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Hema Flashcards

1
Q

Abnormal labs in hemochromatosis

A

High transferrin saturation

High ferritin

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2
Q

Best screen for hemochromatosis

A

Transferrin

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3
Q

Acute phase reactants

A

ESR
CRP
PLTs

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4
Q

Mechanism of aspirin

A

Permanent acetylation of platelet enzyme cyclooxygenase > inhibit PG

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5
Q

When to stop aspirin prior to surgery?

A

5 days

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6
Q

Labs in hemolytic anemia

A

High retic
High LDH
High unconjugated bilirubin

Low haptoglobin

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7
Q

Pathophysiology of HIT

A

Platelet aggregation from heparin induced antibodies

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8
Q

Rx of HIT

A

Stop heparin

Start lepirudin, argatroban, or desirudin

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9
Q

Healthy + clumped platelets ?

A

Repeat
Usually antibodies to anti coagulant in CBC tube

Repeat w/ citrate in tube.

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10
Q

Warfarin antidote

A

Vit K

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11
Q

Oral iron absorption is better w/ acidic or alkalic environment?

A

Acidic

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12
Q

Improve oral iron supplement?

A

Give Vit C

Take on empty stomach

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13
Q

Lower oral iron absorption?

A

PPI

H2 blockers

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14
Q

When to stop iron supplement? Why?

A

Months after reaching target Hgb

To replenish iron store

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15
Q

Causes of B12 deficiency

A

Strict vegetarian diet

Chronic pancreatitis

Pernicious anemia

Tapeworm (diphyllobothrium)

Ileum disease + gasterectomy / bypass

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16
Q

Hemochromatosis triad

A

Skin hyper pigmentation
DM
Cirrhosis

+ Cardiac disease
+ infertility
+ joint pain

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17
Q

Hemochromatosis pathophysiology

A

Single gene mutation (HFR)

Increased iron absorption > deposition in heart, liver, skin, pituitary, genitalia

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18
Q

What accelerate the expression of hemochromatosis

A

Hep C

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19
Q

Normal transferrin saturation

A

14-50%

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20
Q

Hemochromatosis gene

A

HEF gene Ch 6

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21
Q

Dx of iron deficiency anemia

A

Low ferritin

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22
Q

Rx of sickle cell crisis

A

IVF
Oxygen
Pain control (IV opiates)
If fever => Abx

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23
Q

Hgb electrophoresis in thalassemia trait

A

Hgb A2

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24
Q

MOA of warfarin

A

Inhibits epoxide reductase > low K > alters factors 2, 7, 9, 10

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25
Q

Dx low B12?

A

High methylmalonic acid

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26
Q

Dx HIT

A

PLT low w/in 5-15 day oh heparin

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27
Q

In HIT antibodies are against what

A

Heparin-platelet factor 4 complex

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28
Q

Complication of HIT?

A

Thrombosis > bleeding albeit low platelet count

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29
Q

HIT Rx

A

Stop heparin
Start danaparoid or fondaparinux

If warfarin started = stop + add Vit K

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30
Q

Hemophilia A inheritance

A

XL

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31
Q

Serum iron in hemochromatosis

A

300 mg/dL

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32
Q

Indication of response to iron supplement in iron deficiency

A

Increase retic after 1 wk of replacement

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33
Q

Aplastic anemia labs

A

Normocytic anemia

Low retic

34
Q

Dx aplastic anemia

A

Bone marrow biopsy

35
Q

Type of ab in HIT

36
Q

PLT level in HIT

37
Q

Contraindicated in HIT

38
Q

T/F: 2-3 drinks / day of alcohol don’t alter INR

39
Q

Effect of alcohol on warfarin

A

Reduce its metabolism = increase INR

40
Q

Active bleeding on warfarin

A

Stop warfarin
5-10 mg Vit K
FFP
Till INR < 5

41
Q

High INR on warfarin + no bleeding

A

Stop warfarin
INR q24hr
Resume warfarin when INR is therapeutic range.

42
Q

Risk of tea and toast diet

A

Low vitamin C

43
Q

What’s Vit C

A

Ascorbic acid

44
Q

What’s amyloidosis?

A

Extra cellular deposition of insoluble proteins

45
Q

Dx amyloidosis

A

+ve Congo red dye

Pink in H+E stain

Apple green birefringence under polarized light.

46
Q

What’s Rivaroxban?

A

Factor Xa inhibitor

47
Q

Advantages of rivaroxban

A 
Fixed dose 
Acts in hours 
No monitoring 
No drug or food interaction 
Not metabolized by liver = not affected by P450 inducers / inhibitors.
48
Q

Daily maintenance of Vit B12

49
Q

Is Vit B12 supplement effective in pernicious anemia, gastrectomy, terminal ileum damage?

50
Q

TTP classic

A

Easy bruising
Fever
Dark urine

Low PLT
High Bleeding time
High bilirubin

51
Q

Marker of liver dysfunction in bleeding

A

Abnormal INR + aPTT

52
Q

Dx polycythemia Vera (1ry)

A

Erythropoietin low

O2 low

53
Q

G6PD enzyme function

A

Catalyze the oxidation of glucose-6-phosphate to glucose-6-phosphogluconate

And reduce NADP+ to NADPH

(Nicotinamide adenine dinucleotide phosphate)

54
Q

G6PD Dx

A

No fluorescent on rapid fluorescent spot test.

55
Q

Drugs avoided in G6PD

A

Dapsone
Sulfa
TMP-SMX

56
Q

MCC of anemia in elderly

A

Chronic disease esp renal

57
Q

Normal Hct

58
Q

Normal MCv

59
Q

Dx spherocytosis

A

Osmotic fragility

60
Q

Coombs test in spherocytosis

61
Q

Normal retic count

62
Q

Rx of vW disease

A

Desmopressin

Transfusion of factor VIII or vW concentrate

63
Q

Pathophysiology of TTP

A

Low ADAMS 13

Plasma protease for vW factor.

64
Q

TTP Rx

A

Plasmaphoresis

FFP transfusion

65
Q

Advantage of LMWH

A

No monitor needed

66
Q

aPTT used in monitoring what drug

A

Unfractionated heparin

67
Q

TMP/SMX + warfarin

A

Bleeding risk

68
Q

Criteria for polycythemia Vera

A

2 major or 1 major + 2 minor.

Major:

  1. Hgb >18.5 M or >16.5 F and RBC mass >25%
  2. JAK2 mutation

Minor:

  1. Low erythropoietin (<30)
  2. BM biopsy = hypercellularity + prominent erythroid, granulocyte, megakaryocyte
  3. Endogenous erythroid colony formation
69
Q

Normal PLT

70
Q

Normal ESR

A

M: 1-13
F: 1-20

71
Q

Serum albumin

72
Q

Normal ferritin

73
Q

Normal iron

A

60-160 ug/L or 11-29 umol/L

74
Q

TIBC

A

250-460 ug/L or 45-82 umol/L

75
Q

Most accurate Dx of iron deficiency anemia

A

Bone marrow aspiration for staining of iron

76
Q

Complication of hemochromatosis

A

Liver cirrhosis (Portal HTN)

77
Q

Dx portal HTN

A 
Transjugular cath (dangerous)
US or CT
78
Q

Bleeding when on warfarin?

A

Hold warfarin
FFP transfusion
Vit K IV

79
Q

Antidote of heparin, warfarin, ASA

A

Heparin = protamine

Warfarin = FFP + Vit K

ASA = platelet transfusion

80
Q

Antidote of heparin, warfarin, ASA

A

Heparin = protamine

Warfarin = FFP + Vit K

ASA = platelet transfusion

CanQB (16 decks)

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