leukemias, collagen vast disease, methyldopa Coombs + Tx w. glucocorticpoics, maybe splenectomy

Cold AIHA

IgM leeds to complement activation -> intravascular hemolysis idiopathic or due to mycoplasma pneumonia or mono Tx - avoid the cold, RBC transfusions?, NO steroids

HIT 1 vs HIT 2

1- heparin cause splatelets to aggregate, seen in <48 hrs, no Tx 2 - Heaprin induces Ab-mediated injury to platelet - seen 3-12 days after -STOP heparin

Petechiae and purpura seen in

thrombocytopeina many petechiae -> purpura bruising also seen

TTP = HUS +(2)

HUS + fever and AMA HUS - microangiopathic hemolytic anemia + thrombocytopenia + renal failure

Ristocetin assay

used to test for vWD

Prolonged bleeding time, normal platelet count, maybe a longer PTT meorrhagia, cutaneous/mucosal bleeding

vWD

vWD Tx

DDVAP -desmopression - induces secretion of vFW from endothelial cells Factor VIII concentrates

r/o of DIC

fibrinogen level - normal/elv rules out