Haematology Flashcards
Which of the following are first line treatments for tumour lysis syndrome?
- Allopurinol
- Sodium Bicarbonate
- Renal replacement therapy
- Rasburicase
- Intravenous potassium
- Rasburicase
The treatment priorities for tumour lysis syndrome are
- Aggressive fluid resuscitation
- Correction of hyperkalaemia
- Intravenous rasburicase
- CVVHF if no improvement
Allopurinol can be given as prophylaxis but not immediate treatment.
Bicarbonate will only temporarily improve pH, but won’t correct the underlying issue.
Which bleeding disorder frequently presents for the first time following surgery?
Von Willebrand disease
It usually has normal FBC and Coagulation tests
What are the indications for splenectomy?
Open technique
- Trauma
- Massive splenomegaly
Laparoscopic
- Idiopathic Thrombocytopenic Purpura
- Hereditary spherocytosis
- Thalassaemia
- Hodgkin lymphoma
- Leukaemia
- Myeloproliferative disease
- Felty syndrome
How long before and after thrombolysis can an epidural catheter be sited or removed?
AAGBI advice is:
- 10 days after cessation of thrombolysis before performing a neuraxial block
- 10 days after block (or epidural catheter removal) before thrombolysis should be given
When talking about TEG, what is the R time?
Time from when test starts, to when clot starts to form
Normal is 5-10mins
Determined by clotting factors
If prolonged, give FFP
For ROTEM this is clotting time
When talking about TEG, what is the K time?
The time from the beginning of the clot forming, until the width or deviation of the graph is 20mm on the screen
Normal is 3-5mins
Determined by fibrinogen
If prolonged, give cryoprecipitate
For ROTEM this is clot formation time
When talking about TEG, what is the alpha angle?
This tells you the rate at which the clot is forming
Normal is around 50-70 degrees
Determined again by fibrinogen
If lower then give cryoprecipitate
This is the same in ROTEM
When talking about TEG, what is MA?
Maximum Amplitude
A measure of how big the clot gets
Normal is 50-70mm
Determined largely by platelets
Unsurprisingly - Give platelets if low
For ROTEM this is Maximum Clot Firmness
When talking about TEG, whas it CL30 or LY30?
A measure of how rapidly the clot is breaking down
Should be less than 8% by 30 minutes after maximum amplitude
If more than this, give tranexamic acid
TEG is CL30, ROTEM is LY30
What are the benefits of point of care coagulation testing?
Faster results
Tests in vivo function, rather than in vitro function
More judicious use of blood transfusion
Information about platelet function
Information about fibrinolysis
Tiny volume of blood required
Easy to use with correct training
What is the difference between TEG and ROTEM?
Thromboelastography
Blood added to cup, with pin suspended in the blood
Cup rotates
Rotational and shear forces exerted on the pin are recorded via a torsion wire
Rotational Thromboelastometry
Cup stays still, pin rotates
Optical system detects increased impedence corresponding to rotational forces
Describe the changes in TEG parameters you would see in early and late disseminated intravascular coagulopathy
Early
Shortened R time and K time
Increased alpha angle and MA
Increased LY30
This is due to an excessive consumptive coagulopathy with rapid fibrinolysis
Late
R and K prolonged
MA and alpha angle decreased
This is due to consumption of clotting factors and platelets, resulting in delayed and ineffective coagulation
What are the features of tumour lysis syndrome?
Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia
Hyperuricaemia
High creatinine
High urea
Low bicarbonate
High lactate dehydrogenase
Which drugs are safe in porphyria?
Antacids
Propofol
Nitrous oxide
Suxamethonium, pancuronium, vecuronium
Atropine, glycopyrulate, neostigmine
Opioids
Bupivacaine
Midazolam and lorazepam
Droperidol
Adrenaline and Phenylephrine
Salbutamol
Magnesium
Beta blockers
Which drugs should be avoided in porphyria?
Ropivacaine
Phenytoin
Barbiturates
Sulphonamides
Chlordiazepoxide
Diazepam
Halothane
Steroids
Ketamine
Etomidate
Lidocaine
Atracurium
