generic Flashcards
How would you manage a patient who has an unprovoked DVT (first episode)
1) anticoagulation- 6 months warfarin 2) investigate cause- examination, lab (FBC, Calcium, LFTs, urinalysis), radiology (CXR) * if above negative and age above 40- consider CT abdo pelvic + (mammogram for females) thrombophilia screen- consider testing for APS, consider testing for thromnophilia if hx of DVT / PE in 1st degree relative
what effect is warfarin associated with when first initiated?
inhibition of protein c resulting in procoagulant effect. Complications include venous gangrene and skin necrosis.
What is heparin induced thrombocytopenia?
it is a immune mediated reaction resulting in antibodies formation which causes platelet activation. it results in at least 50% reduction in platelet, thrombosis, and skin allergy Management: 1) Warfarin should be stopped immediately + reversed with VIT K if initiated within 5-7 days due to its prothrombotic risks 2) anticoagulant including direct thrombin inhibitor-bivalirudin and danaparoid (factor Xa inhibitor) can be used to prevent thrombosis
What is the treatment for heparin overdose?
Protamine sulfate
langerhans cell histiocytosis
it is a childhood disorder associated with abnormal proliferation of histiocytes. It presents with bony lesions in skull or proximal femur. X-ray feature- well-defined punched out osteolytic lesions.
What are the causes of neutropenia?
1) post-viral illness (transient myelosuppression)
2) haematological malignancy
3) haemolysis
4) aplastic anaemia
5) drugs- carbimazole, clozapine
What is warm autoimmune haemolytic anaemia?
What are the causes?
How is it managed?
The antibody (IgG) causes haemolysis at body temperature in extravascular sites (e.g. spleen)
Causes
1) drugs- methydopa
2) neoplastic- CLL, lymphoma
3) SLE
It is managed with 1) steroids 2) immunosuppression 3) splenectomy
What is cold autoimmune haemolytic anaemia?
What are the causes?
How is it managed?
IgM causes haemolysis at cold temeprature, mediated by complement. It is associated with intravascular haemolysis. Features-raynauds, acrocyanosis
Causes:
1) neoplasia: lymphoma
2) infections: mycoplasma, CMV
Management: steroids
what is the gene translocation 15:17 associated with
what is the fusion protein called?
acute promyelocytic leukaemia (M3)
15:17 translocation results in fusion of PML:RARa (retinoic acid receptor)
what haematological disorder is associated with acute promyelocytic leukaemia?
DIC
What blood film findings are associated with acute promyelocytic leukaemia?
Auer rods
What anticoagulants can be used in HIT
1) direct thrombin inhibitor- dabigatran, bivalirudin, lepirudin
2) heparinoid- danaparoid
