Haematology Flashcards
DVT - length of treatment
provoked (e.g. recent surgery): 3 months
unprovoked: 6 months
If investigating a suspected DVT, and either the D-dimer or scan cannot be done within 4 hours, then what to do?
start a DOAC
What should be avoided in patients on concurrent bone marrow suppression drugs (especially methotrexate)
Chloramphenicol
G6PD deficiency: what to avoid
sulph- drugs: sulphonamides, sulphasalazine and sulfonylureas can trigger haemolysis
Ciprofloxacin
anti-malaria; Primaquine
Causes of vitamin B12 deficiency
pernicious anaemia: most common cause
post gastrectomy
vegan diet or a poor diet
disorders/surgery of terminal ileum (site of absorption)
Crohn’s: either diease activity or following ileocaecal resection
metformin (rare)
Features of vitamin B12 deficiency
macrocytic anaemia
sore tongue and mouth
neurological symptoms
the dorsal column is usually affected first (joint position, vibration) prior to distal paraesthesia
neuropsychiatric symptoms: e.g. mood disturbances
Management of vitamin B12 deficiency
if no neurological involvement 1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months
if a patient is also deficient in folic acid then it is important to treat the B12 deficiency first to avoid precipitating subacute combined degeneration of the cord
Von Willebrand’s disease features
most common inherited bleeding disorder
epistaxis and menorrhagia are common whilst haemoarthroses and muscle haematomas are rare
Von Willebrand’s disease Investigation
prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin
Von Willebrand’s disease Management
- tranexamic acid for mild bleeding
- desmopressin (DDAVP): raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells
- factor VIII concentrate
Neutropenic sepsis
defined as a neutrophil count of < 0.5 * 109
Neutropenic sepsis: what to avoid
PR exam
Sickle-cell crises: Aplastic crises, Cause
caused by infection with parvovirus
sudden fall in haemoglobin
Drug causes of pancytopaenia
cytotoxics antibiotics: trimethoprim, chloramphenicol anti-rheumatoid: gold, penicillamine carbimazole* anti-epileptics: carbamazepine sulphonylureas: tolbutamide
Enlarged lymph nodes and itching
think of lymphoma
Hodgkin’s lymphoma features
lymphadenopathy (75%) - painless, non-tender, asymmetrical
systemic (25%): weight loss, pruritus, night sweats, fever (Pel-Ebstein)
alcohol pain in HL
normocytic anaemia, eosinophilia
LDH raised
Haemophilia
A - factor VIII deficiency - 90% of cases
B - factor IX deficiency
Blood tests
prolonged APTT
bleeding time, thrombin time, prothrombin time normal
Antiphospholipid syndrome in pregnancy treatment
aspirin + LMWH
Sickle-cell anaemia vaccination
Pneumococcal polysaccharide vaccine every 5 years
to assess for myeloma in people aged 60 and over with persistent bone pain, particularly back pain, or unexplained fracture, what is the first test as per NICE.
FBC, calcium and plasma viscosity or ESR
New guideline for DVT treatment
first line DOACs
at least 3 months, (usually 3-6 months)
Drugs that could cause DVT
combined oral contraceptive pill: 3rd generation more than 2nd generation
hormone replacement therapy: the risk of VTE is higher in women taking oestrogen + progestogen preparations compared to those taking oestrogen-only preparations
raloxifene and tamoxifen
antipsychotics (especially olanzapine) have recently been shown to be a risk factor
iron-deficiency anaemia
Total iron-binding capacity (TIBC) + transferrin levels are typically raised
transferrin saturation level is reduced
Iron deficiency anaemia, when to stop treatment
After correcting iron deficiency anaemia, iron replacement should be continued for 3 months then stopped
the most common inherited thrombophilia
Activated protein C resistance (Factor V Leiden)
Hereditary spherocytosis; presentation
failure to thrive jaundice, gallstones splenomegaly aplastic crisis precipitated by parvovirus infection degree of haemolysis variable MCHC elevated
Benign ethnic neutropenia is commoner in which ethinic group?
Black African and Afro-Caribbean ethnicity. It is characterised by reduced absolute neutrophil counts in the absence of secondary causes
Macrocytosis causes
B12 and folate deficiency
raised GGT and MCV
alcohol
high reticulocytes
haemolytic anaemia
hypercalcaemia
renal failure
back pain
Myeloma
