Nephrology/Hematology ABC Flashcards
Physiologic changes in renal physiology in pregnancy
increase by 30% in size 1-1.5 cm longer GFR increased by 40-50% mild hydro R>L creatinine 0.4-0.8
renal blood flow increases 60-80%
decreased plasma osmolality - release ADH
protein excretion around 200 mg a day
can see glucosuria without hyperglycemia
What’s the recommended rad limitation?
5 rads
rocephin dosing for pyelo
1 gm q 24 hours
ddx of thrombocytopenia
ITP ( anti plt antibodies do not help to differeniate from gestational thrombocytopenia) drug reaction ( heparin, AED, antimicrobials, analgesics) PreE/HELLP/ TTP/HUS/AFLP Chronic disease (autoimmune- SLE/APAS) Infectious ( hep C/ HIV/CMV) Pseudothrombocytopenia ( plt clumping) vWD DIC bone marrow supression/maligancies splenic sequestation congenital thrombocytopenia
ITP managment in pregnancy
at least q trimester CBC
avoid NSAID
if spelectomy- vaccines for H flu, pnemococcus, meningococcus
hold IM injections for neonate until cord blood plt count is resulted. Nadirs at 2-5 days.
ITP treatment
prednisone 10-20 mg daily (should see responce by 4-14 days)
- continue for 21 days than taper
IVIG- need faster response, 1g/kg (responce in 1-3 days)
plt’s if less than <10 k with vaginal delivery or <50 k with c-section
anemia ddx
anemia of chronic disease pregnancy hemoglobinopathy nutritional defecit - folic acid, b12, iron, copper lead posioning
want ferritin to be >30 - acute phase reactant
Sickle cell disease goal hb
transfuse less than 6.
when are you concerned for B thal on electrophoresis
A2 >3.5%
- does not test for alpha thal
laboratory work-up for bleeding disorders
factor 8- hemophilia A
factor 9 - hemophilia B
factor 7- considered congenital
von willibrand factor
von willibrand factor ristocetin cofactor activity level
Von Willibrand levels
Autosomal dominate
check
VIII, Von Willibrand Activity at least every trimester and 1 week before delivery.
needs to be a 50 IU/dL prior to vaginal delivery an 100 for cesarean section
- monitor for 7 days after c-section (needs to stay above 25%)
- avoid antiplt drugs
- have DDVAP intranasal (releases von willibrand factor from endotheilal cells- for Type 1 and 2 only)
- Factor 8 and von willibrand concentration in case she does not respond to DDAVP
- avoid circumcision/ fetal scalp
Treatment of hemophilia A
x-linked recessive
cryo (8.13.vWF, fibrinogen), factor 8, or ddavp
treatement for hemophilia B
x-linked recessive
FFP or Factor 9
Von willibrands type 1
autosomal dominate
70% of vWD
quantitative deficiency of Von Willibrands factor
hemorrhage most common at 10-20 days due to decreasing levels
what to do with a prior unprovoked VTE
ppx, intermediate, full anticoagultion
low risk thrombophilia and VTE what are the options
ppx, intermediate
high risk thrombophilia no prior VTE what are the options
ppx, intermediate
high risk thrombophilia with family history of VTE or personal VTE - options?
ppx, intermediate, full
multiple prior thromboembolisums- options
full
when should you not anticogulate?
low risk thrombophilia and no VTE history
1 prior provoked VTE on thrombophilia
Goal for anti 10 a
.6-1
what to do if you dx HIT
Stop heparin
start fondaprinux
dosing based on no clot or clot
starting lovenox- what other things can you do
plt count in 1 week
calcium/vit D
when to restart lovenox
6 hours after vaginal
12 hours after c-section
discuss with anesthesia
Goal warfarin level and inital dosing
5mg per day
goal INR 2-3
stop lovenox when INR is at goal for 2 days
early decrease in Protein C
who to work up for thrombophilias
personal history of VTE or family history
APAS- who to test
- personal thrombosis IUFD>10 weeks PTD<34 weeks (FGR/PreE) 3 SABs Lupus
What are positive APAS labs
+ LA or >99% IgM or IgG
