Heme Onc Flashcards
Reticulocyte index that indicates BM is responding well
index >2%
Packed RBCs facts
no platelets of clotting factors
Mix with normal saline to infuse faster
Each unit raises Hct 3-4 points
Fresh frozen plasma indication
Contains all clotting factors
Given for high PT/PTT, coagulopathy, and deficiency of clotting factos
Cryoprecipitate indication
Contains factor VIII and fibrinogen
For hemophilia A, decreased fibrinogen (DIC and vWD)
Whole blood indication
Massive blood loss
Anaphylaxis in Blood transfusion
Within seconds to minutes
Due to ABO mismatched blood products
Symptoms: fever/chills, N/V, pain in flanks/back, chest pain, and dyspnea
Complications: hypovolemic shock, DIC, and renal failure with hemoglobinuria
Treatment: stop trasnfusion immediately, epinephrine, fluid replacement and dopamine/NE
Treatment and diagnosis of B thalassemia minor, intermedia and major
Diagnosis
Major: homozygous B chain
Intermedia: indeterminate
Minor: heterozygous B chain
Electrophoresis shows Hb F and Hb A2 are elated
Microcytic hypochromic anemia with target cells
Treatment: frequent packed RBC transfusions are required for major the other two are not treated
a -thalassemia trait, silent, Hb H and hydropsy fetalis diagnosis and treatment
diagnosis:
silent: one a locus deletion or mutation
No treatment
Trait: two a loci deletion or mutation
Mild microcytc hypochromic anemia
no treatment
Hb H: 3 loci deleted or mutated
signficant microcytic hypochromic anemia
electrophoresis shows (hemoglobin bart-B tetramers) Hb H
Treatment is packed RBC transfusions and possible splenectomy
hydrops fetalis: all four a loci are mutated or deleted
Fatal at birth
Treatment and diagnosis of aplastic anemia
Diagnosis: bone marrow biopsy-hypocellular marrow and absence of progenitor cells of all three cell lines
Treatment: bone marrow transplanation
Transfusion of packed RBCs and platelets if necessary
Treatment of B12 deficiency
parenteral cycanocobalamin once per month
Treatment of folic acid deficiency
daily oral folic acid replacement
General treatment of hemolytic anemia
Transfusion of packed RBCs is severe anemia or patient is hemodynamically unstable
Folate supplements
Blood transfusion indications for sickle cell
Acute chest syndrome, stroke, priapism that does not respond to fluids/analgesia, and cardiac decompensation
Diagnosis and treatment of hereditary spherocytosis
Diagnosis
Osmotic fragility to hypotonic saline RBCs undergo lysis at higher (thus earlier) oncotic pressure
Elevated reticulocyte count, elevated MCHC
Treatment:
Splenectomy
Diagnosis and treatment of warm autoimmune hemolytic anemia
Positive direct coombs test (RBCs coated with IgG)
Splenomegaly
Spherocytes
Treatment: glucocoricoids
Splenectomy
Immunosuppression with azothioprine or cyclophosphamide
RBC transfusions and folate supplements if necessary
Diagnosis and treatment of cold autoimmune hemolytic anemia
RBCs coated with complement alone
Avoid cold temps
RBC transfusions if necessary
Various chemotherapeutic agents
Diagnosis and treatment of paroxysmal nocturnal hemoglobinuria
Ham’s test: incubated in acidified serum triggering complement pathway-lysis of PNH cells but not normal cells
Sugar water test: patient’s serum mixed in sucrose-hemolysis ensues
Flow cytometery of anchored cell surface proteins-CD55 and CD59-sensitive and specific for PNH
Treatment: glucocorticoids or bone marrow transplantation
When to treat heparin induced thrombocytopenia
When thrombocytopenia is seen 3-12 days after heparin induction
Diagnosis and treatment of Immune Thrombocytopenic Purpura
Diagnosis: No splenomegaly Platelet count less tan 20,000 Bone marrow has increased megakaryocytes Increased platelet associated IgG
Treatment:
Adrenal corticosteroids
IV immune globulin: saturates the reticuloenodthelial system
Splenectomy
Romiplastim and eltrombopag: thrombopoietin receptor agonists
TTP diagnosis and treatment
Diagnosis:
Prolonged BT, normal PT and PTT
Schistocytes
Treatment:
Plasmapharesis
Corticosteroids and splenectomy may be beneficial
Platelet transfusions are contraindicated
Diagnosis and treatment of HIT
Diagnosis: antiplatelet factor IV Ab and serotonin release assay
Treatment: stop heparin
If anticoagulation needed (DVT or PE) use thrombin inhibitor such as lepirudin
Diagnosis and treatment of vWF deficiency
Diagnosis:
Prolonged BT-normal platelet count
PTT may be prolonged
Reduced ristoceitin induced platelet aggregation
Treatment: desmorpressi-induces cells to secrete vWF (first line)
Factor VIII concnetrates-after major trauma or during surgery
NO cyroprecipiate or asprin/NSAIDs
Treatment of hemophilia A
Acute hemarthorsis:
analgesia with codeine +/- acetaminophen
ice and rest the joint
Factor VIII concentrate-acute bleeding, before surgery and dental surgeries
NOT cryoprecipitate or FFP due to viral transmission risk
Desmopressin may be helpful
Synovesctomy or radiosynovectomy may be needed if severe recurrent hemarthorsis
Mix with normal plasma and if PTT returns to normal then there is not presence of a factor VIII inhibitor
Diagnosis and treatment of DIC
Diagnosis
PT, PTT, BT and thrombin time are elevated
Fibrin split products and D dimer
Fibrinogen is low, thrombocytopenia
Schistocytes
Treatment:
FFP replaces clotting factors
Platelet transfusions
Cryoprecipitate replaces clotting factors and fibrinogen
Oxygen, IV fluids, Maintain BP and renal perfusion
Hb Indication level for blood transfusion
Less than 7
