For Cancer-Associated Thrombosis (CAT): For each phase, explain how much anticoag (full, reduced, etc) and the goal you want to transfuse platelets to…
Within 1 month of an event:
- what is the phase?
- Require how much anticoag? - transfuse to a platelet goal of what?
- Acute Phase
- > Require full anticoagulation
- > transfuse to platelet goal of 50k or greater
For Cancer-Associated Thrombosis (CAT): For each phase, explain the how much anticoag (full, reduced, etc) and the goal you want to transfuse platelets to…
After 1 month:
- what is the phase?
- how much anticoag?
- transfuse to platelet goal of?
Subacute phase
- > Reduce anticoagulation to 50% or to prophylactic dose
- > transfuse to platelet goal between 25k and 50k
For Cancer-Associated Thrombosis (CAT): For each phase, explain the how much anticoag (full, reduced, etc) and the goal you want to transfuse platelets to…
When do you hold anticoagulation?
Hold Anticoagulation if Platelets fall below 15k
In addition to benefit with Post-op patients, some recent studies have shown some benefit for Sequential Compression Devices (SCDs) in addition to prophylactic _____ in patients with immobilization following an Acute ___
Heparin;
CVA
name a good med (and dose = low, medium, or high) that a women with primary, secondary, or preg-related HTN can take, after 12th week of pregnancy, in order to reduce risk of Pre-eclampsia
Low dose ASA (class 1A rec)
Know these associations with following cancers:
hereditary nonpolyposis colorectal cancer (HNPCC), brca gene, dermatomyositits, NMDA encephalopathy (note: all of these are assoc with one particular ca)
Ovarian
hint: if you see brca listed, you can narrow the choices to ovarian or breast
Know these associations with following cancers:
hashimotos, h.pylori (MALT), celiac dz, HIV
lymphoma
Know these associations with following cancers:
pts that have been tx with etoposide or cytoxan
leukemia
Know these associations with following cancers:
brca gene and common after radiation for other cancers like lymphoma
breast
Know these associations with following cancers:
brca gene is assoc with what two ca?
ovarian
breast
Nephritic Syndromes:
usually White or Asian demographic often synchronously with an episode of respiratory (“synpharyngitic hematuria”) or gastrointestinal infection
Dx?
DxM?
IgA Nephropathy
-> biopsy with IgA mesangial immune deposits, and complement levels are normal
Nephritic Syndromes:
traditionally been associated with streptococcal infections of the throat or skin usually >1 week after the infection
Dx?
-> what type of Ab’s will pt have?
In terms of C3 and C4 levels, are they low, normal, decreased?
What biopsy is needed?
Post-infectious Glomerulonephritis
patient will have positive anti-streptolysin O or anti-DNAse B antibodies
C3 = decreased C4 = normal
No bx needed
Summary
- post infectious glomerulonephritis –> s/p strep of throat OR skin > 1 week after infxn –> (+) anti-strep O or anti-DNAas B Ab’s –> C3 decreased, C4 normal –> no bx needed
Nephritic Syndromes:
secondary to immune complex formation in response to CHRONIC antigen stimulation -> thinkHepatitis C, osteomyelitis, autoimmune diseases
Dx?
Kidney bx shows what?
Membranoproliferative Glomerulonephritis
kidney biopsy demonstrating“tram-track” appearance of subendothelial deposits of immune complexes. C3 is low and/or low C4.
nephritic syndromes kidney bx:
biopsy with IgA mesangial immune deposits, and complement levels are normal
IgA nephropathy
nephritic syndromes kidney bx:
No biopsy needed
Post-infectious Glomerulonephritis
nephritic syndromes kidney bx:
kidney biopsy demonstrating“tram-track” appearance of subendothelial deposits of immune complexes. C3 is low and/or low C4.
Membranoproliferative Glomerulonephritis
Patient admitted with heart failure exacerbation -> when to schedule follow up appointment after discharge?
One week
Indication for cardiac device placement:
Persistent NYHA class II or III while taking optimal medical therapy and either of the following:
- Ischemic cardiomyopathy ≥40 days post MI with ejection fraction ≤35%
- Nonischemic cardiomyopathy with ejection fraction ≤35%
- History of hemodynamically significant ventricular arrhythmia or cardiac arrest
Implantable Cardioverter-Defibrillator
Indication for cardiac device placement:
All of the following:
- NYHA class III or IV
- Ejection fraction ≤35%
- QRS interval ≥120 msec
Biventricular Pacemaker (cardiac resynchronization therapy)
Indication for cardiac device placement:
Implantable Cardioverter-Defibrillator
Persistent NYHA class II or III while taking optimal medical therapy and either of the following:
- Ischemic cardiomyopathy ≥40 days post MI with ejection fraction ≤35%
- Nonischemic cardiomyopathy with ejection fraction ≤35%
- History of hemodynamically significant ventricular arrhythmia or cardiac arrest
Indication for cardiac device placement:
Biventricular Pacemaker (cardiac resynchronization therapy)
All of the following:
- NYHA class III or IV
- Ejection fraction ≤35%
- QRS interval ≥120 msec
Nephritic Syndrome: name three findings:
Hematuria (red cell casts) some proteinuria (but
Nephritic Syndrome: name three findings:
- hematuria (red cell casts)
- some proteinuria (
