Haem

Question 1

What is post thrombotic syndrome?

Answer 1

Complication following DVT which leads to chronic venous hypertension secondary to venous insufficiency and venous outflow obstruction.

Features-
Painful calves
Pruritus
Swelling
Varicose veins
Venous ulcers

Keep leg elevated and compression stockings.

Question 2

Transfusion Reactions

Answer 2

Non-haemolytic acute reaction- fever and chills due to antibodies reacting with white cell fragments in blood product. Stop transfusion, paracetamol and monitor

Acute haemolytic reaction- fever, hypotension and abdominal pain. Sx begin in minutes. Stop transfusion, send blood off for Coombs test, fluids.

Anaphylaxis- angioedema, wheeze, hypotension, dyspnoea. Stop transfusion, adrenaline.

Transfusion related acute lung injury- hypoxia, pulmonary infiltrates on CXR, fever, hypotension. Stop transfusion and oxygen

Question 3

What is VWD?

Answer 3

Most common inherited bleeding disorder, autosomal dominant mainly. Due to deficiency/abnormality in VWF which causes platelet adhesion to endothelium and factor 8 carrier.

Prolonged bleeding time, prolonged APTT, reduced factor 8.

Tranexamic acid and desmopressin which increases release of VWF.

Question 4

Hereditary spherocytosis

Answer 4

Autosomal dominant, most common hereditary haemolytic anaemia. Northern European descent.

EMA binding test.

Features-
Failure to thrive, jaundice, gallstones, splenomegaly, aplastic crisis, degree of haemolysis variable, MCHC elevated.

Question 5

AML

Answer 5

Anaemia, neutropaenia, thrombocytopaenia, splenomegaly and bone pain.

Auer rods on blood film.

Question 6

Neutropenic sepsis

Answer 6

Features- malaise, diarrhoea, flu-like illness, pyrexia on the background of cancer/recent chemo.

First line treatment without waiting for blood cultures- tazocin.