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COMAT - IM > Heme/Onc Part 2 > Flashcards

Heme/Onc Part 2 Flashcards

1
Q

What are some signs that platelet issues are causing the bleeding?

A

Gingival bleeding
Heavy menses
Petechiae

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2
Q

How will vWF disease present?

A

Platelet-type bleeding with either normal labs or slightly impaired PTT

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3
Q

What clotting factor may be low with vWF disease and why?

A

Factor 8
– vWF carries it in the blood

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4
Q

Treatment for vWF disease?

A

DDAVP

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5
Q

Where is the issue with Bernard Soulier?

A

Platelet antigen GP1B
– cannot bind to vWF

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6
Q

How will the platelets look with Bernard Soulier?

A

LARGE

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7
Q

Where is the issue with Glanzmann Thrombasthenia?

A

Platelet antigen GP2B3A
– cannot form platelet plug and aggregate platelets

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8
Q

How will the platelets look with Glanzmann Thrombasthenia?

A

Normal

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9
Q

If the issue is with clotting factors, how will that likely present?

A

Hemarthroses or large hematomas

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10
Q

What study should you get if you suspect a clotting factor issue?

A

Mixing study

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11
Q

Following a mixing study, if the PT/PTT do NOT correct, what is the issue?

A

Factor inhibitors

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12
Q

Following a mixing study, if the PT/PTT DO correct, what is the issue?

A

Factor deficient

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13
Q

What causes Paroxysmal Nocturnal Hemoglobinuria?

A

Lack of CD55/59 on RBC membrane allows the complement to attack and destroy RBCs

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14
Q

How will Paroxysmal Nocturnal Hemoglobinuria present?

A

Hematuria, often in the morning
Hypercoagulable state – intraabdominal clots

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15
Q

What is the diagnostic if you suspect Paroxysmal Nocturnal Hemoglobinuria?

A

Flow cytometry
= ABSENT CD55/59

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16
Q

What is the unique treatment for Paroxysmal Nocturnal Hemoglobinuria?

A

Eculizumab which inhibits complement activation

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17
Q

What is the unique treatment for Paroxysmal Nocturnal Hemoglobinuria?

A

Eculizumab which inhibits complement activation

18
Q

With G6PD deficiency, hemolytic anemia occurs with oxidative stress. List 3 common drugs that cause this to occur?

A

TMP-SMX
Dapsone
Nitrofurantoin

19
Q

How will G6PD present?

A

Fatigue
Pallor
Dark urine
Jaundice

20
Q

What 2 things can be seen on peripheral smear with G6PD defiency?

A

Bite cells
Heinz bodies

21
Q

If you measure G6PD levels during an acute attack, what will the levels be?

A

NORMAL

22
Q

What occurs with TTP?

A

ADAMTS-13 deficiency forms hyaline clots that then shred cells going by!

23
Q

What will be seen on peripheral smear with TTP?

A

Schistocytes

24
Q

What is the pneumonic for TTP symptoms?

A

FAT RN

25
Q

TTP symptoms?

A

FAT RN
- Fever
- Anemia (MAHA)
- Thrombocytopenia
- Renal failure
- Neuro sx

26
Q

TTP symptoms?

A

FAT RN
- Fever
- Anemia (MAHA)
- Thrombocytopenia
- Renal failure
- Neuro sx

27
Q

What is the treatment for TTP?

A

Exchange transfusion

28
Q

Physiology behind DIC?

A

Illness causes clots to form everywhere and since using up clotting factors, you also bleed

29
Q

Level of PT/PTT and D-Dimer with DIC?

A

HIGH

30
Q

Level of Platelets and Fibrinogen with DIC?

A

LOW

31
Q

PT/PTT, Platelets, Fibrinogen and D-Dimer levels with DIC?

A

PT/PTT = HIGH
Platelets = LOW
Fibrinogen = LOW
D-Dimer = HIGH

32
Q

Treatment for DIC?

A

Supportive, treat underlying cause

33
Q

If a patient is on heparin and they develop HIT, what will occur?

A

Bleeding + CLOT formation while on heparin

34
Q

Signs of HIT?

A

Recently started on Heparin
- Bleeding
- CLOT WORSENING

35
Q

What is the treatment for HIT?

A

Stop heparin
– Start Argatroban and bridge to Warfarin

36
Q

What occurs with ITP?

A

Autoimmune attack against platelets ONLY

37
Q

What lab change is seen with ITP?

A

Low platelets only

38
Q

If the platelets are below _____ with ITP, give steroids

A

< 30K give steroids

39
Q

If the platelets are above 30K, what is the treatment for ITP?

A

NOTHING just observe

40
Q

Hemolytic anemia lab changes

A

LOW haptoglobin
HIGH bilirubin and LDH

COMAT - IM (17 decks)

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