Hematology

Question 1

Thromboembolic screening after idiopathic DVT/PE

Answer 1

screen 2-4 weeks AFTER d/c warfarin - NOT in setting of acute event

Question 2

Gestation thrombocytopenia (mild)

Answer 2

monitor CBC - occurs in 3rd trimester with plt >50 - if <50 and 1st 2 trimesters then ITP

Question 3

Delayed hemolytic transfusion reaction

Answer 3

Jaundice, dec Hg, T&S with new alloantibody, elev indirect bili, fever, bone pain crisis

Question 4

TRALI

Answer 4

anti-neurtrophil Ab - pulm edema, fever, hypotension, occurs very soon after transfusion NOT days.

Question 5

IgA deficiency

Answer 5

would cause anaphylaxis

Question 6

Aquired hemophillia

Answer 6

prolonged PTT failed to correct with mixing study -> inhibitor presents - treat with factor VIIa

Question 7

DIC tx

Answer 7

hemolytic anemia, low plts, low fibrinogen, elevated d-dimer, prolonged PT - tx with cryoprecip or FFP

Question 8

vWF bleeding

Answer 8

would have some history of heavy bleeding - tx with desmopressin

Question 9

vWF dz

Answer 9

personal/fhx of mucocutaneous bleeding with borderline low vWF on oral contraception - definitive dx d/c oral contraceptive and test 4-6 wks later

Question 10

Factor IX def

Answer 10

prolonged PTT - family members and personal h/o mucocutaneous bleeding

Question 11

Hemophilia A

Answer 11

women rarely affected (turners, homozygotes) - prolonged PTT, low factor VIII

Question 12

Mild hereditary spherocytosis

Answer 12

mild asx dz - no tx except folic acid/immunizations - if sx (leg ulcers, pigmented gallstones from hemolysis, severe sx anemia, extramedullary hematopoetic tumors) - splenectomy +- chole if +gallstones (no steroids)

Question 13

Sickle Cell pt needs transfusion

Answer 13

phenotypically matched blood (minor antigens C, K, E) - r/o erythrocyte alloimmunization -

Question 14

Washed erythrocyte transfusion

Answer 14

prevent anaphylaxis (ie IgA deficient patients)

Question 15

Irradiated erythrocyte transfusion

Answer 15

prevents graft vs host disease by destroying donor WBCs that would attack host cells

Question 16

Paroxysmal Nocturnal hemoglobinuria

Answer 16

unprovoked venous thrombosis at unusual location (mesenteric vein), hemolytic anemia (elev ldh, bili), mild to mod pancytopenia - dx by flow cytometry CD55, CD59

Question 17

Direct coombs test

Answer 17

dx of autoimmune hemolysis - splenomegaly - spherocytes, reticulocytosis, elev unconj bili, elev LDH, dec haptoglobin (used up)

Question 18

Antiphospholipid syndrome

Answer 18

increased risk of venous/arterial thrombosis including visceral vessels - correlation with unexplanined pregnancy loss

Question 19

Factor V leiden

Answer 19

MC inheritted thrombophilic d/o - inc d/o DVT