haematology Flashcards by lana yassin

Blood transfusions: Non-haemolytic febrile reaction tx

Slow or stop the transfusion

Paracetamol

Monitor

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blood transfusion: Minor allergic reaction tx

Temporarily stop the transfusion

Antihistamine

Monitor

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blood transfusion: Anaphylaxis tx

Stop the transfusion

IM adrenaline

ABC support
oxygen
fluids

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blood transfusion: Acute haemolytic reaction tx

Stop transfusion
Supportive care
fluid resuscitation

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blood transfusion: Transfusion-associated circulatory overload (TACO)
tx

Slow or stop transfusion

Consider intravenous loop diuretic (e.g. furosemide) and oxygen

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blood transfusion: Transfusion-related acute lung injury (TRALI) tx

Stop the transfusion

Oxygen and supportive care

(donor plasma has antibodies against neutrophil antigens andhuman leukocyte antigens of transfusion recipient)

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acute intermittent poryphoria tx

IV haematin/haem arginate
IV glucose should be used if haematin/haem arginate is not immediately available

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polycythaemia vera tx
(3)

venesection
(first-line treatment to keep the haemoglobin in the normal range)

aspirin
(reduces the risk of thrombotic events)

chemotherapy
(hydroxyurea - slight increased risk of secondary leukaemia
phosphorus-32 therapy)

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hereditary spherocytosis: acute haemolytic crisis tx

treatment is generally supportive
transfusion if necessary

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hereditary spherocytosis long term tx

folate replacement
splenectomy

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Anti-phospholipid syndrome tx

Aspirin- arterial thrombosis
Warfarin- venous thrombosis and protects against arterial

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Heparin reversal drug

Protamine sulphate
Complete reversal for unfractioned and partial reversal for LMWH

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What patients do better on warfarin (vs xa inhibitors)

Patients with metal heart valves
Those with anti-phosphlipid syndrome

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What test differentiates liver disease and DIC

D- Dimer- elevated in fribrinolysis- occurs toa much greater extent in DIC compared to liver disease

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von willerbrand disease tx

tranexamic acid for mild bleeding
desmopressin (DDAVP): raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells
factor VIII concentrate

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man with hb of 110 or lower- how must he be managed

urgent referral for upper and lower GI endoscopy- 2ww

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Immune Thrombocytopenia purpura (ITP) tx adults

*only treat if platelets less than 30g/l. if >30 then observe

1st line: oral prednisolone

IVIG may also be used- inc platelet count higher than usual therefore may be used if active bleeding or an urgent invasive procedure is required

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ITP tx in kids

usually no treatment (resolves within 6 months spontaneously usually)

if sig. fig bleeding/ platles <10- same tx as for adults. platelet transfusion in emergency

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beta thalassemia major treatment

repeated transfusion + iron chelation therapy

If a DVT is likely management

proximal leg vein US within 4 hours. if pos- DVT diagnosis made and start anticoag tx
If neg- arrange D-dimer

if proximal leg vein US cannot be carried out within 4 hours- do D-dimer and give DOAC whilst waiting for US result.

TTP acute tx

immediate plasma exchange (removes antibodies for ADAMTS13 enzyme and replaces it.)

if severe- cyroprecipitate + solvent detergent FFP
replenish folate

ttp long term tx

IV methylprednisolone/ritiximulab and taper down (weeks)

Waldenstroms tx

Plasmapheresis (quick)
Chemo

1st line tx for DVT

DOAC

unless rena failure/ anti phosphlipid syndrome

neutropenic infection tx

piperacillin with tazobactam

long term management for sickle cell anaemia

hyrdoxyurea (inc HbF levels, prophylactic) pneumococcal polysaccharide vaccine every 5 years

diagnostic criteria for myeloma

1 major and 1 minor or three minor criteria in an individual who has signs and symptoms of multiple myeloma

major criteria multiple myeloma

plasmacytoma (biopsy) 30% plasma cells in bone marrow sample elevated levels of M protein in blood or urine (IgA/IgG in blood and bence jones proteins in urine)

minor criteria multiple myeloma

10% to 30% plasma cells in a bone marrow sample. Minor elevations in the level of M protein in the blood or urine. Osteolytic lesions (as demonstrated on imaging studies). Low levels of antibodies (not produced by the cancer cells) in the blood.

warm AHA tx

treat underlying cause 1st line: steroids +/- rituximab

DOACs endin in ban MOA

direct factor xa inhibitors. eg apixaban

DOACs ending in tran MOA

direct thrombin inhibitor eg. dabigatran

patients without ACS transfusion threshold and targets

70g/l hb target: 70-90

how long should a patient be transfused for in a non urgent scenario

over 90-120 minutes

b12 deficiency (if no neurological involvement) tx

1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months (remember to always treat the b12 st if they have folate deficiency toot)

Cml tx

fatal without stem cell/bone marrow transplant in chronic phase 1st line: Tyrosine kinase inhibitor- imatinib- mainstay Hydroxyurea Interpheron-alpha

essential thrombocythaemia tx (3)

low risk- antiplatelets- aspirin moderate risk: aspirin +/- hydroxy high risk: aspirin + hydroxy (or other cytoreductive therapy eg interpheron alpha)

myelofibrosis tx

supportive (blood transfusion, abx, plateteletsetc) allogenic stem cell transplant in a few splenectomy JAK2 inhibitors

length of anticoagulation for venous thromboembolism

provoked: 3 months unprovoked: 6 months

what should patients with high grade leukemias/lymphomas recieve prior to and after chemo

IV allopurinol or IV rasburicase- to avoid tumour lysis syndrome (^converts uric acid to allatonin preventing AKI, hyperkalaemia, hypocalcaemia, hyperphosphatemia, inc uric acid)

dabigtran reversal agent

IV idarucizumab

rivaroxaban and apixaban reversal agent

IV andexanet alfa

haemophillia b tx

factor IX replacement and avoid aspirin and contact sports

sickle cell crisis tx

Oxygen, IV fluids, opiates. transfuse if Hb low abx if you suspect infection

non hodgkins lymphoma tx

dependant on subtype. watchful waiting, chemo or radiotherapy. rituximab is used in combination with chemo for a variety of NHL types. all receive flu/pneumococcal vaccines patients with neutropenia may need abx prophylaxis

hodgkins lymphoma tx

chemo mainstay, 2 combinations used: 1. ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine)- standard 2. BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone): alternative regime with better remission rates but higher toxicity - radio, combined (chemo then radio), hematopoietic cell transplantation- (relapsed or refractory classic hodgkin lymphoma)

AML general management

chem + targeted therapies targeted therapies: -tyrosine kinase inhibitors eg. inrutinib - monocolonal antibodies- rituximab which target b cells