Hematologic Flashcards
Anemia - hypoproliferative
- 3 subtypes
- Most common cause of each subtype
- Oral manifestations
- Treatment
Microcytic anemia
- Iron deficiency
- Glossitis
- Iron supplement
Normocyctic anemia
- Renal failure
- No specific oral manifestations
- Erythropoetin, Iron supplement
Macrocytic anemia
- B12/folate deficiency
- Glossitis
- B12 supplement
Anemia - Hyperproliferative
- Subtypes
- Most common examples of each
- Blood smear findings
- Site of RBC destruction
Intravascular
- Liver/bloodstream
- G6PD deficiency
- Smear = shistocytes
Extravascular
- Spleen
- Hypersplenism
- Smear = Spherocytes
Non-hemolytic
- Blood loss trauma/surgery
- No smear performed
Sickle Cell Anemia
- Incidence
- Triggers
- Types of Crises
- Treatment and mechanisms
- Anesthesia considerations
- 1:5000 aa
- cold, dehydration, hypoxemia, acidosis
- Vasoocclusive: pain
- Autosplenectomy: infacted spleen
- Hemolytic crisis
- Tx
- Hydroxyurea: increases fetal Hg
- Folate
- Antibiotics
- Anesthesia: keep warm, hydrated, avoid operating if infection present, maintain oxygen, consider transfussion, lowered functional reserve due to poor oxygen carrying capacity
Sickle Cell Complications
- Describe Acute Chest Syndrome
- List two other acute complications
- Acute chest is vasocclusion in pulmonary vasculature resulting in pain, hypoxemia, dyspnea, CVA, infiltrates on CXR
- CVA
- Splenic infact (Autosplenectomy)
Von Willebrand
- VwF has 3 important jobs
- Types of VWf disease
- Treatment
- Platelet agregation
- Adhesion
- Carry Factor VIII
Type 1: quantitative
Type 2: qualitative
Type 3: essentially no VWf
Types 1 and 2 = tx with DDAVP, Amicar
Type 3 = tx with factor VIII, Cryoprecipitate
Mucosal bleeding, petechiae more common in VWf disease or Hemophilia
Mucosa bleeding, petechiae = VWf disease
Hemophilia A = factor?
Hemophilia B = factor?
Treatment
Hemophilia A = factor 8
Hemophilia B = factor 9
Treatment: DDAVP and/or factor for Hemophilia A
Treatment: factor only for hemophilia B
Lab values for bleeding disorders
- Prolonged PTT
- Prolonged PT/INR
- Prolonged bleeding time
- Thrombocytopenia
- Prolonged PTT = Hemophilia, VWf
- Prolonged PT/INR = Normal in all types
- Prolonged bleeding time = VWf
- Thrombocytopenia = ITP
DIC
- 2 main causes
- Lab findings
- Treatments
DIC
- Excess bleeding or excess clotting
- Lab findings: prolonged PT, PTT, d-dimers present, shistocytes
- Treatments: platelets + cryoprecipitate for bleeding, low dose heparin for clotting
Thrombophilia
- Which disease only causes venous thrombi
- Role of Protein C/S
- Mechanism of HIT
Thrombophilia
- Factor V Leiden only causes venous thrombi
- Proteins C/S are anticoagulants
- Proteins C/S bind and destroy clotting factor V (common pathway)
- Protein S also inhibits complement activation to limit inflammation
- Mechanism of HIT
- Antibodies form against Heparin
- Portion of antibody binds and activates platelets
- Platelets are consumed creating bleeding diathesis AND thrombi
- What is difference between Factor V and Factor V Leiden?
- Inheritance of FVL?
- Management of FVL?
- Factor V Leiden is a clotting factor that doesn’t allow anti-clotting Factor C to bind
- Autosomal Dominant with variable penetrance
- Management
- Perioperative anticoagulation
- Standard treatment for thrombotic events
- Lifelong anticoagulation is uncommon
HIT (HITT)
Heparin Induced Thrombocytopenia (and Thrombosis)
- Mechanism
- Incidence
- Management
- How long is patient at risk for redeveloping HIT
Mechanism of HIT
- Antibodies form against Heparin
- Portion of antibody binds and activates platelets
- Platelets are consumed creating bleeding diathesis AND thrombi
Incidence = 1-5%
Management = Switch to non-heparin / non-warfarin anticoagulant
Antibodies remain active for 3 months
Heparin
- Mechanism of Heparin
- What labs are required for monitoring Heparin
Heparin binds antithrombin III which then inactivates thrombin
Monitor anticoagulation with PTT
Monitor for HIT with platelet count
Warfarin blocks production of which clotting factors?
Warfarin blocks production of Vitamin-K dependent factors
II, VII, IX, X
Protein C, S
