HEME/ONC Flashcards
Effects of transfusion of:
PRBCs?
Platelets?
 PRBCs: Hb +1, Hct +3
Platelets: platelets +10,000
Contained in…
FFP? (indications?)
Cryoppt? (indications?)
FFP: factors 1-12; ↓PT, ↓PTT
Cryoprecipitate: factors 1 + 8 only; ↓PTT
TIBC:
reflection of…
___ has negative feedback on TIBC
transferrin levels (protein that binds ferritin)
serum ferritin has a negative feedback on TIBC levels
↓RDW = a/w…
thalassemia
LDH:
enzyme of…
incr in…
enzyme of anaerobyic glycolysis
↑ w/ intravascular hemolysis or tissue hypoxia
Haptoglobin:
binds…
decr in…
free hgb
↓ w/ intravascular hemolysis
Sideroblastic anemia:
tx?
etiology?
Tx underlying cause, vit B6 supplements
lead poisoning, vit B6 deficiency, INH or EtOH use
Fanconi anemia:
presentation?
aplastic anemia + short stature, hypopigmented areas, eye/ear deformities
G6PD deficiency:
presentation?
dx?
etiology?
intravascular hemolysis, back pain, hemoglobinuria in men
Dx blood smear (Heinz bodies, bite cells)
Etiology: sulfa drugs, anti- malarials, infx, fava beans
Paroxysmal nocturnal hemoglobinuria (PNH):
presentation?
dx?
tx?
hemolytic anemia + hepatic vein thromboses
Dx ↑urine hemosiderin
Tx steroids, bone marrow txp

Heparin-induced thrombocytopenia (HIT):
type 1?
type 2?
HIT type 1: heparin directly causes platelet aggregation, within 0-2 days (*reassurance)
HIT type 2: heparin induces auto-antibodies against platelet factor 4, after 3-12 days (*d/c heparin)
Idiopathic thrombocytopenic purpura (ITP):
pathophys?
dx?
tx?
auto-antibodies against gpIIb/IIIa → platelet clearance
Dx plt <20, ↑megakaryocytes
Tx steroids, plt transfusion then splenectomy • (severe)
HUS:
presentation?
dx?
tx?
tons of clots form in small vx (e.g. renal vx) → micro- angiopathic hemolytic anemia + thrombocytopenia + renal failure
Dx CBC (↓plt, ↓RBC) + blood smear (schistocytes)
Tx emergent plasmapheresis
Thrombotic thrombocytopenic purpura (TTP):
presentation?
HUS + fever + ∆MS
Glanzmann thrombasthenia:
presentation?
AR ∆gpIIb/IIIa → platelets can’t aggregate
Bernard-Soulier syndrome:
presentation?
AR ∆gpIb → platelets can’t adhere to subendothelium
HUS × diarrhea =
EHEC (O157:H7)
 PTT measures... PT/INR measures... Thrombin time measures... Bleeding time measures... Factor w shortest T1⁄2?
 PTT: measures intrinsic pathway (12→→1)
PT/INR: measures extrinsic pathway (7→→1)
Thrombin time: measures fibrinogen levels (2→1)
Bleeding time: measures platelet function
Shortest T1⁄2: factor 7
 Heparin:
moa?
side-effects?
reversal?
MOA: potentiates AT-III to inhibit factors 2/10 → ↑PTT
side-effects: bleeding, HIT, osteoporosis

reversal: protamine sulfate
tPA:
moa?
reversal?
moa: activates plasmin to break down existing clots
reversal: aminocaproid acid
von Willebrand disease (vWD):
dx?
tx?
↓/∆/no vWF, ↑bleeding time
DDAVP (types 1 [AD, decr vWF] and 2 [AD, abn vWF])
factor 8 concentrate (refractory type 2, type 3 [AD, no vWF])
Hemophilia A:
dx?
tx?
Dx ↑PTT, ↓factor 8
Tx factor 8 concentrate; analgesia + RICE (for acute hemarthroses)
Hemophilia B (Christmas disease):
dx?
tx?
Dx ↑PTT, ↓factor 9
Tx factor 9 concentrate; analgesia + RICE (for acute hemarthroses)
Hemophilia A vs. factor 8 inhibitor?
mix pt’s plasma w/ normal plasma; if PTT fails to normalize, then factor 8 inhibitor
AT-III deficiency:
pathophys?
presentation?
can’t break down factors 2-12 → hypercoagulability that doesn’t respond to heparin
Factor V leiden:
pathophys?
protein C can’t block factor 5 → hypercoagulability
Multiple myeloma: pathophys? presentation? dx? tx?
monoclonal plasma cell proliferation → makes lots of monoclonal IgG and eats up bone marrow space
CRAB – hyperCalcemia, Renal failure, Anemia, Bone lesions/fx
Dx SPEP (monoclonal spike), urinalysis (Bence Jones protein), X-ray (punched out lytic bone lesions), blood smear (rouleaux formation)
Tx chemo/radiation only if symptomatic
Monocolonal gammopathy of undetermined significance (MGUS): presentation? dx? tx? prognosis?
asx, precursor of myeloma
Dx SPEP (monoclonal spike), urinalysis (Bence Jones protein)
Tx close f/u
20% convert to MM in 10-15 yrs
Waldenstrom macroglobulinemia: pathophys? presentation? dx? tx?
monoclonal IgM plasma cell proliferation → ↑IgM
hyperviscosity (IgM is big), anemia, splenomegaly, LNopathy
Dx SPEP (monoclonal spike), urinalysis (Bence Jones protein), ↑IgM, no bone lesions
no tx exists
MCC multiple myeloma?
recurrent lung or urinary tract infx (↓normal IgG)
