Haematology Flashcards
What are the factors in wells score and PERC?
W (need 2:) prev DVT/PE, findings of DVT, malignancy in last 6mo, surgery/immobilised >3d in 4 weeks, haemoptysis, PE likely, HR >100. PERC: Age < 50, HR < 100, sats >95%, haemoptysis, oestrogen use, surgery/trauma 4 weeks, prev VTE, unilateral leg swelling.
What are exam findings in a DVT? What are possible differentials?
Dilated superficial veins, unilateral swelling (diameter), warmth, tenderness. DDx: muscle strain/tear, baker’s cyst, cellulitis, lymph obstruction.
How are DVTs treated? Monitoring, options, duration.
Bloods for coags, LFTs, UEC. Apixaban/rivaroxaban BD 7/21 then D for 6 weeks to 6mo. Distal, provoked may do U/S only. Trauma/surgery proximal may be 3mo. Warfarin if CKD or antiphospholipid syndrome. Early ambulation.
How does post thrombotic syndrome present/treated? How are DVTs managed in pregnancy?
PTS: swelling/discolouration/lipodermatosclerosis. Graduated compression 30-40mmHg from ankle to below knee w diagnosis or 1mo post, forup to 1 year. Ensure no arterial disease. Preg: LMWH 1.5mg/kg/D, 1mg/kg BD (daily if CrCl < 30).
What are the risk factors for recurrent DVT? How is PICC line related VTE managed?
Unprovoked DVT, proximal DVT, persistent cancer/autoimmune disease, thrombophilia, male. PICC: often silent, elevate, NSAID, anticoagulate 3mo, only remove if obstructed.
How are superficial venous thrombi managed? When is treatment indicated?
Self limit, NSAID 2 weeks. Extension to deep risk if longer >5cm, close to (3cm) from deep system or sig RF (pregnant, cancer). If high risk of extending, treat for 3mo. If long but not near deep, can treat for 6 weeks.
What are the ECG findings in a PE? (4)
Sinus tachycardia (44%), RBBB and R axis deviation, non-specific ST and T wave changes, S wave lead 1, Q wave and inverted T wave in lead III.
What are the causes of splenomegaly? How is it assessed?
CML/leukaemia, lymphoma, thalassaemia, portal hypertension, EBV. U/S is best.
What are the differentials for thrombocytopaenia? What bloods are indicated if investigating?
B12 def, chronic liver disease, cancer, HIV/viruses, pregnancy, medications, sepsis. Haemolysis - FBE, film, reticulocyte count, coombs, LDH, haptoglobin. UEC, LFT, HIV, hepatitis serology, fibrinogen, d-dimer, B12, folate, coags.
What are red flags in the setting of thrombocytopaenia?
Acute bleeding, blasts on blood film, age >60 w new dysplasia, haemolysis w neuro or renal findings (TTP, HUS).
How does ITP present in kids? How is it managed?
Platelet < 100, otherwise well. No meds, Fhx of bleeding disorder or leukaemia symptoms. Repeat FBE, review in 1 week. Avoid contact sport, avoid NSAIDs, avoid IM injections, review if any headaches.
How is a supratherapeutic INR managed?
INR < 4.5, WH next dose. >4.5 - cease warfarin. If high risk (recent bleed/surgery 1mo, liver disease, platelets < 50, antiplatelet therapy) 1 - 2mg PO or IV vit K. If INR >10, 3-5mg IV vit K, and if high risk give prothrombinex. If bleeding, give Vit K.
What are the features of a suspicious lymph node? How is it managed?
Firm, rubbery, painless, fixed and size >1cm. Excisional biopsy.
Neutropaenia - causes, bloods.
Infection, inflammation, haematological malignancy, liver disease, alcohol, GI affecting folate, copper or B12 absorption. Bloods: peripheral smear, B12, folate, copper level, LFTs, viral hepatitis and HIV screen.
What are the risks of polycythaemia? Symptom and workup.
If hypoxia or carbon monoxide, hyperviscosity can cause VTE, visual changes, stroke. Can cause erythromelalgia. If not acute, recheck haematocrit, LFT, UEC, EPO level, urinalysis and oxygen.
