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Clinical Medicine II > Lab Med: CBC/Coagulation studies > Flashcards

Lab Med: CBC/Coagulation studies Flashcards

1
Q

top of the fishbone…

A

hemoglobin

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2
Q

bottom of fishbone

A

hematocrit

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3
Q

left of fishbone

A

WBC

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4
Q

right of fishbone

A

platelets

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5
Q

What would you expect H/H to do in response to these conditions:

Dehydration
COPD
Polycythemia vera
High Altitude

A

Elevate

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6
Q

What would you expect H/H to do in response to these conditions:

Anemia

A

Decrease

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7
Q

This measures the average size of RBCs…

A

MCV

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8
Q

This is an indicator of size variation of RBCs…

A

RDW

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9
Q

Variation in size of RBCs is known as…

A

anisocytosis

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10
Q

What is the primary cause of leukocytosis?

A

Bacterial infection

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11
Q

What are common causes of leukocytosis

A 
bacterial infx
inflammation
neoplasm
leukomoid response
steroid use
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12
Q

What are common causes of leukopenia?

A 
viral infx
overwhelming bacterial infx
bone marrow failure
drug toxicity
autoimmune disorder
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13
Q

Neutrophils, Eosinophils, Basophils are all classified as ______ because they have _____ in their cytoplasm and ________ nuclei

A

granulocytes

granules in cytoplasm

multilobed nuclei

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14
Q

PMNs or “polys” are…

A

polymorphonuclear leukocytes, aka granylocytes

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15
Q

the most common PMN is…

A

neutrophil

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16
Q

This granulocyte is involved in allergic and parasitic infx

A

eosinophil

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17
Q

this granulocyte is the least common, and is involved in allergic reactions

A

basophils

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18
Q

Neutrophilia occurs most common with…

A

bacterial infx

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19
Q

neutropenia most commonly occurs with…

A

overwhelming bacterial infx
aplastic anemia
viral infx

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20
Q

Eosinophilia is common with…

A

fungal, parasitic infx

allergic rxn

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21
Q

Eosinopenia is common with…

A

CS use, acute inflammation

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22
Q

Do eosinophils respond to bacterial or viral infx?

A

no

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23
Q

Basophilia occurs when…

A

myeloproliferative disease

leukemia

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24
Q

basopenia occurs with…

A

acute allergic rxn, stress

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25
Q

T-Cells and B-Cells are classified as ________ and work to fight _________ infections.

A

lymphocytes

fight acute viral infx

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26
Q

these phagocytic cells are capable of fighting bacteria directly…

A

monocytes

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27
Q

Lymphocytosis commonly indicates what diseases?

A

mononucleosis (EBV) and hepatitis

viral infx

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28
Q

Infections, CS use, immunodeficiency, lymphoma, chemo, radiation therapy can all cause what response with lymphocytes?

A

lymphocytopenia

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29
Q

What is a common cause of monocytopenia?

A

CS use

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30
Q

Chronic inflammatory disorders

viral and parasitic infx

TB

severe infx

These can all have what effect on monocytes?

A

monocytosis

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31
Q

These conditions can cause what type of thrombocytosis?

Acute blood loss

Malignancy

Inflammatory conditions

Trauma

Infx

A

Reactive thrombocytosis

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32
Q

What are common causes of thrombocytosis?

A

reactive

essential

polycythemia vera

CML, AML, MDS, Myelofibrosis

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33
Q

The following conditions have what effect on platelets?

ITP

TTP

drug induced immune

cancer s/ BM suppression

infx

chronic liver disease

DIC

aplastic anemia

inherited disorder

A

thrombocytopenia (reduced)

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34
Q

This disease is a chronic myeloproliferative neoplasm that causes clonal proliferation of myeloid cells and an elevated RBC…

A

polycythemia vera

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35
Q

a male patient presents with the following. What do you suspect, and what labs do you order?

Hb: 16.5
HCT: 49

thrombosis
pruritis
splenomegaly
headaches, parasthesias

A

polycythemia vera . evidenced by Hb and HCT

Labs:

Serum EPO

peripheral blood screening for JAK mutation

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36
Q

Females with polycythemia vera will have a Hb of _______ and a HCT of _______

A

Hb: 16 or higher

HCT: 48% or higher

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37
Q

The following are all examples of what type of condition?

platelet dysfunction

splenic sequestration

increased destruction

impaired production

A

platelet disorders

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38
Q

The following are all examples of what type of condition?

Antithrombin deficiency

Protein C deficiency

Protein S deficiency

Factor V Leiden mutation

Prothrombin mutation

A

primary hypercoagulable disorders

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39
Q

What is a threat with primary hypercoagulable disorders?

A

DVT

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40
Q

The following are all examples of what type of condition?

Hemophilia A and B
Von Willebrand Disease

A

congenital coagulation disorders

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41
Q

which etiology of platelet dysfunction is more common:

Acquired or congenital?

A

Acquired

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42
Q

What drugs commonly cause acquired platelet dysfunctions?

A

abx, chemo

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43
Q 
Drugs
Uremia
Liver disease
Von Willebrand
Myeloproliferative disease

These are common causes of…

A

acquired platelet dysfunction

44
Q

How do you manage platelet dysfunction?

A

treat underlying cause

platelet transfusion

45
Q

In this disease, cirrhosis caues vascular congestion leading to splenomegaly and thrombocytopenia…

A

Splenic sequestration

46
Q

ITP

DIC

heparin induced thrombocytopenia

TTP

HUS

Other thrombotic microangiopathies

These can all cause what type of platelet disorder

A

increased destruction

47
Q

this disorder occurs when:

antiplatelet Abs cause platelet activation.

increased platelet activation leads to increased risk of vascular thrombosis

thrombocytopenia and prothrombotic states can occur…

what drug is responsible and what is the disorder called?

A

Heparin induced thrombocytopenia

caused by UFH or LMWH

48
Q

Can pts with hx of HIT have heparin again?

A

no!

49
Q

TTP and HUS are examples of…

A

thrombotic microangiopathy

50
Q

This disease occurs when platelets are incorporated into thrombi in microvasculature, contributing to microangiopathic hemolytic anemia.

A

thrombotic microangiopathy

51
Q

what type of RBCs can you see in thrombotic microangiography?

A

RBC fragmentation, schistocytes

52
Q

This type of thrombotic microangiopathy has the following etiology:

Medical Emergency

Caused by Abs against ADAMTS-13

A

TTP

53
Q

This type of thrombotic microangiopathy has the following characteristics:

Microangiopathic hemolytic anemia

thrombocytopenia

acute kidney injury

neurological deficits

fever

Can also have purpura, petechiae, pallor, jaundice

A

TTP

54
Q

this disease is common in pediatric patients with bloody stool as a result of shiga toxin producing E. Coli

A

Hemolytic Uremic Syndrome (HUS)

55
Q

This disease presents with:

Microangiopathic hemolytic anemia

thrombocytopenia

acute kidney injury

A

hemolytic uremic syndrome

56
Q

This disease presents with the following laboratory findings:

Schistocytes

Increased LDH, Indirect bilirubin

Decreased haptoglobin

coombs negative

thrombocytopenia (CBC)

Normal PT/aPTT

A

thrombotic microangiopathy (HUS, TTP)

57
Q

How do you treat thrombotic microangiopathies?

A

plasma exchange, supportive care

58
Q

Both HUS and TTP present with hemolytic anemia, thrombocytopenia, acute kidney injury.

What two signs/sxs occur in TTP that don’t in HUS?

A

neurological deficits

Fever

59
Q

What are the common causes of impaired platelet production?

A

bone marrow failure

chemo/radiation

B12, folate, iron deficiency

EtOH consumption

60
Q

This coagulation study evaluates the intrinsic and common pathways, as well as monitors UFH therapy…

A

PTT/aPTT

61
Q

This coagulation study is the preferred test to monitor UFH and LMWH therapy

A

anti-factor Xa

62
Q

This coagulation study is used to evaluate the extrinsic and common pathways and to monitor warfarin therapy…

A

PT

63
Q

This coagulation study is calculated as a ratio of the patient’s PT to a control PT. It is used to monitor warfarin therapy.

The goal is depended on the underlying need for anticoagulation.

A

INR

64
Q

This mixing test is used to differentiate between a coagulation factor deficiency vs. an inhibitor problem…

A

inhibitor screen

65
Q

this test measures the conversion of fibrinogen to fibrin and isn’t used as an initial screen.

A

thrombin time

66
Q

Low levels of this can result in impaired clot formation and increased bleeding risk

A

fibrinogen

67
Q

This panel of tests is composed of…

antithrombin
factor V-leiden
protein C
protein S
prothrombin gene mutation
lupus anticoagulant
MTHFR
A

hypercoagulable panel

68
Q

What limits the use of the hypercoagulable panel?

A

it is expensive

69
Q

the fast acting anticoagulants are…

A

UGH, LMWH (lovenox)

70
Q

Long therm anticoagulants are…

A

Warfarin (coumadin)

Factor Xa inhibitors

Dabigatran (oral direct thrombin inhibitor)

71
Q

What are the DOACs (direct oral anticoagulants)?

A

Factor Xa inhibitors

Oral direct thrombin inhibitors (dabigatran)

72
Q

Anticoagulant DOC:

Cancer pts

A

lovenox (LMWH)

73
Q

Anticoagulant DOC:

inability to have parenteral therapy…

A

Rivaroxaban, edoxaban (factor Xa inhibitors)

74
Q

Anticoagulant DOC:

once daily, PO therapy

A

Rivaroxaban, edoxaban (factor Xa inhibitors)

Warfarin (vitamin K antagonist)

75
Q

Anticoagulant DOC:

Liver disease + coagulopathy

A

Lovenox (LMWH)

76
Q

Anticoagulant DOC:

Renal disease and creatinine clearance less than 30

A

Warfarin (vitamin K antagonist)

77
Q

Anticoagulant DOC:

Coronary artery disease

A

Warfarin

Rivaroxaban, apixaban, edoxaban (factor Xa inhibitors)

78
Q

Anticoagulant DOC:

Poor compliance

A

warfarin

79
Q

Anticoagulant DOC:

need for reversal agent

A

warfarin

UGH

Dabigatran

80
Q

Anticoagulant DOC:

Pregnancy

A

Lovenox (LMWH)

81
Q

Which anticoagulants require 5-10 days of parenteral anticoagulation?

A

dabigatran

edoxaban

82
Q

Anticoagulant DOC:

DVT, PE without underlying malignancy

A

DOACs

83
Q

Anticoagulant DOC:

Patients with DVT, PE with underlying malignancy

A

Lovenox (LMWH)

84
Q

A patient is on UFH… what baseline labs do you want? What do you want for monitoring

A

Baseline:

aPTT, PT/INR
CBC

Monitoring:
aPTT
Factor Xa

85
Q

A patient is on LMWH. What baseline labs do you want? What do you order for monitoring?

A

Baseline:

aPTT, PT/INR
CBC
Creatinine

Monitoring:
none

86
Q

A patient is on a DOAC. What baseline labs do you want? What do you order for monitoring?

A

Baseline:

PT/INR
CBC
Creatinine

Monitoring:
none

87
Q

A patient is on a Warfarin. What baseline labs do you want? What do you order for monitoring?

A

Baseline:

aPTT, PT/INR
CBC
Creatinine
LFTs

Monitoring:
PT/INR

88
Q

Can you do a loading dose for warfarin?

A

no

89
Q

What is the initial dose of warfarin?

A

5mg/day

90
Q

How long should parenteral therapy of UFH/LMWH overlap with warfarin?

A

at least 5 days, until INR is therapeutic for minimum of 24 hours or 2 consecutive days

91
Q

What strategy of warfarin dosing should be considered to find optimum dose?

A

titrate to appropriate INR

92
Q

How often should INR be monitored with warfarin therapy?

A

daily, then weekly

every 2-4 weeks once stabilized

93
Q

Target INR for:

Propylaxis

A

1.5-2

94
Q

Target INR for:

VTE

A

2-3

95
Q

Target INR for:

afib

A

2-3

96
Q

Target INR for:

mechanical mitral valve

A

2.5-3.5

97
Q

Target INR for:

mechanical aortic valve

A

2-3

98
Q

Patient on warfarin presents with an INR of 4.5-10 with no evidence of bleeding…

How do you treat?

A

Hold warfarin

Administer PO Vitamin K

99
Q

Patient on warfarin presents with INR greater than 10, no evidence of bleeding. How do you treat?

A

Hold warfarin

give PO vitamin K

100
Q

Patient presents with VKA associated major bleeding. How do you treat?

A

hold warfarin

Rapid reversal with PCC, give IV vitamin K

101
Q

UFH and LMWH Reversal agent…

A

protamine

102
Q

Warfarin reversal agent

A

Vitamin K

PCC

103
Q

Dabigatran reversal agent

A

idarucizumab (praxbind)

104
Q

Rivaroxaban (xarelto) reversal agent

A

none, supportive care

105
Q

Apixaban (eliquis) and edoxaban (lixiana, savaysa) reversal agent

A

adexanet

106
Q

Why do you give PCC and vitamin K to get the INR down in warfarin therapy?

A

PCC rapidly reduces INR as bridge until Vitamin K begins.

work synergistically

Clinical Medicine II (31 decks)

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