haematology Flashcards
(37 cards)
which infection is commonly known to precipitate haemolytic crisis
parvovirus (Erythema infectiosum)
slapped cheek syndrome
Mx acute haemolytic crisis
supportive treatment +/- transfusion
long term MX of hereditary spherocytosis
folate replacement
splenectomy
classic presentations of the hereditary causes of haemolysis
neonatal jaundice
infection/ drugs precipitate haemolysis
gallstones
+/- splenomegaly depending on whether it is due to intra or extravascular haemolysis
red blood cell transfusion thresholds
patients without acute coronary syndrome, transfusion threshold is 70g/L with post-transfusion target 70-90g/L
patients WITH acute coronary syndrome, transfusion threshold is 80g/L with post-transfusion target 80-100g/L
*does not apply to ongoing major haemorrhage or chronic anaemia requiring transfusion
why do we irradiate blood products?
deplete T-lymphocytes
avoid transfusion related graft vs host disease
most common genetic bleeding disorder and its inheritance pattern
presentation
Ix.
von willebrand disease
autosomal dominant
Ix. prolonged PT, APTT, low factor 8 and normal platelets. defective platelet aggregation with ristocetin
presentation of VWF disease
mucosal bleeding (gums, nose) + menorrhagia
Mx. of vwf disease
- tranexamic acid for mild bleeding
- desmopressin raises levels of vWF
- factor 8 concentrate
1 unit of RBCs
how quickly must be given after removal from fridge and over what timespan
non-urgent transfusions, transfuse 1 unit of RBCs over 90-120 minutes. Give within 4 hours of removal from fridge
G6PD deficiency drugs causing haemolysis
aspirin, antimalarials, sulph-group drugs
mx of patients at high risk of neutropenia.
which patients are at high risk of neutropenia and neutropenic sepsis
filgrastim (granulocyte-colony stimulating factor)
risk factors: elderly specific ca: non-hodgkins, ALL previous neutropenic episodes combo chemo + radiotherapy
** odly not given to patients with myeloid malignancies as can precipitate them further
mx febrile neutropenia
piperacillin with tazopbactam
prophylaxis chemotherapy induced neutropenia
fluorquinolone
Histology of hodgkin’s lymphoma
4 types
***nodular sclerosing - women, good prognosis
mixed cellularity
lymphocyte predominant - best prognosis
lymphocyte depleted - rare, worst prognosis
man with CLL comes in with fever, and swollen lymph nodes
richter transformation into high grade non-hodgkin’s lymphoma
causes of iron deficiency
intake - poor diet
absorption - coeliac disease
use - children, pregnancy
loss - menstruation, GI bleeding
Well’s score criteria
1 point for each
risk factors: active cancer (<6mo), paralysis, bedridden (surgery), previous documented DVT
signs: local leg tenderness, swollen, calf swelling >3cm compared to other, unilateral pitting oedema, non-varicose distended leg veins
- 2 if an alternative diagnosis is AS LIKELY
DVT likely wells score and what do you do
DVT likely (2 or more)
USS within 4 hours → if it positive then treat, if it is negative do a D-dimer to confirm
if can’t do USS within 4 hours, do a D-dimer and treat with DOAC (rivaroxaban) and do the USS within 24hrs
if USS negative, D dimer positive, stop DOAC and repeat USS one week later
DVT UNlikely wells score and what do you do
DVT unlikely (1 point or less)
do a D dimer within 4 hours, if positive then do USS
within 4 hours, if not possible within 4, give DOAC and do USS within 24
if can’t do a D dimer within 4 hours, give a DOAC until you can
what cases would you NOT give a DOAC for VTE treatment?
what do you give?
severe renal impairment GFR<15/min
antiphospholipid syndrome
LMWH, unfractionated heparin or VKA
duration of VTE anticoagulation
everyone for 3 months
+ 0 months if provoked eg. surgery
+ 3 months if unprovoked VTE – absence of bleeding risk factors
+ 1 - 3 months if cancer – a grey area and patient specific
reversal agent for DOACs eg. rivaroxaban
andexanet alfa
causes of neutropenia
Infection - viral (HIV, EBV< hepatitis), severe sepsis
Inflammation - rheumatological conditions, rheumatoid arthritis (Felty’s hypersplenism), SLE
Malignancy - aplastic anaemia, myelodysplastic malignancies
drugs - clozapine
