Heme 1 Flashcards
Mucocutaneous Bleeding, normal platelet Count.
Next step?
Platelet Function Analyzer. (SSRIs and Ginko can affect plt dysfunction)
LE swelling, SOB, Elevated D-dimer, Pulmonary Embolism severity index score (PESI) 59.
Rx?
Apixaban and Rivaroxaban (Eliquis and Xarelto) - Requires NO Bridging
Index score less than 65 Managed Outpatient (age, sex, current cancer, heart failure, lung disease, pulse, systolic, 02 sat, RR, temp, stupor/lethargy) can be managed outpatient.
Rx for Myelodysplastic Syndromes that require frequent Transfusions?
Lenalidomide (used in 5q deletions)
(Helps with Transfusion Dependence and Progression to AML)
Rx of choice with in pts with PE and Active Cancer?
LMWH (Enoxaparin)
Management of patient with MGUS and M spike of less than 1.5, normal SPEP and UPEP?
Repeat labs in 6 months
Risk of progression to MM and other Lymphoproliferative disorders is low.
Rx for patients with Acquired Hypogammaglobulinemia from MM with recurrent sinusitis?
IVIG to provide Passive immunity.
Pt presents with Scleral icterus, Fever, Tea Colored urine, LOW Hemglobin and Elevated bilirubin 10 days after being transfused.
Dx? What test confirms this?
Delayed Hemolytic Transfusion Reaction
Confirmed by positive Direct Antiglobulin (Coombs test) DAT
Antibodies bind to antigen and agglutin
Pt with Sick cell Anemia Presents with SOB, fatigue, Hemoglobin of 4 and retic count of 0.1
Dx?
Parovirus B19 - Aplastic Crisis
(affects Erythrocyte Precursors in bone marrow)
Rx for Essential Thrombocytosis?
What test should be done?
Next step if Negative?
Rx for P Vera?
Aspirin and Hydroxyurea.
Check for Jak2 Mutation
IF negative then Bone Marrow Biopsy
Phlebotomy (Get Hematocrit Down), Aspirin and Hydroxyurea- Prevent thrombosis
Black ppl WBC 1.8 and NO Symptoms
Dx?
Benign Ethnic Neutropenia
Edema, Dizziness, Indentations on side of tongue, JVD, Orthostatic Hypotension, Decrease breath sounds, S3 gallop, Elevated Cr, Albuminuria, IgG lambda spike, THICKENED left ventricular wall, Diastolic dysfunction
Dx?
Rx?
Amyloidosis (infiltrative Disorder)
Abdominal fat pad biopsy
Hepatosplenomegaly, Night sweats, Anemia, Hyperviscosity, IgM spike
Dx?
What confirms diagnosis?
Rx?
Waldenstrom Macroglobulinemia
- 1st M spike on Electrophoresis
- Then Immunofixation to identify which abnormal protein it is (IgM)
- Bone marrow biopsy
Plasmapharesis
Rx for DVT with acute limb ischemia?
Alteplase
- Serum Monoclonal M protein < 3 and Bone marrow clonal plasma cells < 10%
No symptoms? - Pt presents with serum M protein of >3 g/dl or 500mg/24 hr of urinary Monoclonal Free light chains or Bone Marrow Plasma Clonal cells > 10% or greater and NO other symptoms.
Dx? - Plasma cells > 10% with Protein > 3 + symptoms of BONE PAIN?
Dx?
- MGUS
- Smoldering
- MM
MGUS <10% Plasma Cells) —-> Smoldering (> 10% Plasma Cells) —> MM (>10% Plasma Cells + Symptoms)
- INR 4.5 - 10 and No bleeding
- > 10 and No Bleeding
- > 10 and Bleeding
- Omit Dose
- Vitamin K
- Vit K 10mg IV + Four Factor PCC
Rx for secondary Iron Overload from frequent transfusions Dx?
Deferasirox (oral)/Deferoxamine (IV)
What is the Rx of Anemia of ckd pts?
Epo stimulating agents (darbepoetin) to avoid increased Cardiovascular Events caused by Frequent Transfusions.
Pt with Minor Bleeding while on Pradaxa? Next step
Observation (wait 24 hrs before finding cause of bleeding)
Test to r/o probable PE and Avoid unnecessary D- Dimer checking?
Wells Criteria and PERC
Age< 50years
HR < 100
O2 sat 95%,
No hemoptysis
No Leg Swelling
No Estrogen use
No Previous DVT/PE
No Surgery or Trauma
No Recent hospitalization in last 4 weeks
Symptoms, Vitals, Medical Hx
Chronic Hemolytic Anemia (smear shows no Schistocytes, Spherocytes, immature appearing leukocytes, Agglutinate Erythrocytes), Red Urine (Hemoglobinuria), Venous Thrombosis and Pancytopenia.
Dx?
Test?
Rx?
Treatment if Young?
- Paroxysmal Nocturnal Hemoglobinuria (PNH)
Flow Cytometry looking for cell surface markers CD55, CD59.
Chemo: Eculizumab
Allogenic HSCT if < 50 years
Rx iron, folate as indicated.
- Management of sickle cell patients who have Uncomplicated Pregnancies?
- What is a known complication of Pregnancy in patient with Sickle Cell Dz?
Monitor
Pulmonary HTN, Evaluated with Echo
- Low serum ferritin, low RBC count, High RDW, normal hgb electrophoresis ?
- Target cells, Normal serum ferritin, normal or High RBC count, Normal RDW, Normal hemoglobin electrophoresis?
- Target cells, Normal serum ferritin, Normal or High RBC count, Normal RDW, Elevated Hgb A2 and Fetal hemoglobin (Hgb F) on electrophoresis?
- Iron deficiency
- Alpha-thal
- Beta-thal
- 90% Hb S and no HbA?
- HbS 30% and HbA 50%?
- Sickle cell Dz
- Sickle Cell Trait (no painful cries)
Pt hospitalized for PNA, treated with Ceftriaxone, Hgb 6.5g/dl, Elevated LDH, Spheroctyes on smear and Direct Antiglobulin test POSITIVE or IgG ?
Drug Induced Hemolysis
- Hemolytic anemia caused by IgG, IgG positive, C3 positive or negative on DAT, spheroctyes present on smear, Aggulinates in > 37degree ?
Dx?
Rx? - Hemolytic anemia (caused by IgM), IgG negative, C3 POSITIVE on DAT, RBC agglutination on smear when Cold?
Rx?
Dx?
- Warm autoimmune Hemolytic Anemia
Steroids
IVIG
Rituximab OR Splenectomy
- Cold Agglutinin Disease (Mycoplasma, EBV)
Avoid Cold Exposure
Warm saline
Steroids
This mainly occurs Extravascularly (IVIG, Splenectomy Not helpful)
- Respiratory distress within 6 hrs of transfusion, positive fluid balance, elevated BNP and CXR showing pulmonary edema?
- Respiratory distress, dyspnea, hypoxia, no JVD within 6 hrs of transfusion and CXR showing B/L Pulmonary Infiltrates?
- Occurs when donor plasma constituents react with recipients IgE on mast cells, causing rash, hives, wheezing, mucosal edema?
- Rare but fatal complication in which donor lymphocytes…… immunocompromised or HLA similar recipient and cause reactions that affect bone marrow, liver, skinned GI tract?
- Transfusion Associated Circulatory Overload. (TACO)
- Transfusion Related Acute Lung Injury (TRALI)
- An Allergic Rransfusion Reaction
- Transfusion-associated Graft-Versus-Host- Disease
Reversal agent for Dabigatran?
Reversal Agent for Warfarin?
Idarucizumab
Prothrombin Complex. (Kcentra)
Alcohol dependence, low Hgb, MCV > 110, Hypersegmented Neutrophils on smear.
Dx?
Folate deficiency!
B12 Deficiency (Effectively Stored) not seen with alcohol Dependence
Elevated CA, Renal failure, Anemia and Bone disease.
Dx?
Test?
Rx?
How do you Managed Lytic bone lesions?
MM
SPEP
Immunofixation
Skeletal Survey
Chemotherapy : Bortezomib, Lenalidomide,
Dexamethasone, IV Zoledronic Acid.
