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GP FELLOWSHIP RNZGP > Haematology > Flashcards

Haematology Flashcards

1
Q

Bleeding diathesis history questions

(Then a focus on nose bleeds)

A
  • Family history of bleeding disorders
  • Previous surgical procedures incl tooth extractions - with significant bleeding
  • Previous abnormal bleeding: gums, nose, haematuria, malena
  • Constitutional symptoms
  • Menstrual history
  • Alcohol history
  • Intranasal steroids/sprays
  • Nose picking
  • Cocaine use
  • Domestic violence
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2
Q

Bleeding diatheses examination findings

A
  • Shock/hypovolaemia signs
  • Hepatomegaly/ splenomegaly
  • Lymphadenopathy
  • Signs of anaemia- conjunctival pallor
  • Petechiae/ecchymoses
  • Stigmata of liver disease- scleral icterus, spider naevi
  • Telangiectasia
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3
Q

Causes of polycythemia

A
  • Dehydration (relative)

Primary
- Polycythaemia vera
- EPO receptor mutation

Secondary (elevated EPO)
a) hypoxia
- Lung dx
- OSA
- R-L shunt
- Altitude

b) EPO
- EPO tumor: RCC, HCC
- Androgen use

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4
Q

Investigations for polycythaemia

A
  • FBC, EUC, LFT
  • Iron studies
  • 02 sats
  • EPO level

Consider:
- Genetics: Jak2, BCR-ABL1 (Philadelphia cr)
- Sleep study
- US/CT abdo (Epo tumor)
- ECHO
- CXR

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5
Q

Four classic Myeloproliferative neoplasms:

A
  • Polycythemia vera
  • Essential thrombocytosis
  • PMF
  • CML
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6
Q

Platelet level cut off for thrombocytopenia

A

<150

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7
Q

Work up for asymptomatic thrombocytopenia

A

FBC and film
Platelets
fibrinogen, D-dimer, clotting factors
Haemolysis screen
B12, folate
LFTs
HIV & hepatitis serology
FOBT
EUCs

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8
Q

Platelet level when to refer

A

50-100 non urgent referral
Consider early referral >60yo

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9
Q

When to administer Vitamin K for supratherapeutic INR

A

4.5-10
Also HIGH risk for bleeding

** high risk =
Major bleed in last 4 weeks, major surgery in last 2 weeks, platelets <50, Liver disease or on antiplatelet therapy

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10
Q

Investigations for neutropenia

A
  • Repeat FBC in 8 weeks
  • B12, folate ,copper levels
  • LFTs, HIV, HBV, HCV, EBV, CMV
  • Coags ,LDH (for febrile or unstable patient)
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11
Q

Investigations for persistent polycycthaemia

A
  • Pulse ox
  • LFTs, EUC, Creatinine, BGL
  • EPO
  • Urinalysis
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12
Q

Haemachromatosis: p.Cys282Tyr (aka C282Y) homozygote

At risk of iron overload?
At what rates ?
Should you screen relatives

A

Yes
Male: 75-100%
Female 40-60%

YES - screen >18yrs

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13
Q

Haemachromatosis: p.Cys282Tyr /p.His63Asp
(aka C282Y/H63D)
Compound heterozygote

At risk of iron overload? At what rates ?
Recommended time frame for iron studies

A

Yes 1%

Every 2-5 yrs
Should

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14
Q

Haemachromatosis:
C282Y or H63D Heterozygote
OR
p.His63Asp (H63D) Homozygote

At risk of iron overload?

A

NO increased risk

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15
Q

Time frame for anticoagulation post PROVOKED VTE

A

6 weeks

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16
Q

Time frame for anticoagulation post UNPROVOKED VTE

A

3 months

17
Q

Diagnostic tetrad:
Fatigue, weightloss, fever/nightsweats + lymphadenopathy ….= what??

A

CLL

18
Q

Diagnostic tetrad:
Fatigue, fever/nightsweats + abdominal fullness ….= what??

A

CML

19
Q

Causes of thrombocytopenia

A
  • Artefactual
  • Immune thrombocytopenia purpura
  • Drug induced thrombocytopenia (eg heparin, doxycycline)
  • Gestational
  • B12 deficiency
  • Autoimmune: SLE
  • Infections: HIV, MMR, EBV
  • CLD
20
Q

Examination if thrombocytopenia

A
  • Petechiae, bruising
  • Bleeding: mucosal, haematuria
  • Hepatosplenomegaly
  • Lymphadenopathy (malignancy or infection)
  • Signs of CLD
  • Signs of sepsis
21
Q

VTE anticoagulation dose & regime

A

Apixaban 10mg BD for 1 week then 5mg BD

OR
Rivaroxaban 15mg BD for 3 weeks then 20mg daily

22
Q

Dosing for b12 deficiency of Hydroxocobalamin

A

Hydroxocobalamin 1000mg alternate days for 2 weeks then every 2-3 months

23
Q

What tests are involved in a thrombophilia screen ?

A
  • Prothrombin gene mutation
  • Antiphospholipid antibodies (lupus anticoagulant, anticardiolipin antibodies)
  • Protein C deficiency
  • Protein S deficiency
  • Antithrombin
  • Activated protein c resistance
24
Q

Investigations for clotting disorder

A
  • Prothrombin gene mutation
  • Antiphospholipid antibodies
  • Serum protein C and S
  • Antithrombin
  • Activated protein c resistance
25
Q

Haemolysis screen tests:

A
  • FBE
  • Blood film
  • Direct and indirect antibody test (coombs)
  • LDH
  • Haptoglobin
  • Urinary haemosiderin
  • Haemoglobin

GP FELLOWSHIP RNZGP (20 decks)

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