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In service CCM > Heme Onc > Flashcards

Heme Onc Flashcards

1
Q

Dabigatran(Pradaxa) reversal

A

idracizumab

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2
Q

Dabigatran MOA

A

inhibits thrombin

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3
Q

MOA of apixaban

A

inhibits factor Xa

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4
Q

apixaban prolongs what coagulation study

A

prothrombin time, but it is the least of the anti Xa drugs

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5
Q

Pradaxa prolongs?

A

aPTT, thrombin time

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6
Q

half life of NOAC? prolonged by what?

A

out of system within 1-2 days, renally cleared so can take longer if decreased creatinine clearance

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7
Q

reversal for Anti Xa drugs?

A

PCC

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8
Q

HLH mechanism

A

extreme inflammation and upregulated immune activation, can be inherited(perforin gene) or acquired

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9
Q

Signs of HLH

A

fever, HSM, cytopenia, very high ferritin, elevated LFT, low fibrinogen, and high bili. High levels of IL-2

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10
Q

Adult onset stills disease dx with Yamaguchi criteria

A

fever >39 for a week, athritis for 2 weeks, nonpruritic salmon rash on trunk and ext, granulocytiuc leukocytosis >10000. Minor criteria with sore throat, lymphadenopathy, negative Rf and ANA

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11
Q

TEG- R time- what is it, interpretation, treatment?

A
  • time from reagent addition to fibrin formation
  • prolonged R time is coagulation factor deficiency
  • give FFP
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12
Q

TEG- K time-what is it, interpretation, treatment?

A
  • measurement of clot strength
  • prolongation means dec coag factors and fibrinogen
  • give FFP and cryo
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13
Q

TEG- alpha angle-what is it, interpretation, treatment?

A
  • rate of clot formation due to cross linking and fibrin buildup
  • decreased angle means dec coag factors and fibrinogen
  • give FFP and cryo
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14
Q

TEG- MA-what is it, interpretation, treatment?

A
  • reflects overall clot strength and fibrin and platelet bonding
  • low means need platelet
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15
Q

TEG- LY30-what is it, interpretation, treatment?

A
  • reflects clot stability, breakdown
  • if prolonged then increased fibrinolysis
  • give TXA
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16
Q

acquired perforating disorder

A

associated with cancer, renal dysfunction, DM, HIV

  • lesions on body
  • bx invagination with keratin plugs
17
Q

PLEVA

A

cutaneous T cell lymphoma, pretty much

18
Q

contact activation clotting pathway factors

A

VIII, IX, XI, XII

19
Q

common pathway clotting factors

A

X, V, II(thrombin), I(fibrin)

20
Q

APTT measures what?

A

both the contact activation and the common pathway

21
Q

PT measures what?

A

VII and the common pathway

22
Q

what is the INR a measurement of?

A

a means of standardizing the PT at multiple sites

23
Q

things that affect the common pathway can affect APTT, PT and INR. What are they?

A

DIC, heparin, Xa inhibitors, warfarin, vik K deficiency, hepatic insufficiency

24
Q

heparin lock concentration?

A

10000 u/ml and each lumen is locked with 1.5 to 2.5 ml, so it must be wasted before using the lumens

25
Q

DIC coag studies?

A

increased PT, PTT, INR decreased fibrinogen, low fibrin degradation products

26
Q

what does thrombin time measure?

A

how long it takes a clot to form in plasma, when thrombin is added. It measures a problem with a conversion of fibrinogen to fibrin

27
Q

type 1 HIT

A

small drop in plt in the first few days, non immune mediated, no need to stop heparin

28
Q

type II HIT

A

immune mediated against Pf4. usually occurs around day 5. heparin needs to be stopped an nees to be fully anticoagulated to prevent thrombosis

29
Q

HLH

A
  • widespread macrophage activation due to failure of NK and t lymphs
30
Q

Criteria for HLH

A

5/8

  • fever
  • splenomegaly
  • cytopenias in at least 2 cell lines
  • hypertriglyceridemia
  • hemophagocytosis
  • low or absent NK activity
  • ferritin >500 ng/mL, very specific if >3000
  • increased solube CD25
31
Q

treatment for HLH

A

etoposide(VP-16) and dexamethasone

32
Q

Reason for argatroban over fondaparinux in HIT?

A

fondaparinux has a much longer half life

33
Q

Car T cell therapy, what is it?

A

patients own T lympho are harvested and modified with an external antigen domain , these new t cells are given back to patient and the external domain recognizes B lympho CD-19

34
Q

3 different side effects of Car T cell therapy?

A

cytokine release syndrome, CarT cell relate encephalopathy syndrome, HLH

35
Q

high grade CRS, 3 or 4? tx?

A

grade 3- IL6 receptor antagonist tocilizumab

grade 4- tocilizumab plus solumedrol at 1g.d

36
Q

when is the most likely time a patient will develop neutropenic enterocolitis?

A

following chemo for hematologic malignancies

- treat with abx and support

37
Q

hyperuricemia, hyperkalemia, hyperphos, hypocalcemia in a newly diagnosed cancer patient?
what is the treatment?
what is the most likely cancers to cause it?

A

tumor lysis syndrome

  • hydration and the initiation of rasburicase, fluids to maintain a relatively high urine output
  • non hodgkin lymphoma, ALL

In service CCM (17 decks)

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