Definition/Diagnosis
Bleeding that lasts more than how many days is considered menorrhagia?
What is 7 days?
What is first line therapy for severe abnormal uterine bleeding?
What is OCPs?
List 4 labs you want to order in a patient with heavy menstrual bleeding with a Hg of 5
What is iron, TIBC, ferritin, reticulocyte count
What is target iron replacement/day?
3 mg/kg/day
How can TRALI present?
What is fever, chills, respiratory distress
Menorrhagia is defined as the use of more than how many pads per day?
What is 7 pads per day?
What type of OCP do you want to prescribe for heavy menstrual bleeding?
What is a combined OCP
Name 3 causes of menorrhagia in adolescents.
What is anovulation, PCOS, obesity, hypothyroidism, bleeding disorders.
What can you tell your patients to take with iron to increase absorption?
What is typical volume of blood transfusion?
10-15 cc/kg (children >20 kg, 1 unit)
What coin size clots are worrisome?
What is quarter sized?
Which IUD is not recommended for nulliparous women?
What is Mirena.
List three possible underlying bleeding disorders in adolescents with heavy menstrual bleeding.
What is - von Willebrand - Clotting Factor Deficiency - thrombocytopenia - platelet dysfunction disorder
What beverage should your patient avoid drinking 30 minutes before taking iron?
What is milk?
You are called to a patient's room who is receiving a blood transfusion for tachycardia, shortness of breath, and swollen legs. What transfusion reaction are you worried about?
What is TACO? Transfusion Associated Circulatory Overload
A blood loss of more than how many mL per cycle meets criteria for menorrhagia?
What is 80 mL/cycle?
Which IUD is best for inducing amenorrhea?
What is Mirena
Iron replacement should be continued until iron stores are replenished which is evidenced what lab value?
What is a normal ferritin?
What is the ratio of iron/mL of blood in pRBCs?
1 mL iron/1 mL of pRBC. 1:1!
You are on your first resitern. You get a call about a child who just started a transfusion who has developed itchy skin +/- rash. This is their first transfusion. Name 3 things you should do.
What is
- Assess
- Stop the transfusion
- Benadryl and observe
- If Benadryl helps, resume the transfusion
If itchiness does not resolve, can trial second dose of Benadryl, different antihistamine, IV Methylpred
You are an intern seeing your first patient in Gen Peds clinic. It is a 16 year old with the CC of ‘heavy periods.’ The CBC returns with a Hgb 8. You see that her heart rate is mildly elevated for her age (110) You are struggling with the decision of whether to send this patient to the ED. What other factors will you look at to ultimately decide? (Name at least 3)
- Other VS
- symptomatic vs asymptomatic
- ability to send home with OCPs
- whether bleeding is active and ongoing
- mental status
- concern for underlying disorder
How long do you need to wait after resolution of STIs to place an IUD?
What is 3 months?
What lab value responds first to oral iron replacement therapy?
Reticulocyte count
What equation do you use to calculate the iron deficit?
Ganzoni equation
A hypotensive transfusion reaction is generally a systolic blood pressure drop of how much and what time frame following transfusion initiation?
What is
SBP drop > 30
At onset of transfusion (10-15 min) and within one hour