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Last EOR exam > heme part 2 > Flashcards

heme part 2 Flashcards

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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
Hemophilia B is what factor deficiency
factor XI 9 - Christmas disease
26
Key terms for this diagnosis- x-linked recessive trait occurs in males, Intrinsic pathyway affected, hemathrosis
Hemophilia A - Factor VIII 8 deficiency
27
Hemophilia A - Factor VIII 8 deficiency | labs
Prolonged PTT normal PT normal platelet levels
28
Treatment for Hemophilia A - Factor VIII 8 deficiency
1. Factor VIII 8 & vWF | 2. Desmopressin - DDAVP
29
Key terms for this diagnosis- X-linked recessive trait in males, deep tissue bleeding, prolonged PTT that corrects with a mixing study
Hemophilia B- IX 9 Christmas factor
30
Treatment for Hemophilia B
Factor IX 9 infusion only | Desmopressin DDAVP is not helpful
31
Key terms for this diagnosis- autosomal dominant disorder with ineffective platelet adhesion most common hereditary bleeding disorder
Von Willebrand disease
32
What is necessary for initial platelet adhesion and prevents factor VIII 8 degradation
Von Willebrand disease
33
Labs positive with Von Willebrand disease
VwF levels decreased PTT prolonged PTT will correct with a mixing study
34
Treatment for Von Willebrand disease
Type I: desmopressin, cryoprecipitate Type II: DDAVP + Von willebrand factor and factor 8 Type III: Von willebrand factor and factor 8
35
Lymphoctye neoplasm that is associated with EBV, upper body lymph noes most common
Hodgkins Disease | Hodgkins lymphoma
36
What are Pel-Ebstein Fevers | what disease?
Cyclical fevres that increase and decrease over a period of 1-2 weeks night sweats are present
37
key terms for this diagnosis- male with enlarged lymphnodes in upper body, fevers that come and go, night sweats, weight loss
Hodgkins lymphoma
38
Reed Sternberg cells are seen in what disease
Owl-eye appearance | Hodgkins lymphoma
39
What are some work-up tests to do for Hodgkins lymphoma
1. CT scan or PET for staging | 2. Blood cells- Reed sternberg cells
40
Treatment for Hodgkins lymphoma
1. radiation and chemo | * Highly curable
41
What are the differences between Hodgkins and non-hodgkins lymphoma
Hodgkins- YOUNGER, upper lymph nodes | Non- OLDER Peripheral lymph nodes (GI, skin, CNS)
42
what is Burkitt lymphoma?
Type of Non-Hodgkin lymphoma | that starts with abdominal pain
43
Treatment for Non-Hodgkin Lymphomas
1. Follicular- not curable 2. Large B-cell type- aggressive but curable with Chemo and radiation 3. Rituxamab
44
Proliferation of a single clone of plasma cells | increase monoclonal antibodies like IgG or IgA
Multiple Myeloma
45
Key terms for this diagnosis- AA man older, bone pain at spine or ribs, recurrent infections, elevated calcium, anemia and kidney failure
Multiple Myeloma - plasmacytoma
46
Multiple Myeloma - "BREAK" | what does it stand for based on the symptoms
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
what is seen on labs with Multiple Myeloma
serum electrophoresis- monocolonal protein spike Urine electrophoresis- Bence-jones proteins blood smear - rouleaux formation
48
What will an x-ray show with MM
Punched-out leasions
49
Treatment for Multiple Myleoma
Stem cell transplant | with chemotherapy
50
what is the most common childhood malignancy
Acute Lymphocytic leukemia - ALL
51
Key terms for this diagnosis- 3-7 years with pancytopenia, fatigue, lethargy, bone pain, headaches, stiff neck, visual changes, , hepatosplenomegaly lymph-node enlargement
Acute Lymphocytic leukemia - ALL
52
What will a blood smear show with Acute Lymphocytic leukemia - ALL
> 20% blasts WBC 5-100K anemia PLT'S low
53
Treatment for Acute Lymphocytic leukemia - ALL
Oral chemotherapy | good prognosis 90% remission
54
What is the most common leukemia in adults
Chronic Lymphocytic Leukemia - CLL
55
Key terms for this diangosis- often asymptomatic but seen on blood tests, fatigue, increased infections, lymphadenopathy, hepatospleomegaly, smear- well differeniated lymphocytes with smudge cells
Chronic Lymphocytic Leukemia - CLL
56
Treatment for Chronic Lymphocytic Leukemia - CLL
1. observe 2. chronic- chemotherapy 3. if in blast crisis- Allopurinol
57
What is the most common ACUTE leukemia in adults
Acute Myeloid leukemia - AML
58
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
Acute Myeloid leukemia - AML
59
Treatment for Acute Myeloid leukemia - AML
1. Combination chemotherapy | * risks of tymor lysis syndrome can kill them due to a large number of cells being destroyed
60
Key terms for this diangosis- asympatomatic until blastic crisis, labs show WBC 100,000, Philadelphia chromosome +
Chronic Myeloid Leukemia - CML
61
Treatment for Chronic Myeloid Leukemia - CML
1. Chemotherapy in Philadelphia +
62
Acquired Myeloproliferatvie disorder with overproduction of 3 stem cell lines, mostly RBC's but increased WBC and PLT's
Polycythemia Vera
63
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
Polycythemia Vera
64
Treatment for Polycythemia Vera
1. Phlebotomy -> do until HCT is less than 45 | 2. Hydroxyurea - will stop cells that divide quickly
65
Key terms for this diangosis- obese smoker or a normal person with hypoxic environment with high HCT but normal WBC and plts
Secondary Erythrocytosis
66
Genetic disorder with excess iron deposits in the heart, liver, pancreas. Increased intestinal iron absorption
Hereditary Hemochromatosis
67
Key terms for this diangosis- 40years, iwht abd pain cirrhosis, fatigue, cardiomyopathy, arrhythmias, tesicule atropy/immpotence, metallic or bronze skin
Hereditary Hemochromatosis iron overload will show the bronze skin "bronze diabetes"
68
What is the gold standard test for Hereditary Hemochromatosis
Liver biopsy for increase hemosiderin
69
Treatment for Hereditary Hemochromatosis
1. Phlebotomy test relatives genetic couseling no iron pills alcohol or vitamin C
70
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
Coagulopathy of advanced liver disease | the liver is failing and cant not make coagulation factors
71
Treatment for Coagulopathy of advanced liver disease
1. FFP | 2. Cryo will contain fibrinogen, factor VIII 8 and vWF
72
Most common inherited cause of Hypercoagulability
Factor V leiden
73
Key terms for this diagnosis- young patient with a DVT or PE with no precipitating factor
Factor V leiden
74
Treatment for Factor V leiden
1. high risk- Anti coagulation always | 2. moderate risk- give anticoagulants during high risk procedures
75
Protein C deficiency will lead to what problem?
increased risk of recurrent DVT's and PE's | Protein C is needed for fibrinolysis and clot lysis
76
If a patient with Protein C deficiency is given heparin what is a common side effect they experience
Warfarin-induced skin necrosis
77
Antihrombin III deficiency will lead to what problem?
recurrent DVT's and PE's | first episode often occurs between 20-30years

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