HEME/ONC Flashcards
What to look for someone w/ unprovoked thrombus?
- CANCER
- increased PTT, multiple SABs, false +VLDRL
- skin necrosis after warfarin is started
- MC inheritable pro-coag state. resistance to C
- heparin wont’ work. clots on heparin
- No Go for women >35 who smoke
- Pee out ATIII protein C +S preferentially. puts at risk for renal vein thrombosis
- CANCER
- increased PTT, multiple SABs, false +VLDRL- SLE
- skin necrosis after warfarin is started- Protein C/S def
- MC inheritable pro-coag state. resistance to C- Factor V leiden
- heparin wont’ work. clots on heparin- AT III deficiency
- No Go for women >35 who smoke- OCPs/HRT
- Pee out ATIII protein C +S preferentially. puts at risk for renal vein thrombosis- Nephrotic syndrome
7 days post-op, a patient deelops an arterial clot. her platelets are found to be 50% less than pre-op.
Mechanism?
Tx?
HIT!!!!
MOA- IgG to heparin bound to PF4
Tx- stop heparin, reverse warfarin w/ vit k and start lepirudin
patient walk in with thrombocytopenia and smear shows shistiocytes
- if PT and PTT are elevated, fibrinogen is decreased, D-Dimer and fibrin split products are elevated? causes? tx?
- If PT and PTT are normal? causes? tx?
- if PT and PTT are elevated, fibrinogen is decreased, D-Dimer and fibrin split products are elevated- DIC
causes- sepsis, rhabdo, adenocarcinoma, heatstroke, pancreatitis, snake bites, OB stuff
tx- FFP, platelet transfusion, correct underlying d/o - If PT and PTT are normal- HUS or TTP
causes- )157H7, ticlopidine, quinine, cyclosporine, HIV, Cancer
tx- plasmapheresis… no platelets!!!!!
patient walk in with thrombocytopenia…30 yo F recurrent epistaxis, heavy menses and petechiae. decreased platelets only? tx?
ITP
tx w/ prednisone then splenectomy
IVIG if <10k rituximab
patient walk in with thrombocytopenia…. 20 yo f recurrent epistaxis, heavy menses, petechiae, normal plts, increased bleeding time and PTT. tx?
VWD
Tx- DDAVP for bleeding or pre-op. replace factor VIII (contains vWF) if bleeding continues
patient walk in with thrombocytopenia… 20 yp M recurrent bruising, hematuria, & hemarthroses, increased PTT that corrected w. mixing studies? tx?
Hemophilia
tx- if mild tx w/ DDAVP otherwise replace factors
patient walk in with thrombocytopenia…. 50 yo M meat-a-tarian just finished 2wks of clinda has hemarthroses and oozing at venipuncture sites? tx?
Vit. K def. decreased II, VII, IX, X. same for warfarin tox
Tx- w. FFP acutely + vitk shot
patient walk in with thrombocytopenia… 50 yo M beer-a-tarian w/ severe cirrhosis? 1st factor depleted? 2 factors not depleted?
Liver disease; GI bleeding is MC
1st factor depleted- VII, so PT increases first
2 factors not depleted- VII and vWF b/c they are made by endothelial cells
a patient walks in with microcytic anemia….
MCV=70
decreased Fe, retic., ferritin
increased TIBC, RDW
iron deficiency
a patient walks in with microcytic anemia….
MCV= 70
decreased Fe, TIBC, retic
nl ferritin
chronic anemia
a patient walks in with microcytic anemia….
MCV= 70
increased Fe, ferritin
decreased TUBC
sideroblastic anemia
a patient walks in with microcytic anemia….
MCV= 60
decreased RDW
thalassemia
a patient walks in with macrocytic anemia….
MCV= 100
decreased retic.
increased homocysteine
nl methylmelonic acid
FOLATE deficiency
a patient walks in with macrocytic anemia….
MCV= 100
acanthosytes
liver disease
a patient walks in with macrocytic anemia….
MCV= 100
decreased retic
increased homocysteine, methylmelonic acid
B12 deficiency
Normal MCV, increased LDH + indirect bilirubin, decreased haptoglobin
hemolysis
Normal MCV, increased LDH + indirect bilirubin, decreased haptoglobin
- sickle cell kid w/ sudden drop in Hct
aplastic crisis
sickle crisis from hypoxia, dehydration or acidosis
Normal MCV, increased LDH + indirect bilirubin, decreased haptoglobin
- cyanosis of fingers, ears, nose + recent mycoplasma infx
cold agglutinins; destruction occurs in the liver; IgM mediated
Normal MCV, increased LDH + indirect bilirubin, decreased haptoglobin
- sudden onset after PCN, ceph, sulfas, rifampin or Ca tx?
warm agglutinins; destruction in spleen
tx w/ steroids then splenectomy
Normal MCV, increased LDH + indirect bilirubin, decreased haptoglobin
- splenomegaly, +FH, biliruibin, gallstones, Increased MCHC. tx?
hereditary spherocytosis (loss of spectrin)
tx w/ splenectomy
Normal MCV, increased LDH + indirect bilirubin, decreased haptoglobin
- Dark urine in AM, Budd-Chiari syndrome
Paroxysmal nocturnal hemoglobinuria. defect PIG-A lysis by complement.
*increased risk for aplastic anemia
Normal MCV, increased LDH + indirect bilirubin, decreased haptoglobin
- sudden onset after primiquine, sulfa and fava beans
G6PDH def. Heinz bodies, bite cells
avoid oxidant stress
