Hematology

Question 1

Indications for Platelet Transfusion

Answer 1

If no bleeding and < 10,000
If invasive procedure and < 20,000
If bleeding and < 50,000
If cardiac or neuro surgery and < 100,000

Question 2

Prothrombin Complex Conc

Answer 2

Consists of Vit K dep clotting factors
4 factor = 2, 7, 9, 10
3 factor = 2, 9, 10
Reverses INR in 15-30 min, preferred over FFP for warfarin reversal when bleeding

Question 3

Febrile Reaction

Acute Intravascular Hemolytic Reaction

Delayed Extravascular Hemolytic Reaction

TRALI

Allergic Reaction

Graft v Host

Answer 3

Febrile reaction - inc temp in 1 hr, antipyretics and stop transfusion (MOST COMMON)

Acute Intravascular Hemolytic Rxn - IMMEDIATE
Fever, nausea, vomiting, pain

Delayed Extravascular Hemolytic Rxn - days to weeks
Anemia, jaundice, fevers
Use Ag negative transfusions in future

TRALI - within 6 hrs
ARDS like
Oxygen, airway, pressors, low tidal volumes, NO diuretics (not cardiogenic)

Allergic reaction - hives and itching, cont transfusion with anti-histamine

Graft v Host -immunocompromise, rash, pancytopenia, increased LFTs
Prevention: irradiated blood products in immunocompromise

Question 4

Labs in DIC

Answer 4

inc PT, inc PTT, inc bleeding time, inc thrombin time, inc d-dimer,

dec fibrinogen, dec platelets

Question 5

Definition of Neutropenic Fever

Answer 5

Definition - 100.8 (38.3C) once OR 100.4 (38C) over 1 hour AND abs neutrophil count < 1000

Question 6

When do you give vanc in neutropenic fever (4)?

Answer 6

line infection, mucositis, MRSA risk factors or hypotension

Question 7

Goal HCT in polycythemia

Answer 7

< or = 55%

Question 8

Transplant Infections by Timing

Answer 8

< 1 mo
Post op (UTI, PNA)
Hospital-acquired (C diff, VRE, MRSA)
Donor-derived (HSV, rabies, west nile)

1-6 mo
Opportunistic (fungal, mycobacteria)
Host Reactivation (CMV, zoster, BK)

> 6 mo
Community Acquired PNA and UTI
Late Viral (CMV, HSV, hepatitis)

Question 9

CREST Sx

Answer 9

Calcinosis

Renal dx

Esophageal dysmotility

Sclerodactyly

Teleangiectasias

Question 10

When do you use exchange transfusion in sickle cell?

Answer 10

Acute stroke, acute chest with severe hypoxia, priapism, acute multi-organ failure

Question 11

SLE Diagnosis

Answer 11

DOPAMINE RASH (4/11)

Discoid Rash
Oral ulcers
Photosensitive rash 
Arthritis
Malar rash
Immunologic criteria 
Neuro / psych (psychosis)
Renal
ANA pos 
Serositis 
Heme disorders

Question 12

Drug-Induced Lupus - 5 Drugs

Answer 12

HIPPS

Hydralazine
Isoniazid
Phenytoin
Procainamide
Sulfonamides

Question 13

TTP

Answer 13

(thrombotic thrombocytopenia purpura)

PENTAD - FAT RN
F -fever
A - anemia (hemolytic) 
T - thrombocytopenia 
R - renal disease
N - neuro sx 

Mgt - plasma exchange, steroids