Hematology

Question 1

Blood thinner for HIT

Answer 1

Argatroban

Question 2

Diagnostic criteria for primary HLH

Answer 2

Histiocyte society 2004 criteria

1. A molecular diagnosis consistent with HLH
   -AR mutations in perforin
   -MUNC13-4
   -MINC 19-2
   -Syntaxin 11
2. Presence of 5 of the following:
   -Fever
   -Splenomegaly
   -Cytopenias from 2/3 cell lines or more
   -Hypertriglyceridemia and/or hypofibrinogenemia
   -Hemophagocytosis in bone marrow, spleen, or lymph nodes
   -Low or absent NK cell activity
   -Ferritin >/= 500
   -Soluble CD25 > 2.4K

Question 3

R value in TEG

Answer 3

Reaction time

represents time to fibrin formation

normal 4-8 minutes

Treatment: FFP

Question 4

K value

Answer 4

Time to achieve clot strength

Normal: 1-4 min

Treatment: Cryo, fibrinogen

Question 5

Alpha angle

Answer 5

rate of clot formation

normal: 47 - 74 degrees

Treatment: Cryo, fibrinogen

Question 6

MA

Answer 6

Strength of the clot

Normal: 55 - 73 minutes

Treatment: Platelets

Question 7

LY-30

Answer 7

Lysis phase timing

normal: 0 - 8%

Treatment: TXA

Question 8

Answer 8

Normal TEG

Question 9

Answer 9

R and K prolonged
MA and alpha angle decreased

Anticoagulants use or hemophilia

Question 10

Answer 10

R normal
K prolonged
MA decreased

Platelet blockers, thrombocytopenia

Question 11

Answer 11

R normal
MA decreased decremental

Fibrinolysis (i.e. tPA)

Question 12

Answer 12

R and K decreased
MA and alpha angle increased

Hypercoagulation

Question 13

Answer 13

Stage 1 DIC (Hypercoagulable)

Question 14

Answer 14

Stage 2 DIC (hypocoagulable)

Question 15

Syndrome induced by CAR-T therapy

Answer 15

Cytokine release syndrome

Question 16

Treatment of cytokine release syndrome

Answer 16

Tocilizumab (anti-IL6)

Question 17

Lab value that is inaccurate in patients with a very high WBC count

Answer 17

Pao2

Question 18

FFP, platelets, and PRBC transfusion ratio in massive transfusion protocol

Answer 18

1:1:1

Question 19

4 severe reactions to immune checkpoint inhibitors for malignancy

Answer 19

Myocarditis
Pneumonitis
Enteritis
Neurologic dysfunction

Question 20

Disease characterized by new or worsening hypotension, AKI, thrombocytopenia, MAHA, PHTN, and neurologic dysfunction post bone marrow or stem cell transplant

Answer 20

Transplant associated thrombotic microangiopathy

Question 21

Symptoms of acute graft vs host disease post stem cell transplant

Answer 21

maculopapular rash, GI symptoms, liver function abnormalities

Question 22

Syndrome post stem cell transplant characterized by fever, rash, and diffuse capillary leak with pulmonary edema

Answer 22

Engraftment syndrome

Question 23

Factors in 4 factor complex

Answer 23

2, 7, 9, and 10

Question 24

Treatment for catastrophic antiphospholipid antibody syndrome

Answer 24

Anticoagulation, corticosteroids, and plasma exchange

Question 25

TTP testing findings

Answer 25

Elevated LDH Low Haptoglobin Schistocytes Negative Coombs test Low level of ADAMTS13

Question 26

Antibodies in antiphospholipid syndrome

Answer 26

Anti-cardiolipen Anti-glycoprotein IIb

Question 27

Diagnosis with DIC type labs (low platelets, fibrinogen, etc) but multiple promyelocytes with multiple Auer rods

Answer 27

Acute promyelocytic leukemia

Question 28

Treatment for APL

Answer 28

All trans retinoic acid

Question 29

Risk in APL that makes treatment of it a medical emergency

Answer 29

Catastrophic bleeding and clotting both

Question 30

3 conditions in which TXA is associated with mortality reduction

Answer 30

Postpartum hemorrhage Trauma TBI

Question 31

Syndrome that is similar to HIT and induced by vaccines

Answer 31

Vaccine induced immune thrombotic thrombocytopenia Will be positive for platelet factor 4 antibodies like in HIT

Question 32

Blood condition for which desmopressin is used

Answer 32

Uremic platelet dysfunction

Question 33

Treatment for TTP

Answer 33

Steroids AND plasma exchange, add rituximab after

Question 34

5 symptoms of TTP

Answer 34

MAHA Thrombocytopenia Fever Neurologic dysfunction Renal dysfunction

Question 35

Condition associated with reduced ADAMTS13 levels

Answer 35

Primary TTP

Question 36

Test required to confirm catastrophic antiphospholipid antibody syndrome and rule out vasculitis

Answer 36

Biopsy of effected tissue

Question 37

Treatment for neutropenic enterocolitis (typhlitis)

Answer 37

Antibiotics and supportive care

Question 38

Treatment of tumor lysis syndrome

Answer 38

Rasburicase and IV hydration

Question 39

Medication added to TTP treatment if they fail standard therapy

Answer 39

Caplacizumab

Question 40

Antidote to eliquis and xarelto

Answer 40

Adexanet alpha

Question 41

Initial treatment for splenic rupture

Answer 41

Embolization rather than removal

Question 42

Alternative to andexanet alpha for DOAC reversal

Answer 42

4 factor prothrombin complex concentrate