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3rd Year (Step 2) > Heme/Onc 1 (Anemias) > Flashcards

Heme/Onc 1 (Anemias) Flashcards

1
Q

4 causes of Microcytic Anemia?

A
  • Iron deficiency
  • Thalassemia
  • Sideroblastic anemia (can also be macrocytic)
  • Anemia of chronic disease
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2
Q

How to treat severe anemia?

A

Packed red blood cells

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3
Q

At what point do you transfuse a patient w/ anemia (via giving packed RBCs)?

A
  • if they are symptomatic (SOB, light-headed, syncope, hypotension, tachycardia, CP)
  • if the hematocrit is very low (i.e. 25-30) in an elderly patient or a patient w/ heart disease
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4
Q

What do you use to transfuse a IgA deficient patient?

A

IgA deficient donor FFP

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5
Q

What are packed RBCs?

A

Concentrated blood, it is a unit of whole blood w/ 150mL of plasma removed
- Hematocrit = 70-80% (double normal)

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6
Q

How much should each unit of PRBCs raise the hematocrit?

A

~ 3 points/unit

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7
Q

When is Fresh Frozen Plasma used?

A

Replaces clotting factors in those w/ elevated PT, aPTT, or INR & bleeding
- used as replacement w/ plasmapheresis

(NOT used for hemophilia A/B or vWD)

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8
Q

What is Cryoprecipitate used for?

A

Used to replace Fibrinogen & has some utility in DIC

  • has high levels of clotting factors in smaller plasma volume
  • high levels of Factor 8 & vWF

(basically this is never used first for anything)

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9
Q

Whole blood is divided into what 2 products?

A

PRBCs & FFP

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10
Q

Type of anemia?

Alcoholic w/ microcytic anemia

A

Sideroblastic anemia

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11
Q

Type of anemia?

Rheumatoid arthritis patient w/ microcytic anemia

A

Anemia of Chronic Disease

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12
Q

Type of anemia?

Asymptomatic patient w/ microcytic anemia

A

Thalassemia (trait)

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13
Q

Specific lab findings for iron deficiency anemia?

A

Microcytic anemia + Low Ferritin

  • High TIBC
  • High RDW (newer cells iron deficient & smaller)
  • Elevated platelet count
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14
Q

Formula for Transferrin saturation?

A

Iron divided by TIBC

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15
Q

Microcytic anemia - best initial test?

A

Iron studies

- low ferritin = iron deficiency, low TIBC = Chronic disease, high iron = Sideroblastic

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16
Q

Specific lab findings for Anemia of Chronic Disease?

A

Microcytic anemia + Low TIBC

  • High ferritin
  • Low serum iron
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17
Q

Specific lab findings for Sideroblastic Anemia?

A

Microcytic anemia + Elevated Iron

  • Ringed sideroblasts w/ Prussian blue staining
  • Basophilic stippling
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18
Q

Which microcytic anemia has normal iron studies?

A

Thalassemia

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19
Q

Specific lab findings for Thalassemia?

A

Microcytic anemia w/ normal iron studies

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20
Q

Sideroblastic anemia – Most accurate test?

A

Prussian blue staining for ringed sideroblasts

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21
Q

Iron deficiency anemia – most accurate test?

A

Bone marrow biopsy for stainable iron

RARELY done

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22
Q

Thalassemia – most accurate test?

A

Hemoglobin electrophoresis

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23
Q

Bleeding disorders: 1st step?

A

Det. if related to platelets or clotting factors

Platelets: Superficial (epistaxis, gingival, petechiae, purpura, mucosal surfaces such as the gums, vaginal bleeding

CFs: Deep (Joints & Muscles)

24
Q

Immune Thrombocytopenic Purpura (ITP) – presentation?

A
  • Isolated thrombocytopenia (normal hematocrit & WBC count)
  • Normal-sized spleen

(Ex: 23-yr old woman w/ markedly increased menstrual bleeding & bleeding gums when she brushes her teeth, & petechiae on physical exam)

25
Q

ITP:

Mild bleeding w/ platelet count between 10,000-30,000 — Tx?

A

Glucocorticoids

Prednisone

26
Q 
ITP:
Severe bleeding (GI/CNS) w/ platelet count < 10,000 --- Tx?
A

IVIG, anti-Rho (anti-D)

27
Q

ITP – when to undergo splenectomy?

A

Recurrent episodes of bleeding, steroid dependent

28
Q

ITP – Tx if splenectomy or steroids not effective?

A

Romiplostim or Eltrombopag, Rituximab, Azathioprine, Cyclosporine, Mycophenolate

29
Q

ITP:

Before splenectomy, give vaccination to what organisms?

A
  • Neisseria meningitidis
  • Haemophilus influenzae
  • Pneumococcus
30
Q

What is Romiplostim?

A

Synthetic thrombopoetin for ITP

31
Q

What is Eltrombopag?

A

Synthetic thrombopoetin for ITP

32
Q

vWD – AR or AD?

A

Autosomal Dominant

33
Q

vWD – Dx tests?

A
  • vWF (antigen) level may be dec’d
  • Ristocetin cofactor assay (detects vWF dysfx)
  • Factor 8 activity
  • Bleeding time (inc’d duration – rarely done)
34
Q

vWD – best initial Tx?

A

DDAVP (Desmopressin) – releases subendothelial stores of vWF

  • if no response, use factor 8 replacement or vWF concentrate
35
Q

DIC – what type of bleeding?

A

Bleeding related to both clotting factor deficiency & thrombocytopenia

36
Q

Most common hyper-coagulable state?

A

Factor V Leiden mutation

37
Q

Factor V Leiden mutation – Tx?

A

Warfarin to an INR of 2-3 for 6 months

38
Q

When & how does HIT present?

A

5-10 days after the start of Heparin w/ a marked drop in platelet count (~30%)

  • Venous & arterial thromboses (clots)
  • rarely leads to bleeding (platelets just precipitate out)
39
Q

HIT – Dx?

A

Confirmed w/ ELISA for platelet factor 4 (PF4) antibodies or the serotonin release assay

40
Q

HIT – Tx?

A
  • Stop all Heparin products
  • Give DTIs: Argatroban, Lepirudin, Bivalirudin
  • Give Warfarin AFTER using a DTI
41
Q

Name 3 Direct Thrombin Inhibitors

A

Argatroban, Lepirudin, Bivalirudin

42
Q

What is the only cause of Thrombophilia w/ an abnormality in aPTT?

A

Antiphospholipid Syndrome

43
Q

Antiphospholipid Syndrome – best initial & most accurate test?

A

Best initial = Mixing study (aPTT remains elevated)

Most accurate = Russell Viper Venom test (for lupus anticoagulant)

44
Q

2 types of Antiphospholipid Syndrome?

A

Lupus anticoagulant & Anticardiolipin antibody

  • both cause thrombosis
  • Anticardiolipin antibodies are ass’d w/ multiple spontaneous abortions
45
Q

3 molecules that normally promote platelet aggregation?

A

Thromboxane A2 –platelet activator & vasoconstrictor
(synthesized from arachidonic acid w/in platelets)

ADP – powerful inducer of platelet aggregation

5-HT (serotonin) – stimulates aggregation & vasoconstriction

46
Q

When platelets are activated, the _____ receptor binds fibrinogen, which cross-links adjacent platelets, resulting in aggregation & formation of a platelet plug.

A

GP 2b/3a

47
Q

ITP – mechanism?

A

Autoimmune production of IgG against platelet antigens (i.e. GP2b/3a)

    • autoantibodies are produced by plasma cells in the spleen
    • antibody-bound platelets are consumed by splenic macrophages, resulting in thrombocytopenia
48
Q

Most common cause of thrombocytopenia in children & adults?

A

ITP

49
Q

How do Proteins C & S exert their anticlotting effects?

A

They inactivate factors Va & VIIIa (via proteolysis)

50
Q

Heparin – MOA?

A
  • Cofactor for the activation of Antithrombin
  • Inhibits effects of Factors Xa & IIa (thrombin)

(whereas Warfarin affects “synthesis” of factors 2, 7, 9, 10 & Protein C & S)

51
Q

Arterial vs. Venous clots – which are more fibrin-rich vs. platelet rich?

A

Arterial clots = platelet rich

Venous clots = fibrin rich

**though both are mixed

52
Q

Most common cause of inherited hyper coagulability?

A

Factor V Leiden

– mutant factor V that is resistant to degradation by activated Protein C

53
Q

Difference btwn unfractionated & LMW Heparin in their MOA?

A
  • Both activate Antithrombin & enhance its inactivation of Factor Xa
  • Unfractionated Heparin and to a lesser-extent, LMWH, also enhances Antithrombin’s inactivation of Thrombin
54
Q

Fondaparinux – MOA?

A

Antithrombin activator (same as LMW Heparin)

55
Q

Rivaroxaban & Apixaban – MOA

A

Direct Factor Xa inhibitors

  • given PO
  • do NOT require monitoring
  • 1/2-life = 10 hrs

3rd Year (Step 2) (44 decks)

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