Hematology Review Flashcards by Jesse Santos

highest risk of transmission from a blood transfusion is what blood born illness?

Hepatitis B

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most common congenital bleeding disorder

Von Willebrand’s disease

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What is the issue in type I vWD

What is the mode of inheritance

autosomal dominant inheritance

- quantitative decrease in endogenous vWF

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initial treatment for type 1 vWD

Desmopressin (DDAVP)

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what is the issue in type 2 vWD

What is the inheritance pattern

autosomal dominant inheritance

- qualitative decrease in vWF

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initial treatment for type 2 vWD

desmopressin (DDAVP)

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what is the issue in type 3 vWD

Give inheritance pattern

autosomal recessive inheritance

- near-complete absence of endogenous vWF

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initial treatment for type 3 vWD

Factor VIII/vWF Concentrate

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needle stick from Hep C+ patient, do you get post-exposure prophylaxis?

no, the risk of infection is 0.1-1.8%

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mechanism of action for Dabigatran?

direct thrombin inhibitor

- non-vitamin K dependent

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what can you use to reverse dabigatran?

idraucizumab
or hemodialysis
or PCC

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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

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what is a provoked DVT?

DVT caused by a known event (i.e. surgery, recent travel, OCPs, pregnancy)

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how long do you anti-coagulate for a provoked DVT?

12 weeks

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Anticoagulation time line for provoked DVT in patient with mobility impairments

6-12 months

also for patients with phlegmasia cerulean dolens

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what is an unprovoked DVT

DVT caused by malignancy or inherited disorder

life long anticoagulation

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Absolute indications for IVC filter?

contraindication to anti-coagulation
recurrent thromboembolic disease despite AC
significant bleeding complications from AC

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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

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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