haem Flashcards
how do you monitor LMWH
anti-Xa assay
how does LMWH work
inactivated factor Xa
how do you monitor unfractionated heparin
APTT
Vitamin K antagonis
warfarin
how do you monitor warfarin
INR
how does dabigratan work
direct thrombin inhibior
monitoring for dabigatran?
none required
how does rivaroxaban work
block Xa
monitoring for rivaroxaban?
none needed
resistance to the natural anticoagulant protein C
factor V leiden
most common inherited thrombophilia
factor V leiden
deficiency of factor VIII
haemophilia A
deficiency of factor IX
Haemophilia B
christmas disease
in a single clotting factor deficiency (haemophlia), what increased
APTT increased
in a multiple clotting factor deficiency, what increases
PT and APTT
causes of multiple clotting factor deficiecny
Vit K deficieincy
Liver disease
Warfarin
DIC- sepsis, obstetric emergencies, malignancy, hypolvolaemic shock
most common inherited bleeding disorder
von willebrand factor deficiency
male with sternal pain, multiple lytic lesions, what invetsigation do you do>
protein electrophoresis
looking for bence jones protein as this is melanoma
bleeding into breast, has haemophilia B, what do you give?
factor 9 precipitate
what happens to calcium in myeloma
hypercalcaemia
dad has haemophilia and wife is pregnant with son, which test?
no test, as X linked so dad cant give it to boy as son receives Y from dad
on warfrain for heart valve, INR is 8 but he isnt bleeding, what do you do
5mg oral vit K
and stop warfarin
on warfarin , having a major bleed, what do you do
IV Vit K and prothrombin complex (or FFP)
and stop warfarin
on warfarin and INR >8 and minor bleeding, what do you do
stop warfarin
IV vit K 1-3mg
INR 5-8 and minor bleeding
what do you do
stop warfrain
Iv vit K 1-.3mg
INR 5-8 with no bleeding what do you do
withhold a couple of warfarin doses
at what INR can you restart warfarin
<5
target INR if AF
2.5
high MCV
macrocytic anaemia
low MCV
microcytic anaemia
how would you look at RBC morphology
blood film
what might cause a high retic count
haemolysis
bleeding
what can cause a normocytic anaemia
chronic diseasee
pregnancy
haemolysis
acute blood loss
what is microcytic anaemia
whennot enough Hb can be made due to lack or glob, lack of iron so small cells get produced with low Hb content
what causes microcytic anaemia
iron deficicney
thalasaemia
structure Hb variants
what kind of mutations do you get in thalassaemia
point mutations
normally autosomal recessive
what is macrocytic anaemia
red cells have a larger volume than nomral
what is a megaloblast
abnormally large nucleated red cell presurosr with an immature nucelus
(remember red cells dont have a nucleus!)
what happens in megaloblastic macrocytic anaemia
defects in DNA synthesis and nuclear maturation,
thinks it has enough Hb so doesnt divide to become smaller
what causes megaloblastic macrocytic anamia
B12 and folate deficiency
pernicious anaemia
what happens in pernicious anaemia
autoimmine destruction of gastric parietal cells so no intrinsic factor to absorb B12
need B12 injections for life
anti- intrinsic factor
anti- gastric parietal cell
pernicous anamia
causes of non megaloblastic anaemia
alcohol
hypothyroidism
liver disease
marrow failure