hematology Flashcards
high INR
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
occular melanoma
raditherapy , if under 10mm nothing only observe because its nevus :l
warfarin in pregnancy
discontinue but we can use in some patients In second and third trimester with mechanical heart disease
contraindication for LMWH
renal insufficiency
polycythemia (high RBC and HB)
first erythropoietin level
hypercalcemia tratment in MM
hydration dexamethasone, and then bisphosphonates
hyperviscosity syndrome
dizziness, headachem vetigo , nystagmus, hearing loss, vision impairment, somnolence, coma , seizure. mucosal hemorrhage, due t impaired platllet function, treatment : pasmaphoresis
neonatal polycythemia treatment and symptomes
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
TTP treatment
plasma exchange, high dose corton and rituximab to prevent b cell from producing autoantibodies. caplacizumab ( blocks platlets binding to vWF to initiate the thrombie
usual type 2 heparin induced thrombocytopenia
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
physiologic anemia of infancy
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
cryoglobulinemia
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 +.
maximum duration for lymphadenopathy
1 mounth after that must biopsy
doxorubicin
cardiotoxicity more than 10 % in radionuclide ventriculography then discontinuation
reverse for dabigatran
idaruczimab
treatment for anemia of chronic disease
underlying inflammatory disorder, In RF infliximab ( tnf a inhibitor) and erythropoietin ( if low) can use as treatments
100% transfusions reactions
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
platelet dysfunction in CKD
urea : elvated nitric oxide; pletelate adhesion activation and aggregation decreases
treatment desmopressin(vWF secretion from endothelial cells) only with bleeding and upcoming procedure
ttp treatment
plasma exchange, corticosteroids , rituximab , and calpuczimab for sever
