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
