HAEMATOLOGY Flashcards

Question

treatment for pe

Answer 1

``` rivaroxiban for 3 months 15 mg for 3 weeks then 20 mg for remainder different dose after 3 weeks provoked 3 months unprovoked 6 months ```

Answer 2

Anti-fibrinolytic | Stops (prevents) the breakdown of clots

Answer 3

Direct tests for antibody on RBC surface | Indirect tests for antibodies in blood, this one is used to diagnose reactions to blood transfusion.

Answer 4

1) Complete response 2) Partial response 3) No response

Answer 5

``` Better pharmacokinetics (stable half lives regardless of dose so dont need daily monitoring) Less adverse reactions - lower risk of HIIT because dont have mechanism of action on thrombin (which is mechanism of action that caused thrombocytopaenia) ```

Answer 6

Activate major haemorrhage protocol Administer high flow oxygen Insert 2 wide bore peripheral cannulae and provide fluid resuscitation. Contact key personnel, including experts to treat bleeding cause. Arrest bleeding and treat underlying cause as soon as possible. Request laboratory investigations and perform Point of Care Tests where available, including blood gas analysis and viscoelastic tests (ROTEM/ TEG). Transfuse red cells to maintain a haemoglobin level of 70-90 g/L Administer tranexamic acid within 3 hours of onset of haemorrhage unless complicated by disseminated intravascular coagulation Transfuse FFP empirically if estimated blood loss greater than 20% blood volume or if microvascular bleeding Anticipate the need for additional blood components (including red cells, FFP, platelets and cryoprecipitate) Use cell salvage where available and appropriate When bleeding is under control additional doses of FFP should be based on results

Answer 7

``` thrombocytopaenia hypothermia hypocalcaemia hyperkalaemia ARDS coagulopathy ```

Answer 8

FBC - Hb, infection, platelets Clotting - PT, APTT, including Fibrinogen (DIC) Group and save - group blood Cross match - cross matched blood Calcium - needed for coagulation factors to work ABG - ongoing Hb and electrolytes

Answer 9

2 units RBC (O negative emergency) 1 unit of FFP to every 2 units of RBC Platelets if fall below <75 Cryo only if fibrinogen is not correcting by FFP and is <1.5

Answer 10

Fibrinogen supplementation in patients with congenital hypofibrinogenaemia; as prophylaxis before surgical procedures, or to treat bleeding Correction of low fibrinogen levels due to acquired bleedingdisorders in Europe and in the Republic of Ireland, although not yet licensed for this indication in the UK. Alert!! Fibrinogen concentrate can cause widespread thrombi, if administered inappropriately or in excessive dose. A critically low fibrinogen level should be confirmed beforehand.

Answer 11

``` Febrile, allergic, hypotensive reactions Acute haemolytic transfusion reaction TACO - circulatory overload TA Lung injury Transfusion related dyspnea Septic shock - from bacterial contaminant ```

Answer 12

Haemolytic reactions from pregnancy or previous transfusion Graft vs host disease Iron overload Post transfusion purpura

Answer 13

STOP THE TRANSFUSION Rapidly assess patient A-E (observations and interventions as necessary) Any concerns - call for help Check component and patient are correct/ correct blood has been given Commence medical treatment as necessary eg salbutamol for bronchospasm Send giving set to blood bank for coombs test Document event Report on local incident management Report to SHOT

Answer 14

STOP the transfusion Maintain IV access Undertake rapid clinical assessment including ABC (Airway, Breathing, Circulation) If appropriate, call for help Check identification details between the patient, their identity band and the compatibility label of the blood component Visually assess the unit looking for evidence of unusual clumps or discolouration and check the expiry date Check standard observations.

Answer 15

Call for help/medical staff immediately Disconnect the component and giving set from the patient and retain for further investigation Maintain IV access with physiological saline and use blood pressure, pulse and urine output to guide fluid administration Ensure the airway is patent, and if the patient is severely dyspnoeic give high flow oxygen through a mask with a reservoir. Shock/severe hypotension associated with wheeze/stridor i.e. anaphylaxis Shock/severe hypotension without clinical signs of anaphylaxis or fluid overload i.e. ABO incompatibility or bacterial contamination Severe dyspnoea without shock i.e. TRALI or TACO (Transfusion Related Acute Lung Injury or Transfusion Associated Circulatory Overload).

Answer 16

Moderate febrile symptoms Differential diagnosis is similar to severe ATR In most cases the transfusion will be discontinued. If the transfusion is resumed then the patient should be monitored closely. Moderate allergic symptoms Symptoms may include angioedema and dyspnoea but not sufficiently severe to be life-threatening. Antihistamines should be given. Consider oxygen therapy and inhaled salbutamol.

Answer 17

In mild ATR, medical staff should be informed, but the transfusion may be continued with appropriate treatment and close observation. Treat mild febrile reactions with oral paracetamol (500-1000mg in adults). Treat mild allergic reactions with antihistamines and slow the transfusion rate. BEST PRACTICE POINT A mild reaction may be the early stages of a severe reaction - DON’T IGNORE IT. Observe the patient closely

Answer 18

Full Blood Count (FBC) Urea and Electrolytes (U&Es), Liver Function Test (LFTs) Urine analysis (for haemoglobinuria, to exclude haemolysis)

Answer 19

Well patient / no RFs - if fall below 10 (as long as plts are >5 there shouldnt be any increased risk of bleeding in the absence of any other RFs) If RFs - transfuse at <20 If having surgery <50 If having anything to do with brain eyes - <100 Epidural - <80 Severe bleeding <50 Multiple trauma incl intracerebral bleed <100

Answer 20

< fibrinogen von willebrands disease factor 8 and 13 deficiency DIC

Answer 21

15 mls of cryo Can keep replacing without overload Higher concentration of fibrinogen in cryo (250mg in 10 mls) than FFP (400 mg in 200 mls)