Hematology

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Author:
anders
ID:
243594
Filename:
Hematology
Updated:
2013-11-04 12:37:09
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Hematology
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  1. What is Polycythemia Vera?
    A myeloproliferative disorder characterized by abnormally increased number of RBCs

    • Men Hct >/= 50%
    • Women Hct >/= 45%
  2. Polycythemia diagnosis:
    • Initial:
    • - RBC mass study - elevated
    • - Erythropoietin level - low/normal

    • Confirm:
    • - Bone marrow biopsy - hypercellular marrow
  3. Polycythemia Vera treatment:
    • Serial phlebotomy to Hct <45 in men; <42 women
    • Daily Aspirin
    • Hydroxyurea for those at high risk of thrombosis
    • ¬†- age>70, prior thrombosis, platelets>1500000, + CV risk factors
    • Anagrelide - decreases platelets in refractory cases
  4. Warfarin therapy INR goals:
    1.5-2.0 - older pts with nonvalvular afib or recurrent systemic embolization

    2.5-3.5 - pts with mechanical prosthetic valves
  5. Disseminated Intravascular Coagulation
    Platelets
    PT
    PTT
    Fibrinogen
    D-dimer
    • Platelets -¬†elevated
    • PT - elevated
    • PTT - elevated
    • Fibrinogen - low
    • D-dimer - elevated (d/t microvascular clotting)
  6. Causes of DIC:
    • Infections
    • Carcinomas
    • Acute leukemia
    • Trauma
    • Liver disease
    • Pregnancy
    • Envenomations
    • Transfusions
  7. DIC =
    Acquired bleeding disorder characterized by low platelets, prolonged coagulation times (esp factors 5, 8, & 13), and low fibrinogen levels

    The disease process causes fibrin formation and then breakdown, consuming clotting factors.  Fragmentation of RBCs can also occur as they travel through fibrin strands.

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