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Cancer care > Haematology > Flashcards

Haematology Flashcards

1
Q

What are the risks of blood transfusion?

A

Incorrect blood given/identification error
Transfusion reaction - mild = fever, rash, chills, severe = TRALI, acute haemolytic transfusion reaction (IgM causes), sepsis, anaphylaxis
Fluid overload
Contract BBV infection
Fe overload
Ab formation eg. Rh -ve

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2
Q

What are the types of blood products that can be given?

A

Red blood cells - sx anaemia or <70
White blood cells
Platelets - <10 or <20 w bleed, pre op <50
Fresh frozen plasma - used for bleeding in multiple CF def or def where there is no factor conc yet eg. Factor V, massive haem and DIC
Cryoprecipitate - fibrinogen, factor VIII, vWF
CF concentrate - specific CFs - safer than FFP and cryoprecipitate as no contamination
Human albumin solution - burns, pancreatitis, plasma exchange - replace plasma vol loss
Anti D

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3
Q

What is amyloidosis?

A

Extracellular deposits of abnormal insoluble protein leading to tissue and organ dysfunction, can affect anywhere in the body so CF are v vague - signs of the organ that is failing

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4
Q

What are some common causes of lymphadenopathy?

A

Reactive - viral infection eg. EBV, HIV, bacterial infection eg. TB
Neoplastic - lymphoma, mets, leukaemia, head and neck cancers
Systemic inflam eg. RA
Drug induced - allopurinol, phenytoin, trimethoprim

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5
Q

What are some causes of splenomegaly?

A

CML, CLL, HL
Myelofibrosis
Portal HTN (±Hep B and C)
Malaria, EBV, Schistomaniasis, TB
Haemolytic anaemia
Sickle cell (but most have atrophied spleen)
Spherocytosis
Splenic abscess
RA and SLE

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6
Q

What are some causes of hyposplenism?

A

Splenectomy
Sickle cell
Coeliac disease and dermatitis herpetiformis
SLE
Amyloid

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7
Q

What is the management of hyposplenism?

A

Vaccinations against encapsulated bacteria
Neisseria meningitidis
Haemophilus influenzae
S. pneumoniae
Flu jab
Abx prophylaxis - penicillin V, amoxicillin or erythromycin

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8
Q

Apart from VTE, whawt else can cause elevated D Dimer?

A

Pneumonia
Malignancy
HF
Surgery
Pregnancy

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9
Q

What are the ix into VTE?

A

D dimers but not specific
DVT - doppler US
PE - CTPA

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10
Q

What is the management of VTE?

A

Apixaban immediately when suspected
Long term - DOAC, warfarin (used if pt has antiphospholipid syndrome) or LMWH (used in pregnancy)
Cont for 3 months (apixaban or rivaroxaban) if reversible cause, beyond 3 months if unclear cause or recurrent, 3-6 months if active cancer

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11
Q

How do you ix unprovoked DVT?

A

Screen for antiphospholipid syndrome
Hereditary thrombophilias

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12
Q

What are some causes of pancytopenia?

A

Haem malignancy - ALL, AML, MDS
Meds - esp MTX
Folate and B12 def
Secondary mets to BM
Viral infections, esp in children
Severe sepsis

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13
Q

What are the benefits of blood transfusion?

A

Improve sx of anaemia
Keep pt out of hospital
Avoid complications of long term anaemia eg. HF

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14
Q

G+S vs crossmatch, how long does it take?

A

G+S - what the pt blood group is, takes 40 mins
Crossmatch - mix pt serum and donor blood to check its compatible, ask for date and time to get blood ready, takes an extra 40 mins (1 hour 20)

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15
Q

Who need special blood and what are the types?

A

CMV -ve = neonates, immunosuppressed pt, pregnant women, intrauterine transfusion (blood to babies while inside mums tummy)
Irradiate products - take out excess WBC, reduces the risk of immune reaction eg. host vs graft disease eg. HL
HbS -ve = can’t give to sickle cell pt ?

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16
Q

How is a pt monitored during their transfusion?

A

Check obs at 0 mins, 15 mins and after

17
Q

How long will a blood transfusion run for?

A

Red cells = has to be given <3.5 hours, can run as quickly as possible but normally over ~2 hours
Cryoprecipitate = STAT
Plt = 30 mins

18
Q

What is non haemolytic febrile reaction?

A

Fever and chills during blood transfusion, mostly in plt transfusion

19
Q

How do you manage non haemolytic febrile reactions?

A

Slow or stop transfusion
Paracetamol
Continue monitoring obs

20
Q

Minor allergic reaction vs anaphylaxis reaction to blood products

A

Minor allergic reaction - pruritis and urticaria
Anaphylaxis - hypotension, dyspnoea, wheeze, angioedema, pt have IgA def?

21
Q

What is the management of allergic and anaphylactic reactions?

A

Allergic reaction - temporarily stop transfusion, antihistamine, monitor
Anaphylaxis - AtoE, stop transfusion, IM adrenaline 1:1000 500 mcg

22
Q

What is an acute haemolytic transfusion reaction?

A

Cause - ABO incompatibility = massive IV haemolysis
Sx - mins after transfusion started = fever, abdo and chest pain, hypotension, agitation

23
Q

What is the treatment of acute haemolytic transfusion reaction?

A

STOP TRANSFUSION
IV fluid resus
Inform lab - check ID of patient and blood product, repeat G+S and crossmatch

24
Q

What is TACO?

A

Transfusion associated circ overload = transfusion too quick or have HF already
Sx - pulm oedema and HTN

25
Q

What is the management of TACO?

A

Slow or stop transfusion
Consider - furosemide? O2?

26
Q

What is TRALI?

A

Transfusion related acute lung injury - hypoxia, pulm infiltrates, fever, hypotension

27
Q

What is the management of TRALI?

A

Stop transfusion
O2 and supportive care

28
Q

TACO vs TRALI

A

TACO = HTN

29
Q

How can you ensure safety and reduce risk of wrong blood when requesting blood products?

A

x3 points of ID
Consent pt appropriately
Label bottle at the bedside
Complete transfusion request form at the bedside

30
Q

What cannula can you give blood products through?

A

Green - 18G
Grey - 16G
Otherwise mechanical haemolysis = sheering

31
Q

How much should each blood product one unit increase FBC?

A

Red cells - +10g/L
Plt - +20-40

32
Q

What are some general CF of anaemia?

A

Flow murmur - ejection systolic
Generalised and conjunctival pallor
Tachycardia and tachypnoea

33
Q

Short term blood transfusion reactions

A

Haemolytic ABO incompatibility
Non haemolytic febrile reaction
Bacterial contamination
Anaphylaxis
Mild allergic reaction
TACO
TRALI

34
Q

Long term blood transfusion reactions

A

Fe overload
BBV infection
Graft vs host disease

Cancer care (6 decks)

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