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 above - 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 in lesion suggesting active bleeding and expanding haematoma

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

Why does this happen?

A

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

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

Usually ABO incompatibility

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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 (less serious)
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. hypersplenism
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?

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

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

A

IV igs
IV methylpred
IV platelets

22
Q
A

LP under 50
CVC under 20
asymptomatic under 10

23
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

25
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
26
Q

what skin manifestations are consistent with anaphylaxis?

A
  • itch
  • erythma
  • urticaria
  • angiodema
  • pallor
27
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
28
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

29
Q

describe two abnormalities?

Interpretation

A

tongue oedema with protrusion
peri orbital erythema
pallor

likely anaphylaxis

30
Q

what does a positive coombs test indicate?

A

immune mediated

31
Q

what bloods suggest haemolytic anaemis

Film?

Others

A

Bilirubin (mainly unconjugated) and LDH increased

Haptoglobins- decreased

  • U/A and micro – casts, haematuria, urinary haemosiderin
  • Blood film – polychromasia – increased RBC production
32
Q

what can cause G6PD
what is the treatment

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

Treatment
IV fluid
oral folate

33
Q

define massive transfusion

A

as replacement of >1 blood volume (or 10 units) in 24 hours or >50% of blood volume in 4 hours

34
Q

what are the potential complications of a massive transfusion

A
  • volume overload
  • hypothermia
  • dilutional coagulopathy
  • TRALI
  • hyperkalemia
  • disease transmission
35
Q

DOAC and ICH
What treatments may you use and why?

What may affect decision?

A
  • PRBC and platelets - ongoing blood loss
  • TXA - low cost and low ris
  • Desmopressin - low cost and risk
  • idarucizumab and haemodyalisis - only works for dabigatran
  • Not FFP in DOACS

affecting decision
* time of ingestion
* renal and liver function

36
Q

what is this

A

contre-coup injury
bleeding occuring on opposite side of brain where direct trauma was
right fronto-tempero cerebral contusion
small SDH
tissue haematoma

37
Q

haemophilia A and bleeding - what can you give