FBC and bleeding disorders

Question 1

Target INR for

1. DVT/PE
2. Recurrent DVT/PE
3. AF
4. Bioprosthetic valve
5. Post MI

Answer 1

1. 2.5-3.0
2. 3.5
3. 2.5-3.0
4. 2.5-3.0
5. 2.5-3.0

Question 2

Duration of warfarin treatment in

1. Provoked DVT/PE
2. Unprovoked DVT/PE

Answer 2

1. 3 months

2. 6 months

Question 3

When do you stop warfarin for surgery?
What INR do you want for an operation?
What could you use to as anti-coagulation instead of warfarin peri-op?

Answer 3

1. 5 days before.
2. Less than 1.5 (so can use vitamin K if their value is still high the night before).
3. Low molecular weight heparin bridging.

Question 4

Reasons for a raised d-dimer and what is a d-dimer

Answer 4

PE
DVT
DIC
Pregnancy
Malignancy
Sepsis

Marker of fibrinolytic activity.

Question 5

If Hb is low but MCV is very very low what is good differential

Answer 5

Thalassaemia

Question 6

Most common cause for drug-induce thrombocytopenia

Answer 6

Heparin

Rifampicin

Question 7

1. Wells score for PE components

2. How to interpret results

Answer 7

1. • Heart rate >100bpm (1.5pts). Immobilisation for 3 days / surgery in last month (1.5pts). Previous DVT or PE (1.5pts). Haemoptysis (1pt). Malignancy (1pt). Clinical signs and symptoms of DVT (3pts). PE is the most likely diagnosis (3pts).
2. If score >4 CTPA asap. If less than 4 arrange d-dimer to exclude PE.

Question 8

1. Wells score for DVT components
2. How to interpret results
3. What Ix to do next

Answer 8

1. Active cancer (1pt). Bedridden for 3 days or surgery within last 3months (1pt). Paralysis/paresis/plaster immobilisation of lower limb (1pt). Calf swelling >3 cm compared to the other leg measured 10 cm below tibial tuberosity (1pt). Nonvaricose superficial veins (1pt). Entire leg swollen (1pt). Local tenderness in deep venous system anatomy (1pt). Pitting oedema on symptomatic leg (1pt). Hx of DVT (1pt). Alternative diagnosis likely (-2pts).
2. DVT likely is 2pts or more. DVT unlikely is 1pt or less.
3. If likely Proximal leg vein USS, d-dimer, give dalteparin.
   If unlikely offer d-dimer.

Question 9

Causes of high platelet count

Answer 9

Infection
Blood loss/haemorrhage
Essential thrombocythaemia, polycythaemia vera and CML (myeloproliferative disorders).

Question 10

What

1. Haematocrit
2. Ferritin
3. Transferrin
4. Total iron binding capatity

Answer 10

1. the ratio of the volume of red blood cells to the total volume of blood.
2. Iron storage protein AND acute phase reactant (like CRP).
3. Transported of iron.
4. Amount of transferrin in blood which is available for iron to attach to

Question 11

Causes for acute drop in Hb

Answer 11

Blood loss
Sudden onset ineffective blood production e.g. aplastic crisis.
Increased destruction/sequestration of RBCs (acquired haemolytic anaemias).

Question 12

Differentials for pancytopenia

Answer 12

Post-chemotherapy
B12 and folate deficiency
Lymphoma
AML, CLL
Autoimmune hepatitis
Aplastic anaemia / EBV