Haematology Flashcards
Examples of significant bleeding: grade 2
Haematemesis, malaena, prolonged epistaxis
Examples of severe bleeding: grades 3,4
CNS, airway, abdo, intraarticular, intramuscular
Platelet threshold for transfusion in grade 2 bleed
<30
Platelet threshold for transfusion in grade 3, 4 bleed
<100
When do you tranfuse most patients who are thrombocytopaenic before surgery?
> 50
When do you tranfuse patients at high risk of bleeding who are thrombocytopaenic before surgery?
50-75
When do you tranfuse patients who are thrombocytopaenic before surgery at a critical site?
> 100
When is fresh frozen plasma indicated and whats the universal donor?
Abnormal PT or APTT
AB blood
When is cryoprecipitate indicated?
Low fibrinogen (<1.5) e.g. DIC and liver failure
Management of antiphospholipid syndrome?
Primary thromboprophylaxis: low-dose aspirin
Secondary thromboprophylaxis: warfarin
Platelets, fibrinogen, PT, and APTT in DIC
Low platelets and fibrinogen
High PT and APTT
DIC treatment
Platelet transfusion if platelets below 20
FFP if fibrinogen is low
Specific test for autoimmune haemolytic anaemia
Positive DAT (Coombs’)
What usually causes haemolytic uraemic syndrome?
Shiga toxin-producing E. coli
What blood changes seen HUS?
Microangiopathic haemolytic anaemia, thrombocytopaenia, schistocytes
HUS management
Supportive e.g. fluids, blood transfusion
No antibiotics
Abnormal blood test in haemophilia, and factors affected in A and B?
Prolonged APTT
A - factor 8
B - factor 9
ITP laboratory findings
Isolated thrombocytopaenia with normal coagulation
ITP management
1) Oral predinsolone
2) IVIG
Leukaemia with testicular and thymic enlargement
ALL
Genetic syndrome associated with acute leukaemia
Down’s
Auer rods leukaemia
AML
Most common leukaemia in the west
CLL
Leukaemia mostly diagnosed on routine bloods, with symmetrical painless lymphadenopathy?
CLL
Leukaemia with Philadelphia chromosome
CML
Richter’s transformation
CLL to large cell lymphoma
Hodgkin’s lymphoma associated sex and virus
Males
EBV
Most common lymphoma
Non-Hodgkin’s
Treatment for B cell and T cell lymphoma
B - Rituximab
T - Alemtuzumab
Multiple myeloma diagnosis
Narrow gamma band in serum electrophoresis
Bence-Jones protein in urine
What does FBC, U&Es and bone profile show for multiple myeloma?
Anaemia
Renal failure (high creatinine)
Hypercalcaemia
How does myelodysplasia present on FBC and what cancer can it progress to?
Anaemia, neutropaenia, thrombocytopaenia
AML
Patient has pruritus, splenomegaly, thrombosis, and low ESR. What is the mutation seen in 95% of patients?
JAK2
(polycythaemia vera)
Polycythaemia vera management
Aspirin
Venesection
Hydroxyurea
Young patient has failure to thrive, hepatosplenomegaly, microcytic anaemia, HbA2 and HbF raised. Condition?
Beta-thalassaemia major
What causes TTP?
Deficiency of ADAMTS13
Can’t break down long strands of vWF (platelets clumping)
RBCs are cute up
TTP blood change apart from thrombocytopaenia
Microangiopathic haemolytic anaemia
Most common inherited bleeding disorder
vWD
vWD bloods
Prolonged bleeding time
APTT may be prolonged
Factor 8 reduced
vWD management
Tranexamic acid
Desmopressin (raises vWF)
Factor 8 concentrate
Which sickle cell crisis is associated with a reduced reticulocyte count?
Aplastic crisis
Which sickle cell crisis is associated with an increased reticulocyte count?
Sequestraiton crisis
When is an exchange transfusion indicated in sickle cell crisis?
Acute vaso-occlusive e.g. stroke, acute chest syndrome, multiorgan failure, splenic sequestration crisis
What analgesia is required for sickle cell crisis?
IV opiates
