Haematology

Question 1

Idiopathic thrombocytopaenia

Question 2

von Willibrands disease

Question 3

Haemophilia

Question 4

Hereditary Haemorrhagic Telangectasia

Question 5

Practice Point - Oral Iron

Answer 5

Take 1hr before eating (if tolerating)
Avoid taking with calcium/milk/PPI/H2RA
Take with vitamin C
May cause nausea
May cause constipation
Cause dark stool
Keep away from children
Continue for 3/12 then recheck

Dose 100-210mg/day in adults (3-6 mg/kg/day in children up to 210max)

Remember to consider GI blood loss

Question 6

Warfarin adjustment

Answer 6

Most intracranial bleeds occur with patients in normal range. 0.1-0.5% of patients

Avoid NSAIDs, heavy alcohol, certain ABX, antiplatelet therapy, (except in mechanical heart valves, ACS, coronary stent)

If INR mildly raised (<10%) dose reduction usually not necessary

Vitamin K can be used orally or IV. IV works 6-8 hours, orally 24 hours

Prothrombinex (PTX) contains Factors II, IX and X - and small amount of VII. Can reduce INR within 15 minutes. Need Vitamin K to sustain reversal effect.

FFP not used to reverse warfarin unless used with Vit K + Prothrombinex for life-threatening bleeds or INR>10 with high risk of bleeding

WITHOUT BLEEDING:

• INR 4.5-10 and low risk of bleeding - cease warfarin, recheck following day. If high risk of bleeding, vitamin K 1-2mg recheck next day
• INR >10 low risk bleeding = Cease warf, 3-5mg oral vit K. High risk bleeding = cease warf, 3-5mg oral vit K, PTX

WITH BLEEDING:
INR >1.5 life threatening bleed = cease warf, vit K IV, PTX, (FFP if no PTX). Recheck 20 mins.
INR >1.5 major non-life threatening bleed = as above, lower dose of PTX. Recheck 20mins
ANY INR with minor bleeding = cease warfarin
INR >4.5 with minor bleeding = Cease warfarin, Consider 1-2mg oral vit K. Recheck 24hr

High risk bleeding = previous major surgery within 4/52, antiplatelet therapy, thrombocytopaenia <50, liver disease

Question 7

Acute Lymphatic Leukaemia

Answer 7

2-10 years, second peak around 40yo

Symptoms:

• Malaise
• Anaemia
• Susceptibility of infection
• Easy bruising/bleeding (epistaxis, gingival bleeding)
• Bone pain (particularly children)
• Gingival hypertrophy

Signs:

• Palor
• Petechiae, bruising
• Gum hypertrophy
• Stomatitis
• Signs of infection
• Hepatosplenomegaly, cervical lymphadenopathy
• Bone tenderness (particularly sternum)

Question 8

Chronic Lymphocytic Leukaemia

Answer 8

Late middle age and elderly
Insidious onset
Constitutional symptoms, malaise, weight loss, night sweats
Lymphadenopathy (rubbery lymph nodes)
Hepatosplenomegaly
Anaemia
Lymphocytosis (mature appearing lymphocytes)

Most cases observation warranted

Question 9

Chronic Myeloid Leukaemia

Answer 9

Middle age 40-60yo
Insidious onset
Constitutional symptoms: Malaise, weight loss, night sweats
Symptoms of anaemia
Very large splenomegaly
Abdominal discomfort
Priapism
Gout
Markedly high WCC (granulocytosis)
Left shift in myeloid series
?presence of Philidelphia Chromosome (Having chromosome = better prognosis)