Haem Misc Flashcards
Why might there be a high MCV in a sickle cell crisis
Reticulocytosis
Preventative medication in sickle cell anaemia?
Hydroxycarbamide - increases HbF level therefore decreasing percentage of HbS
Start if 2 or more sickle cell crises in a year
What are smear cells? What are they seen in?
Lymphocytes in which the membrane has burst in preparation of the film
Seen in CLL
What electrolyte abnormality can occur with transfusion of packed RBC’s?
Hyperkalaemia
More assoc w high volumes and old blood (cell lysis releases potassium)
What blood pattern is usually seen in alcoholics?
Macrocytic anaemia and thrombocytopaenia
Management of neutropaenic sepsis?
Piperacillin + Tazobactam (Tazocin)
Add Vancomycin if the patient has a central line
Add Gentamicin if severe sepsis (NEWS > 6)
If severe sepsis
When is a patient treated for neutropaenic sepsis?
When does it most commonly occur?
Temperature >38C, Neutrophils <0/5
OR
Neutrophils <1 and chemo in last 21 days
Most commonly 7-14 days after chemotherapy
Prophylaxis for neutropaenic sepsis if it is anticipated with treatment?
Consider giving fluoroquinolone e.g. Ciprofloxacin
What to give in neutropaenic sepsis if penicillin allergy?
Teicoplanin + Aztreonam
Likely cause of isolated thrombocytopaenia?
ITP
What happens to total protein level in multiple myeloma?
Increased
Is the neutropaenic sepsis treatment different in different hospitals?
No, same across all health boards
Why do you get prolonged aPTT in von willebrand disease?
vWF stabilises factor 8
What to do if DVT likely (Wells score >2)?
Arrange proximal leg doppler USS within 4 hours
If one CANNOT be arranged within 4 hours, then test D-dimer and give prophylactic LMWH to cover until USS
What to do if DVT is unlikely (Wells score 1 point or less)?
Do D-dimer
If raised then arrange doppler USS within 4 hours
If it CANNOT be done within 4 hours, give LWMW
Management of confirmed DVT?
Give LMWH or Fondaparinux
Start on Warfarin and continue LMWH for 5 days or until INR >2
Continue Warfarin for 3 months if provoked DVT, or 6 months if unprovoked/cancer
Does tamoxifen therapy increase VTE risk?
Yes
What is the main complication of CLL?
Recurrent infection due to Hypogammaglobulinaemia
Which haem malignancy is thrombosis more common in?
CML
What can CLL transform into?
High grade non-Hodgkin’s lymphoma (Richter’s transformation)
Rarely also AML
What type of haemolysis is CLL associated with?
Warm haemolysis
What is Waldenstrom’s Macroglobulinaemia caused by?
Lymphoplasmacytic Lymphoma
It is an IgM paraprotein disease (Myeloma very rarely causes IgM paraprotein)
How can Waldenstrom’s macroglobulinaemia present?
Hyperviscosity (e.g. stroke) Paraproteinaemia Lymphadenopathy, Splenomegaly Normal renal function No lytic bone lesions on skeletal survey
How do Rivaroxaban and Apixaban work?
Direct Xa inhibitor
How does Dabigatran work?
Direct thrombin (IIa) inhibitor
How long after transfusion does Graft vs Host disease appear?
What is it associated with?
What does it present with?
Management?
4-30 days (subacute)
Non-irradiated blood being given to immunosuppressed patients
Presents with fever, erythroderma, desquamation, diarrhoea, abnormal LFTs
Rx: steroids
What cells mediate transfusion-related acute lung injury?
Management?
Neutrophils (occurs when patient has antibodies to donor leucocytes)
Normally respond to fluid and oxygen therapy
Treatment of what haem malignancy often results in tumour lysis syndrome?
What causes the syndrome?
How does it present?
Burkitt’s lymphoma
Tumour cell lysis releasing large quantities of intracellular substances such as K, uric acid and phosphate
Feeling unwell, confusion and leg cramps about 24 hours after starting chemo