Hematology indications CC

Question 1

Exchange transfusion in sickle cell

Answer 1

• Severe chest crisis
• Suspected CNS event
• Multiorgan failure—when the proportion of HbS should be reduced to <30%

Question 2

Indications for therapeutic apheresis (plasma exchange)

Answer 2

Link1 Link2

MCQs

Question 3

Platelet transfusion

Answer 3

• Clinically stable patients with chemotherapy-induced thrombocytopenia who are not bleeding do not benefit from platelet transfusion when the platelet count is 10,000/µL (10 × 109/L) or greater

AABB Guideline:

• transfuse below 10,000/mm3
• May increase threshold for:
  
  • Fever and infection
  • Combined coagulopathy
  • Acute promyelocytic leukemia

Question 4

Platelet transfusion contraindications

Answer 4

• TTP/HUS
• HELLP
• HIT

Question 5

Pre-surgery/procedures platelets transfusion thresholds

Answer 5

Link, Link

Question 6

Recommend prophylactic platelet transfusions

Answer 6

• Single apheresis unit or equivalent in pt at risk of bleeding, for platelet count ≤10 × 109/l
• Therapeutic platelet transfusions are required in hemorrhage to keep platelet count >100 × 109/l required to create stable clot & minimize rebleeding
• Suggest platelet transfusion for pt having elective central venous catheter placement with platelet count <20 × 109/l
• Suggest platelet transfusion for pt having elective diagnostic lumbar puncture with platelet count <50 × 109/l
• Suggest platelet transfusion for pt having major elective nonneuraxial surgery with platelet count <50 × 109/l

Question 7

Transfusion of red blood cells

Answer 7

• Current guidelines recommend transfusing red blood cells if a patient has symptoms attributable to anemia or a hemoglobin level less than 7 to 8 g/dL (70-80 g/L)
• For patients with cardiovascular disease and postoperative anemia, transfusion of red blood cells is recommended if the patient has symptoms attributable to anemia or a hemoglobin level less than 7 to 8 g/dL (70-80 g/L)
• Symptomatic anemia should be treated with transfusion in patients with hemoglobin <10 g/dL, regardless of the hemoglobin level, provided that the symptoms are severe enough and are clearly related to the anemia rather than the underlying condition
• Acute coronary syndrome: transfuse when hemoglobin is <8 g/dL and to consider transfusion when the hemoglobin is between 8 and 10 g/dL. If the patient has ongoing ischemia or other symptoms, we maintain the hemoglobin ≥10 g/dL

Question 8

RBC transfusion in adult trauma and critically ill patients

Answer 8

Link

Question 9

Cryoprecipitate transfusion

Answer 9

• hypofibrinogenemia,
• tPA-related life-threatening bleeding,
• von Willebrand’s disease,
• uremic bleeding,
• massive transfusion
• hemophilia A

Link

Question 10

Stem cell transplant (Malignant)

Answer 10

• Acute lymphoblastic leukemia
• Acute myelogenous leukemia
• Myelodysplastic syndrome
• Non–Hodgkin’s lymphoma
• Hodgkin’s lymphoma
• Chronic myelogenous leukemia
• Chronic myelomonocytic leukemia
• Neuroblastoma

Question 11

Stem cell transplant (Nonmalignant)

Answer 11

• Bone marrow failure syndromes
• Hemoglobinopathies
• Immunodeficiencies

Question 12

Extended indications for prophylactic vena cava filter placement in a pt with established DVT or PE

Answer 12

• Large free-floating thrombus in the iliac vein or IVC
• Following massive PE in which recurrent emboli may prove fatal
• During/after surgical embolectomy

Question 13

Possible contraindications to anticoagulation

Answer 13

Link

Question 14

Indications to choose warfarin over a DOAC

Answer 14

• Valvular atrial fibrillation
• Mechanical heart valves
• Severe hepatic impairment
• BMI > 40 or Weight > 120 kg
• Anti-phospholipid syndrome

Question 15

Fresh Frozen Plasma (FFP) transfusion indications

Answer 15

• Bleeding due to Deficiency of Multiple Coagulation Factors
• Disseminated Intravascular Coagulation (DIC)
• Thrombotic Thrombocytopenic Purpura (TTP) or Hemolytic Uremic Syndrome (HUS) when plasmapheresis is not available
• Liver disease with active bleeding
• Over-anticoagulation with warfarin and active bleeding
• Dilutional coagulopathy in massive transfusion scenarios
• Prothrombin Time (PT)/International Normalized Ratio (INR) > 1.5 times the upper limit of normal with active bleeding
• Massive Transfusions: A balanced transfusion strategy with a plasma to RBC ratio of 1:1 is recommended in cases of massive transfusion
• Warfarin Overdose: FFP can be used to reverse warfarin effects in patients with bleeding or those with warfarin-related intracranial hemorrhage. If available, Prothrombin Complex Concentrate (PCC) is preferred
• Prolonged Prothrombin Time (PT) or Partial Thromboplastin Time (PTT): PT/PTT > 1.5 times the upper limit of normal with active bleeding

Question 16

Non-recommended situations for FFP transfusion

Answer 16

• Routine use in patients undergoing surgery without massive transfusion
• Stable patients with liver disease, hemophilia A or B, or other factor deficiencies without active bleeding
• Antithrombin deficiency in situations requiring anticoagulation with heparin

Question 17

Indications for IVC filters

Answer 17

• Acute venous thromboembolism (VTE), including deep vein thrombosis (DVT) or pulmonary embolism (PE), when anticoagulation is contraindicated (e.g., due to active bleeding or high risk for bleeding) [Strong Recommendation]
• Recurrent VTE despite adequate anticoagulation therapy [Strong Recommendation]

Question 18

Indications to choose irradiated red cells and platelets for transfusion

Answer 18

• Hodgkin lymphoma
• Severe T-lymphocyte immunodeficiency syndromes
• Recipients of allogeneic stem cell transplants during conditioning chemotherapy, throughout the 6 month posttransplant prophylaxis and as long as immunosuppression is required
• Recipients of autologous stem cell transplant during conditioning chemotherapy and throughout 3 to 6 months of posttransplant prophylaxis
• Patients undergoing bone marrow harvest during and 7 days before the procedure
• Patients treated with purine analogue immunosuppressive agents
• All intrauterine fetal transfusions

It is not typically necessary to use irradiated products for patients with human immunodeficiency virus (HIV), solid tumors, autoimmune disease, or after solid organ transplantation

Question 19

Hemodialysis indications in patient with tumor lysis syndrome

Answer 19

• patients who are oliguric or anuric,
• have persistent hyperkalemia, or
• have hyperphosphatemia-induced symptomatic hypocalcemia.

MCQs