Download - Hematology Pimp Session
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HematologyPimp Session
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1. What is the sequence of the intrinsic pathway of coagulation?
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Prekallikrein + HMW kininogen + factor XII + exposed collagen → activates Factor XI → activates Factor IX +Factor VIII → activates Factor X + Factor V → converts prothrombin (Factor II) to thrombin → thrombin converts fibrinogen to fibrin
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2. What is the sequence of the extrinsic pathway of coagulation?
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Factor VII + tissue factor → activates Factor X +Factor V → converts prothrombin to thrombin → thrombin converts fibrinogen to fibrin
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3. Which factors are known as the labile factors (i.e. activity lost in stored blood)?
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Factors V and VIII
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4. Which factor has the shortest half-life?
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Factor VII
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5. What are the Vitamin K dependent factors?
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Factors II, VII, IX, and X and proteins C and S
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6. Which factor is the convergence point for both the extrinsic and intrinsic pathways of coagulation?
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Factor X
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7. PT measures the function of which factors?
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Factors II, V, VII, and X and fibrinogen
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8. PTT measures the function of which factors?
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Factors II, V, VIII, IX, X, XI, and XII and fibrinogen
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9. What 2 electrolytes are required for the formation of a platelet plug?
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Calcium and Magnesium
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10. What is the sequence of physiologic reactions that mediate hemostasis following vascular injury?
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1. Vasoconstriction
2. Platelet activation/adherence/aggregation
3. Thrombin generation
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11. Uremia leads to a downregulation of?
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GpIb, GpIIb/IIIA, and vWF
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12. What is the treatment of choice for uremic coagulopathy?
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Dialysis
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13. Which drug can be given to help correct platelet dysfunction from uremia, bypass, or ASA?
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Desmopressin (DDAVP)
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14. DDAVP and conjugated estrogens stimulate the release of?
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Factor VII and vWF
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15. What platelet count is needed before surgery?
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>50,000/mL
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16. What platelet count is associated w/ spontaneous bleeding?
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< 20,000/mL
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17. What platelet count suggests the prophylactic transfusion of platelets?
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<10,000
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18. What is Virchow’s triad?
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Stasis, endothelial injury, and hypercoagulability
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19. What is the most common cause of acquired hypercoagulability?
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Smoking
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20. What is the most common inherited hypercoagulable state?
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Factor V Leiden
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21. What is the treatment for hyperhomocysteinemia?
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Vitamin B-12 and folate
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22. Name the prothrombin gene defect causing spontaneous venous thrombosis?
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Prothrombin gene defect G20210A
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23. What is the normal life of a platelet?
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7-10 days
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24. What electrolyte is most likely to fall after the infusion of stored blood?
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Ionized calcium (citrate in stored blood binds serum calcium)
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25. How long can PRBCs be stored?
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~ 42 days or 6 weeks
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26. What is the most common blood product to contain bacterial contamination?
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Platelets (stored at room temperature)
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27. What type of bacteria is usually found in contaminated platelets?
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Gram-positives
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28. What is the most common bacteria found w/ blood product contamination?
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Gram negative rods (E. coli)
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29. Who would you transfuse with leukocyte reduced packed red blood cells?
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Patients with multiple reactions despite premedication with antipyretics, patients needing long term platelet support, and transplant candidates in order to prevent formation of HLA antibodies
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30. What are the indications for blood transfusion?
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Hgb < 10 w/ h/o CAD/COPD, Healthy symptomatic pt. w/ Hgb < 7, acute blood loss
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31. What is the approximate formula to convert Hct to Hgb?
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Hct / 3 = Hgb
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32. 1 U PRBC should increase the Hgb and Hct by this much?
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Should increase Hgb by 1 g/dL and Hct by ~3-4%
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33. What happens during a type and screen?
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Patient's blood is screened for antibodies and blood type is determined
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34. What happens during a type and cross?
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Pts. blood is sent to the blood bank and cross-matched for specific donor units for possible transfusion
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35. What fluid cannot be infused with PRBC and why?
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Lactated Ringer's; Calcium in LR may result in coagulation w/in IV line
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36. Most common cause of transfusion hemolysis?
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Clerical error leading to ABO incompatibility
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37. What is the treatment for transfusion hemolysis?
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Stop transfusion; fluids; Lasix; alkalinize urine w/ bicarbonate; pressors as needed
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38. How long does it take for Vitamin K to take effect?
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6 hours
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39. How long does it take for FFP to work?
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Immediately
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40. How long do the effects of FFP last?
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6 hours
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41. What does cryoprecipitate contain?
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vWF, Factor VIII, and fibrinogen
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42. What does FFP contain?
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All factors including labile Factors V and VIII, AT-III, protein C and S
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43. What is the best method for detecting pts. at risk for bleeding?
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A complete history and physical exam
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44. What is the most common congenital bleeding disorder?
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Von Willebrand's disease
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45. What factor is deficient in hemophilia A?
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Factor VIII
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46. What is the preoperative treatment for hemophilia A?
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Factor VIII infusion to 100% normal preoperative levels
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47. What factor is deficient in Hemophilia B?
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Factor IX
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48. What is the treatment for hemarthrosis in a pt. w/ hemophilia A?
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Initial therapy includes Factor VIII, joint rest, cold packs (3-5 days) and a compression dressing (3-5 days); Followed by active range of motion exercised 24 hrs. after Factor VIII therapy.
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49. What receptor deficiency is found in Glanzmann's thrombocytopenia?
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GpIIb/IIIa receptor deficiency; platelets can not bind to each other
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50. What receptor deficiency is found in Bernard Soulier disease?
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GpIb receptor deficiency; platelets can not bind to collagen
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51. What are the desired platelet counts and Hct for a pt. with polycythemia vera before an elective operation?
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Plt < 400,000/mL and Hct < 48%
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52. What protein does Heparin bind to for its anti-coagulation effects?
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Anti-thrombin III; Heparin-antithrombin III complex then binds factor IX, X, XI
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53. What is the half-life of heparin?
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60-90 minutes
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54. What is the dose of protamine to reverse 100 U or 1 mg of heparin?
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1-1.5 mg
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55. What signs will you see in a protamine reaction?
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Bradycardia, hypotension, and decreased heart function
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56. How does warfarin induced skin necrosis occur?
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Protein C and S have a shorter half life than Factors II, VII, IX, and X. Coumadin leads to a decrease in Protein C and S before the other factors leading to a hypercoagulable state
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57. Pts. with this deficiency are at increased risk for Warfarin induced skin necrosis?
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Protein C deficiency
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58. What is the desired activated clotting time for routine anticoagulation?
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150-200 seconds
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59. What is the desired activated clotting time for cardiopulmonary bypass?
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400 seconds
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60. What INR is a contraindication to intramuscular injection?
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INR > 1.5
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61. What are the absolute contraindications to the use of thrombolytics?
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Recent CVA (<2 months), intracranial pathology, and active internal bleeding
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62. What are the indications for an IVC filter?
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Pts. who have undergone a pulmonary embolectomy, pts. with documented PE while anticoagulated, pts. with free floating femoral, ileofemoral, IVC DVT, pts. with contraindication to anticoagulation, and pts. at high risk for DVT (head injured/orthopedic injured on prolonged bed rest)"
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63. What is Argatroban?
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A synthetic direct thrombin inhibitor derived from L-arginine
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64. What is Hirudin?
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An irreversible direct thrombin inhibitor derived from leeches
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65. What is Ancrod?
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Malayan pit viper venom that stimulates tPA release