Haematology Flashcards
How is VWF inherited? What are the levels of platelets, bleeding time, PT and APTT
Autosomal Dominant
Normal platelets (number not affected)
Prolonged bleeding time
Normal PT but prolonged APTT
Nb// Reduced Factor 8 level slightly (but not as much as Haemophilia A)
What do you do if patient is on warfarin and there is bleeding, with INR >5
stop warfarin. IV Vit K.
Prothrombin complex concentrate (contains factors 2,7,9,10)
what to do if on warfarin and INR 5-8? No bleeding
Stop warfarin, oral vitamin K
How do you monitor response to haemachromatosis Mx (i.e. venesection)?
Monitor ferritin and transferrin saturation
What nerve is usually injured when the lateral aspect of knee/head of fibula is injured?
Common peroneal nerve
(the sciatic nerve divides into common peroneal nerve and tibial nerve)
The common peroneal innervates dorsiflexion and ankle eversion.
Therefore you get foot drop.
What can be a trigger of ITP?
Infection
Management of ITP?
Prednisolone
At what threshold are platelet transfusions indicated?
If bleeding >30
If no bleeding <10
If pre-op, and surgery high bleeidng risk, transfuse to aim >100
medium risk aim 50-75
low risk aim >50
Which blood product carries the most infection risk?
Platelets, as they can’t be refrigerated
Do you have to stop the COCP prior to surgery?
Yes, 4 weeks before
(DVT risk)
Which bacteria commonly implicated in neutropenic sepsis?
Staph Epidermidis
(due to indwelling lines commonly seen in cancer patients)
Why do you get anaemia in CKD?
1) decreased EPO
2) increased hepcidin which impairs iron absorption gut
What is the management of ITP?
Only needs treatment if severe bleeding or platelets less than 10
Otherwise, no treatment needed
Resolves by itself in 6 months
What happens in tumour lysis syndrome and which cancers are high risk for it?
How can you reduce risk of it?
breakdown of tumour when treated, causing
HIGH K
HIGH Ph
HIGH URIC ACID
LOW Ca
Leukaemia and lymphoma
Reduce risk with IV Fluids and Allopurinol
How do you reverse each of the anticoagulants?
Heparin - protamine
Warfarin - Vit K +/- PCC
Apixaban/Rivaroxaban (both 10a inhibitors) - adnexet alpha (10a)
Dabigatran (monoclonal antibody)
Edoxaban - there isn’t one licensed :/
Which malignancies is EBV associated with?
Burkett’s lymphoma
Hodgkin’s lymphoma
Nasopharyngeal carcinoma
How often should patients with sickle cell receive pneumococcal vaccine?
Every 5 years
Slightly raised APTT, normal platelets, slightly low Factor 8
Bleeding
What’s diagnosis?
Von Willebrand Disease
(inherited)
Which virus causes aplastic anaemia (pancytopenia) in those with haem issues (e.g sickle cell)?
Parvovirus B19
ie. 5th disease (slapped cheek syndrome)
- rash over face
Which Hb rises in compensation in B thalassaemia trait?
Hb A2
Which Hb is dominant in B thalassaemia major?
HbF
What is HSP and what is the triad of symptoms?
IgA vasculitis following URTI
Abdominal pain, haematuria, joint pain (+purpuric rash/petechiae on buttocks)
What happens to clotting factor levels in liver disease? What happens to PT and APTT?
Clotting factors all fall, except factor 8 (made throughout body)
APTT and PT both raised
However also at risk of thrombus as well as bleeding because natural anticoags (protein c, s, antithrombin) fall
What are the criteria in Well’s score?
-Entire leg swollen
-Tender along deep venous system
-One leg 3cm more dilated than other
-Immobility in last 3 days or surgery requiring GA in last 12 weeks
-Previous DVT
-Active cancer
-Paralysis or casting of leg
-Pitting oedema on that leg only
-2 points of Other diagnosis as likely
How to use Well’s score in suspected DVT?
Score 1 or 0 (DVT less likely) = d-dimer. If positive, do USS. If not available in 4hrs, start treatment.
2 or more (DVT more likely) = do USS
If USS going to delay more then 4hrs, start treatment and ensure USS done within 24hrs
What to do in suspected DVT if d-dimer positive but USS negative?
Stop anticoagulation
Offer repeat USS in 6-8 days
Most commonly inherited thrombophilia?
Factor V Leiden
What is CML and what are the symptoms?
Increased granulocytes at different stages of maturation
Increased WCC +/- increased platelets
Low Hb - anaemia
Massive splenomegaly -> abode discomfort
Occurs due to Philadelphia chromosome (9:22 translocation, forming BCR:ABL fusion gene which produces overly active tyrosine kinase protein -> cell proliferation)
What is the management of CML?
1st line = imatinib (TKI)
What are the causes of massive splenomegaly?
CML
Myelofibrosis
Management of beta thalassaemia major?
Regular bloods transfusions
(they don’t have HbA - instead increased A2 and F)
But need also desferioxamine to prevent iron overload
What are the official diagnostic criteria for multiple myeloma?
Need 1 major and 1 minor Orr 3 minor
major: plasmacytoma identified on biopsy, plasma cells >30% in BM, elevated M proteins blood/urine
minor: plasma cells 10-30% BM, slightly elevated M protein blood/urine, osteolytic lesions, low non-cancer antibody levels in blood
What is the management of sickle cell patients long term?
Hydroxyurea to prevent attacks
And they should have the pneumococcal vaccine every 5 years
How should you manage antiphospholipid patients when they’re pregnant?
Stop warfarin
Start aspirin from 12 weeks (to prevent pre-eclampsia)
Start LMWH once fetal heartbeat detected
They are at increased risk of VTE especially during pregnancy!!
Indications for warfarin as 1st line anticoagulant?
Metallic heart valve, valvular AF
Antiphospholipid syndrome
Coeliac disease + splenomegaly = WHY?
What do you see on blood film as a consequence?
Coeliac disease causes functional hyposplenism
You may see Howell Jolly bodies (RBC remnant) and target cells on blood film - basically cos spleen isn’t working as well to remove abnormal blood stuff
Effect of EBV on FBC?
Lymphoyctosis and neutropenia (the former can precipitate recurrent infections)
NB// FERRITIN IS ACUTE PHASE REACTANT AND WILL BE RAISED WHEN UNWELL (so can be deceivingly normal or high in someone with IDA when they’re acutely unwell!)
What are the causes of microcytic anaemia?
1) Iron deficiency is most common (in females, think GI loss vs menorrhagia)
2) Thalassaemia
When should you transfuse platelets?
If no bleeding, <10
if significant bleeding <30
(i.e. malaenia, haematemesis, prolonged epistaxis)
