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Clinical Pathology > CP7-8 haematological emergencies > Flashcards

CP7-8 haematological emergencies Flashcards

1
Q

What are some thrombosis related haematological emergencies?

A

DVT
PE
Thrombotic thrombocytopenic purpura (TTP)

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2
Q

What are some haemolysis related haematological emergencies?

A

HELLP syndrome
Microangiopathic haemolyis (MAHA)

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3
Q

What are some transfusion reactions which are haematological medical emergencies?

A

Haemolysis
Febrile non-haemolytic
Transfusion related acute lung injury
Massive transfusion
Transfusion associated circulatory overload

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4
Q

What are some haemostasis related haematological emergencies?

A

disseminated intravascular coagulation
Heparin induced thrombocytopenia
Immune thrombocytopenic purpura
Over anticoagulated patient
Management of anticoagulated patient undergoing acute surgery

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5
Q

What are some disease related haematological emergencies?

A

acute haemolysis
haemorrhage in patients with bleeding disorders
sickle cell crisis
mediastinal mass (SVCO)
new acute leukaemia
hyperviscosity
hypercalcaemia
spinal cord compression

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6
Q

What are some treatment related haematological emergencies?

A

tumour lysis syndrome
cytokine release syndrome
neurological toxicity

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7
Q

What are some haematological emergencies that can be caused by either disease or treatment?

A

neutropenic sepsis
non-neutropenic infection
AKF

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8
Q

What is a normal Hb count for women?

A

> 115

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9
Q

How might a patient with TTP present/what signs are found?

A

Confusion/seizures strokes
Fever
Renal failure
Low haemoglobin
Low platelet count
Recent onset headache
Pale and scattered bruising
Red cell fragments in blood
Potentially organ ischaemia due to thrombosis

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10
Q

What is TTP?

A

A type of MAHA where there is severely reduced activity of ADAMTS13 enzyme resulting in accumulation of larger vWF. This causes intravascular thrombosis and shearing of red cells

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11
Q

How is TTP acquired?

A

Through acquisition of autoantibody to ADAMTS13 or rarely inherited

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12
Q

What is looked for in a haemolysis screen?

A

FBC with reticulocyte count
Bilirubin
LDH
DCT
blood film
Haptoglobin count

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13
Q

What tests are done to investigate TTP?

A

ADAMTS13 levels
Test for Troponin
Hep B/C and HIV serology
Pregnancy test in women of childbearing potential

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14
Q

What should never be given to patients with TTP?

A

Platelet transfusion

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15
Q

How are patients treated for TTP?

A

Urgent plasma exchange
Suppression of antibody production
Prevention of thrombosis with aspirin and LMWH when platelets >50
Capalcizumab

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16
Q

What is normal Hb in men?

A

> 135

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17
Q

How may a patient with new leukaemia present?

A

Pancytopenia
Low Hb, platelets and WCC
Easy bruising
Sore mouth and gums with blood blisters
Pale rash on feet
Progressively feeling unwell

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18
Q

How is a diagnosis of leukaemia confirmed?

A

With a bone marrow biopsy

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19
Q

How is new leukaemia treated?

A

antibiotics for infections
blood transfusions of RBCs and platelets when necessary
intensive chemo if patient is fit enough

20
Q

How might a patient with sudden compression of spinal cord by a malignant myeloma tumour present?

A

Sudden onset leg weakness
Saddle anaesthesia
Back pain and tiredness
Abdominal distension
Supra-pubic dullness
Low Hb, high Ca, more need to add

21
Q

What is the medical term for losing your balance when leaning backwards?

A

Retropulsion

22
Q

How is spinal cord compression by malignant myeloma treated?

A

steroids to reduce size
radiotherapy if largely soft tissue
occasionally surgery

23
Q

How might a patient with superior vena cava obstruction present?

A

Pain in chest when drinking alcohol
Facial swelling and breathlessness
Sweating and fever
Generally unwell
Distended neck veins
Plethora

24
Q

What can cause superior vena cava obstruction?

A

Hodgkin lymphoma

25
Q

What may suggest that a patient has Hodgkin lymphoma?

A

Sweating
Pain on drinking alcohol
Young

26
Q

How may a patient with tumour lysis syndrome present?

A

Confused
Aneuric (not passing urine)
Agitated
Raised creatinine, uric acid, potassium and phosphate
Low calcium
Just started chemotherapy

27
Q

What can tumour lysis syndrome lead to?

A

Renal failure
Cardiac arrhythmia due to hyperkalaemia
Low calcium can cause confusion and seizures
Death if untreated

28
Q

How are patients with tumour lysis syndrome treated?

A

IV fluids
Dialysis if needed
Rasburicase
Treat for high potassium

29
Q

How does rasburicase work?

A

Converts uric acid into a more soluble form

30
Q

How may a patient with neutropenic sepsis present?

A

Fever
Rigors
Recent R-CHOP chemotherapy
High temp
Low BP
High HR
slightly low Hb and platelets
Very low neutrophils

31
Q

What initial tasks are done if neutropenic sepsis is suspected?

A

Septic screen for patient
Give broad spectrum antibiotics

32
Q

What is neutropenic sepsis?

A

Life threatening infection characterised by a neutrophil count <1 with a potential unobvious source of infection

33
Q

If a patient has neutropenic sepsis, what procedures should be avoided?

A

Catheter insertion
ABG
Rectal or vaginal exams

34
Q

How is neutropenic sepsis investigated?

A

Blood cultures
Urine cultures
FBC, renal and liver function and CRP blood tests
Chest x-ray
VBG for lactate levels
COVID test

35
Q

How might a patient with cytokine release syndrome present?

A

High temp
Low BP
Hypoxia
Recent CAR-T cell infusion
Flushed
Rigor
Tremor
Confusion

36
Q

What is CAR-T therapy?

A

Genetic modification of patient’s own T-cells to activate them and redirect them towards cancer cells.

37
Q

What is cytokine release syndrome?

A

Exaggerated physiological response to immune therapies resulting in release of inflammatory cytokines

38
Q

What are causes of cytokine release syndrome?

A

CAR-T therapy
Some antibody therapies like Blinatumumab
Some types of stem cell transplant

39
Q

How is cytokine release syndrome treated?

A

Broad spectrum antibiotics
IV fluid and oxygen
Tocilizumab

40
Q

How does Tocilizumab work?

A

Blocks IL6 reducing inflammatory response

41
Q

What other syndrome/pathology can cure alongside or just after cytokine release syndrome?

A

Immune cell related neurological toxicity

42
Q

How do patients with immune cell related neurological toxicity present?

A

Neurological symptoms including confusion +/- seizures +/- coma

43
Q

How are patients with immune cell related neurological toxicity treated?

A

With steroids to suppress immune cells

44
Q

What neurological assessments are used to test immune cell related neurological toxicity?

A

ICE
ICANS

45
Q

What is involved in ICE scoring?

A

Assessing patients orientation - do they know the year, month, the city and hospital they’re in
Can patient name 3 objects they can see
Can the patient follow simple commands
Can a patient write a standard sentence - how does they’re handwriting change
Assesses attention by seeing if patient can count backwards from 100 in 10s

46
Q

What is an ICANS score?

A

Uses ICE score alongside consciousness assessment, if patient is having seizures, motor findings and if there is elevated ICP/cerebral oedema to grade severity

47
Q

How does rasburicase work?

A

Converts uric acid into a more soluble form

Clinical Pathology (65 decks)

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