Hematology Review Flashcards
highest risk of transmission from a blood transfusion is what blood born illness?
Hepatitis B
most common congenital bleeding disorder
Von Willebrand’s disease
What is the issue in type I vWD
What is the mode of inheritance
- autosomal dominant inheritance
- quantitative decrease in endogenous vWF
initial treatment for type 1 vWD
- Desmopressin (DDAVP)
what is the issue in type 2 vWD
What is the inheritance pattern
- autosomal dominant inheritance
- qualitative decrease in vWF
initial treatment for type 2 vWD
desmopressin (DDAVP)
what is the issue in type 3 vWD
Give inheritance pattern
- autosomal recessive inheritance
- near-complete absence of endogenous vWF
initial treatment for type 3 vWD
Factor VIII/vWF Concentrate
needle stick from Hep C+ patient, do you get post-exposure prophylaxis?
no, the risk of infection is 0.1-1.8%
mechanism of action for Dabigatran?
- direct thrombin inhibitor
- non-vitamin K dependent
what can you use to reverse dabigatran?
idraucizumab
or hemodialysis
or PCC
patient is started on Warfarin and presents 3 days later with necrotic skin lesions…what happened?
- patient is deficient in protein C
- transiently becomes prothrombotic as protein C dissolves clots and is inactivated by Warfarin before its anticoagulant effects can take hold
what is a provoked DVT?
- DVT caused by a known event (i.e. surgery, recent travel, OCPs, pregnancy)
how long do you anti-coagulate for a provoked DVT?
- 12 weeks
Anticoagulation time line for provoked DVT in patient with mobility impairments
6-12 months
also for patients with phlegmasia cerulean dolens
what is an unprovoked DVT
DVT caused by malignancy or inherited disorder
life long anticoagulation
Absolute indications for IVC filter?
- contraindication to anti-coagulation
- recurrent thromboembolic disease despite AC
- significant bleeding complications from AC
Patient with DES for unstable angina place 3 months ago on dual anti-platelet therapy, but has obstructing colon mass at hepatic flexure…next step
hold clopidogrel for 5 days and do surgery on aspirin alone
what is the name given to effort thrombosis/thrombosis from repetitive motions
Paget-Schroetter disease
Patient with acute paget-schroetter disease, first step?
catheter directed thrombolysis
after recovery can consider decompression surgery
multiple 45 um cells with multiple nuclei containing large inclusion nucleoli
this describes Reed-Sternberg cells
associated with Hodgkin-type lymphoma
treatment of choice for thrombotic thrombocytopenia purpura
Plasmapheresis
first line treatment for methemoglobinemia from drug exposure?
methylene blue injection
R time of TEG
time to start forming a clot
normal R time in TEG
treatment if abnormal
4-8 minutes
FFP
K time of TEG
time it takes for clot to get to fixed state
normal time for k-time
treatment if abnormal
1-3 minutes
Cryoprecipitate
alpha angle on TEG
speed of fibrin accumulation
normal alpha angle on TEG
treatment if abnormal
53-72 degrees
Cryoprecipitate
maximum amplitude on TEG
highest vertical amplitude on TEG, deals with platelet function
normal maximal amplitude on TEG
treatment if abnormal
50-70 mm
platelets and/or desmopressin
Lysis at 30 minutes on TEG
percentage decrease of max amplitude at 30 minutes, a measure of fibrinolysis
normal value of L-30 on TEG
treatment if abnormal
0-8% decrease of MA
TXA or aminocaporic acid
when do you give anti-histamines for transfusion reaction?
- in a non-hemolytic transfusion reaction, within 30-60 minutes patient should show signs of an allergic reaction (urticaria)
blood transfusion started, 15 minutes later patient has fever, chills, and uticaria
- febrile non-hemolytic reaction
what is the underlying cause of a non-hemolytic reaction during a blood transfusion?
reaction to DONOR cytokines released from DONOR WBCs
female with history of menorrhagia presents with petechiae and platelets are noted to be 25,000. CT scan shows normal spleen and blood smear shows megakaryocytes. What does she have?
idiopathic thrombocytopenia purpura
Antidote for Rivaroxaban
Andexanet alfa (Andexxa)
how do you treat bleeding when patient is on clopidogrel
platelet transfusion
how do you treat bleeding while on Argatroban
- no antidote, but half-life is 45 minutes so just stop transfusion and support patient
mechanism of action of aspirin
inhibits prostaglandin synthesis from platelets, which causes permanent dysfunction of platelets
best treatment for bleeding skin squamous cell carcinoma for non-surgical patients
radiation treatment will stop the bleeding
what is heparin-induced thrombocytopenia a result of?
autoantibodies against endogenous platelet factor 4 (PF4)
how long do you hold warfarin before a surgery
5-7 days
when do you start your bridge with heparin for a patient on warfarin
once INR < 2
treatment for a fat embolus
supportive, may need endotracheal intubation
highest rate of transfusion transmitted infections, come from what?
bacterial infections
