Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/88

Click to flip

88 Cards in this Set

  • Front
  • Back
What are considered the life-threatening bleeds?
bleeding in oropharynx
intracerebral hemorrhage
What is the best screening test for coagulation?
partial thromboplastin time (PTT)
What does PTT measure?
intrinsic pathway
factors VIII, IX, XI, XII
Heparin
circulating anticoagulants
What does PT measure?
extrinsic pathway
factor VII, vitamin K
Warfarin
What test measures fibrin degradation products?
D-dimer
What does a negative D-dimer mean?
no clot
What is thrombocytosis?
marked proliferation of megakaryocytes in bone marrow
What are the clinical manifestations of thrombocytosis?
Thrombosis
Erythromelalgia
Bleeding, typically mucosal
Splenomegaly
In thrombocytosis, where do the venous thrombosi usually occur?
mesenteric, hepatic, or portal veins
What is erythromelalgia?
painful burning of the hands with erythema
What lab findings would you expect to see in thrombocytosis?
increased platelets
increased WBC, mild
large platelets on peripheral smear
normal RBC morphology
prolonged bleeding time
bone marrow
- increased megakaryocytes
What differentiates thrombocytosis from CML?
no Philadelphia chromosome in thrombocytosis
What is the differential for thrombocytosis?
secondary causes of thrombocytosis (inflammatory disorders, chronic infections, iron deficiency)
polycythemia vera
myelofibrosis
CML
How do you treat thrombocytosis?
Hydroxyurea
Anagrelide
What limits the dosing of hydroxyurea?
dose limiting neutropenia
What is the major source of morbidity in thrombocytosis patients?
Thrombosis
What are the different etiologies for thrombocytopenia?
decreased bone marrow
splenic sequestration
acccelerated destruction
drug induced
A patient presents with thrombocytopenia and a bone marrow biopsy shows decreased megakaryocytes. What might you expect as a cause of the thrombocytopenia?
Decreased bone marrow production:
- marrow aplasia
- fibrosis
- infiltration with malignant cells
- cytotoxic drugs
What percentage of the mass of platelets stay in the spleen?
1/3 platelet mass
What does a splenectomy causes? Splenomegaly?
splenectomy: thrombocytosis
splenomegaly: thrombocytopenia
What conditions can cause accelerated destruction of thrombocytes?
vasculitis
hemolytic uremic syndrome (HUS)
ITP
TTP
DIC
Viral or bacterial infections
What drugs can induce thrombocytopenia?
chemotherapeutic agents
alcohol
sulfonamides
thiazides
phenytoin
unfractionate heparin
Unfractionated heparin can cause what syndrome?
White clot syndrome: intravascular platelet aggregation and paradoxical thrombosis
What are the clinical manifestations of thrombocytopenia?
purpura
petechiae
ecchymoses
hematomas
menorrhagia
GI hemorrhage
Can thrombocytopenia be controlled by local measures?
Yes
What labs would you expect to see with thrombocytopenia?
Prolonged bleeding time
Decreased platelet count
A patient has a platelet count less than 20,000. What would you expect to see?
spontaneous bleeding, petechiae
A platelet count less than 50,000 can lead to what?
easy bruising, purpura after minor trauma, bleeding after mucous membrane surgery
At what platelet count does bleeding time prolong?
at less than 100,000
What is idiopathic thrombocytopenia purpura?
an autoimmune disorder in which an IgG autoantibody is formed that binds to platelets
Acute ITP is most common in what age group? What causes it?
children
follows viral exanthem or URI
What is the differential for acute ITP?
aplastic aplasia
acute leukemia
metastic tumor
How do you diagnose ITP?
bone marrow examination
Who gets chronic ITP?
adults, age 20-50
What is the differential for chronic ITP?
SLE
primary hematologic disorder
People with ITP usually present with what?
Mucosal or skin bleeding: epistaxis, oral bleeding, menorrhagia, purpura, petechiae
True or False: Thrombocytosis, thrombocytopenia, and ITP can present with splenomegaly.
False: Thrombocytosis and thrombocytopenia can both present with splenomegaly, but ITP does not.
What labs would you expect with ITP?
thrombocytopenia
mild anemia
slightly enlarged platelets
normal bone marrow
normal coagulation studies
10% of ITP patients also have what?
a coexistent hemolytic anemia (Evans syndrome)
How do you treat ITP?
Glucocorticoids
IV immunoglobulin
Splenectomy
Immunosuppressive drugs
- azathioprine
- cyclophosphamide
- vincristine
- vinblastine
- cyclosporine
Danazol
What is the definitive treatment for ITP?
splenectomy
If platelet count falls below 5,000, what is the patient at risk for?
cerebral hemorrhage
True or False: ITP with have normal bone marrow biopsy and normal coagulation studies.
True.
What deficiency causes TTP?
deficiency of a von Wildebrant factor
What causes TTP?
pregnancy
metastatic cancer
mitomycin C - antitumor antibiotic
high-dose chemotherapy
HIV infection
Drugs
- Ticlopidine
- Estrogen
What are the clinical findings of TTP?
Thrombocytopenia (pallor, purpura, petachiae)
Microangiopathic hemolytic anemia
Renal failure
Neurological abnormalities (confusion, delirium, seizures, hemiparesis, aphasia)
Pancreatitis
Involvement of myocardial vessels
What causes the sudden death in TTP patients?
involvement of myocardial vessels
What is the differential for TTP?
DIC
Vasculitis
SLE
HUS
Evans syndrome
What labs do you expect with TTP?
increased indirect bilirubin
increased LDH
negative Coombs' test
increased reticulocytes
fragmented RBCs (schistocytes, helmet cells)
decreased platelets
evevated firbrin degradation products
proteinuria
increased BUN
How do you treat TTP?
large-volume plasmapheresis
- daily until patients are in complete remission
What causes hemolytic-uremic syndrome (HUS) in children?
occurs after a diarrheal illness due to shigella, salmonella, E.coli, or viral
What causes HUS in adults?
estrogen use or postpartum
delayed complication of high-dose corticosteroids
delayed complication of autologous bone marrow or stem cell transplantation
use of cyclosporine or tacrolimus
familial type
What are the clinical findings and laboratory findings of HUS?
Microangiopathic hemolytic anemia
Thrombocytopenia
Acute renal failure
What differentiates TTP from HUS?
TTP has neurological symptoms
HUS does not
What is the most common inherited bleeding disorder?
Von Willebrand's Disease
True or False: Von Willebrand Factor facilitates platelet aggregation.
False: It facilitates adhesion.
What type of Von Willebrand's Disease is the most common? What is the problem?
Type I: quantitative decrease in vWF
What is Type II Von Willebrand's Disease?
normal or near-normal levels of a dysfunctional protein
Is Von Willebrand's disease a qualitative or quantitative platelet disorder?
qualitative
What are the clinical manifestations of Von Willebrand's Disease?
mucosal bleeding
GI bleeding
incisional bleeding
exacerbation with aspirin
True or False: Most causes of Von Willebrand's Disease are very serious and require hospitalization.
False: Most cases are mild.
True or False: In pregnancy, bleeding due to Von Willebrand's Disease decreases.
True.
What lab findings would you see with Von Willebrand's Disease?
prolonged bleeding time
Type I - vWF levels reduced
Severe - prolonged PTT
What morphology would you expect to see with Von Willebrand's Disease?
morphology normal
What antigen measures immunologic presence of vWF?
Factor VIII antigen
How do you treat Von Willebrand's disease?
factor VIII concentrates (during surgery or after major trauma)
oral contraceptives to suppress menses
desmopressin (DDAVP)
How are the best candidates for desmopressin therapy?
Type I Von Willebrand's disease patients.
What antigen measures immunologic presence of vWF?
Factor VIII antigen
How do you treat Von Willebrand's disease?
factor VIII concentrates (during surgery or after major trauma)
oral contraceptives to suppress menses
desmopressin (DDAVP)
How are the best candidates for desmopressin therapy?
Type I Von Willebrand's disease patients.
What is the most common severe bleeding disorder?
Hemophilia A
Hemophilia A is a deficiency of what?
factor VIII
What are complications of Hemophilia A?
necrosis of muscle - compartment syndrome
venous congestion - pseudophlebitis
ischemic damage to nerves

Repetative hemarthrosis
-osteoarthritis
-articular fibrosis
-joint ankylosis
-muscle atrophy
Hematuria
CNS bleeding
What labs would you see with Hemophilia A?
prolonged PTT
normal PT, BT, fibrinogen level
decreased factor VIII:C levels
vWF normal
How do you treat Hemophilia A?
Factor VIII concentrate (only with an episode)
Desmopressin for minor surgical procedures
Infusion of factor VIII with E-aminocaproic acid before dental procedures
Hemophilia B is a deficiency of what?
Factor IX
How do you differentiate hemophilia A from B?
They are clinically identical.

A: decreased factor VIII
B: decreased factor IX
How do you treat hemophilia B?
fresh-frozen plasma
factor IX concentrates
What is DIC?
excess thrombin activity
What causes DIC?
Obstetric complications
Metastatic malignancy
Massive trauma
Bacterial sepsis
Major hemolytic transfusion reactions
What is the most common finding of DIC?
bleeding
What are the lab findings in DIC?
thrombocytopenia
decreased fibrinogen
increased fibrin degradation products (positive D-dimer)
prolonged PT
prolonged PTT (sometimes)
may have microangiopathic hemolytic anemia (RBC fragments and schistocytes)
How do you differentiate liver disease and DIC?
liver disease has normal fibrinogen and normal or slightly low platelets
DIC has decreased fibrinogen and thrombocytopenia
How do you treat DIC?
correct reversible causes
control the major symptom
- bleeding
- FFP
- platelet transfusion
- cryoprecipitate
- thrombosis
- IV heparin
prophylaxis to prevent recurrence
What causes Vitamin K deficiency?
Poor diet
Malabsorption
Broad-spectrum antibiotics
What are the symptoms of Vitamin K deficiency?
bleeding fom any site
What lab findings would you see with Vitamin K deficiency?
prolonged PT
prolonged PTT
How do you treat Vitamin K deficiency?
subcutaneous vitamin K