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1. Fellowship Written - SAQ > Haematology > Flashcards

Haematology Flashcards

1
Q

What factors of a prosthetic valve replacement affect the risk of anticoagulation referral?

What would the daily thrombosis risk be?

A

valve location - mitral more risk than aortic
valve material - metal more than prosthetic

risk is less than 1%

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2
Q

What drugs are used to reverse warfarin?

A

Vit k 10mg IV
Prothrombinex 50u/kg iv
FFP 2 units

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3
Q

Name 6 lab targets post massive transfusion

A
  1. PH >7.2
  2. Lactate <4
  3. Ca >1.1
  4. Platelets over 50
  5. INR less than 1.5
  6. fibrinogen over 1
  7. aptt less than 1.5 normal
  8. base excess less than - 6
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4
Q

In an acute bleeder what are the 5 steps of management

A

Resus
Reversal
Analgesia - fentanyl
Specific - IR
Disposition - ICU/HDU for monitoring

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5
Q

What are the findings in this CT of bleeder

A

left sided abdominal wall haematoma
arterial blush - active bleeding
Swirl sign – hypodensity – suggesting active bleeding

NB negatives
No haemoperitoneum / pneumoperitoneum

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6
Q

in a child with petichial rash

A
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7
Q

diagnosis?
Why

A

iron deficient anaemia secondary to menorrhagia

low HB, low MCV, low haematocrit

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8
Q

blood transfusion - What is happening?
4 complications

A

haemolytic transfusion reaction - occurs in first 24 hours as immune response to blood

Complications
* DIC
* renal failure
* ARDS
* pulmonary oedema
* Death

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9
Q

what are the immediate, short term and long term management priorities with haemolytic transfusion reaction?

A

immediate
* stop tranfusion
* treat shock
* oxygen

short term
* investigate cause eg culture the bllod
* clarify details with staff
* open disclosure

  • long term
  • ongoing disclosure
  • M and M
  • education
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10
Q

list five differentials of symptomatic anaemia with FBC investigaiton plus another key investigation

A
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11
Q

what are the indicaitons for a blood transfusion?

A

symptomatic
hb under 70
co morbiditis eg CCF, liver failure

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12
Q

list four early and four late complications of blood transfusion

A

Early
1. acute haemolytic reaction
2. actue febrile non haemolytic reaction
3. sepsis
4. anaphylaxis

Late
1. blood borne viruses eghiv
2. alloimmunisation
3. post tranfusion thrombocytopenia
4. iron overload

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13
Q

what are alternatives to blood transfusion

A

oral iron
iv iron
EPO

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14
Q

what are the significant findings?
diagnosis in someone with long term nsaid use?

A

severe microcytic anaemia
low hb, red cell count,packed cell volume

Diagnosis
UGIB

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15
Q

finding?

A

pancytopenia

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16
Q

what are three central and three peripheral causes of pancytopenia?

A

Central (marrow affected)
1. aplastic anaemia
2. myelofibrosis
3. leukemia/lymphoma
4. chemo induced
5. TB

Peripheral
1. sepsis
2. hyposplenism
3. autoimmune

17
Q

what blood products can be used without confirming compatibility?

A
  • O neg
  • platelets
  • FFP
  • prothrombinex
  • cryoprecipitate
18
Q

what are the descriminating features of each transfusion reaction?

A
19
Q

differentials?
list differentials to help diagnosis
management

A
  • ITP - blood film for platelet bound antibodies - steroids
  • Thrombotic thromocytopenic purpura - blood film for schistocytes - plasma exchange and steroids
  • Sepsis - coags for DIC - abx and souce control
  • haematological malignancy - bone marrow biopsy - oncology referral
  • bone marrow suppresion eg drugs - bone marrow aspirate - treat or cease cause
20
Q

differentials for microcytic anaemia

A
  • iron deficient anaemia from GI GU loss
  • IDA from poor diet
  • haemolysis
  • haemaglobinopathy
  • bone marrow malgnancy or infiltration
  • megaloblastic anaemia from b12/folate deficiency
  • anaemia of chronic disease
21
Q

main features
What investigations and why?

A

petichaie and purpura both legs
bruising

ix:
Coag profile - bleeding or DIC
FBC - ?low platelets
Renal function - ?MAHA or TTP
CT head - if trauma possible in hx
septic screen if febrile

22
Q

low platelets - diagnosis?

A

immune thrombocytopenic purpura

23
Q

if someone has ITP and ongoign bleeding with low GCS what is the management?

A

IV igs
IV methylpred
IV platelets

24
Q
A

LP under 50
CVC under 20
asymptomatic under 10

25
Q

what are the features of thrombotic thrombocytopenic purpura?

What are the treatment options?

A
  1. Fever
  2. thrombocytopenia
  3. renal impairtment
  4. CNS changes - headache, altered menta state
  5. microangiopathic haemolytic anaemia

Treatment
1. plasmapheresis
2. corticosteroids
3. splenectomy

26
Q
A
27
Q

what are the risk factors for a fatal anaphylaxis reaction?

A
  • asthma
  • atopic disease
  • delay or no adrenaline
  • upright posture during shock
  • cardiorespiratory disease in general
  • misdiagnosis of condtion
  • erratic behaviour around allergens
28
Q

what skin manifestations are consistent with anaphylaxis?

A
  • itch
  • erythma
  • urticaria
  • angiodema
  • pallor
29
Q

What are the steps in using an epipen?

A
  1. store at room temp
  2. use the epipen as soon as you recongnise youre having reaction
  3. flip open the carrier tube and grip in hand with needle pointing down
  4. remove safey cap on the end and push against upper outer thigh
  5. push in until click and hold for 3 seconds
  6. remove and massage area for 10 seconds
30
Q

what are the normal side effects of im adrenaline?

serious side effects

A

Normal:
* nausea
* tremor
* anxiety
* palpitations
* headache

Serious:
* hypertensive crisis
* MI
* VT
* ICH
* APO
* gangrene

31
Q

describe two abnormalities?

Interpretation

A

tongue oedema with protrusion
peri orbital erythema
pallor

likely anaphylaxis

32
Q

what are the signs of impeding airway obstruction in anaphylaxis

A

stridor
hypoxia
increased WOB
reduced GCS (fatigue)

33
Q

what are the treatment steps for anaphylaxis?

A
  1. IV fluid to mainrain BP over 90
  2. Stat IM adrenaline 500mcg repeating after 5 mins up to 3 times
  3. IV adrenaline infision at 60ml/hr (5-10mcg/min)

aiming for reduction in sx

34
Q

what does a positive coombs test indicate?

A

immune mediated

35
Q

what bloods suggest haemolytic anaemis

A

Bilirubin – increased indirect
* Haptoglobins- decreased
* LDH – elevated
* Coags
* U/A and micro – casts = renal, haematuria, urinary haemosiderin (severe haemolysis)
* Blood film – polychromasia – increased RBC production, bite cells – splenic removal hb,
Heinz bodies, rule out malaria
* G6PD level – should be taken during well stages so no mark for this

36
Q

what can cause G6PD

A

Drugs – antimalarials, sulphonamides, cipro, aspirin - trimethoprim
Infections – multiple –
Napthalene blue (moth balls)
Fava beans
Ketoacidosis

Treatment
IV fluid
oral folate

1. Fellowship Written - SAQ (25 decks)

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