heme 2 Flashcards
Percent saturation
transferrin saturation
percent saturation calculation
serum iron divided by the total iron-binding capacity of the available transferrin
POD meaning
progression of disease
anticoagulants that will prolong PTT
Heparin, dabigatran, argatroban, direct factor Xa inhibitors (variable)
What are the direct factor Xa inhibitors
Apixaban, edoxaban, and rivaroxaban
NOACs approved for VTE
apixaban, dabigatran, edoxaban and rivaroxaban
elimination half life of most NOACs
12 hours
NOAC that must be taken with food
rivoraxaban (xarelto)
NOACs with liver metabolism
eiliquis, xarelto
NOACs affecting PTT
dabigatran, Xa inhibitors
triple antithrombotic therapy means
Dual antiplatelet therapy + oral anticoagulation
anyone on triple therapy should be on a
PPI
Novel P2Y12 receptor inhibitors
prasugrel, ticagrelor
management of NOAC overdose?
activated charcoal (if OD within 2h)
NOAC with dominant renal excretion
dabigatran
Perioperative management of NOACs
Depends on bleeding risk
Minor bleeding risk –> European guidelines say discontinued 24h before
Higher bleeding risk –> stop 48h before sugery
long acting derivative of fondaparinux
idraparinux
agents that cause HIT
UFH and LMWH, not fondaparinux
fondaparinux trade name
arixtra
fondaparinux mechanism
synthetic pentasaccharide factor Xa inhibitor. Fondaparinux binds antithrombin and accelerates its inhibition of factor Xa.
what is alloimmunization
An immune response to foreign antigens after exposure to genetically different cells or tissues.
RCE means
red cell exchange transfusion
what are the thrombopoietin receptor agonists (TPO-RA)?
eltrombopag or romiplostim
what is microangiopathic hemolytic anemia (MAHA) defined as?
Descriptive term for non-immune hemolysis (ie, Coombs-negative hemolysis) resulting from intravascular red blood cell fragmentation that produces schistocytes on the peripheral blood smear (picture 1) [1]. Abnormalities in the microvasculature, including small arterioles and capillaries, are frequently involved. However, intravascular devices such as a prosthetic heart valve or assist devices may also cause MAHA.
what is TMA physiologically?
Defined specific pathologic lesion in which abnormalities in the vessel wall of arterioles and capillaries lead to microvascular thrombosis. Pathologically defined, but commonly clinically inferred. Includes TTP and HUS.
definition of neutropenia and severe neutropenia
neutropenia = ANC <1500
severe neutropenia = ANC <500
what is Evans syndrome?
- very rare autoimmune disease causing autoimmune thrombocytopenia and hemolytic anemia
treatment of iron overload syndrome
IF HgB okay → phlebotomy
IF anemic → Deferasirox PO or deferoxamine (only IV) + council on GI side effects
IF SCD → exchange transfusion
types of stem cell transplants
High intensity (myeloablative) and low intensity
myeloablative HSCT
Myeloablative (high-intensity) stem cell transplant uses high doses of chemotherapy and may use radiation therapy to destroy cancer cells. In this process, bone marrow/stem cells are also destroyed. Patients receive an infusion of new stem cells to rebuild blood and the immune system.
clinical features of pure red cell aplasia
Isolated anemia + SCD patient + low reticulocyte response + no retics in bone marrow
what is the function of tranexamic acid?
antifibrinolytic agent
management of bleeding patient with supratherapeutic INR
1) Vitamin K IV 10 mg, slow infusion, repeat q12h if warfarin persistently supratherapeutic
2) 4 Factor-prothrombin complex concentrate, dosing – (table 3
Recheck PT/INR 30 minutes after
why vitamin K should be given PO rather than IV
small risk of anaphylaxis, especially when given rapidly
when do you treat iron overload?
ferritin >1000
IDA diagnosis
IF noninflammatory state –>
Ferritin <20 OR <41 ng/mL in a patient with anemia and comorbidities = IDA by definition
High ferritin can’t be used to rule out because can be independently elevated. Ferritin >100 makes IDA unlikely.
TIBC → 16% = cutoff for IDA
IF inflammatory state →
***soluble transferrin receptor (measures level of transferrin in blood, which isn’t sensitive to inflammation)
etiology of upper extremity DVTs
The majority (70 to 80 percent) of thrombotic events occurring in the superficial and deep veins of the upper extremity are due to intravenous catheters. The remainder are due to mechanical compression from anatomic abnormalities (eg, venous thoracic outlet syndrome)
sequela of upper extremity DVT
embolism is less common compared with lower extremity DVT due to differences in epidemiology and risk factors [14]. (See ‘Epidemiology and risk factors’ above.)
Nevertheless, venous thromboembolism is still a serious problem.
anticoagulation for upper extremity DVT
We suggest initial therapy with parenteral anticoagulants (low-molecular-weight heparin [LMWH], fondaparinux, unfractionated heparin) followed by a vitamin K antagonist (eg, warfarin) or LMWH. Sufficient data are lacking to recommend the use of a direct oral anticoagulant (DOAC) for the management of the acute phase of catheter-related upper extremity DVT.
what are the deep veins of the upper extremity?
paired radial veins, paired ulnar veins, paired brachial veins, axillary vein, and subclavian vein
Thalassemia lab profile
MCV very low + target cells, mildly elevated ferritin + normal red cell distribution width + normal RBC count or increased
polycythemia definition
Increased hemoglobin: >16.5 g/dL (10.3 mmol/L) in men or >16.0 g/dL (10.0 mmol/L) in women
Increased hematocrit: >49 percent in men or >48 percent in women
Relative polycythemia definition
Elevation of Hb and/or Hct due to a decrease in plasma volume alone (ie, without an increase of the RBC mass)
leading cause of cancer-related death among men and women
lung cancer
Normal hematocrit in men and women
Normal levels of hematocrit for men range from 41% to 50%. Normal level for women is 36% to 48%.
why does warfarin require bridging?
1) In the initial period of starting warfarin a paradoxically increased state of coagulation exists and without bridging the patient is at risk of worsening of the clot.
2) Due to warfarin’s mechanism of action and the long half-life of some coagulation factors, the effects of warfarin to provide a therapeutic level of anticoagulation do not occur immediately.
Do DOAC’s require bridging?
A study that evaluated an unfractionated heparin pharmacy dosing protocol for the treatment of VTE found that the average time to the first therapeutic lab value was 15 hours. This is also well beyond the time where a DOAC would reach a therapeutic level.
Difference in gender in cancer death rates in the US
Cancer death rates are higher among males than females, although this gap has narrowed over time.
3 highest incident cancer types in men
prostate, lung, crc
3 highest incident cancer types in women
breast, lung, crc
DIC labs
- mild thrombocytopenia + low fibrinogen + elevated d-dimer + prolonged PT + PTT
- think of it physiologically: dysfunction of fibrinolysis and activation of clotting cascade so you have low fibrinogen and consumption of clotting factors, leading to prolonged PT/PTT
rare causes of microcytic anemia
lead poisoning, copper or zinc deficiency, some forms of drug-induced anemia, inherited syndromes of defective iron metabolism
sideroblastic anemia → alcohol, INH, lead exposure
hemolysis →
correlation of fibrinogen level to DIC
Fibrinogen level was initially thought to be useful in the diagnosis of DIC but because it is an acute phase reactant, it will be elevated due to the underlying inflammatory condition. Therefore, a normal (or even elevated) level can occur in over 57% of cases. A low level, however, is more consistent with the consumptive process of DIC.
Dabigatran reversal agent
idarucizumab (Praxbind, Boehringer Ingelheim)
Eliquis reversal agent
andexanet alfa (AndexXa)
