Heme-Onc Flashcards
Blood donations are collected in plastic bags containing the anticoagulants:
ACD (Acid-Citrate-Dextrose) or CPD (Citrate-Phosphate-Dextrose)
PRBCs are stored at what temperature? How long is the shelf life?
0 - 6 degrees, 42 days
At what temperature are platelets stored? Shelf life?
Room temperature with 5 day shelf life.
RBC transfusions generally indicated when Hb drops below
7
The restrictive RBC transfusion policy aims at a lower target Hb around:
7 - 8 Gms
In an actively bleeding patient, goal of platelet transfusion is to keep platelets:
Above 50k in most cases, above 100k if evidence of DIC or CNS bleeding
Platelet transfusions are also given to patients in preparation for invasive procedures. Major surgery and endoscopies aim for __k while a spinal tap with a heme malignancy aims for __k.
50k
20k
Prophylactic platelet transfusions are generally above 10k, but may be higher in patients with:
Fever, sepsis, APL
Prophylactic platelet transfusions should not be given to patients with
TTP/HIT
For a massive transfusion, a 1:1:1 ratio of what should be given?
PRBCs:FFP:Platelets
What are some major concerns with a massive transfusion?
Citrate toxicity, hypothermia, hyperkalemia, hypocalcemia, metabolic alkalosis, coagulation parameters
A transfusion reaction wherein antibodies to donor leukocytes cause a release of cytokines and result in symptoms of fever, chills, dyspnea
Febrile, nonhemolytic RBC or platelet transfusion reaction
A transfusion reaction wherein ABO incompatibility leads to rapid destruction of donor erythrocytes and results in DIC, shock, acute renal failure, fever, bakc pain, hemoglobinuria.. May only see fever and chills in comatose or anesthetized pt!
Acute hemolytic transfusion reaction
What is the appropriate response to an AHTR?
Stop transfusion, ABCs, saline, diuretics, blood sample for DAT, Hb, type and cross
A transfusion reaction wherein ABO incompatibility results in shock, hypotension, angioedema, respiratory distress. IgA deficient patients at high risk.
Anaphylactic transfusion reaction to RBCs, platelets, cryoppt, granulocytes, or gamma globulin.
A transfusion reaction wherein allergenic substances in donor plasma react with recipient antibodies with mast cell and basophil histamine release.
Urticarial transfusion reaction, give benadryl
A transfusion complication more common in elderly patients, pediatric patients, patients with compromised cardiac function (seen in ICU)
Transfusion associated circulatory overload
A transfusion complicated associated with two hit theory of neutrophil sequestration, priming, and activation paired with donor Abs vs HLA1, 2, and human neutrophil antigens.
Transfusion related acute lung injury
TRALI occurs how long after transfusion?
1 - 6 hours
A transfusion complication occurring days or weeks after transfusion, presenting with anemia, hyperbilirubinemia as a result of extravascular hemolysis.
Delayed hemolytic transfusion reaction
A transfusion complication that occurs days to weeks after transfusion and presents with fever, rash, anorexia, vomitting, abd pain, diarrhea, pancytopenia, abnormal LFTs
Graft vs Host disease
Most common mortality in travelers:
Cardiovascular disease
What percentage of travelers will develop some type of diarrhea?
20 - 60%
What questions might you want to ask someone who is planning to travel?
Country, duration, accommodations, purpose, travel history, allergies, current illnesses
What treatment is recommended for altitude sickness?
Descent, oxygen. Prevention: avoid alcohol and sedatives, high carb diet, sildenafil and acetazolamide.
Catfish that ascends the urethra, attracted by urea.
Candiru
Prophylaxis for traveler’s diarrhea is not recommended, but may recommend _____ before a high-risk meal
Peptobismol
Treatment for traveler’s diarrhea with blood in stool:
Fluids, zithromax
Three R’s of travel immunization
Routine childhood
Required for crossing borders
Recommended: according to risk (Hep A, typhoid, etc)
Routine travel immunizations:
Diphtheria, tetanus, Polio, MMR, Influenza, Pneumococcal
Recommended travel vaccines:
Hep A, Hep B, typhoid, japanese encephalitis, rabies
DEET concentration that is sufficient for repellent for travelers:
40%
Clotting in the arterial system generally results in ____ clots of platelets.
White
Clotting in the venous system generally results in ____ clots of red blood cells.
Red
Risk factors for arterial thrombosis include:
Vascular injury (#1), lipoproteins decreasing fibrinolysis, inflammatory changes, homocysteine
An anti-coagulant that decreases thromboxane and lasts for the lifespan of a platelet
Aspirin
Most commonly used inhibitor of ADP-induced platelet aggregation
Clopidogrel (Plavix)
Thrombin inhibitors for VTE prophylaxis and atrial fib
Dabigatran (Pradaxa) and Apixaban (Eliquis)
Bone marrow has the capacity to increase production ______ x the normal production
5 - 10
RBC lifespan can reach as low as __ days before marrow cannot compensate and anemia develops.
18 days
A person can lose up to __% of their blood without clinical signs at rest.
20%
A loss of __ - __% of blood can lead to circulatory collapse and shock
30 - 40%
Anemia as a result of _______ may present with signs of malnutrition and neurological changes
B12 deficiency
Anemia as a result of _______ may present with severe pallor, a smooth tongue, and esophageal webs.
Iron deficiency
Anemia as a results of ______ may present with jaundice
Hemolysis
A CBC includes:
RBC count (n = 3.8-5.2, 3.9-5.9) Hct/PCV (n = 38-46%, 41-53%) Hb (n = 12 0 16, 13.5-17.5) RBC indices
RBC indices on a CBC are:
MCV (mean corpuscular volume)
MCHC (Mean corpuscular hb concentration)
MCH (Mean corpuscular hb)
RDW (Red cell distribution width)
MCV =
(Hct%/RBC) x 10
n = 80 - 100 fL
MCHC =
(Hb/Hct%)x100
n = 31 - 37
MCH =
(Hb/RBC) x 10
n = 26 - 34
RDW =
(Standard dev/mean MCV) x 100
n = 11.5 - 14.5%
What stain is used on PBS to visualize remaining ribosomes and ER of reticulocytes?
Methylene blue
Special considerations in treating a patient for HIV include:
Adolescents, pregnant patients, IV drug users, older patients, HIV-2, coinfection with HBV/HCV/TB
The best predictor of disease progression, indicator of immune function, and key factor in determining urgency of ART:
CD4+ cell count
An adequate response to ART is
Increase in CD4 cells by 50 - 1500 /uL/year
How often should a patient have their CD4 count checked during first two years of ART?
Every 3 - 6 months
How often should a patient have their CD4 count checked after two years of adequate and consistent suppression? (300 - 500 cells/uL)
Every 12 months
A factor to consider in the decision to start ART and the goal of art with regard to this factor:
HIV RNA, goal to achieve undetectable levels (
How often should HIV RNA be checked?
Every 2 - 4 weeks after starting or changing the ART regimen, then every 4 - 8 weeks until levels are
Drug resistance testing is indicated in HIV patients with:
Acute HIV infection, chronic infection at entry into care, virologic failure during ART, suboptimal suppression, pregnancy
Drug resistance testing is not usually indicated in HIV patients:
After discontinuation of ARVs, if plasma HIV RNA
Patients with this HLA should not receive ABC and should be recorded as an ABC allergy.
HLA-B*5701
Current recommendations for initiating ART with the intention of preventing transmission:
HIV infected pregnant women, patients at risk of transmitting HIV to a sexual partner
Current 6 categories of ARV medications:
NRTI, NNRTI, PI, Integrase inhibitors, fusion inhibitors, PK boosters
3 categories of regimens for ART:
1 Integrase inhibitor + 2 NRTIs
1 PK-boosted PI + 2 NRTIs
1 NNRTI + 2 NRTIs
In the 3 main categories for ART regimens, each includes 2 NRTIs, one of which should include:
3TC (Lamivudine) or FTC (Emtricitabine)
In patients with CD4
RPV-based
DRV/r +RAL
In patients with HIV RNA >100k, it is not recommended to use _____, _____, or _____ due to high rate of virologic failure.
RPV-based
ABC/3TC + EFC or ATV/r
DRV/r + RAL
In patients with chronic kidney disease and ostoporosis, one should avoid ____ in ART regimen:
TDF
In patients with a psychiatric illness, one should consider avoiding ____ in ART regimen
EFV