Haematology Flashcards
Indications for CMV negative and irradiated blood: which of the following? granulocyte tranfusions intra-uterine tranfusions neonates up to 28 days delivery pregnancy (elective transfusions during pregnancy only, not labour/delivery) bone marrow/stem cells transplants immunocompromised (chemo, congenital) patients with previous Hodgkin lymphoma HIV
granulocyte tranfusions: both
intra-uterine tranfusions: both
neonates up to 28 days delivery: both
pregnancy (elective transfusions during pregnancy only, not labour/delivery): CMV neg
bone marrow/stem cells transplants: irradiated
immunocompromised (chemo, congenital): irradiated
patients with previous Hodgkin lymphoma: irradiated
HIV: neither
If a DVT is likely (2 points on Wells Score), you should…
hint: US scan +ve...? US scan -ve...? 4 hours not possible...? scan is -ve but DD +ve...?
carry out proximal leg vein US scan within 4 hours
○ if the result is positive then a diagnosis of DVT is made and anticoagulant treatment (DOACs) should start
○ if the result is negative a D-dimer test should be arranged. A negative scan and negative D-dimer makes the diagnosis unlikely and alternative diagnoses should be considered
if a proximal leg vein ultrasound scan CANNOT be carried out within 4 hours a D-dimer test should be performed and interim therapeutic anticoagulation (DOACs e.g. apixaban/rivaroxaban) given whilst waiting
if the scan is negative but D-dimer is positive: stop therapeutic coagulation, offer repeat proximal leg vein US scan a week later.
If a DVT is unlikely ( point or less on Wells Score), you should…
perform D-dimer test (within 4 hours)
If not possible, give interim therapeutic anticoagulation until result is available.
If -ve, DVT is unlikely. Consider other causes.
If +ve, then carry out proximal leg vein US scan within 4 hours. If not possible, give interim therapeutic anticoagulation until result is available.
Name a few of the 10 things on the two-level DVT Well’s Score. They all have 1 point each, remember!
active cancer
paralysis/paresis/recent immbolisation of extremities
bedridden for 3 days +/ major surgery within 12 weeks
localised tenderness in region of deep venous system
entire leg swollen
calf swelling at least 3 cm
larger than asymptomatic side
pitting oedema (only on symptomatic leg)
collateral superficial veins (non-varicose)
previous DVT
Management after DVT diagnosis (1st and 2nd line)
1) apixaban or rivaroxaban (DOACs)
2)LMWH followed by dabigatran or edoxaban
OR
LMWH followed by a vit K antagonist (warfarin)
- if there is severe renal impairment, then LMWH, unfractionated heparin or LMWH followed by warfarin.
How long should anticoagulation be for patients after VTE?
Minimum of 3 months (if it was provoked*).
If unprovoked, then typically for 6 months.
If the patient has active cancer, then between 3-6 months.
*provoked= due to obvious precipitating event e.g. immobilisation after surgery.
What is the pathophysiology of G6PD deficiency?
↓ G6PD → ↓ NADPH → ↓ glutathione → increased red cell susceptibility to oxidative stress
Name some of the features of G6PD deficiency
male (X-linked recessive) african +mediterranean descent intravascular haemolysis certain drugs can precipitate haemolysis Heinz bodies (and bite cells) on blood film inherited haemolytic anaemia* neonatal jaundice* gallstones* infection can precipitate haemolysis*
*features shared with Hereditary Spherocytosis
Name some features of hereditary spherocytosis
Male + female (autosomal dominant) northern european descent extravascular haemolysis spherocytes on blood film (round, lack of central pallor) inherited haemolytic anaemia* neonatal jaundice* gallstones* infection can precipitate haemolysis*(although tend to have more chronic symptoms)
*features shared with G6PD deficiency
Drugs that can precipitate haemolysis
antimalarials (primquine)
ciprofloxacin
sulph-group drugs: sulphonamides (antibiotics), sulphasalazine (DMARD), sulfonylureas (T2DM drugs, work by increasing release of insulin from the pancreas)
3 types of Non-Hodgkin’s lymphoma
The most rapidly progressing +aggressive tumour, associated with Epstein-Barr virus, malaria and HIV. Microscopy gives “starry sky” appearance: Burkitt’s Lymphoma
Affects the Mucosa-Associated Lymphoid Tissue, usually around the stomach. It is associated with H. pylori infection. Less aggressive: MALT lymphoma
Often presents as a rapidly growing painless mass in patients over 65 years. Aggressive: Diffuse B-cell lymphoma
Complications of tumour lysis syndrome (rapid response following chemo)
What can be given before chemo to reduce risk of developing tumour lysis syndrome? (works by catalysing uric acid->allantoin which allows for better renal excretion)
- Hyperkalaemia
- Hyperphosphataemia
- Hypocalcaemia (due to the high phosphate binding with the all the calcium).
- Hyperuricaemia
- Acute renal failure
Rasburicase
Types of Hodgkin’s lymphoma
Nodular sclerosing: most common (~70%), good prognosis, more common in women, associated with lacunar cells
Mixed cellularity: (~20%), good prognosis, associated with lots of Reed-Sternberg cells
Lymphocyte predominant (~5%), best prognosis!!
Lymphocyte depleted (rare), worst prognosis :(
Name the B symptoms (systemic symptoms of lymphoma)
note: B symptoms imply poor prognosis
Fever
Weight loss (>10% in last 6 months)
Night sweats
Other symptoms of Hodgkin’s lymphoma/ Non-Hodgkin’s lymphoma (same presentation, can only be differentiated when biopsied)
Lymphadenopathy: the enlarged lymph node or nodes might be in the neck, axilla (armpit) or inguinal (groin) region. They are characteristically non-tender and feel “rubbery”. Some patients will experience pain in the lymph nodes when they drink alcohol. Fatigue Itching Cough Shortness of breath Abdominal pain Recurrent infections
