Heme/Onc Part 2 Flashcards
What are some signs that platelet issues are causing the bleeding?
Gingival bleeding
Heavy menses
Petechiae
How will vWF disease present?
Platelet-type bleeding with either normal labs or slightly impaired PTT
What clotting factor may be low with vWF disease and why?
Factor 8
– vWF carries it in the blood
Treatment for vWF disease?
DDAVP
Where is the issue with Bernard Soulier?
Platelet antigen GP1B
– cannot bind to vWF
How will the platelets look with Bernard Soulier?
LARGE
Where is the issue with Glanzmann Thrombasthenia?
Platelet antigen GP2B3A
– cannot form platelet plug and aggregate platelets
How will the platelets look with Glanzmann Thrombasthenia?
Normal
If the issue is with clotting factors, how will that likely present?
Hemarthroses or large hematomas
What study should you get if you suspect a clotting factor issue?
Mixing study
Following a mixing study, if the PT/PTT do NOT correct, what is the issue?
Factor inhibitors
Following a mixing study, if the PT/PTT DO correct, what is the issue?
Factor deficient
What causes Paroxysmal Nocturnal Hemoglobinuria?
Lack of CD55/59 on RBC membrane allows the complement to attack and destroy RBCs
How will Paroxysmal Nocturnal Hemoglobinuria present?
Hematuria, often in the morning
Hypercoagulable state – intraabdominal clots
What is the diagnostic if you suspect Paroxysmal Nocturnal Hemoglobinuria?
Flow cytometry
= ABSENT CD55/59
What is the unique treatment for Paroxysmal Nocturnal Hemoglobinuria?
Eculizumab which inhibits complement activation
What is the unique treatment for Paroxysmal Nocturnal Hemoglobinuria?
Eculizumab which inhibits complement activation
With G6PD deficiency, hemolytic anemia occurs with oxidative stress. List 3 common drugs that cause this to occur?
TMP-SMX
Dapsone
Nitrofurantoin
How will G6PD present?
Fatigue
Pallor
Dark urine
Jaundice
What 2 things can be seen on peripheral smear with G6PD defiency?
Bite cells
Heinz bodies
If you measure G6PD levels during an acute attack, what will the levels be?
NORMAL
What occurs with TTP?
ADAMTS-13 deficiency forms hyaline clots that then shred cells going by!
What will be seen on peripheral smear with TTP?
Schistocytes
What is the pneumonic for TTP symptoms?
FAT RN
TTP symptoms?
FAT RN
- Fever
- Anemia (MAHA)
- Thrombocytopenia
- Renal failure
- Neuro sx
TTP symptoms?
FAT RN
- Fever
- Anemia (MAHA)
- Thrombocytopenia
- Renal failure
- Neuro sx
What is the treatment for TTP?
Exchange transfusion
Physiology behind DIC?
Illness causes clots to form everywhere and since using up clotting factors, you also bleed
Level of PT/PTT and D-Dimer with DIC?
HIGH
Level of Platelets and Fibrinogen with DIC?
LOW
PT/PTT, Platelets, Fibrinogen and D-Dimer levels with DIC?
PT/PTT = HIGH
Platelets = LOW
Fibrinogen = LOW
D-Dimer = HIGH
Treatment for DIC?
Supportive, treat underlying cause
If a patient is on heparin and they develop HIT, what will occur?
Bleeding + CLOT formation while on heparin
Signs of HIT?
Recently started on Heparin
- Bleeding
- CLOT WORSENING
What is the treatment for HIT?
Stop heparin
– Start Argatroban and bridge to Warfarin
What occurs with ITP?
Autoimmune attack against platelets ONLY
What lab change is seen with ITP?
Low platelets only
If the platelets are below _____ with ITP, give steroids
< 30K give steroids
If the platelets are above 30K, what is the treatment for ITP?
NOTHING just observe
Hemolytic anemia lab changes
LOW haptoglobin
HIGH bilirubin and LDH
