Haematology

Question 1

How is VWF inherited? What are the levels of platelets, PT and APTT

Answer 1

Autosomal Dominant

Normal platelets (number not affected)
Prolonged PT and APTT

Nb// Reduced Factor 8 level slightly (but not as much as Haemophilia A)

Question 2

What do you do if patient is on warfarin and there is bleeding, with INR >5

Answer 2

stop warfarin. IV Vit K.
Prothrombin complex concentrate (contains factors 2,7,9,10)

Question 3

what to do if on warfarin and INR 5-8? No bleeding

Answer 3

Stop warfarin, oral vitamin K

Question 4

How do you monitor response to haemachromatosis Mx (i.e. venesection)?

Answer 4

Monitor ferritin and transferrin saturation

Question 5

What nerve is usually injured when the lateral aspect of knee/head of fibula is injured?

Answer 5

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.

Question 6

What can be a trigger of ITP?

Answer 6

Infection

Question 7

Management of ITP?

Answer 7

Prednisolone

Question 8

At what threshold are platelet transfusions indicated?

Answer 8

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

Question 9

Which blood product carries the most infection risk?

Answer 9

Platelets, as they can’t be refrigerated

Question 10

Do you have to stop the COCP prior to surgery?

Answer 10

Yes, 4 weeks before
(DVT risk)

Question 11

Which bacteria commonly implicated in neutropenic sepsis?

Answer 11

Staph Epidermidis

(due to indwelling lines commonly seen in cancer patients)

Question 12

Why do you get anaemia in CKD?

Answer 12

1) decreased EPO
2) increased hepcidin which impairs iron absorption gut