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Flashcards in Hematology Deck (25)
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1
Q

Ddx for Microcytic anemia (MCV <100)

A
Iron Deficiency
Thalassemia
Anemic or Chronic disease (low normal MCV)
Sideroblasic anemia
Lead poisoning
2
Q

DDX Macrocytic amenia (MCV >100)

A
Megaloblastic anemia:folic acid or Vit B12 def
Liver diease
Alcoholism 
Reticulocytosis
Hypothyroidism
Myelodysplastic syndrome
Antiretrovirals (AZT)
3
Q

What is the onset and peak effect of vitamin k? IV and PO

A

IV 1-2 hours onset peak effect 6-12 hours

PO 6-12 hours onset peak effect 12-24 hours

4
Q

What are the vitamin K sensitive clotting factors?

A

2,7,9,10

5
Q

At what platelet count do you worry about spontaneous hemorrage?

A

<20

6
Q

What are some common anti-platelet drugs?

A
  1. Aspirin (irreversible* cyclooxygenase inhibitor)
  2. Adenosine diphosphate (ADP) receptor inhibitors
    - Clopidogrel (Plavix)
    - Prasugrel (Effient)
    - Ticagrelor (Brilinta)
    - Ticlopidine (Ticlid)
  3. Glycoprotein IIB/IIIA inhibitors (intravenous use only)
7
Q

With low platelets or patients with platlet dysfunction, where do they normally bleed?

A
  • Can bleed anywhere but may present with petechiae, have mucosal bleeding
  • May have purpura - usu non palpable
8
Q

What time course does HIT (heparin induced thrombocytopenia) appear?

A

5-7 days after starting heparin or LMWH. There is such thing as delayed onset hit usu up to 14 days post starting, but has been reported to occur 40 days after starting heparin

9
Q

Other than low platelets itself what are other complications of HIT?

A

Patients can develop an arterial or venous thrombus.

10
Q

What is the HUS triad?

A

Microangiopathic hemolytic anemia (MAHA)
Renal failure
Thrombocytopenia

11
Q

What is the TTP pentad?

A
MAHA
Renal Failure (less prominent feature)
Thrombocytopenia
Fever
Neurologic symptoms
- AMS
- Stroke
- Headaches
- Bizarre behavior

Its not common to see this pentad..

12
Q

If you suspect TTP what therapy should you avoid?

A

Transfusing platelets, may actually worsen condition causing additional thrombi in the micro-circulation.
- Consult Hematology

13
Q

DDX incr INR (measures extrinsic pathway)

A
  • Warfarin
  • Vit K deficency
  • Severe Liver disease
  • Factor 7 def or inhibitor
14
Q

DDX elevated PT/INR and PTT

A
  1. Deficencies of prothrombin, fibrinogen, Factors V and X
  2. Heparin + warfarin
  3. DIC *
  4. Liver Dx
15
Q

DDX incr PTT (measures intrinsic pathway)

A
  1. Heparin
  2. Hemophilias
  3. vWF
16
Q

Hemophilia A effects what factor?

A

8

17
Q

Hemophilia B effects what factor?

A

9 aka. Christmas disease

18
Q

In Hemophiliacs where do they most commonly bleed?

A

Joints, Deep muscle, urinary tract, Intracranial

19
Q

In platelet disorders like vWF where do they commonly bleed?

A

Oral bleeding, epistaxis, menorragia,

GIB rare unless other cause - like ulcer etc.

20
Q

What is in cryoprecipitate?

A
  1. Fibrinogen 150-250 mg with a half-life of 100-150 hours
  2. Factor VIII 80-150 U with a half-life of 12 hours
  3. von Willebrand factor 100-150 U with a half-life of 24 hours
  4. Factor XIII 50-75 U with a half-life of 150-300 hours.
21
Q

What is in FFP?

A

All the blood clotting components, even the liable ones (5,8) but you have to give early after thawing.

22
Q

What is the INR of FFP?

A

1.5

23
Q

What is a d-dimer?

A

D-dimers are cross-linked fibrin degradation products

  • it is a product of plasmin mediated fibrinoyltic degradation
  • They are an excellent marker of fibrinolytic activity
24
Q

What non-pathologic conditions are assoc with an elevated D-dimer? (5)

A

Non-pathological conditions associated with elevated D-dimer titres include:

  1. Age (healthy elderly people)
  2. Cigarette smoking
  3. Functional impairment
  4. Post-operatively
  5. Pregnancy
  6. Race (e.g. African Americans)
25
Q

When can D-dimer be used to r/o VTE?

A

In a patient with low pre-test probability of having a VTE

- Need to use Wells criteria for PE or DVT.