Haematology

Question 1

How to diagnosAdde myelofibrosis?

Answer 1

Question 2

vWD presentation

Answer 2

bleeding tendency in face of normal PT and APTT

AD inheritance

Desmopressin can be used before surgery

Question 3

Most likely infection in platelet transfusion

Answer 3

Staph epidermidis

Question 4

Indication platelet tranfusion

Answer 4

platelets below 20

Question 5

Indication blood transfusion

Answer 5

R1 Acute blood loss Objective: to maintain circulating blood volume and haemoglobin (Hb) concentration > 7 g/dl in otherwise fit patients, and 8 - 9g/dl in older patients and those with known cardiovascular disease. 15-30% loss of blood volume (800-1500 in an adult) red cell transfusion is unlikely to be necessary, transfuse crystalloids or synthetic colloids. In obstetrics transfusion should commence when blood loss approaches 1000ml and is continuing. 30 -40% loss of blood volume (1500-2000 in an adult) Rapid volume replacement is required with crystalloids or synthetic colloids and red cell transfusion probably required to maintain Hb levels. >40% loss of blood volume (>2000ml in an adult) Rapid volume replacement is required including red cell transfusion. R2 Hb concentration < 7g/dl R3 Hb concentration < 8 or 9g/dl in patients with known cardiovascular disease or those with significant risk factors of such disease ( e.g. elderly patients, those with hypotension, diabetes mellitus PVD. For Chronic renal failure transfuse to maintain Hb > 10g/dl ) R4 In critical care transfuse to maintain Hb > 7 g/dl. or >9 g/dl if cardiac or respiratory disease present. R5 Post-chemotherapy / radiotherapy: There is no evidence based guide to practice Most hospitals use a threshold of Hb 8 or 9 g/dl for chemotherapy and 11 – 12 for radiotherapy R6 Chronic anaemia; Transfuse to maintain the Hb concentration just above the lowest concentration which is not associated with symptoms of anaemia. Many patients may be asymptomatic with an Hb >8g/dl. Do not transfuse when effective alternatives exist.

Question 6

Indication cryoprecipitate

Answer 6

Low fibrinogen <1.5 and ongoing bleeding where blood transfusion did not help

Question 7

Fresh frozen plasma

Answer 7

Where fibrinogen above 1.5 and PT/APTT prolonged

Question 8

PCC indication

Answer 8

Warfarin reversal where there is bleeding or when urgent surgical treatment indicated or head injury with significant bleeding on warfarin

Question 9

AIHA tx

Answer 9

1st line prednisolone

2nd line rituximab

Question 10

CLL tx

Answer 10

1st line: fludarabine

OR

Chlorambucil

2nd line: rituximab

Question 11

Most common transfusion related morbidity

Answer 11

TACO

Question 12

polycythaemia association

Answer 12

gout (increased serum urate)

Question 13

Coagulation cascade

Answer 13

Question 14

Late consequence of chemo and radio for Hodgkins

Answer 14

Question 15

Felty’s syndrome triad

Answer 15

rheumatoid arthritis

splenomegaly

neutropenia