hematology

Question 1

high INR

Answer 1

under 4.5; hold for one or two days or reduce the dose

4.5-10: hold warfarin administer 1-2.5 mg vitamin K

if more than 10 : hold and administer 2,5-5 oral vitamin K

any serious life threatening: hold and IV vitamin K10 mg as well as PCC

Question 2

occular melanoma

Answer 2

raditherapy , if under 10mm nothing only observe because its nevus :l

Question 3

warfarin in pregnancy

Answer 3

discontinue but we can use in some patients In second and third trimester with mechanical heart disease

Question 4

contraindication for LMWH

Answer 4

renal insufficiency

Question 5

polycythemia (high RBC and HB)

Answer 5

first erythropoietin level

Question 6

hypercalcemia tratment in MM

Answer 6

hydration dexamethasone, and then bisphosphonates

Question 7

hyperviscosity syndrome

Answer 7

dizziness, headachem vetigo , nystagmus, hearing loss, vision impairment, somnolence, coma , seizure. mucosal hemorrhage, due t impaired platllet function, treatment : pasmaphoresis

Question 8

neonatal polycythemia treatment and symptomes

Answer 8

65% or HB more than 22<

can be asymptomatic: observe for 24 hours

if with symptom of hyperviscosity: hypoperfusionanf tissue hypoxia: like plethora, lethargy, irritability, drowsiness, poor feeding, abdominal distention and hypoxia, can cause cyanosis, and hypoglycemia and hyperbilirubinemia, first hydration and glucose then partial blood exchange

Question 9

TTP treatment

Answer 9

plasma exchange, high dose corton and rituximab to prevent b cell from producing autoantibodies. caplacizumab ( blocks platlets binding to vWF to initiate the thrombie

Question 10

usual type 2 heparin induced thrombocytopenia

Answer 10

5-14 days
more than 50 (30-50)
arterial or venuos thrombosis,
necrotic lesions
acute systemic (anaphylactoid ) reaction after heparin
diagnosis( serotonin release assay
tart the suspected treatment before,
stop all heparin( direct thrombin inhibitor, or fondaparinux(synthetic pentasaccharide)
start the warfarin after the platelet comes up

Question 11

physiologic anemia of infancy

Answer 11

can be as low as 9

in will be considered pathalogic if; anemia within the first month, Hb under 9, sign of hemolysis(jundice , reticulocytosi), hypochromic, microcytic

Question 12

cryoglobulinemia

Answer 12

type 1 : plasma cell dyscrasias(waldenstrom, MM) Bcell, monoclonal IM
cryoprecipitates: vascular occlusion(livedoreticularis, retiform purpura, digital ischemia)
high cryocrit: hypervescosity( blurred vision, vertigo ataxia)

normal complement ESR hgh, monoclonal spike

type2: chronic viremia(HIV,HCV), autoimmune( SLE Sjogren)

IgM RF with polyclonal IgG.
immune complex: vasculitis(palpable purpura, GN, arthralgia, neuropathy),
complement low, cryocrit low, RF +.

Question 13

maximum duration for lymphadenopathy

Answer 13

1 mounth after that must biopsy

Question 14

doxorubicin

Answer 14

cardiotoxicity more than 10 % in radionuclide ventriculography then discontinuation

Question 15

reverse for dabigatran

Answer 15

idaruczimab

Question 16

treatment for anemia of chronic disease

Answer 16

underlying inflammatory disorder, In RF infliximab ( tnf a inhibitor) and erythropoietin ( if low) can use as treatments

Question 17

100% transfusions reactions

Answer 17

anaphylactic : check
acute hemolytic : within 1 hour, ABO incompatible, : flank pain , hemoglubino=uria, DIC, positive coombs

febrile nonhemolytic, : within 1-6 hours, cytokines accumulation only fever and chills

urticarial; within 2-3 hours, recipient IgE against blood, check

trasfusion related acute lung injury : within 6 hours, donor anti leukocyte AB, respiratory distress, and noncardiogenic pulmonary edema with bilateral pulmonary infiltriates

delayed hemolytic, within days and weeks, anmnessric aAB: often asymptomatic, laboratory evidence of anemia, positive coombs,

graft versus host : within weeks, donor t cell, rash fever , gastrointestinal symptoms, pancytopenia

Question 18

platelet dysfunction in CKD

Answer 18

urea : elvated nitric oxide; pletelate adhesion activation and aggregation decreases

treatment desmopressin(vWF secretion from endothelial cells) only with bleeding and upcoming procedure

Question 19

ttp treatment

Answer 19

plasma exchange, corticosteroids , rituximab , and calpuczimab for sever