105.2 📚 國考版醫垫國考 / PGY OSCE

105.2.0.1 📌 Cram Sheet

105.2.0.1.1 🔥 高 yield 12
  1. Hemolysis markers: retic ↑, LDH ↑, indirect bili ↑, haptoglobin ↓
  2. G6PD: X-linked; bite cells + Heinz bodies; primaquine/dapsone/sulfa/fava
  3. HS: AD; spherocytes + MCHC ↑; splenectomy curative
  4. Warm AIHA: DAT IgG+; SLE/CLL/Hodgkin/drug; steroid + rituximab
  5. Cold AIHA: DAT C3+; lymphoplasmacytic, mycoplasma, EBV; sutimlimab (FDA 2022)
  6. TTP: ADAMTS13 < 10%; pentad (FAT RN); PEX + caplacizumab + rituximab
  7. TTP: 䞍 transfuse platelet (worsens)
  8. HUS typical: STEC E. coli O157:H7; bloody diarrhea; avoid antibiotic
  9. aHUS: complement; eculizumab/ravulizumab
  10. PNH: PIG-A → CD55/CD59 def; intravascular hemolysis + thrombosis + AA
  11. PNH treatment: eculizumab/ravulizumab + iptacopan oral 22E
  12. Neisseria vaccine before complement inhibitor
105.2.0.1.2 🔢 必背
項目 æ•žå­—
ADAMTS13 cutoff < 10% (TTP)
Schistocytes MAHA ≥ 1% on smear
MCHC HS > 36 (typical)
TTP plt < 30K typical
G6PD test post-acute re-test 3 mo
PNH FLAER test flow cytometry

105.2.0.2 ⭐ 高 yield

105.2.0.2.1 Coombs Test
DAT (direct) IAT (indirect)
Detects Ab on RBC Free Ab in serum
Use Immune hemolysis dx Transfusion compatibility, HDN
105.2.0.2.2 AIHA Comparison
Warm Cold
Temp 37°C 4°C
Ab class IgG IgM
DAT IgG+ (± C3) C3+
Site of hemolysis Spleen (extravascular) Liver (extravascular) + intravascular
Causes Lymphoma (CLL, Hodgkin), SLE, drug, idiopathic Lymphoplasmacytic, Mycoplasma, EBV
Treatment Steroid + rituximab Avoid cold + rituximab + sutimlimab
105.2.0.2.3 Hemolytic MAHA Differential
TTP HUS DIC aHUS HELLP
ADAMTS13 < 10% normal normal normal normal
Coags normal normal abnormal normal varies
Renal mild-moderate severe varies severe varies
Neuro severe mild varies mild varies
Trigger autoimmune STEC sepsis/cancer complement pregnancy
Treatment PEX + caplacizumab supportive (avoid abx) treat cause eculizumab deliver baby
105.2.0.2.4 Drug-Induced AIHA
  • Hapten: penicillin (high dose) — washes off → Coombs neg
  • Immune complex: quinidine
  • Autoantibody: methyldopa, ICI, fludarabine, cephalosporins
105.2.0.2.5 Complement Inhibitors (PNH/aHUS)
Drug Target Route
Eculizumab (Soliris) C5 IV q14d
Ravulizumab (Ultomiris) C5 long-acting IV q8wk
Pegcetacoplan (Empaveli) C3 SC q3-4d
Iptacopan (Fabhalta) Factor B (oral) PO BID
Danicopan (Voydeya) Factor D (oral) PO TID

105.2.0.3 🎯 自我檢枬

  1. Hemolysis markers 4? → Retic, LDH, indirect bili, haptoglobin
  2. G6PD smear? → Bite cells + Heinz bodies
  3. HS smear? → Spherocytes + MCHC ↑
  4. HS curative? → Splenectomy
  5. Warm AIHA DAT? → IgG+
  6. Cold AIHA DAT? → C3+
  7. Cold AIHA new drug? → Sutimlimab (FDA 2022)
  8. TTP ADAMTS13? → < 10%
  9. TTP treatment 3? → PEX + caplacizumab + rituximab
  10. TTP plt transfusion? → 侍 (worsens unless life-threatening bleed)
  11. STEC-HUS antibiotic? → 避甚 (worsens)
  12. aHUS treatment? → Eculizumab/ravulizumab
  13. PNH genetics? → PIG-A → CD55/59 deficient
  14. PNH new oral? → Iptacopan
  15. Pre-eculizumab vaccine? → Neisseria meningitidis

⚠ AI 草皿。