Heme Rem Exam

Question 1

Heparin reversal

Answer 1

Protamine sulfate originally isolated from sperm of salmon

Dosing: 1.0-1.5mg iv for every 100 iu of active heparin

Question 2

What is a side effect of heparin reversal?

Answer 2

Hypotension & anaphylaxis

Question 3

What is the reversal administered for warfarin?

Answer 3

Vitamin K PO or IM
P0= mephyton
IM = aquamephyton
Duration of action: a couple of hours

Question 4

Why can’t vitamin K be given iv?

Answer 4

It will cause anaphylaxis

Question 5

What is a suggested antidote for newer anticoagulants?

Answer 5

Fresh frozen plasma

Question 6

What is an antidote for oral direct anticoagulants such as Apixaban, rivaroxaban, and edoxaban?

Answer 6

Andexxa

Question 7

What type of antidote is andexanent & what is its mechanism of action?

Answer 7

A modified recombinant factor Xa that inhibits factor Xa

Question 8

What are injectable anticoagulants that act on factor Xa?

Answer 8

Enoxaparin (Lovenox) and fondaparinux (arixtra)

Question 9

What is pradaxa reversed by?

Answer 9

Praxbind

Question 10

What are p2y12 inhibitors?

Answer 10

Drugs that block platelet aggregation

AKA ADP receptor blockade

Question 11

What is an example of an irreversible P2Y12 inhibitor?

Answer 11

Plavix & plasugrel
AKA clopidogrel & effient
Class of thienopyridines

Question 12

What is an example of a p2y12 inhibitor that is reversible?

Answer 12

Nonthienopyridines
Brilinta and kengreal
Aka ticagrelor and cangrelor

Question 13

What does FFP consist of?

Answer 13

Mixture of factors II, VII, IX, X
Possibly C, S, Z
Coumadin does not interfere with FFP

Question 14

In what situations would heparin reversal be indicated?

Answer 14

Patients that need urgent surgery but are on heparin

Must be administered slowly

Question 15

What is the benefit of using direct thrombin inhibitors?

Answer 15

They are low molecular weight heparin that are more selective to factor Xa
* more predictable than warfarin
Ex) pradaxa and acova ( dabigatran and aragatroban)

Question 16

What type of anticoagulant is lovenox & what is its mechanism?

Answer 16

Low molecular weight heparin

Short fragments of heparin that direct anti-thrombin more selectively against factor X than against activated factor IIa

Question 17

What is the red cell morphology of iron deficiency anemia?

Answer 17

Low MCV
Normal RDW
Microcytic
Hypochromic: more than 1/3 of RBC is pale

Question 18

What lab is used to measure iron deficiency anemia & why?

Answer 18

Ferritin = main storage form of Fe
Low in iron deficiency anemia
*helps to differentiate b/t anemia of chronic disease

Question 19

Hydroxyurea

Answer 19

Sickle cell disease
Polycythemia
Thrombocytosis

Question 20

How does hydroxyurea treat sickle cell disease?

Answer 20

It promotes HbF production

Question 21

What causes iron deficiency anemia?

Answer 21

Inadequate supply of iron
Either due to -
decreased intake
Decreased absorption
Increased losses of iron

Question 22

What is the cell morphology of anemia of chronic disease?

Answer 22

Size: microcytic to normocytic
Pattern: normochromic

Question 23

What would the lab findings be in anemia of chronic disease?

Answer 23

Low serum iron
Low/normal transferritin
Ferritin is increased******
Low retic count
Low / normal TIBC
* total amount of iron in body is normal but access to it is limited

Question 24

What is the morphology of Macrocytic anemia?

Answer 24

MCV > 100 fl
B12 deficiency and folate deficiency
Alcoholism
Down syndrome
Hypothyroidism
Liver disease

Also seen in myelodysplasia, leukemia; reticulocytosis

Question 25

Common peripheral blood smear finding in macrocytosis

Answer 25

Hypersegmented neutrophils

Ex) B12 deficiency

Question 26

What lab finding is consistent with macrocytosis?

Answer 26

Increased MCV

Question 27

What type of drug is hydroxyurea?

Answer 27

Bone marrow suppressant that promotes production of fetal hemoglobin

Question 28

What is the most common hereditary coagulopathy?

Answer 28

Von Willebrand Disease

Affects primary Hemostasis