12-1: Rapid Review I

Front 1

Flow murmur may indicate ______.

Back 1

Anemia

Front 2

MCV < ___ = microcytosis

Back 2

under 80

Front 3

MCV > ___ = macrocytosis

Back 3

Over 100

Front 4

Stains with methylene blue.

Back 4

Reticulocytes

Front 5

Retic count = (formula)

Back 5

#retics/#RBC's

Front 6

Effect of RBC count on retic count.

Back 6

Retic count = #retics/#RBCs

If low RBCs-->high retic count

Front 7

Corrected retic count = (formula)

Back 7

Corrected retic count = retic count x pt HCT/45

Front 8

Retic Production Index = (formula)

Back 8

(Retic count x Pt HCT/45)/2

Front 9

Retic count:
Cutoff for hyperproliferative
Cutoff for hypoproliferative

What does hyperproliferative and hypoproliferative mean?

Back 9

RPI > 3: hyperproliferative (good marrow response to anemia)

RPI <2: hypoproliferative (inadequate response to anemia)

Front 10

Mentzer index:
Formula
Value for Fe deficiency
Value for Thalassemia

Back 10

Mentzer Index: MCV/RBC count

>13: Fe def
<13: thalassemia

Front 11

Causes of microcytic anemia.

Back 11

Fe def
Thalassemia
Lead poisoning
Severe Anemia of CD
Sideroblastic anemia

Front 12

Causes of macrocytic anemia.

Back 12

B12/Folate def
Hemolytic Anemia
Liver Dz
MDS

Hypothyroid
Hyperlipidemia
Hydroxyurea

Front 13

Anemia of Chronic Disease:
Iron Levels
TIBC
Transferrin
Ferritin
Hemoisderin

Back 13

Iron: Low
TIBC: Low
Transferrin: variable
Ferritin: HIGH
Hemosiderin 4+

Front 14

Hereditary hemochromatosis:
Pathophys

Back 14

Abnl HFE perceives Fe def state, upregulates DMT-->inc'd Fe absorption

Low hepcidin level-->unopposed ferroportin transfer

Front 15

With iron supplementation, how long does it take to see reticulocytosis?

Back 15

Within 5-7 days

Hgb should inc by 2-3 grams every 3 weeks

Front 16

Neuropathy + anemia = ______.

Back 16

B12 deficiency

Front 17

Folate dietary deficiency causes.

Back 17

EtOH

(Methotrexate)

Front 18

RBC vs Serum Folate Levels

Back 18

RBC folate reflects folic acid storage over past few months--more accurate than serum folate.

Front 19

G6PD Deficiency:
Type of blood disorder
Trigger

Back 19

G6PD def = hemolytic anemia

Inc'd sensitivity to oxidative stress--fava beans, drugs, infections

SEE HEINZ BODIES

Front 20

Hereditary spherocytosis:
Treatment

Back 20

splenectomy

Front 21

What drugs cause hemolytic anemia?

Back 21

QUININE
PCN
Cephalosporins
Methyldopa

Front 22

Mechanical causes of hemolytic anemia.

Back 22

Valves
March hemolysis
TTP, HUS, DIC

Front 23

What is DIC (general)?

Back 23

Fibrin strands in capillaries slice RBCs--see schistocytes on smear

Front 24

Warm autoimmune hemolytic anemia:
Antibody type
Coombs Results
Treatment

Back 24

Warm AHA:
IgG Abs
Direct Coombs positive for IgG and/or complement
Indirect positive for panagglutinin

Tx: Steroids (block FCR on macs to decrease phagocytosis of RBCs by spleen)

Front 25

Cold autoimmune hemolytic anemia:
Antibody type
Coombs Results
Treatment

Back 25

IgM

Direct Coombs positive for complement (NOT IgG)

Tx: keep pt warm

Front 26

This autoimmune hemolytic anemia results in extravascular hemolysis.

Back 26

COLD

Front 27

Secondary causes of cold autoimmune hemolytic anemia.

Back 27

Mycoplasma
EBV

Front 28

Primary vs Secondary Hemostasis:
Physical Signs

Back 28

Primary Defect: Petechiae, purpura
Secondary Defect: Delayed bleeding, intracranial bleeds

Front 29

Vitamin K Def:
PT
PTT
Fibrinogen
Factor Levels
Platelets

Back 29

Vit K Def:
PT Up
PTT +/-
Fibrinogen +/-
Factor levels: Low II, VII, IX, X
Platelets: +/-

Front 30

Liver Disease:
PT
PTT
Fibrinogen
Factor Levels
Platelets

Back 30

PT: High
PTT: High
Fibrinogen: +/- or low
Factor levels: ALL LOW except VIII
Platelets: Low

Front 31

DIC:
PT
PTT
Fibrinogen
Factor Levels
Platelets
D-Dimer

Back 31

PT Up
PTT Up
Fibrinogen Down
Factor Levels: ALL DOWN
PLT: Down
D-dimer: up

Front 32

What is DIC?

Key event?

Risk?

Back 32

Widespread deposition of fibrin with consumption of coag factors and PLTs.

Key event : inc'd activity of Tissue Factor (III)

Risk: intravascular thrombin formation produces large amounts of circulating fibrin, which can cleave RBCs

RESULTS IN:
Microangiopathic hemolytic anemia

Front 33

DIC:
Causes
Treatment

Back 33

Causes:
Infection (Gram neg, meningococcal, falciparum malaria, HIV, hepatitis, HIV
Malignancy (APML!!!!)

Tx: Treat underlying cause

Front 34

This leukemia presents with DIC.

Back 34

APML

Front 35

Factor V:
Role

Back 35

Activated to Va by Thrombin

Acts as cofactor with Xa to convert prothrombin (II) to thrombin (IIa)

Front 36

Factor V Leiden:
What is it?

Back 36

Inactivated more slowly by Prot C leading to more thrombin formation an dinc'd likelihood of thrombosis

Thus, dec'd anticoag (inc'd coag)

Front 37

Protein C:
Role

Back 37

degrades VIIIa and Va

Front 38

How is Factor V ledien diagnosed?

Back 38

PCR

Front 39

How is APC resistance tested in vitro?

Back 39

PTT by adding APC (should prolong PTT)

Front 40

Does a patient with a DVT and Factor V Leiden heterozygosity need lifelong anticoagulation?

Back 40

No.

Front 41

Prothrombin 20210 Mutation:
Effect

Back 41

Increases prothrombin levels by 30%

Note Prothrombin is FII and is vitamin-k dependent

Front 42

Woman with cerebral vein thrombosis, pregnant.

Back 42

Prothrombin 20210 mutation

Front 43

Antithrombin:
Role

Back 43

Inhibits Thrombin, Xa, IXa (2, 9, 10)

Front 44

Heparin:
MOA

Back 44

Augments antithrombin activity by 4000x

Front 45

These three things can lower antithrombin in patients with AT deficiency.

Back 45

Estrogen
Nephrotic Syndrome (pee out AT)
Heparin!

Front 46

How is Protein C deficiency diagnosed?

Back 46

ELISA for antigenic level

Front 47

Neonatal purpura fulminans:
Associated disorder
Treatment

Back 47

Homozygous protein C Deficiency

Tx: Protein C concentrate

Front 48

Warfarin skin necrosis:
Associated disorder
Treatment

Back 48

Protein C Deficiency (has shorter half-life than other vitK clotting factors)

Tx:
Withdraw warfarin
Administer vitK, heparin

Warfarin can later be restarted in low doses

Front 49

Warfarin:
MOA

Back 49

Inhibits VitK epoxide-->VitK

Front 50

Protein S:
Role

Back 50

Co-factor for protein C

Front 51

Child with purpura fulminans, varicells infection

Back 51

AutoAb x Protein S

Front 52

Mesenteric vein thrombosis, pregnant

Back 52

Protein S Deficiency

also with OCP

Front 53

Russel viper venom:
Utility

Back 53

Lupus anticoag screen

Russel viper venom usually clots blood, but won't do it if phospholipids aren't available

Need to add phospholipids

Front 54

Strongly Thrombophilic:
Criteria
Lab Tests

Back 54

Strongly thrombophilic:
Idiopathic venous thrombosis before 50 OR
hx recurrent thrombosis OR
first-degree relative w/thromboembolism before 50

Tests:
Specific to strong:
AT def
Prot C def
Prot S def

General:
APC resistance
PT 20210
Anti-PL Ab

Front 55

Weakly Thrombophilic:
Criteria
Lab Tests

Back 55

Criteria:
VTE > 50 years of age AND
Negative Famhx TBE

Tests:
APC resistanec
PT 20210

Front 56

Who needs indefinite anticoagulation?

Back 56

AT def
Homozygous thrombophilic defect
Heterozygous for 2 or more prothrombotic defects

Front 57

HIT:
I vs II
Treatment

Back 57

I: Not immune mediated; not clin sig

II: Immune-mediated thrombocytopenia; high risk of thrombosis

Tx (for HIT II): Stop heparin, start argatroban (for at least 6 weeks)

Don't use warfarin!!