Haematology Flashcards
1
Q
Plasma vs Serum
A
Plasma contains clotting factors, WBCs and RBCs
Serum is when these have been removed, containing glucose, electrolytes and proteins
2
Q
What condition contains target cells on blood film finding
A
Iron deficiency anaemia
Post-splenectomy
3
Q
In what condition are Heinz bodies seen in
A
G6PD and alpha-thalassaemia
4
Q
In what condition are Howell-Jolly Bodies seen in
A
Post-splenectomy
Severe Anaemia (sickle cell disease)
5
Q
What are reticulocytes
A
Immature red blood cells
6
Q
What causes reticulocyte counts to go up
A
Rapid turnover of red blood cells (e.g., haemolytic anaemia
7
Q
What are sideroblasts
A
Immature red blood cells containing LOTS of iron
8
Q
In what condition are smudge cells found in
A
Chronic Lymphocytic leukaemia
9
Q
Name two conditions in which spherocytes are found
A
Autoimmune haemolytic anaemia
Hereditary spherocytosis
10
Q
Where is iron mainly basorbed
A
Duodenum and jejunum
11
Q
What causes the reduction of Fe2+ to Fe3+
A
When acid levels drop
12
Q
What is the issue of Fe2+ to Fe3+ reduction
A
It becomes insoluble
So anything that can reduce acid levels (e.g., PPIs) can cause iron deficiency
13
Q
Why can coeliac and crohn’s cause iron-deificency
A
Inflammation of the jejunum and duodenum
14
Q
What is the most common cause of iron deficiency anaemia
A
Blood loss
15
Q
What are the most common causes of GI tract bleeding
A
Oesophagitis and gastritis
16
Q
What protein is Fe3+ bound to in th eblood
A
Transferrin
17
Q
What is TIBC
A
Total space on the transferrin to bind to iron molecules
18
Q
How does Total iron binding capacity and transferrin levels relate
A
They directly correlate to the number of transferrin molecules in t heblood
19
Q
What is ferritin
A
Iron that is stored inside cells
20
Q
What causes ferritin to be eleveated in the blood
A
Released from cells during inflammatory conditions (e..g, infections or cancer)
21
Q
What serum ferritin level indicates Iron deficiency
A
Low
22
Q
What happens to the level of TIBC and transferrin levels in iron deficiency
A
Increase
23
Q
What happens to TIBC and transferrin levels in iron overload
A
Decrease
24
Q
What is a normal transferrin saturation level
A
30%
25
If there is new iron deficiency without a clear underlying cause, what should be done
Oesophago-gastroduodenoscopy + colonscopy to look for cancer
26
Management of iron deficiency anaemia
Blood transfusion
Iron infusion (cosmofer)
Oral Iron (furous sulphate) 200mg three times a day
27
What type of MCV anaemia is iron deficiency anaemia
Microcytic anaemia
28
What cells produce intrinsic factor
Parietal cells
29
What is intrinsic factor needed for
B12 absorption in the ileum
30
Name four symptoms of B12 deficiency
Peripheral neuropathy (paraesthesia)
Loss of virbation and proprioception
Visual changes
Mood or cognitive changes
31
What is the first line investigation for pernicious anaemia
Intrinsic factor antibodies
Gastric parietal cell antibodies (second line)
32
Management of pernicious anaemia
Cyanocobalamin (dietray replacement)
33
If dietary replacement is insufficient for pernicious anaemia, what should be done
IM Hydroxycobalamin 3 times a week for 2 weeks, then every 3 months
34
If there is folate deficiency alongside pernisious anaemia, what should be treated FIRST, B12 or folate deficiency
B12 FIRST, otherwise folic acid correction can cause subacute degenertaion of the cord
35
What type of anaemia is haemolytic anaemia
Normocytic anaemia
36
What test should be done to diagnose autoimmune haemolytic anaemia
Direct coombs test
37
Describe the genetic inheritance of Hereditary spherocytosis
Autosomal Dominant
38
What virus causes hereditary spherocytosis
Parvovirus
39
What crisis is seen in hereditary spherocytosis
Aplastic crisis (parvovirus infection)
40
How is spherocytosis treated
Folate supplementation and splenectomy
41
In what population is G6PD deficiency common
Neonates with meditteranean and African background
42
How is G6PD inherited
X linked recessive
43
What causes G6PD crises
Infections
Medications
Broad Beans
44
Symptoms of G6PD deficiency
Gallstones
Anaemia
Splenomegaly
45
How is G6PD deficiency diagnosed
G6PD enzyme assay
46
What medications can trigger G6PD deficiency
Primaquine
Ciprofloxacin
Sulfonylureas
Sulfsalazine
47
What is autoimmune haemoltic anaemia
Antibodies created against the patient's red blood cells
48
What causes warm autoimmune haemoltic anaemia
Idiopathic
49
At what temperatures does cold haemolytic anaemia occur at
less tahn 10 degrees
50
What happens in autoimmune haemolytic anaemia
Agglutination
51
What conditions can cause cold autoimmune haemolytic anaemia
Lymphoma
Leukaemia
SLE
EBV, CMV and HIV
52
Management of autoimmune haemolytic anaemia
Blood transfusion
Prednisolone
Rituximab
Splenectomy
53
What is characteristic of paroxysmal nocturnal haemoglubinuria
Red urine in the morning (contains haemoglobin and haemosiderin)
Anaemia
54
Management of Paroxysmal nocturnal haemoglobinuria
Eculizumab and bone marrow transplant
55
Name three conditions which has microangiopathic haemolytic anaemia
HUS
SIC
TTP
SLE
56
What are normal haemoglobin consisted of
2 alpha
2 beta gloobin chains
57
How are thalassaemia inherited
Autosomal recessive
58
What type of anaemia is seen in thalassaemia
Low mean corpucular volume
59
What phsyical features change in thalassaemia
Pronounced forehead and cheekbones
60
GOLD standard diagnosis of thalassaemia
Haemoglobin electrophoresis
61
How are serum levels affected in thalassaemia
Serum feritin levels increase due to iron overload
62
How is iron overload in thalassaemia corrected
Iron chelation
63
What gene is affected in alpha thalassamia
16
64
How is alpha thalassaemia managed
Monitoring FBC
Monitoring complications
Blood transfusions
Splenectomy
65
How can alpha thalassaemia be cured
Bone marrow transplant
66
What gene is affected in beta thalassaemia
11
67
What is thalassaemia minor trait
Beta thalassaemia where there is one abnormal and one normal gene
68
Beta thalassaemia trait vs major
Slightly anaemic (low MCV and MCH) and ASYMPTOMATIC
vs
SEVERE haemolytic anaemia: hepatosplenomegaly, VERY low MCV and MCH
69
Management of thalassaemia minor
Monitoring
70
Management of thalassaemia major
Transfusions, iron chelation and splenectomy
71
At what age is feotal haemoglobin replaced by Haemoglobin A
6 weeks of age
72
What gene causes SCA
11
73
What type of inheritance is SCA
Autosomal recessive
74
What condition does SCA protect people against
Malaria
75
How is SCA diganosed
Electrophoresis
Neowborn screening heel prick test at 5 days
76
Name som ecomplictaions of SCA
Stroke
Avascular necrosis of the hip
Pulmonary Hypertension
Priapism
CKD
Sickle cell crisis
Acute Chest Syndrome
77
Management of SCA
Rehydration
Vaccine check
Penicillin V
Hydroxycarbamide to increase foetal Heamoglobin
Blood transfusion for severe anaemia
Bone marrow transplant
78
What pain relief should be avoided in SCA with CKD
NSAIDs
79
What triggers SCA crises
Infections
Hypoxia
Acidosis
80
How is pripism treated in SCA
Emergency: Aspiration of blood from penis
81
What is indicative of splenic sequestration
SEVERE anaemia
Hypovolaemic shock
82
How is splenic sequestration crisis managed
Blood transfusion and fluid resus
83
What can prevent a splenic sequestration crisis
Splenectomy
84
What infection commonly triggers an aplastic crisis
Parvovirus B19
85
How do we diagnose Acute Chest Syndrome
Fever or respiratory symptoms
New infiltrates seen on a chest X-Ray
86
What HbA2 level is diagnostic for thalassaemia
>3,5%
87
Name trhee lymphocytes
Bcells
T-Cells
NK cells
88
Lymph node appearance in infetcions vs lymphoma
Lymphoma is hard and fixed (cannot move)
+ B symptoms
89
Is a fine needle aspiration of lymph node diagnostic for lymphoma?
No
90
What is needed to diagnose a lymphoma
Excisional biopsy
91
Hodgkin vs non-hodgkin lymphoma
The presence of reed-sternberg cells = hodgkin's
92
How can we stage a lymphoma
PET/CT scan
93
Describe the ann arbour staging system for lymphoma
Stage 1 - One lymph node on one side of the diaphgram
Stage 2 - Multiple lymph nodes on one side of the diaphgram
Stage 3 - Multiple lymph node involvement on both sides of the diaphrragm
Stage 4 - Distant metastases
94
What does A stage mean in lymphoma
Absence of additional symptoms
95
What does B substage mean in lymphoma
Presence of B-Symptoms
96
What does X subclass mean in lymphoma
Bulky disease (lymph node >10 cm diameter)
97
What does E subclass mean in lymphoma
Involvement of a single organ (e..g, lung inovlvement in mediastinal lymphadenopathy)
98
What does S mean in subclass of lymphoma
Spleen involvement
99
What cells do hodgkin lymphoma airse from
B-cells
100
Age onset of hodgkin lymphoma
15-30
50+
101
What antigens are positive in hodgkin's classical lymphoma
CD15 and 30
102
What cells are seen in non-classical hodgkin's lymphoma
Popcorn cells
103
What antigens are seen in popcorn cells
CD20 + 45
104
Where are hodgkin lymphoma commonly found
Cervical
Axillary
Mediastinal
105
Symptoms of Mediastinal lymphadenopathy
itchy rash
Pel Ebstein Fevers
COUGH + SOB
Hoarseness
Superior vena cava syndrome
Pleural effusion
Minimal Change Disease
106
Blood test results in Lymphoma
Increased ESR and LDH
107
Treatment of hodgkin Lymphoma (stage 1 and 2)
ABVD
108
Treatment of Hodgkin Lymphoma Stage III + IV
BEACOPP
Bleomycin
Etoposide
Adramycin
Cyclophosphomaide
Oncovin
Procarbazine
Prednisolone
109
How can non-classical hodgkin lymphoma be treated
Rituximab
110
Side-effect of Doxorubicin
Cardiotoxicity
111
Side effect of Vincristine
Peirpheral Neuropathy
112
Side-effect of bleomycin
Pulmonary Toxicity
113
Side-effect of Cyclophosphomaide
Haemorrhagic cystitis
114
Most common type of non-hodgkin lymphoma
Diffuse Large B-Cell Lymphoma
115
What is Richetr Syndrome
Where CLL -> Diffuse large B-Cell LYmphoma
116
What lymphoma is seen in HIV patients
Primary CNS Lymphoma
117
What is Burkitt's Lymphoma
8:14 translocation
Associated with EBV or HIV
118
Symptom of Burkitt Lymphoma
Ileocaecal abdominal mass
or Jaw mass in a CHILD
119
What causes marginal zone lymphoma
11:18 chromosomal translocation
120
What Rheumatological condition can cause marginal zone lymphoma
Sjogren's Syndrome
121
What other condition than Sjogren's syndrome can give rise to marginal zone lymphoma
H.Pylori infection (MALToma)
122
Treatment of Non-Hodgkin Lymphoma
R-CHOP
Rituximab
Cyclophohsphomade
Hydroxydaunorubicin
Oncovin
prednicolone
123
What threshold defines Leukaemia
WCC >11 x 10^9
124
What is laeukaemia
Cancer of bone marrow progenitor cells
125
Name 4 myeloid cells
basophils
Eosinophils
neutrophils
Mast Cells
126
Acute vs Chronic leukaemia
Acute: Immature blast cells
Chronic:
127
Describe the symptoms of CML
EFFECTS OLD people:
1. Chronic Phase: Asymptomatic
Symptoms: Anaemia
Early Satiety
Frequent infections + Bleeding
From abnormal cells
2. Accelerated phase
3. Blast Crisis: Becomes Acute laeukaemia (ALL or AML)
128
Onset of CLL
55+
129
Onset of CML
65+
130
Onset of AML
75+
131
Name some differentials of thrombocytopenia petechiae
Meningococcal septicaemia
Vasculitis
HSP
ITP
Non-accidental injury
132
What is the initial invetsigation for leukaemia
FBC within 48 hours
133
If a child or young adult present with petechiae or hepatosplenomegaly at GP and have suspected laeukaemia, what is the first line management
Urgent refrral to haemotolgy
134
Wher eis a bone marrow biopsy typically taken
Iliac Crest
135
What condition is ALL associated with
Downs Syndrome
136
What does a blood film show in ALL
Blast cells
137
What translocation is associated with ALL
Philadelphia chromosome (9:22)
138
What other leukaemia has a philalephia chromsome phenomenon
CML
139
What blood film finding is seen in CLL
Smear or Smudge cells
140
How long does the chornic phase in CML last for
5 years
141
Symptoms of the blast phase in CML
Severe pancytopenia
142
What does a blood film show in AML
Blast cells with auer rods
143
What anaemia is associated with CML
Haemolytic anaemia
144
Symptoms in chronic phase CML
Asymptomatic
145
What conditions can progress onto AML
Polycythaemia ruby vera or Myelofibrosis
146
Treatment of CML caused by translocation
Tyrosine Kinase inhibitors
Imatinib
147
What genes are switched in the 9:22 translocation
Tyrosine Kinase ABL and BCR
148
How is a blast crisis treated in CML
Allogeneic hematopoietic stem cell transplanttaion
149
Name the two types of ALL
T-cell
B-cell
150
Signs of pre t_cell ALL
Superior vena cava syndrome (mediastinal mass
151
What is superior vena cava syndrome
Facial Swelling
SOB
Venous distention
152
Signs of Pre B -Cell ALL
Fatigue
Infections
Bleeding
Leukostasis
153
Complication of ALL (pre B-Cell
CNS:
Headaches
Meningitis
Cranial nerve palsies
154
Name the chemotherapy phases for ALL
Induction: Kills most leukaemia cells
(4-6 weeks)
Consolidation: Kill remaining cells not detected by tests
Maintenance: 2 years
155
What is Myeloma
Cancer of the plasma cells (make lots of one type of antibody)
156
What chromosome is affected in myeloma
14
157
What is monoclonal gammopathy of undetermined significance
Where there is an excess of one type of antibody without features of myeloma or cancer (may progress to myeloma)
158
What is smouldering Myeloma
Progression of MGUS with higher levels of antibodies - more likely to porgress to myeloma than MGUS
159
What is the main type of immunoglobulin seen in myeloma
IgG
160
What is a monoclonal paraprotein
Abnormal protein derivative of an antibody
161
Why do we get anaemia in myeloma
As cancerous plasma cells inflitrate the bone marrow causing anaemia, neutropenia and thrombocytopenia
162
Name the four key features of myeloma
CRAB
Calcium (elevated)
Renal Failure
Anaemia (normocytic)
Bone lesions/pain
163
Risk Factors for multiple myeloma
Older Age
Male
Black African history
Family HIstory
Obesity
164
Why do we get hypercalcaemia in myeloma
Myeloma bone disease: Increased osteoclastic activity and suppression of osteoblasts
Causes the release of calcium into the blod
165
What would be seen on an X-Ray in myeloma
Osteolytic lesions
166
What tumours are usually seen in myeloma bone disease
Plasmacytomas (tumours made of plasma cells)
167
Why do we get hyperviscocity in myeloma
Due to increase of proteins in th eblood: causes easy bruising, bleeding, reduced sight, heart failure
168
What initial investigations would we do in suspected myeloma cases
FBC
Calcium
ESR
Plasma Viscocity
169
Name the four specific tests used for myeloma after initial investigation
B - Bence-Jence protiene (urine electrophoresis)
L - Serum-free Light-chain assay
I - Serum Immunoglobulins
P - Serum Protein Electrophoresis
Then a bone marrow biopsy to confirm
170
How do we check for bone lesions in multiple myeloma
Whole body MRI
171
X-Ray signs in Myeloma
Raindrop skull appearance
172
What is the first line treatment of myeloma
Bortexomid
Thalidomide
Dexamethasone
Stem cell transplantation
173
Why do patients with myeloma need venous thromboembolism prophylaxis with aspirin
During chemotherapy regimes as they can cause thrombuses
174
How can myeloma bone disease be improved/supplemented
Bisphosphonates
175
If someone complains of bone pain, what adjuvant can be used
Radiotherapy
176
How should fractures in multipl emyeloma be supported
Sabilise bones (prophylactic intramedullary rod)
177
What is cement augmentation
Injecting cement into vertebral fractures to improve spine stability
178
What gene is involved in polycythaemia vera
JAK2 gene: continues differentiation of stem cells into red cells (remain active without erythropoietin)
179
What cells are affected in Polycythaemia Vera
Haematopoietic stem cells
180
How does erythropoietin increase RBC production
Binds to JAK2 receptors on hematopoietic stem cells causing them to divide and differentiate
181
What happens in Polycythaemia vera to cause anaemia, thrombocytopenia and leukopenia (spent phase)
Stem cells start to die out from exhaustion
Bone marrow cannot produce any more blood cells, leading to myelofibrosis
182
What rheumatological condition can be seen in polycythaemia vera
Build up of uric acid -> Gout and kidney stones
183
What Hb level indicates polycythaemia vera
Hb > 18.5 in men or 16.5 in women
184
Define relative polycythaemia
Decrease in plasma volume which causes increase in RBC percentage:
Fluid loss from dehydration and burns
185
Define primary polycythaemia
Genetic condition in which there is excessive responsiveness to reythropoietin
186
Define secondary polycythaemia
Due to hypoxia stimulating erythropoetin release such as COPD, smoking and Eisenmenger's, cancers (e.g, WILM's)
187
FBC findings in polycythaemia vera
Elevated Hb and WCC and platelets
LOW ferritin
188
Erythropoietin levels in PV
Low
189
First line management of polycythaemia
Hydroxycarbamide and interforn alpha
190
How is itching in PV managed
Antihistamines or SSRIs
191
What cytokine causes fibrosis of the bone marrow
Cytokines (fibroblast growth factor) released by proliferating cells
192
Define extramedullary hematopoeisis
When the bone marrow is scarred, the liver and spleen try to make RBCs insread
193
Complication of extramedullary haematopoeisis
Hepatosplenomegaly or portal hypertension
194
What key signs are seen in someone with polycythaemia vera
Conjunctival plethora (redness)
ruddy complexion
Splenomegaly
195
Managemnt of primary myelofibrosis
Stem cell transplant
196
What defines thrombocytopenia
<50 x 10^9 count
197
Management of ITP
Prednisolone
IV Immunoglobulins
Rituximab (a monoclonal antibody against B cells)
Splenectomy
198
Name four fat soluble vitamins
Vit D, E, A and K
199
What is a left shift
Presence of immature cells
Right shift is hypermature, multisegmented cells
200
In what condition is a left shift seen in
Acute infections, fibrosis or leukaemia
201
Define anisocytosis
Variation in RBC size
202
Diagnosis of paroxysmal nocturnal haemoglobinuria
Flow cytometry
203
What blood test finding is seen in vWD
Abnormal APTT
204
How to treat acute haemolytic transfusion reactions
Stop transfusion + Give Saline
205
How to treat febrile non-haemolytic transfusion reactions
Slow transfusion and give paracetamol
206
How to treat transfusion associated circulatory overload
Slow transfusion + give Furosemide
207
Define the Wells criteria for a DVT
Active cancer
Paralysis
Bedridden for 3 days or more or major surgery within 12 weeks requiring anaesthesia
Localised tenderness along deep venous system
Entire leg swollen
Calf swelling >3cm than the other
Pitting Oedema
Collateral superficial veins
Previous DVT
Alternative diagnosis is at least as liekly as DVT
208
What Well's score indicates likely DVT
2 or more
209
Investigations for DVT
Doppler USS
210
What is the problem with D-Dimer in diagnosing DVT
It can only exclude VTE not confirm it
211
What else can increase a D-dimer (false positive)
Malignancy
Infection
Pregnancy
Stroke
MI
AOrtic Dissection
212
Management of a DVT
DOAC, LMWH (Apixaban) or Warfarin
213
How long is Anticoagulation given for a DVT
3 months at least
Unprovoked DVT: 6 months
214
What is an IVC filter used for in managing DVTs
Reduce thr isk of DVT emboli into the pulmonary arteries (reduces risk of PE)
215
Clinical features of a DIC
Epixstasis
Gingival Bleeding
Haematuria
Bleeding from cannula sites
Petechiae
Hypotension
216
What type of leukaemia is commonly associated with DICs
Acute Promyelocytic leukaemia
217
Blood findings in DIC
Increased Prothrombin AND APTT
Decreased fibrinogen
Thrombocytopenia
218
How long shohuld a patient with. a DVT/PE be treated on DOAC if they have an active cancer
3-6 months
219
In what patients would a PE/DVT be an indication for lifelong warfarin use
Those with ongoing risk factors (e.g., antiphospholipid syndrome)
220
How do we manage a high INR
Stop antigoagulants
Administer IV Vit K
Administer fresh frozen plasma or prothrombin complex
Repeat INR in 24 hours
221
Define some causes for non-megaloblastic marcocytic anaemia
Chronic liver disease
Hyposplenism
Chronic inflammation
Alcoholism
Hypothyroidism
222
What is the antidote for methotrexate overdose
Folinic acid (NOT folic acid)
223
What is Gaisbock's Syndrome
Pseudopolycythaemia in people who smoke (reduces plasma volume) - relative polycythaemia cause
224
What post-splenectomy prophylaxis should be given
Pneumococcal vaccination
Seasonal influenza vaccination
Haemophilus type b vaccination
Men C vaccination
Low dose penecillin V life long
225
What is th etarget INR for AF
2.3
226
What is the target INR for metallic valve replacement
2-3
227
What is the typical target INR for VTE
2-3
228
What should be the target INR for patients with recurrent VTE while on warfarin
3-4
229
What is Factor V Leiden
Mutation in clotting factor 5 which stops factor S and C from deactivating it -> causes lots of clots
230
What is the role of Protein C and S
Inactivates clotting factors V and VIII
231
What factors are inhibited by antithrombin III
IIa, Xa, IXa and XIa
232
What condition usually causes vWD manifesttaion
CHildbirth
233
TIBC and serum ferritin levels in thalassamia minor
NORMAL
NOTE: Gets mistaken for iron deficiency easily, but iron deficiency, TIBC and ferritin INCREASES
234
Define thalassaemia intermedia by HB levels
70-100 g/L (mild anaemia)
235
Define pulmonary hypertension
MAP >25 mmHg
236
When should Anti-D be given during pregnancy (criteria)
- Mother is RhD-negative
-Baby is RH-D positive
500IU if IgG Anti D IM within 72 hours
237
What is the role of the Kleihauer test
TO determine whether more Anti-D is required beyond the first dose
238
First line management of PV
Venesection THEN hydroxycarbamide + Interforn alpha
239
What blood is given in an emergency (needs immediately)
O - negative
240
How long does it take to cross-match blood
45 minutes
241
What is given first in major bleeding from anticoagulants, prothrombin or vet K
Prothrombin Complex
242
If PT >1.5, what should be done
Give Fresh Frozen Plasma
243
If Fibrinogen levels <1.5, what should be done
Give Cryoprecipitate
244
If Platelets < 75 x 10^9, what should be done
Give PLatelets
245
What is fresh frozen plasma
Contains factors to replace for coagulation
246
Under what Hb level should blood transfusion be given
<80
247
First line management of neutropenic sepsis
IV Tazocin first (do not need to order WBCs)
248
Signs of TTP
Altered Mental State
Microcytic anaemia
Fever
Renal Failure
Thrombocytopenia
249
First line management of ITP
Oral prednisolone
250
Neurological signs distinctive of B12 deficiency
Symmetrical paraesthesia or ataxia in the lower limbs
251
When can MCV be normal in B12 and folate deficiency
If iron deficiency is co-present
252
What specific test can be used to check for B12 deficiency
Serum cobalamin levels
253
When is hydroxycobalamin indicated over oral cyanocobalamin
IM = if not thought to be diet related
Oral = thought to be diet related
254
What are good sources of B12
Eggs
Meat
Milk
Salmon
255
Management of folate deficiency
B12 FIRST (check if deficiency)
Then 5mg folic acid daily
256
What should be monitored in B12 or folate replacement therapy
Reticulocyte count and FBC
257
What Hb level is okay in pregnant women
>110 in first trimester
>105 in second or third trimester
258
IN what people is a trial of oral iron considered a first line diagnostic test for iron deficiency
Pregnant women (as ferritin levels are not accurate - main cause is usually anaemia)
DO NOT do this with postmenopausal or men
259
What is the main cause of siderblastic anaemia
Alcoholism
260
Ferritin levels in thalassaemia
Raised ferritin
Low TIBC
261
What is a positive test to show improvement of iron supplements
Increase in Hb by 20 in a month
262
When should someone with iron deficiency be referred to the 2 week pathway
60 years or older
50 and under + rectal bleeding
263
Management of iron deficiency anaemia in men and postmenopausal women
Refer to gastroenterology
Also people whop are coeliac need to be referred
264
In what conditions are DOACs contraindicated in
A prosthetic heart valve
Oesophageal varices
265
When is warfarin contraindicated
Within 72 hours of major surgery
Within 48 hours postpartum
266
Stepwise invetsigation for a DVT
USS of the leg
If not available: then do a D-dimer first
267
First line management iof polycythaemia in pregnancy
Interferon alfa = high risk
Venesection = low risk
