Heme Onc Flashcards
Dabigatran(Pradaxa) reversal
idracizumab
Dabigatran MOA
inhibits thrombin
MOA of apixaban
inhibits factor Xa
apixaban prolongs what coagulation study
prothrombin time, but it is the least of the anti Xa drugs
Pradaxa prolongs?
aPTT, thrombin time
half life of NOAC? prolonged by what?
out of system within 1-2 days, renally cleared so can take longer if decreased creatinine clearance
reversal for Anti Xa drugs?
PCC
HLH mechanism
extreme inflammation and upregulated immune activation, can be inherited(perforin gene) or acquired
Signs of HLH
fever, HSM, cytopenia, very high ferritin, elevated LFT, low fibrinogen, and high bili. High levels of IL-2
Adult onset stills disease dx with Yamaguchi criteria
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
TEG- R time- what is it, interpretation, treatment?
- time from reagent addition to fibrin formation
- prolonged R time is coagulation factor deficiency
- give FFP
TEG- K time-what is it, interpretation, treatment?
- measurement of clot strength
- prolongation means dec coag factors and fibrinogen
- give FFP and cryo
TEG- alpha angle-what is it, interpretation, treatment?
- rate of clot formation due to cross linking and fibrin buildup
- decreased angle means dec coag factors and fibrinogen
- give FFP and cryo
TEG- MA-what is it, interpretation, treatment?
- reflects overall clot strength and fibrin and platelet bonding
- low means need platelet
TEG- LY30-what is it, interpretation, treatment?
- reflects clot stability, breakdown
- if prolonged then increased fibrinolysis
- give TXA
acquired perforating disorder
associated with cancer, renal dysfunction, DM, HIV
- lesions on body
- bx invagination with keratin plugs
PLEVA
cutaneous T cell lymphoma, pretty much
contact activation clotting pathway factors
VIII, IX, XI, XII
common pathway clotting factors
X, V, II(thrombin), I(fibrin)
APTT measures what?
both the contact activation and the common pathway
PT measures what?
VII and the common pathway
what is the INR a measurement of?
a means of standardizing the PT at multiple sites
things that affect the common pathway can affect APTT, PT and INR. What are they?
DIC, heparin, Xa inhibitors, warfarin, vik K deficiency, hepatic insufficiency
heparin lock concentration?
10000 u/ml and each lumen is locked with 1.5 to 2.5 ml, so it must be wasted before using the lumens
DIC coag studies?
increased PT, PTT, INR decreased fibrinogen, low fibrin degradation products
what does thrombin time measure?
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
type 1 HIT
small drop in plt in the first few days, non immune mediated, no need to stop heparin
type II HIT
immune mediated against Pf4. usually occurs around day 5. heparin needs to be stopped an nees to be fully anticoagulated to prevent thrombosis
HLH
- widespread macrophage activation due to failure of NK and t lymphs
Criteria for HLH
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
treatment for HLH
etoposide(VP-16) and dexamethasone
Reason for argatroban over fondaparinux in HIT?
fondaparinux has a much longer half life
Car T cell therapy, what is it?
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
3 different side effects of Car T cell therapy?
cytokine release syndrome, CarT cell relate encephalopathy syndrome, HLH
high grade CRS, 3 or 4? tx?
grade 3- IL6 receptor antagonist tocilizumab
grade 4- tocilizumab plus solumedrol at 1g.d
when is the most likely time a patient will develop neutropenic enterocolitis?
following chemo for hematologic malignancies
- treat with abx and support
hyperuricemia, hyperkalemia, hyperphos, hypocalcemia in a newly diagnosed cancer patient?
what is the treatment?
what is the most likely cancers to cause it?
tumor lysis syndrome
- hydration and the initiation of rasburicase, fluids to maintain a relatively high urine output
- non hodgkin lymphoma, ALL
