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Line 38: − =Missed Concepts=+ − *For supratherapeutic INR in a patient on Warfarin, if INR <4.5, can hold Warfarin for 1-2 days then recheck and resume, if INR 4.5-10, give 1-2.5 mg PO vitamin K.+ − *The biggest drawback of IVC filters is that they '''double the risk of DVT''' − *Factor V Leiden accounts for about 50% of hereditary thrombophilia. − *Technetium-99 bone scan detects plastic lesions, CT detects lytic lesions.
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=HIT=
=Missed Concepts=
*Tx: Discontinuation of heparin and transition to a DOAC if anticoagulation is still required (Warfarin causes transient hyper coagulable state due to '''depletion of protein of C'''). '''Avoidance of heparin for life'''
*For supratherapeutic INR in a patient on Warfarin, if INR <4.5, can hold Warfarin for 1-2 days then recheck and resume, if INR 4.5-10, give 1-2.5 mg PO vitamin K.
*The biggest drawback of IVC filters is that they '''double the risk of DVT'''
*Factor V Leiden accounts for about 50% of hereditary thrombophilia.
*Technetium-99 bone scan detects plastic lesions, CT detects lytic lesions.
*Tumor lysis syndrome causes '''release of K, Phos, and Urea''' leading to '''uremic syndrome, stones, hypocalcemia, [[Renal|AKI]], and cardiac arrhythmias'''. Treatment is with '''IV fluids and rasburicase'''
=[[Anemia]]=
*Micro: Thalassemia (Mentzer Index < 13: MCV/RBC), Iron (RDW high), Chronic inflammation (ESR, CRP), Lead (serum level), Sideroblastic
*Normo:
** Non-Hemolytic (retic count ≤ 2%, normal LDH/haptoglobin/RDW): Chronic inflammation, Iron, CKD, Aplastic
** Hemolytic (retic count > 2%, elevated LDH, low haptoglobin, elevated RDW):
*** Intrinsic: MEH (HS/PNH, G6PD/Pyruvate kinase, SCD/HbC)
*** Extrinsic: MAMI
*Macro:
** Megaloblastic: B12 Folate Fanconi
** Non-Megaloblastic: Alcohol Liver disease
=Thrombocytopenia=
==ITP==
*H&P: Caused by autoantibodies against platelet membrane proteins.
*Dx: Low platelets with otherwise normal labs. Petechiae and purpura.
*Tx: Corticosteroids if Plt < 30k
==TTP==
*H&P:
*Dx: Low platelets plus microangiopathic hemolytic anemia with low Hgb, shistocytes on smear, elevated LDH. Sometimes associated with acute renal failure (hemolytic uremic syndrome)
*Tx: Treat HUS with plasma exchange
==DIC==
*H&P: Spontaneous bleeding due to widespread intravascular coagulation and consumption of clotting factors.
*Dx: Low platelets plus elevated d-dimer, prolonged PT/PTT, low fibrinogen
==HIT==
*Dx: T score (timing, thrombocytopenia, thrombosis, alTernate causes)
*Tx: Discontinuation of heparin and '''transition to a DOAC if anticoagulation is still required (usually is immediately)''' (Warfarin causes transient hyper coagulable state due to '''depletion of protein of C'''). '''Avoidance of heparin for life'''
=Multiple Myeloma=
=Multiple Myeloma=
*Tx: Autologous Stem Cell Transplant or chemotherapy
*Tx: Autologous Stem Cell Transplant or chemotherapy
https://www.ohsu.edu/knight-cancer-institute/thomas-deloughery-mds-famous-handouts