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heme part 2 Flashcards

1
Q

What are some reasons for prolonged PTT

A

Heparin
DIC
vWD
Hem A/B

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2
Q

What is the treatment for Heparin overdose

A

Protamine Sulfate

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3
Q

What measuring the intrinsic pathway

A

PTT - I II V VIII IX X XI XII

1, 2, 5, 8, 9, 10, 11, 12

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4
Q

What measuring the extrinsic pathway

A

PT - I, II, V, VII, X

1, 2, 5, 7, 10

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5
Q

What are some reasons for prolonged PT

A

warfarin therapy
vitamin K
DIC

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6
Q

what is the treatment for warfarin overdose

A

Vitamin K

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7
Q

Key terms for this diagnosis- Thrombocytopenia, microangiopathic hemolytic anemia, neurologic (headache, stroke) symptoms, fever

A

Thrombotic thrombocytopenic Purpura - TTP

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8
Q

ADAMTS-13 is positive in what ?

A

Thrombotic thrombocytopenic Purpura - TTP

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9
Q

What labs are positive with Thrombotic thrombocytopenic Purpura - TTP

A 
Thrombocytopenia - low pLT's
Normal PT, PTT
Hemolytic anemia
The problem is not clotting factors 
this is how you can tell the difference between DIC
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10
Q

Treatment for Thrombotic thrombocytopenic Purpura - TTP

A
  1. Plasma
  2. steroids to suppress the immune system
  3. Cyclophosphamides
    Do not give pLT’S it will cause CLOTS!
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11
Q

Key terms for this diagnosis- Thrombocytopenia, microangiopathic hemolytic anemia and kidney failure, children

A

Hemolytic Uremic Syndrome - HUS

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12
Q

what is Hemolytic Uremic Syndrome - HUS usually caused by?

A

Enterohemorrhagic E Coli 0157: H7
Shigella
Salmonella

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13
Q

Labs for HUS

A

Hemolytic anemia

BUN/Creatine

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14
Q

Treatment for Hemolytic Uremic Syndrome - HUS

A
  1. Plasma - FFP

2, antibiotics can make worse

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15
Q

Pathological activation of coagulation system leading to widespread micro-thrombi which consumes clotting proteinss V, VIII fibrinogen and plts
leading to severe thrombocytopenia and diffuse bleeding

A

Disseminated Intravascular Coagulation- DIC

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16
Q

What are some causes of DIC

A

Infections- Gram neg endotonixs
Maligancy- AML, Lung or GI, Prostate
OB- pre-eclampsia, abruptio placentae
burns, trauma, liver disease

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17
Q

what are symtoms of DIC

A

widespread hemorrhage- at blood draw sites, mouth nose bleeding
clots -> renal failure and gangrene

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18
Q 
Labs for DIC
Fibriogen 
PTT
PT/INR 
PLTS 
RBCs shape
A 
Fibriogen- decreased it is being used up 
PTT- proglonged
PT/INR - proglonged
PLTS- severely low 
RBCs shape - schistocytes 
Fibinolysis- D-dimer +
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19
Q

aquired abnormal isolated thrombocytopenia of unknown cause

A

Idiopathic autoimmune thrombocytopenia purpura- ITP

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20
Q

Acute ITP is most common in whom?

Chronic ITP ?

A

Acute- boys with viral infection and self limiting

chronic- adults often recurrent

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21
Q

S/S of ITP

A

often asymptomatic
mucous bleeding- purpura or bruises
petechiae, bullae, nose bleeds, hemorrhage, bleeding gums

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22
Q

what labs are positive in ITP

A

only low PLT’S

smear- megakaryocytoes or large sized platelets

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23
Q

Treatment for ITP

A

Children- observe

Adults- steroids, IVIG, splenectomy

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24
Q

Hemophilia A is what factor deficiency

A

factor VIII 8

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25
Q

Hemophilia B is what factor deficiency

A

factor XI 9 - Christmas disease

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26
Q

Key terms for this diagnosis- x-linked recessive trait occurs in males, Intrinsic pathyway affected, hemathrosis

A

Hemophilia A - Factor VIII 8 deficiency

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27
Q

Hemophilia A - Factor VIII 8 deficiency

labs

A

Prolonged PTT
normal PT
normal platelet levels

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28
Q

Treatment for Hemophilia A - Factor VIII 8 deficiency

A
  1. Factor VIII 8 & vWF

2. Desmopressin - DDAVP

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29
Q

Key terms for this diagnosis- X-linked recessive trait in males, deep tissue bleeding, prolonged PTT that corrects with a mixing study

A

Hemophilia B- IX 9 Christmas factor

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30
Q

Treatment for Hemophilia B

A

Factor IX 9 infusion only

Desmopressin DDAVP is not helpful

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31
Q

Key terms for this diagnosis- autosomal dominant disorder with ineffective platelet adhesion
most common hereditary bleeding disorder

A

Von Willebrand disease

32
Q

What is necessary for initial platelet adhesion and prevents factor VIII 8 degradation

A

Von Willebrand disease

33
Q

Labs positive with Von Willebrand disease

A

VwF levels decreased
PTT prolonged
PTT will correct with a mixing study

34
Q

Treatment for Von Willebrand disease

A

Type I: desmopressin, cryoprecipitate
Type II: DDAVP + Von willebrand factor and factor 8
Type III: Von willebrand factor and factor 8

35
Q

Lymphoctye neoplasm that is associated with EBV, upper body lymph noes most common

A

Hodgkins Disease

Hodgkins lymphoma

36
Q

What are Pel-Ebstein Fevers

what disease?

A

Cyclical fevres that increase and decrease over a period of 1-2 weeks
night sweats are present

37
Q

key terms for this diagnosis- male with enlarged lymphnodes in upper body, fevers that come and go, night sweats, weight loss

A

Hodgkins lymphoma

38
Q

Reed Sternberg cells are seen in what disease

A

Owl-eye appearance

Hodgkins lymphoma

39
Q

What are some work-up tests to do for Hodgkins lymphoma

A
  1. CT scan or PET for staging

2. Blood cells- Reed sternberg cells

40
Q

Treatment for Hodgkins lymphoma

A
  1. radiation and chemo

* Highly curable

41
Q

What are the differences between Hodgkins and non-hodgkins lymphoma

A

Hodgkins- YOUNGER, upper lymph nodes

Non- OLDER Peripheral lymph nodes (GI, skin, CNS)

42
Q

what is Burkitt lymphoma?

A

Type of Non-Hodgkin lymphoma

that starts with abdominal pain

43
Q

Treatment for Non-Hodgkin Lymphomas

A
  1. Follicular- not curable
  2. Large B-cell type- aggressive but curable with
    Chemo and radiation
  3. Rituxamab
44
Q

Proliferation of a single clone of plasma cells

increase monoclonal antibodies like IgG or IgA

A

Multiple Myeloma

45
Q

Key terms for this diagnosis- AA man older, bone pain at spine or ribs, recurrent infections, elevated calcium, anemia and kidney failure

A

Multiple Myeloma - plasmacytoma

46
Q

Multiple Myeloma - “BREAK”

what does it stand for based on the symptoms

A

B- bone pain
R- Recurrent Infections
E- Elevated calcium from bone destruction
A- Anemia
K- Kidney failure due to proteins in the kidney it can deposit

47
Q

what is seen on labs with Multiple Myeloma

A

serum electrophoresis- monocolonal protein spike
Urine electrophoresis- Bence-jones proteins
blood smear - rouleaux formation

48
Q

What will an x-ray show with MM

A

Punched-out leasions

49
Q

Treatment for Multiple Myleoma

A

Stem cell transplant

with chemotherapy

50
Q

what is the most common childhood malignancy

A

Acute Lymphocytic leukemia - ALL

51
Q

Key terms for this diagnosis- 3-7 years with pancytopenia, fatigue, lethargy, bone pain, headaches, stiff neck, visual changes, , hepatosplenomegaly
lymph-node enlargement

A

Acute Lymphocytic leukemia - ALL

52
Q

What will a blood smear show with Acute Lymphocytic leukemia - ALL

A

> 20% blasts
WBC 5-100K
anemia
PLT’S low

53
Q

Treatment for Acute Lymphocytic leukemia - ALL

A

Oral chemotherapy

good prognosis 90% remission

54
Q

What is the most common leukemia in adults

A

Chronic Lymphocytic Leukemia - CLL

55
Q

Key terms for this diangosis- often asymptomatic but seen on blood tests, fatigue, increased infections, lymphadenopathy, hepatospleomegaly,
smear- well differeniated lymphocytes with smudge cells

A

Chronic Lymphocytic Leukemia - CLL

56
Q

Treatment for Chronic Lymphocytic Leukemia - CLL

A
  1. observe
  2. chronic- chemotherapy
  3. if in blast crisis- Allopurinol
57
Q

What is the most common ACUTE leukemia in adults

A

Acute Myeloid leukemia - AML

58
Q

Key terms for this diagnosis- acute anemia, throbocytopenia, neutropenia, splenomegaly, gingival hyperplasia and bone pain
Leukostatsis >100,000, blood smear shows Auer rods with>20% blasts

A

Acute Myeloid leukemia - AML

59
Q

Treatment for Acute Myeloid leukemia - AML

A
  1. Combination chemotherapy

* risks of tymor lysis syndrome can kill them due to a large number of cells being destroyed

60
Q

Key terms for this diangosis- asympatomatic until blastic crisis, labs show WBC 100,000, Philadelphia chromosome +

A

Chronic Myeloid Leukemia - CML

61
Q

Treatment for Chronic Myeloid Leukemia - CML

A
  1. Chemotherapy in Philadelphia +
62
Q

Acquired Myeloproliferatvie disorder with overproduction of 3 stem cell lines, mostly RBC’s but increased WBC and PLT’s

A

Polycythemia Vera

63
Q

Key terms for this diangosis- Older Man with Jak2 mutation, Increased HCT with no hypoxia, pruritius with a hot bath, facial flushing, episodic burning/throbbing of hands and feet with edema

A

Polycythemia Vera

64
Q

Treatment for Polycythemia Vera

A
  1. Phlebotomy -> do until HCT is less than 45

2. Hydroxyurea - will stop cells that divide quickly

65
Q

Key terms for this diangosis- obese smoker or a normal person with hypoxic environment with high HCT but normal WBC and plts

A

Secondary Erythrocytosis

66
Q

Genetic disorder with excess iron deposits in the heart, liver, pancreas. Increased intestinal iron absorption

A

Hereditary Hemochromatosis

67
Q

Key terms for this diangosis- 40years, iwht abd pain cirrhosis, fatigue, cardiomyopathy, arrhythmias, tesicule atropy/immpotence, metallic or bronze skin

A

Hereditary Hemochromatosis
iron overload will show the bronze skin
“bronze diabetes”

68
Q

What is the gold standard test for Hereditary Hemochromatosis

A

Liver biopsy for increase hemosiderin

69
Q

Treatment for Hereditary Hemochromatosis

A
  1. Phlebotomy
    test relatives
    genetic couseling
    no iron pills alcohol or vitamin C
70
Q

Key terms for this diagnosis- cirrhosis, end stage liver disease with bleeding
increased PT/PTT that corrects with mixing study, low albumin. decreased fibrinogen and PLTS

A

Coagulopathy of advanced liver disease

the liver is failing and cant not make coagulation factors

71
Q

Treatment for Coagulopathy of advanced liver disease

A
  1. FFP

2. Cryo will contain fibrinogen, factor VIII 8 and vWF

72
Q

Most common inherited cause of Hypercoagulability

A

Factor V leiden

73
Q

Key terms for this diagnosis- young patient with a DVT or PE with no precipitating factor

A

Factor V leiden

74
Q

Treatment for Factor V leiden

A
  1. high risk- Anti coagulation always

2. moderate risk- give anticoagulants during high risk procedures

75
Q

Protein C deficiency will lead to what problem?

A

increased risk of recurrent DVT’s and PE’s

Protein C is needed for fibrinolysis and clot lysis

76
Q

If a patient with Protein C deficiency is given heparin what is a common side effect they experience

A

Warfarin-induced skin necrosis

77
Q

Antihrombin III deficiency will lead to what problem?

A

recurrent DVT’s and PE’s

first episode often occurs between 20-30years

Last EOR exam (6 decks)

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