Haematology Flashcards
How long to treat a provoked and unprovoked DVT
3 months provoked
6m unprovoked
What to do if suspect DVT
2 level wells score.
If 2 or more - DVT likely
if 1 or less - DVT unlikely
If it is likely:
Can you do USS within 4h
If yes do it
If no the d-dimer should be done and USS must be done within 24h.
What do you do for ? DVT if scan is negative but the D-dimer is positive?
Stop anticoagulant
Re scan in 6-8 days
What do do if wells score suggests DVT unlikely
Do d-dimer first
If +ve request USS
If can’t be done within 4h anticoagulant and do within 24
Which DOAC is first choice in VTE. What can you use if that’s not appropriate
Rivaroxaban or apixaban. If no good then edoxaban or dabigatran. With these latter 2 need to give LMWH first
When would you not use DOAC in VTE
If renal impairment. Then would use UF heparin or LMWH then warfarin
If triple positive antiphospholipid syndrome - then its LMWH then warfarin
Sickle cell - types of crisis
Thrombotic
Acute chest
Aplastic crisis
Thrombotic crisis (sickle cell) precipitants
Also called painful crises or vaso-occlusive crises
Precipitated by infection, dehydration, deoxygenation (e.g. high altitude)
Complications = e.g. avascular necrosis of hip, hand-foot syndrome in children, lungs, spleen and brain
Features of acute chest syndrome
Management?
Vaso-occlusion within the pulmonary microvasculature → infarction in the lung parenchyma
SOB, chest pain, pulmonary infiltrates on chest x-ray, low pO2
Management
pain relief
respiratory support e.g. oxygen therapy
antibiotics: infection may precipitate acute chest syndrome and the clinical findings (respiratory symptoms with pulmonary infiltrates) can be difficult to distinguish from pneumonia
Transfusion: improves oxygenation
the most common cause of death after childhood
Aplastic crisis causes and features
Caused by Parvovirus
Sudden fall in haemoglobin
Bone marrow suppression causes a reduced reticulocyte count
Sequestration crises
Sickling within organs such as the spleen or lungs causes pooling of blood with worsening of the anaemia
INCREASED reticulocyte coun
Cells in Hodgkins Lymphoma?
Reed Sternburg
What ca do you dee tumour lysis syndrome
Leukaemia and lymphoma
what can you give for tumour lysis syndrome prophylaxis
Allopurinol rasburicase
Tumour lysis syndrome bloods
High k+, high Phos, low ca
AKI
