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Heme/Genetics > Lab Med Blood Disorders & Malignancy > Flashcards

Lab Med Blood Disorders & Malignancy Flashcards

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1
Q

What are the 2 broad categories of bleeding disorders?

A
  1. Coagulopathy

2. Platelet disorder

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2
Q

Coagulopathies include… (4)

A
  • intrinsic factor defect
  • extrinsic factor defect
  • combination defect
  • hypercoagulable state (inherited or acquired)
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3
Q

Platelet disorders include… (2 categories, 5 disorders)

A

Thrombocytopenia

  • -Drug Induced
  • -ITP (immune thrombocytopenic purpura)
  • -Heparin-Induced:Immune Mediated

Platelet Dysfxn

  • -Acquired
  • -Inherited
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4
Q

Coagulopathy vs. Platelet Disorder (amount of bleed after surface cut)

A

Coag: Normal to slight increased time

Plt: Excessive, prolonged

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5
Q

Coagulopathy vs. Platelet Disorder (onset of bleed after injury)

A

Coag: Delayed bleed after sx or trauma // Spontaneous bleed into joints or hematoma development

Plt: Immediate bleeding

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6
Q

Coagulopathy vs. Platelet Disorder (clinical presentation)

A

Coag: Deep & excessive bleeding into joints, muscles, GI tract, and GU

Plt: Superficial & mucosal bleeding (GI, gingival, nasal), Petechiae, ecchymosis

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7
Q

Initial labs for bleeding disorders

A

-PT/PTT
-CBC
-Platelet count – in CBC
-DIC Panel:
D-dimer
Fibrinogen
Peripheral blood smear

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8
Q

When looking at labs for platelet disorders you should…

A
  • consider if it’s low count or dysfunction
  • Focus on PLT count 1st – if low then we have thrombocytopenia
  • If PLT disfxn - count could be normal, just not working/or inhibited fxn
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9
Q

When looking at labs for coagulopathy you should…

A
  • Focus on PT and PTT values
  • If one or both are elevated there is a coagulation defect.
  • Think clotting cascade and coagulation factors involved.
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10
Q

Define thrombocytopenia

A

LOW PLT count < 90,000 cells/uL

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11
Q

What can cause low plt count?

A

Most Common is Drug-induced – R/o with medication reconciliation and short discontinuation of causative agent prior to procedure then resume after recovery period. (Clopidogrel, Enoxaparin, etc.)

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12
Q

Would would severely low platelets indicate?

A

ITP (immune thrombocytopenic purpura)

*exclude DIC after running a negative panel

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13
Q

What would delayed low platelets indicate?

A

Heparin-induced: Immune-mediated

  • usually 4-14 days after initiated heparin treatment.
  • Confirmed with LAB order = PF-4 antibodies
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14
Q

What plt count would you see in plt dysfunction that’s acquired?

A

NORMAL - PLT count 150-400 x 10,000cells/uL

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15
Q

What is on your diff dx for acquired plt dysfunction?

A
  • Severe Liver Dz
  • HELLP syndrome(seen in pregnancy with pregnancy-induced HTN)– Hemolysis, elevated liver enzymes, & low plts.
  • Cirrhosis, End Stage Liver Dz.
  • Severe Renal Dz (ARF/CRF, HUS, ESRD)
  • DIC
  • Aspirin use
  • Multiple myeloma
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16
Q

What plt count would you see in plt dysfunction that’s inherited?

A

NORMAL - PLT count 150-400 x 10,000cells/uL

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17
Q

What is on your diff dx for inherited plt dysfunction?

A
  • Bernard-Soulier Syndrome
  • Glanzmann’s thrombasthenia
  • Storage Pool Disease
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18
Q

What is the treatment for both acquired and inherited plt dysfxn?

A

*give them normal platelets
MEDS: Desmopressin, OCPs (oral contraceptive pills), and FFP (fresh, frozen plasma - used in severe cases when plt infusion doesn’t work) or cryoprecipitate

19
Q

What 3 steps do you follow to confirm plt disorder?

A

1 Confirm Platelet Count in citrated blood

#2 Repeat CBC, peripheral blood smear and 1 HR post transfusion platelet count.
*Distinguish between LOW PLT PRODUCTION/pancytopenia/ small plts/or increased plt count following plt transfusion.
*AND INCREASED PLT DESTRUCTION large plts/ no significant increase in plt count post transfusion.
#3 Obtain bone marrow biopsy with cases of severe thrombocytopenia

20
Q

What do you focus on for coagulation defects?

A

PT/PTT

21
Q

What do you expect to see for intrinsic coagulation defects?

A

Normal PT
Elevated PTT

Dx = heparin use
*could order mixing study

22
Q

What do you expect to see for extrinsic coagulation defects

A

Elevated PT

Normal PTT

23
Q

What do you expect to see for combined coagulation defects

A

Elevated PT

Elevated PTT

24
Q

What is a mixing study?

A

Lab tech mixes equal amounts of the patient’s plasma with normal value plasma and then rerunning the PT and PTT tests on the mix

25
Q

What is your diff dx if after mixing study, PTT is now normal?

A

DIAGNOSIS:

  • Factor VIII deficiency (Hemophilia A, sort of Von Willebrand)
  • Factor IX deficiency (Hemophilia B)
  • Factor XI deficiency (Hemophilia C)
  • All intrinsic factors
  • Order each of these Factor tests to confirm which deficiency.
26
Q

What is your diff dx if after mixing study, PTT is still elevated?

A

DIAGNOSIS:

  • Factor VIII inhibitor
  • Factor IX inhibitor
  • Factor XI inhibitor
  • Order each of these Factor tests to confirm which inhibitor.
27
Q

Hemophilia A is deficiency in which factor?

A

VIII (8)

28
Q

Hemophilia B is deficiency in which factor?

A

IX (9)

29
Q

What will occur in both hemophilia A/B after mixing study?

A

Both fall under Intrinsic coagulopathy, therefore initially the PTT will be elevated and then normalize after mixing study.

30
Q

What is your diff dx if PT is elevated? (extrinsic coagulation defect)

A

-Early DIC
-Liver Disease
-Warfarin use
-Vitamin K deficiency
Confirm with empirical treatment of oral vitamin K to see PTT normalize

31
Q

How do you confirm early DIC?

A

Confirm with Panel D-dimer, fibrinogen, blood smear (see handout)

32
Q

How do you confirm liver disease?

A

Confirm with elevated LFTs, Hepatitis Panel (to come in GI)

33
Q

How do you confirm warfarin use?

A

Confirm with medication reconciliation

34
Q

How do you confirm vitamin K deficiency?

A

Confirm with empirical treatment of oral vitamin K to see PTT normalize

35
Q

What is your diff dx if both PT & PTT are elevated? (combined coagulation defect)

A
  • Heparin use (confirm with medication reconciliation)
  • Severe DIC (confirm with DIC panel)
  • Severe Liver Disease (confirm with elevated LFTs, Hepatitis Panel)
  • Severe Vitamin K deficiency (confirm with empirical treatment of oral vitamin K to see PT normalize. Research probable cause to prevent continued deficit)
36
Q

What do you order if no previous diff dx is confirmed?

A

Then order FACTOR LEVELS (all 3) to see which one is low…

  • Factor II deficiency
  • Factor V deficiency
  • Factor X deficiency
  • Fibrinogen < 100mg/dl
  • VWD - Factor
37
Q

Hypercoagulation is commonly referred to as…

A

Thrombophilia

38
Q

Examples of inherited hypercoagulation (6)

A
  • Most common = Factor V Leiden Deficiency
  • Prothrombin 20210 mutation
  • Protein C or S Deficiency
  • Anti-thrombin III Deficiency
  • Homocystinemia
  • Fibrinolysis Defects
39
Q

Examples of acquired hypercoagulation (9)

A
  • Prolonged Rest
  • Immobilization
  • Smoking
  • OCP
  • Pregnancy
  • Nephrotic Syndrome
  • Cancer
  • DIC
  • Lupus anticoagulant
40
Q

What is another hypercoagulation?

A

Antiphospholipid Syndrome - APS

41
Q

What is APS?

A

Arterial or venous thrombosis or pregnancy loss and the presence of antiphospholipid antibodies

42
Q

Primary APS vs. Secondary APS

A 
Primary if alone
Secondary if associated with: 
--SLE
--Rheumatic disorders
--Or infection
--Or medication
43
Q

Labs for APS

A
  • Antiphospholipid Abs
  • Anticardiolipin Abs
  • Lupus Anticoagulant
  • B2-glycoprotein I Ab
  • Plus tests for inherited factors

Heme/Genetics (15 decks)

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