Hematology Flashcards
What is the reversal agent for heparin?
Protamine sulfate
What blood product may be used to reverse warfarin?
Fresh frozen plasma
What is the primary mechanism of pain in a vaso-occlusive crisis?
Obstruction of small blood vessels by sickled red blood cells
What is the most common trigger for a vaso-occlusive crisis in patients with sickle cell disease?
Dehydration or infection
Which bacteria are sickle cell patients most susceptible to due to functional asplenia?
Encapsulated organisms (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis)
What is the hallmark finding on peripheral blood smear in sickle cell disease?
Sickled red blood cells and Howell-Jolly bodies
A 15-year-old boy with sickle cell disease presents with severe pain in his back and legs. He has a history of similar episodes. His vitals are stable, and there are no signs of infection. What is the most appropriate initial management?
A. Intravenous fluids and opioids for pain control
B. Hydroxyurea
C. Exchange transfusion
D. Bone marrow transplant
Intravenous fluids and opioids for pain control
Vaso-occlusive crisis is managed with hydration, pain control, and addressing any underlying triggers
A 22-year-old man with sickle cell disease presents with fever, chest pain, shortness of breath, and hypoxia. Chest X-ray shows bilateral pulmonary infiltrates. What is the most appropriate treatment?
A. Hydroxyurea
B. Exchange transfusion
C. High-dose corticosteroids
D. Blood transfusion
Exchange transfusion
Acute chest syndrome is a severe complication requiring exchange transfusion to reduce sickled cells and improve oxygenation.
A 6-year-old child with sickle cell disease presents with fever of 102.5°F but no other symptoms. Physical exam is unremarkable. What is the most appropriate next step?
A. Discharge with antipyretics
B. Obtain blood cultures and start empiric antibiotics
C. Perform a bone marrow biopsy
D. Administer hydroxyurea
Obtain blood cultures and start empiric antibiotics
Fever in a sickle cell patient is considered a medical emergency due to the risk of overwhelming sepsis from encapsulated bacteria. Prompt empiric antibiotics are required.
Which class of medications is the most common cause of drug-induced immune hemolytic anemia?
Cephalosporins
What are some common underlying conditions associated with the development of DIC?
What is the most common cause of DIC?
- Sepsis
- Trauma (especially crush injuries or head trauma)
- Malignancy
- Obstetric complications (placenta abruption, amniotic embolism)
- Severe liver disease
Sepsis
What lab values are consistent with DIC?
- Low Platelets (<150,000)
- Low fibrinogen (<100-150)
- Prolonged PT and aPTT
- Elevated D-dimer
- Schistocytes on peripheral smear
A 67-year-old woman presents with generalized fatigue and malaise for the past week. She also notes melenic stool for the past few months. Her vital signs include HR of 112 bpm, BP of 105/37 mm Hg, and RR of 15/minute. Laboratory studies show a hemoglobin level of 4.0 g/dL and platelet count of 110,000/µL. How many units of packed red blood cells should be given to raise her hemoglobin level to 8 g/dL?
4 units
A single PRBCs unit will raise hemoglobin by 1 g/dL and hematocrit by 3%, therefore, a patient with a hemoglobin of 4 g/dL would require 4 units of PRBCs to achieve a hemoglobin of 8 g/dL.
What is the appropriate ratio of red cells, platelets, and plasma in a massive transfusion protocol?
1:1:1
