Haem Flashcards
What antibiotic is contraindicated in G6PD deficiency
ciprofloxacin
how does factor v leiden increase risk of VTE
factor V is a clotting agent
protein c inactivates it 10 times slower
Role of von willibrand factor
large glycoprotein that triggers platelet adhesion to damaged endothelium
Normal platelets, raised APTT, raised bleeding time
What is used to monitor heparin
APTT
Activates antithrombin III. Forms a complex that inhibits thrombin, factors Xa, IXa, Xia and XIIa
What is used to monitor LMWH
Factor Xa
Activates antithrombin III. Forms a complex that inhibits factor Xa
polycythaemia vera long term management
aspirin
what factors does warfarin affect?
2,7,9,10
treatment of von willibrand
desmopressin
TTP deficiency
ADAMTS13 which breaks down large clumps of von willebrand factor
polycythaemia vera complications
AML or myelofibrosis
trasnfusion thresholds
normally 70g/L but 80g/L if ACS
drugs contraindicated in G6PD
sulph- drugs: sulphonamides, sulphasalazine and sulfonylureas can trigger haemolysis
anti-malarials: primaquine
ciprofloxacin
first line investigation for PRC
JAK2 mutation
AIHA treatment
steroids + rituximab
secondary cause of PRV
copd: hypoxia leads to increased EPO
Wide distribution of red blood cells/High RDW
mixed anaemia e.g. iron deficiency with b12.
Blister cells
G6PD
electrolyte abnormality with packed red blood cells
hyperkalemia
what viral infection causes facial flushing
dengue fever
waldenstroms macroglobulinaemia
secretion of a monoclonal IgM paraprotein
platelet transfusion before invasive procedure
must be above 50
1st line imaging for multiple myeloma
whole body MRI
acute haemolytic transfusion reaction patho
Binding of IgM-type antibodies to red blood cells causing haemolysis
39%
how to differentiate AML and CML
AML: neutropenia
CML: neutrophillia
atypical lymphocytes
glandular fever
richters transformation
CLL -> non-hodgkins (DLBCL)
reverseal of dabigatran
idarucizumab
Reversal of other doacs
andexanet alfa
why are irradiated blood products used
avoid transfusion-associated graft versus host disease e.g. hodgkins lymphoma
most common type of hodgkins lymphoma
nodular scelrosing
painful when drinking alcohol
hodgkins
clinical TLS signs
increased serum creatinine (1.5 times upper limit of normal)
cardiac arrhythmia or sudden death
seizure
gastric malt lymphoma association
h.pylori (non-hodgkin’s)
G6PD diagnosis
enzyme assay at the time and in 3 months
what effect can p450 inducers have on warfarin
increased clearance
cause of acute haemolytic febrile reaction
ABO incompatible blood
Name 2 immediate steps that need to be taken after a acute haemolytic reaction
Stop blood transfusion & inform the hospital Transfusion Laboratory
Take a post transfusion sample from patient & send to Transfusion Laboratory for direct Coombs test, repeat typing and cross-matching
What can cause TACO
Excessive rate of transfusion, pre-existing heart failure
what causes minor allergic reaction in transfusions?
reaction to foreign plasma proteins
cause of non-haem febrile reaction
antibodies reacting with white cell fragments in the blood product and cytokines that have leaked from the blood cell during storage
sickle cell management
pneumococcal polysaccharide vaccine every 5 years
HbH vs Barts
HbH: beta chains form tetrameres (splenomegaly, hypochromic, microcytic anaemia)
Barts: gamma chains form tetramers (hydrops fetalis)
How can warfarin lead to skin necrosis
when warfarin is first started biosynthesis of protein C is reduced
this results in a temporary procoagulant state after initially starting warfarin, normally avoided by concurrent heparin administration
thrombosis may occur in venules leading to skin necrosis
features of haemochromatosis
fatigue, erectile dysfunction and arthralgia (often of the hands)
‘bronze’ skin pigmentation
diabetes mellitus
vitamin k dependent clotting factors
2,7,9,10
blood products
Fresh frozen plasma (FFP)
- universal donor of FFP is AB blood because it lacks any anti-A or anti-B antibodies
Cryoprecipitate
- contains concentrated Factor VIII:C, von Willebrand factor, fibrinogen, Factor XIII and fibronectin
- fibrinogen concentration < 1.5 g/L
Prothrombin complex concentrate
- emergency reversal of anticoagulation in patients with either severe bleeding or a head injury with suspected intracerebral haemorrhage
factors to reduce risk of sickle cell crisis
avoid dehydration/cold/exhaustion
smoking + alcohol
neutropenic sepsis organism
staph epidermis
target cells
‘pencil’ poikilocytes
iron deficiency
most common type of non-hodgkins lymphoma
diffuse large b cell
contraindications to platelet transfusion
Chronic bone marrow failure
Autoimmune thrombocytopenia
Heparin-induced thrombocytopenia, or
Thrombotic thrombocytopenic purpura.
complication of myelodysplasia
AML
transformations
Myelodysplasia –> AML
CML –> ALL or AML
CLL –> NHL