Quiz 2

(Ref: Harrison 20th edition, p 854 and blood banking and transfusion medicine by Hillyer: 2nd edition p 490)
 An FFP volume of 15 mL/kg (approximately 4 units in a 70 kg adult) is typically sufficient to reverse coagulopathy caused by warfarin toxicity.
 Ideally prothrombin complex concentrates at 50-100 units/kg IV at 12 hour interval is given for major bleeding episodes in warfarin toxicity. Recombinant factor VIIa is also used to reverse the coagulopathy in hours. Oral vitamin K1 is given in absence of serious/life threatening hemorrhage.

(Ref: Harrison 19th edition, p 673 and 2733)
 The main complications of copper sulphate ingestion include intravascular haemolysis, met-hemoglobinaemia, acute kidney injury and rhabdomyolysis. The lethal dose can be as small as 10 grams.
 Viper bite is primarily vasculotoxic. It causes rapidly developing swelling of the bitten part. Local necrosis is mainly ischemic as thrombosis blocks the local blood vessels and causes a dry gangrene. Systemic absorption is slow; it occurs via the lymphatics and leads to lymphangitis. Hemostatic abnormalities are characteristic of viper bites and are the cause of the complications that lead to death. A Persistent ooze from the bite mark and the site of the IV cannula is an indication of the altered clotting mechanism. Hemorrhage and increased capillary permeability leads to shock and pulmonary edema. Oliguria ensues, followed by loin pain due to renal ischemia. Renal failure is the common event before death.
 Massive hemolysis due to mismatched blood transfusion will lead to hemoglobinuria.

(Ref: Harrison 18th edition, p ch. 106)
Coomb's positive hemolytic anemia may be seen in autoimmune conditions. All options other than alcoholic cirrhosis may have autoimmune etiologies and hence, may very well have coomb's positive hemolytic anemia as a feature.