Haematology

Question 1

Haematoligcal assessm pre op

Answer 1

FBC- correct anaemia before surg. Hb under 100g/l bad.
GS- high risk bleed eg cardiothoracic, uorlogy, polypectomy, liver or spleen, vasc surgery.
Platelet- thrombocytopenia or cytosis
Blood film
Clotting- PT extrinsic, aPTT intrinsic, TT, fibrinogen, INR. Only do if hx suggs probs.
Hx of unusual bleeding or thrombosis
Fam hx bleeding disorder
Antithrombotic meds- asp, clopidogrel, warf, NOAC, CS.
Imm competence- neutropenia ie under 1 or philia

Question 2

Group and save

Answer 2

Confirms blood grp and any RBC Abs, info saved.

Question 3

X match

Answer 3

Pt sample mixed with a blood unit to ensure compatability.

Question 4

If known bleeding disorder

Answer 4

Contact haematologist

Question 5

Surgery that doesnt require stopping anticoags

Answer 5

Dental extrac
Catarct surg
Minor skin procedures

Question 6

If do need to stop anticoag

Answer 6

5 days to get INR under 1.5
6 days if INR target 3-4
Is bridging with LMWH req
Discuss with haem

Question 7

Anitpl therapy patients

Answer 7

Asp can usually continue unless v high risk bleed procedure
Clopidogrel usually stopped before, discuss with CVS team
Asp plus clopidogrel never stop without talking to their speciality

Question 8

Thromboprophylaxis factors

Answer 8

Age
BMI
Personal or fam hx VTE or thrombophilia
Ortho ops
Spinal surg
Plaster cast
Pelvic op
Long anaes
Ops for malig

Question 9

If thrombocytopenia- low pl

Answer 9

Test if true or artefact
Repeat and req blood film
Citrate sample if pl clumping reported
Full clotting screen- PT, APTT, TT, fibrinogen

Question 10

low pl

Answer 10

Px- petechiae, epistaxis, purpura
Causes- drugs, alc, genetic, liver or spleen dis, AI
Reduced produc- haemantic defic, BM fail
Incr remov- DIC, AI
Avoid asp and NSAID
Pl transfus can be dangerous

Question 11

Emergency surg in warfarin pt

Answer 11

Stop warf
Delay surg if poss
Vit K 5mg IV
Rep INR
If surg req v soon then reverse warf with prothrombin complex concentrate eg octaplex, beriplex.

Question 12

Warfarin pt for surg in 1 wk

Answer 12

Stop warf
Start LMWH if req
Rep INR in 2d
Proceed when INR under 1.5
Omit LMWH at least 24 hr bef procedure if therapeutic, 12hr if prophylactic. 
Contin LMWH if active CA confirmed

Question 13

FFP

Answer 13

Rich in clotting facs

Dose- 10-15ml/kg

Question 14

Cryoprecip

Answer 14

Rich in fibrinogen and VWF and FVIII

Dose- 10U for adult