Haematology Flashcards
INR of 5-8 with no bleeding - action?
Omit 1-2 doses warfarin, continue when INR under 5 and reduce subsequent dose
INR of 5-8 with minor bleed- action?
Omit warfarin, give Vit K IV, restart warfarin when INR is <5
INR of 5-8 with major bleed - action?
Any major bleed (regardless of INR)
= Stop warfarin, give IV vit K and either dried prothrombin complex concentrate or FFP
INR >8 with minor bleed - action?
Stop warfarin, give IV vit K (which may need repeating)
INR > 8 with no bleed - action?
Stop warfarin, give oral vit K, repeat vit K if still too high after 24 hours
What is the Chadsvasc score where treatment is indicated?
> 2 for females
>1 for males
Name 2 indications for LMWH?
Prophylaxis of VTE or treatment of thrombolytic events
Name 3 side effects of LMWH?
Haemorrhage
HIT (Heparin induced thrombocytopenia) - low platlets
Hyperkalaemia
What should be done about surgical procedures which carry a high risk of bleeding for patient taking warfarin?
Stop warfarin 5 days before
If high risk VTE then start LMWH (TREATMENT DOSE) bridging therapy
What should be done about surgical procedures which carry a low risk of bleeding for patient taking warfarin?
Can continue warfarin as normal if INR around 1.5-2
How should warfarin be restarted for a post op patient?
Restart LMWH and warfarin together
Continue LMWH until INR is in range for 48 hours
(This is done as warfarin gives a transient hypercoaguable state when first started)
What changes to use of LMWH should be considered in renal impairment?
Safe to use
LMWH is safest anti-coag in renal impairment
What patient consideration needs to be asked about when prescribing LMWH?
Are they able to self-inject?
What MCV is seen in thalassemia?
Low MCV (microcytic)
Anaemia of chronic disease and haemolytic anaemia both show what MCV?
Normocytic (normal MCV)
Pernicious anaemia shows what MCV/ Hb results?
Hb: Low
MCV: High (macrocytic)
What MCV is seen in (a) iron deficiency anaemia (b) folate/ vit B12 deficiency
(a) Low MCV (microcytic)
b) High MCV (macrocytic
A 57-year-old woman presents with breathlessness. On further questioning, she also notes fatigue and lethargy. This has been going on for the last year. On examination, the GP notices a lemon tinge to her skin as well as impaired vibration sense in her distal legs and feet.
Given her presentation what is the most likely diagnosis?
Pernicious anaemia
A lemon tinge to the skin is associated with pernicious anaemia
What are the features of acute haemolytic transfusion reaction?
Mismatched blood group + massive intravascular haemolysis
- Mins after starting
- Fever
- Hypotension
- Agitation, chest pain
How should acute haemolytic transfuion reaction be treated? (3)
Immediate termination of transfusion
Fluid resus
Inform lab
How does an anaphylactic transfusion reaction present?
Urticaria
Stridor
Hypotension
Angioedema
How should anaphylactic transfusion reaction be treated?
Simple urticaria: Stop transfusion, give antihistamine, resume once syx resolve
Severe: Permenantly stop, IM adrenaline, supportive care. Consider steroids
What is the difference between Haemophillia A and Haemophillia B?
A deficiency in FVIII (5x more common)
B deficiency in FIX
How is haemophillia inherited?
X-linked recessive (mainly male and NO male-male transmission)
Note acquired haemophillia is also possible
How does haemophillia present?
Deep muscle bleeds and haemarthrosis are characteristic
How do you diagnose haemophillia on bloods?
Low factor 8/9
Increased APTT
Normal bleed time (raised in vWB disease)
Normal prothrombin time (raised in vitK deficiency)
Normal platelets
How do you manage haemophillia, how does this change if the patient is bleeding?
Avoid NSAIDS and IM injections
Minor bleed - Pressure, elevation and DDVAP (desmopressin)
Mod - Replace F8/9 to 50% normal levels
Severe - Replace F8/9 to 100% normal levels
How do you distinguish between haemophillia, vitk deficiency and von willibrand disease on bloods?
All have raised APTT
Haemophillia - PT and bleed time are normal
VonWillibrand - PT normal but bleed time raised
VitK deficiency - PT raised but bleed time normal
What are the characteristics of vonWillibrand disease? (Inheritance and incidence)
Deficiency in vWFactor
Autosomal dominant!
Up- to 1% incidence, most common in females
What are the presenting features of vonWillibrand disease?
Bleeding from mucus membranes
(Epistaxis, post surgery, menorrhagia
How do you manage bleeding in a patient with vWD?
1) DDAVP (desmopressin)
2) vWF/ VIII concentrates
If minor bleed can use tranexamic acid
How does vWD show on bloods?
Raised APTT
Raised bleed time
Normal PT
Low FVIIIc (as VWF normally binds to FVIII)
Name three microcytic anaemia’s?
Iron deficiency
Thalassaemia
Sideroblastic anaemia
Name three normocytic anaemias?
Anaemia of chronic disease
Anaemia due to CKD
Aplastic anaemia
Haemolytic anaemia
Name three macrocytic anaemias?
B12 or folate deficiency (including pernicious)
Alcohol or liver disease
Anaemia of pregnancy
Hypothyroidism
What is Fanconi anaemia?
Autosomal recessive aplastic anaemia
- Causes pancytopenic marrow failure
- Increases cancer susceptibility
What is pernicious anaemia?
Antibodies to gastric parietal cells or intrinsic factor
- Don’t absorb B12
(Associated with other autoimmune like thyroid, diabetes, rheumatoid)
How is pernicious anaemia treated?
3 months of vitB12 injections
Folic acid suppliment may also be needed
What is sickle cell anaemia and how is it inherited?
Autosomal recessive
- Abnormal synthesis of HbS chain, more common in africans and presents in first 6 months or when exposed to hypoxia