Haematology

Question 1

DVT Wells score

Answer 1

• Active cancer
• Paralysis or immobilisation of legs
• Bedbound >2 days or major surgery in past 12 weeks
• Tenderness along deep venous system - back of calf
• Entire leg swelling
• Calf swelling >3cm compared to asymptomatic leg
• Pitting oedema of symptomatic leg only
• Collateral veins
• Previous DVT

Question 2

DVT pathway

Answer 2

if suspected DVT in pregnant or <6 weeks post partum for same day assessment

Wells 2 or more = likely
- USS within 4 hours
- if above unavailable, arrange D Dimer and start anticoagulation, scan within 24 hours

Wells 1 or less = Unlikely
- D Dimer - if results within 4 hours not available, to OFFER anticoagulation until results.
- if D Dimer POS for USS
- if D Dimer NEG to stop anticoagulation and consider alternative

Interim Anticoagulation
1st - Apixaban or Rivaroxaban
2nd - LMWH 5/7 followed by dabigatran

Question 3

Myeloma Explained

Answer 3

A blood cancer arising from plasma cells. Represents 2% of all cancers. Mainly aged >65
years although can be much younger.

Question 4

Symptoms raising suspicion of Myeloma

Answer 4

• Unexplained back pain
• Fatigue (30%).
• Symptoms of hypercalcaemia (30%), e.g. pain (bone, abdominal), low mood, confusion,
  muscle weakness, constipation, thirst, polyuria.
• Weight loss (25%).
• Hyperviscosity symptoms, e.g. headache, cognitive impairment, visual disturbance,
  mucosal bleeding (7%).
• Cord compression symptoms.
• Fever (1%).
• Onset often GRADUAL may be picked up following pathological fracture or recurrent
  infection.

Question 5

Myeloma Ix

Answer 5

Bloods - normocytic anaemia, AKI, hypercalcaemia, raised ESR
Urine and plasma protein electrophoresis

For 2WW if suspected

Question 6

Anaemia in children

Answer 6

Hb cut offs
* 6 months – 5 years: <110 g/L
* 5–12 years: <115 g/L
* 12–14 years: <120 g/L

Causes:
Iron deficiency = most common due to poor diet (however consider coeliacs)

B12 and folate deficiency tend to cause megaloblastic anaemia. Again, usually dietary; rarely pernicious

Consider inherited anaemias, particularly in certain ethnic groups, e.g. sickle cell, thalassaemia.

Other genetic causes, e.g. sideroblastic anaemia, hereditary spherocytosis, G6PD.

Where there are other abnormalities on the FBC consider conditions affecting the bone marrow such as leukaemia, secondary cancers or fibrosis.

Acquired haemolytic anaemias

Question 7

Apixaban counselling

Answer 7

VTE: 10mg BD for 7/7 followed by 5mg BD - minimum 3 months then review

Non Valvular AF: 5mg BD. 2.5mg BD if renal impairment, >80yo, <60kg

Monitor:
annual - Renal and liver function
3 monthly - review compliance

Missed tablets = no cover. Effect reduces after 12-24 hours

If surgery required may need to be stopped

If spontaneous bleeding to seek medical advice