Haematology 1 Flashcards
most common inherited bleeding disorder?
- lab:
1. Bleeding time?
2 Platelet count?
3 APTT? - what might be reduced?
Management:
1. mild bleed =
2. **
Von Willebrand’s disease
Investigation
1. prolonged bleeding time
2. APTT may be prolonged
3. Normal platelets
4. factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin
Management
1. tranexamic acid for mild bleeding
2. desmopressin
3. factor VIII concentrate
Neutropenic Sepsis
Should be suspected in a person with: (4)
1. cause ie…
2
3
4
Pathogen?
Prophylaxis- whats given if neutrophil count < 0.5 x 10^9
- known cause for neutropenia (recent cancer treatment)
- presumed or confirmed infection
- temperature >38ºC
- respiratory rate >20 breaths per minute
coagulase-negative, Gram-positive bacteria are the most common cause, particularly Staphylococcus epidermidis
Prophylaxis- fluoroquinolone
Management of neutropenic sepsis/ suspected
- If febrile after 48 hours…
- No respeonse after 4-6 days…
- Abx IV **Pip-taz ( aka tazocin) immediately
+/- Vancomycin is central venous access - If febrile after 48 hours… alternative abx such as vancomycin or meropenim
- No respeonse after 4-6 days… investigate for fungal infection
Platelet transfusion for thrombocytopaenia
BLEEDING RULES
1. mod bleed
2. severe bleed or…
PRE-INVASIVE RULES
1.
2.
3.
NO BLEEDING OR PLANNED INVASION RULES
BLEEDING
1. offer if platelet < 30 x 10^9 and bleeding grade 2- e.g. haematemesis, melaena, prolonged epistaxis
- Severe bleeding- platelets < 100 x10^9 or bleeding at critcal site such as CNS
PRE-INVASIVE RULES
1. > 50×109/L for most patients
2. 50-75×109/L if high risk of bleeding
3. >100×109/L if surgery at critical site (CNS)
NO BLEEDING OR PLANNED INVASION RULES
threshold of 10 x 10^9 except where platelet transfusion is contradindicated or there are alternative treatments for their condition
CI of platelet transfusion (4)
- Chronic bone marrow failure
- Autoimmune thrombocytopenia
- Heparin-induced thrombocytopenia
- Thrombotic thrombocytopenic purpura.
If you see on the blood film- Increase in granulocytes at different stages of maturation +/- thrombocytosis
CML
Painless, ASYMMETRICAL node swelling in the neck → ?
Hodgkin’s lymphoma
Iron deficiency anaemia 2ww rule (1)
men of any age with a Hb below 110g/L should be referred for upper and lower GI endoscopy as a 2ww.
Iron def anaemia give me 4/5 reasons why it might happen
Features rogue
mail changes-
Serum ferritin high or low?
TIBC low or high?
blood film you see (2)
- Most common pre-school age due to increase reuirement
- Heavy bleeding- menorrhagia
- GI blled- malig
- Poor diet iron
- Malabsorption
rogue
1. koilonychia (spoon-shaped nails)
2. Atrophic glossitis
3. Post-cricoid webs
4. Angular stomatitis
Serum ferritin- low
TIBC- high
Blood film
- target cells, ‘pencil’ poikilocytes
DVT investigation: if the scan is negative, but the D-dimer is positive …. (2)
- Stop anticoag
- Repeat USS in 1 week
- Look at lymphocytes
- Look at WBC
- Others hint (blast cell/ bands)
Example
1.Low Lymphocytes -> the answer should be AML or CML
2. WBC > 100 -> Chronic causes so Consider CML (rule out AML)
3. Presence of bands cell -> confirm CML
*blast -> Acute
*bands -> Chronic
Just recveived a transplant of somesort
- painful maculopapular rash is a common feature of
graft versus host disease
After PPH and resus complete- what blood products should be given first?
max you can give?
FFP
- request ‘Clotting studies and a platelet count ugently’ and give FFP while you wait for them.
up to 4 units of FFP and 10 units of cryoprecipitate
What is the definition of aplastic anaemia (3)
Drug case of aplastic anaemia?
normocytic anaemia, leukopenia and thrombocytopenia
Phenytoin
Disproportionate microcytic anaemia - think beta-thalassaemia trait- raised HbA2 points to a diagnosis of beta-thalassaemia trait
