Term
| 28 yo G2P1 at 28 wks comes or routine pregnancy apt complaint of unilateral ankle swelling. L is 2cm>R leg. US shows non-compressible L popliteal vein. What medication do you give? |
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Definition
LMWH until 24 hours prior to delivery.
Restart after delivery x 4 weeks
Warfarin is an option post-partum. |
|
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Term
| What are some inherited causes of thrombophilia? |
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Definition
Factor V Leiden deficiency
Prothrombin 20210 mutation
protein C or S deficiency
Anti-thrombin III deficiency
Homocystinemia
Fibrinolysis defects |
|
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Term
| What are some acquired causes of thrombophilia? |
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Definition
Prolonged rest
Immobilization
Smoking
OCP
Pregnancy
Nephrotic syndrome
Cancer
DIC
Lupus anticoagulant |
|
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Term
| How do you evaluate thrombophilia? |
|
Definition
Two weeks after anticoagulation..... look for primary causes.
Hx first thrombotic event before age 50
Recurrent thrombotic episodes
First degree relative with thromboembolic event before age 50 |
|
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Term
| What kind of screening is used with thrombophilia? |
|
Definition
APC resistance (Activated protein C) suggests Factor V Leiden
Prothrombin mutation, antiphospholipid antibody
Plasma hommocysteine
Antithrombin deficiency
Protein C deficiency
Protein S deficiency |
|
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Term
| What do you do if APC resistance is confirmed? |
|
Definition
| Check Factor V Leiden genotypic mutation assay. |
|
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Term
| How do you treat homocystinemia? |
|
Definition
| Vitamin B12 and folate supplements |
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Term
Transfusion Reaction:
Major/Minor hemolytic reaction presentation? |
|
Definition
Chills, fever, SOB, nausea, chest/flank pain, hypotension, flushing
Complications: ARF, DIC |
|
|
Term
Transfusion Reaction:
Major/Minor hemolytic reaction tests? |
|
Definition
Coombs'test: +
Agglutination of RBC on smear
Haptoglobin: Low
Hemoglobinuria: UA + hematuria wiht few RBCs on microscopy |
|
|
Term
Transfusion Reaction:
Major/Minor hemolytic reaction management? |
|
Definition
Stop transfusion
Maintain BP and urine output with IVF
Give furosemide if UOP <100ml/hr
Type and cross RBCs just transfused |
|
|
Term
Transfusion Reaction:
Delayed hemolysis presentation? |
|
Definition
Onset 4-14 days post-transfusion
Jaundice
Anemia
Hemoglobinuria
Fever |
|
|
Term
Transfusion Reaction:
Delayed hemolysis Tests? |
|
Definition
LDH: Increased
Hyperbilirubinemia: Unconjgated
Haptoglobin: Decreased |
|
|
Term
Transfusion Reaction:
Delayed hemolysis Management? |
|
Definition
Type and screen blood before future transfusions
Acetaminophen for fever |
|
|
Term
Transfusion Reaction:
Febrile, nonhemolytic reaction presentation? |
|
Definition
Onset within two hours post-transfusion
Fever
Rigors
Nausea
Vomiting
Chills |
|
|
Term
Transfusion Reaction:
Febrile, nonhemolytic reaction Tests? |
|
Definition
| Rule out biochemical evidence of hemolysis |
|
|
Term
Transfusion Reaction:
Febrile, nonhemolytic reaction management? |
|
Definition
For future transfusions, use leukocyte-reduced RBCs
Avoid transfusion when febrile |
|
|
Term
Transfusion Reaction:
Anaphylaxis presentation? |
|
Definition
Increased risk with IgA deficiency
Sudden onset
flushing
HTN followed by Hypotension
Edema
Respiratory distress
Shock
Wheezing
Chest Pain |
|
|
Term
Transfusion Reaction:
Anaphylaxis Tests? |
|
Definition
|
|
Term
Transfusion Reaction:
Anaphylaxis Management? |
|
Definition
IV epinephrine
Use saline-washed PRBCs in the future |
|
|
Term
Transfusion Reaction:
Urticaria presentation? |
|
Definition
|
|
Term
Transfusion Reaction:
Urticaria tests? |
|
Definition
|
|
Term
Transfusion Reaction:
Urticaria management? |
|
Definition
Stop transfusion: monitor for anaphylaxis
Give diphenhydramine
Resume transfusion at a slower rate when symptoms resolve. |
|
|
Term
Transfusion Reaction:
Transfusion related acute lung injury presentation? |
|
Definition
Occurs 1-6 hours posttransfusion
Looks like ARDS
Acute respiratory distress, cyanosis, fever; gone in 24 hours
DDx: Fluid overload |
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|
Term
Transfusion Reaction:
Transfusion related acute lung injury tests? |
|
Definition
| CXR shows bilateral pulmonary infiltrates without CHF. |
|
|
Term
Transfusion Reaction:
Transfusion related acute lung injury management? |
|
Definition
| Ventilation, diuretics, steroids |
|
|
Term
Transfusion Reaction:
Bacterial infection presentation? |
|
Definition
More likely with platelet transfusions
Fever
Hypotension; onset within four hours |
|
|
Term
Transfusion Reaction:
Bacterial infection tests? |
|
Definition
| Blood culture transfusion product |
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|
Term
Transfusion Reaction:
Bacterial infection management? |
|
Definition
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