haematology txs Flashcards
Blood transfusions: Non-haemolytic febrile reaction tx
Slow or stop the transfusion
Paracetamol
Monitor
blood transfusion: Minor allergic reaction tx
Temporarily stop the transfusion
Antihistamine
Monitor
blood transfusion: Anaphylaxis tx
Stop the transfusion
IM adrenaline
ABC support
oxygen
fluids
blood transfusion: Acute haemolytic reaction tx
Stop transfusion
Supportive care
fluid resuscitation
blood transfusion: Transfusion-associated circulatory overload (TACO)
tx
Slow or stop transfusion
Consider intravenous loop diuretic (e.g. furosemide) and oxygen
blood transfusion: Transfusion-related acute lung injury (TRALI) tx
Stop the transfusion
Oxygen and supportive care
(donor plasma has antibodies against neutrophil antigens andhuman leukocyte antigens of transfusion recipient)
acute intermittent poryphoria tx
IV haematin/haem arginate
IV glucose should be used if haematin/haem arginate is not immediately available
polycythaemia vera tx
(3)
venesection
(first-line treatment to keep the haemoglobin in the normal range)
aspirin
(reduces the risk of thrombotic events)
chemotherapy
(hydroxyurea - slight increased risk of secondary leukaemia
phosphorus-32 therapy)
hereditary spherocytosis: acute haemolytic crisis tx
treatment is generally supportive
transfusion if necessary
hereditary spherocytosis long term tx
folate replacement
splenectomy
Anti-phospholipid syndrome tx
Aspirin- arterial thrombosis
Warfarin- venous thrombosis and protects against arterial
Heparin reversal drug
Protamine sulphate
Complete reversal for unfractioned and partial reversal for LMWH
What patients do better on warfarin (vs xa inhibitors)
Patients with metal heart valves
Those with anti-phosphlipid syndrome
What test differentiates liver disease and DIC
D- Dimer- elevated in fribrinolysis- occurs toa much greater extent in DIC compared to liver disease
von willerbrand disease tx
first line: desmopressin (DDAVP): raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells
acute bleeding:
+ tranexamic acid for mild bleeding/prior to surgery
+factor VIII concentrate- if bleeding persists
man with hb of 110 or lower- how must he be managed
urgent referral for upper and lower GI endoscopy- 2ww
Immune Thrombocytopenia purpura (ITP) tx adults
*only treat if platelets less than 30g/l. if >30 then observe
1st line: oral prednisolone
IVIG may also be used- inc platelet count higher than usual therefore may be used if ACTIVE BLEEDING or an URGENT INVASIVE procedure is required
ITP tx in kids
usually no treatment (resolves within 6 months spontaneously usually)
if sig. fig bleeding/ platles <10- same tx as for adults. platelet transfusion in emergency
beta thalassemia major treatment
repeated transfusion + iron chelation therapy
If a DVT is likely management
proximal leg vein US within 4 hours:
if pos- start anticoag tx
If neg- arrange D-dimer
if proximal leg vein US cannot be carried out within 4 hours:
- do D-dimer and give DOAC whilst waiting for US result.
TTP acute tx
immediate plasma exchange (removes antibodies for ADAMTS13 enzyme and replaces it.)
if severe- cyroprecipitate + solvent detergent FFP
replenish folate
ttp long term tx
IV methylprednisolone/ritiximulab and taper down (weeks)
Waldenstroms tx
Plasmapheresis (quick)
Chemo
1st line tx for DVT
DOAC
unless rena failure/ anti phosphlipid syndrome
neutropenic infection tx
piperacillin with tazobactam
long term management for sickle cell anaemia
hyrdoxyurea (inc HbF levels, prophylactic)
pneumococcal polysaccharide vaccine every 5 years
diagnostic criteria for myeloma
1 major and 1 minor or three minor criteria in an individual who has signs and symptoms of multiple myeloma
major criteria multiple myeloma
plasmacytoma (biopsy)
30% plasma cells in bone marrow sample
elevated levels of M protein in blood or urine (IgA/IgG in blood and bence jones proteins in urine)
minor criteria multiple myeloma
10% to 30% plasma cells in a bone marrow sample.
Minor elevations in the level of M protein in the blood or urine.
Osteolytic lesions (as demonstrated on imaging studies).
Low levels of antibodies (not produced by the cancer cells) in the blood.
warm AHA tx
treat underlying cause
1st line: steroids +/- rituximab
DOACs endin in ban MOA
direct factor xa inhibitors. eg apixaban
DOACs ending in tran MOA
direct thrombin inhibitor eg. dabigatran
patients without ACS transfusion threshold and targets
70g/l hb
target: 70-90
how long should a patient be transfused for in a non urgent scenario
over 90-120 minutes
b12 deficiency (if no neurological involvement) tx
1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months
(remember to always treat the b12 st if they have folate deficiency toot)
Cml tx
fatal without stem cell/bone marrow transplant in chronic phase
1st line: Tyrosine kinase inhibitor- imatinib- mainstay
Hydroxyurea
Interpheron-alpha
essential thrombocythaemia tx
(3)
low - moderate risk: aspirin +/- hydroxy
high risk: aspirin + hydroxy (or other cytoreductive therapy eg interpheron alpha)
myelofibrosis tx
supportive (blood transfusion, abx, plateteletsetc)
allogenic stem cell transplant in a few
splenectomy
JAK2 inhibitors
length of anticoagulation for venous thromboembolism
provoked: 3 months
unprovoked: 6 months
what should patients with high grade leukemias/lymphomas recieve prior to and after chemo
IV allopurinol or IV rasburicase- to avoid tumour lysis syndrome
(^converts uric acid to allatonin preventing AKI, hyperkalaemia, hypocalcaemia, hyperphosphatemia, inc uric acid)
dabigtran reversal agent
IV idarucizumab
rivaroxaban and apixaban reversal agent
IV andexanet alfa
haemophillia b tx
factor IX replacement for big bleeds or prophlactically if severe and avoid aspirin and contact sports
haemophillia a tx
desmopressin acutely for minor bleeds
severe bleeds- factor 8
and if severe haemophillia generally then factor 8 can be used prophlacticlaly along with managing lifestyle etc.
sickle cell crisis tx
Oxygen, IV fluids, opiates.
transfuse if Hb low
abx if you suspect infection
non hodgkins lymphoma high grade tx
R-CHOP (p is for prednisolone)
+
rituximab
autologous and allogenic transplantation can be used for relapsed disease in patients up to 70
flu/pneumococcal vaccines
neutropenia- may need abx prophylaxis
hodgkins lymphoma tx
chemo mainstay, 2 combinations used:
1. ABVD standard
2. BEACOPP - alternative regime with better remission rates but higher toxicity
- hematopoietic cell transplantation- for relapsed or refractory classic hodgkin lymphoma
AML general management
chemo
Antibiotic prophylaxus
Blood products
Bone marrow transplant- risk jnc with increasing age etx
If a DVT is unlikely management
Perform D dimer. If wait is >4hrs anticoagulant in mean time
D dimer neg- other diag stop coag
If d dimer pos> proximal leg us. If > 4hr wait then interim anticoag
management of High INR and major bleed
(INR >5)
stop anticoags, IV vit K, prothombin complex
management of high inr: minor bleed
stop anticoag, IV vit K, repeat INR 24 hours later- may need further vit K
management of INR>8 with no bleeding
stop anticoags
IV/oral vit K
repeat INR after 24 hours
management of INR 5-8 (no bleeding)
withold 1-2 doses of anticoag
review maintenance dose
antiphospholipid syndrome tx
primary thromboprophylaxis: low dose aspirin
secondary thromboprophylaxis- lifelong warfarin. add low dose aspirin if vte even occured whilst on warfarin- target INR is 2-3
post splenectomy vaccination
pneumococcal every 5 years
infulenza yearly
haemophilllus influenza b type- once
meningitis c vax- once
post splenectomy antbiotic prophylaxis
phenoxymethylpenicllin
(clarith or eryth if allergic)
what does rituximab target
monoclonal antibody targeting CD20
( CD20, is important in the maturation of B cells into plasma cells)
