Hematology

Question 1

thrombotic thrombocytopenic purpura pentad.

Answer 1

fever, microangiopathic hemolytic anemia, thrombocytopenia (with associated petechiae), renal dysfunction, and neurological or mental status changes

Question 2

Heparin induced thrombocytopenia

Answer 2

Is a type II hypersensitivity reaction, where antibodies form against and bind to heparin-platelet factor 4 complexes on the surface of platelets.

Question 3

Febrile nonhemolytic transfusion reaction

Answer 3

1-6 hours after a blood transfusion with fever (usually T 38-39 C) and chills.
Is due to the leaking of cyotkines from donor red blood cells due to long periods of storage or by host preformed antibodies to donor white blood cells in the transfusion resulting in a reaction.
The fever often resolves spontaneously within 30 minutes even without treatment

Question 4

Heparin induced thrombocytopenia

Answer 4

There are two forms
Type I is non-immune and occurs in the first 2 days of therapy.
Type II normally occurs 5-10 days after administration and is due to the autoimmune destruction of platelets.
More commonly occurs with unfractionated heparin, but can also occur with low-molecular-weight-heparin (LMWH).
Those receiving an IV infusion may also have a systemic/anaphylactic reaction including fever, chills, tachycardia and shortness of breath.
Initial management: discontinuing heparin and to prevent further clotting, direct thrombin inhibitors (i.e. argatroban) or factor Xa inhibitors (i.e. fondaparinux) can be used.

Question 5

What is the recommended timeline for vaccination against encapsulated organisms and the initiation of penicillin prophylaxis for a patient scheduled to undergo a splenectomy?

Answer 5

Vaccination at least 2 weeks prior to surgery, and 3-5 years of penicillin prophylaxis beginning at the time of surgery.

Question 6

To prevent transfusion reactions in IgA deficient patients?

Answer 6

Must be given washed blood products without IgA.

Question 7

Waldenstrom’s macroglobulinemia

Answer 7

10 percent or more infiltration of bone marrow by clonal lymphoplasmacytic cells and a monoclonal IgM gammopathy. Symptoms: pallor, fatigue, weight loss, lymphadenopathy, hepatosplenomegaly, signs and symptoms constituting hyperviscosity syndrome (blurring or loss of vision, headache, ataxia, dementia, stroke, or coma) and a monoclonal IgM spike on serum protein electrophoresis.

Question 8

IgM monoclonal gammopathy of undetermined significance (MGUS)

Answer 8

It is defined by serum IgM concentration < 3.0 g/dL and the absence of anemia or other systemic symptoms.
This can be a precursor state to multiple myeloma or Waldenstrom’s macroglobulinemia.

Question 9

An unfractionated heparin drip is started. What should be monitored to adjust heparin dosing?

Answer 9

Unfractionated heparin is a cofactor for antithrombin, which inactivates coagulation factors II, X, IX, XI, XII (intrinsic pathway) thereby, increasing aPTT time.

Question 10

Chronic Lymphocytic leukemia blood cells complications

Answer 10

Autoimmune hemolytic anemia and immune thrombocytopenia.
Do not affect the disease progression and are managed with glucocorticoids and usually rituximab.