Heme

Question 1

Direct thrombin inhibitor oral anticoag

Answer 1

Dibigitran–1. no reversal w ffp, 2. can be dialyzed 3. PCC not effective 4. no effective monitor of reversal

Question 2

Factor Xa inhibitors oral anticoag

Answer 2

Rivaroxaban, apixaban–1. no reversal w ffp 2. tightly protein bound, cant be dialyzed but ok oral charcoal in OD 3. PCC-prothrombin complex can reverse prlonged PT no benefit 4. no monitor of reversal

Question 3

Prothrombin complex concentrate

Answer 3

use; Vit K antag bleeding, surgery and Intracerebral hemorrhage
3 factor
4 factor

Question 4

Differentiation syndrome

Answer 4

Cytokine storm. Formally retinoic acid syndrome, Promyelocytic leukemia syndrome, from Ret acid or arsenic. Sx FLUID LEAK, ARDS, wt gain, hypotension, pericardial, pleural effusions. RX STEROIDS

Question 5

Methemoglobinemia

Answer 5

Oxidized Hb Fe2+ converted to Fe3+
Etiology: dapsone, nitrates, phenytoin, benzocaine, sulfates, anilines, benzene or oxidizing agents vs genetic
Rx: methylene blue iv 1 mg/kg, cofactor in activity of NADPH in MetHb reductase pathway
Severe poisoning: exchange transfusion and hyperbaric oxygen