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year 3. > haematology txs > Flashcards

haematology txs Flashcards

1
Q

Blood transfusions: Non-haemolytic febrile reaction tx

A

Slow or stop the transfusion

Paracetamol

Monitor

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2
Q

blood transfusion: Minor allergic reaction tx

A

Temporarily stop the transfusion

Antihistamine

Monitor

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3
Q

blood transfusion: Anaphylaxis tx

A

Stop the transfusion

IM adrenaline

ABC support
oxygen
fluids

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4
Q

blood transfusion: Acute haemolytic reaction tx

A

Stop transfusion
Supportive care
fluid resuscitation

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5
Q

blood transfusion: Transfusion-associated circulatory overload (TACO)
tx

A

Slow or stop transfusion

Consider intravenous loop diuretic (e.g. furosemide) and oxygen

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6
Q

blood transfusion: Transfusion-related acute lung injury (TRALI) tx

A

Stop the transfusion

Oxygen and supportive care

(donor plasma has antibodies against neutrophil antigens andhuman leukocyte antigens of transfusion recipient)

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7
Q

acute intermittent poryphoria tx

A

IV haematin/haem arginate
IV glucose should be used if haematin/haem arginate is not immediately available

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8
Q

polycythaemia vera tx
(3)

A

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)

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9
Q

hereditary spherocytosis: acute haemolytic crisis tx

A

treatment is generally supportive
transfusion if necessary

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10
Q

hereditary spherocytosis long term tx

A

folate replacement
splenectomy

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11
Q

Anti-phospholipid syndrome tx

A

Aspirin- arterial thrombosis
Warfarin- venous thrombosis and protects against arterial

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12
Q

Heparin reversal drug

A

Protamine sulphate
Complete reversal for unfractioned and partial reversal for LMWH

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13
Q

What patients do better on warfarin (vs xa inhibitors)

A

Patients with metal heart valves
Those with anti-phosphlipid syndrome

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14
Q

What test differentiates liver disease and DIC

A

D- Dimer- elevated in fribrinolysis- occurs toa much greater extent in DIC compared to liver disease

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15
Q

von willerbrand disease tx

A

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

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16
Q

man with hb of 110 or lower- how must he be managed

A

urgent referral for upper and lower GI endoscopy- 2ww

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17
Q

Immune Thrombocytopenia purpura (ITP) tx adults

A

*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

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18
Q

ITP tx in kids

A

usually no treatment (resolves within 6 months spontaneously usually)

if sig. fig bleeding/ platles <10- same tx as for adults. platelet transfusion in emergency

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19
Q

beta thalassemia major treatment

A

repeated transfusion + iron chelation therapy

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20
Q

If a DVT is likely management

A

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.

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21
Q

TTP acute tx

A

immediate plasma exchange (removes antibodies for ADAMTS13 enzyme and replaces it.)

if severe- cyroprecipitate + solvent detergent FFP
replenish folate

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22
Q

ttp long term tx

A

IV methylprednisolone/ritiximulab and taper down (weeks)

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23
Q

Waldenstroms tx

A

Plasmapheresis (quick)
Chemo

24
Q

1st line tx for DVT

A

DOAC

unless rena failure/ anti phosphlipid syndrome

25
Q

neutropenic infection tx

A

piperacillin with tazobactam

26
Q

long term management for sickle cell anaemia

A

hyrdoxyurea (inc HbF levels, prophylactic)

pneumococcal polysaccharide vaccine every 5 years

27
Q

diagnostic criteria for myeloma

A

1 major and 1 minor or three minor criteria in an individual who has signs and symptoms of multiple myeloma

28
Q

major criteria multiple myeloma

A

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)

29
Q

minor criteria multiple myeloma

A

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.

30
Q

warm AHA tx

A

treat underlying cause

1st line: steroids +/- rituximab

31
Q

DOACs endin in ban MOA

A

direct factor xa inhibitors. eg apixaban

32
Q

DOACs ending in tran MOA

A

direct thrombin inhibitor eg. dabigatran

33
Q

patients without ACS transfusion threshold and targets

A

70g/l hb
target: 70-90

34
Q

how long should a patient be transfused for in a non urgent scenario

A

over 90-120 minutes

35
Q

b12 deficiency (if no neurological involvement) tx

A

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)

36
Q

Cml tx

A

fatal without stem cell/bone marrow transplant in chronic phase

1st line: Tyrosine kinase inhibitor- imatinib- mainstay
Hydroxyurea
Interpheron-alpha

37
Q

essential thrombocythaemia tx
(3)

A

low - moderate risk: aspirin +/- hydroxy

high risk: aspirin + hydroxy (or other cytoreductive therapy eg interpheron alpha)

38
Q

myelofibrosis tx

A

supportive (blood transfusion, abx, plateteletsetc)
allogenic stem cell transplant in a few
splenectomy
JAK2 inhibitors

39
Q

length of anticoagulation for venous thromboembolism

A

provoked: 3 months
unprovoked: 6 months

40
Q

what should patients with high grade leukemias/lymphomas recieve prior to and after chemo

A

IV allopurinol or IV rasburicase- to avoid tumour lysis syndrome

(^converts uric acid to allatonin preventing AKI, hyperkalaemia, hypocalcaemia, hyperphosphatemia, inc uric acid)

41
Q

dabigtran reversal agent

A

IV idarucizumab

42
Q

rivaroxaban and apixaban reversal agent

A

IV andexanet alfa

43
Q

haemophillia b tx

A

factor IX replacement for big bleeds or prophlactically if severe and avoid aspirin and contact sports

44
Q

haemophillia a tx

A

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.

45
Q

sickle cell crisis tx

A

Oxygen, IV fluids, opiates.
transfuse if Hb low
abx if you suspect infection

46
Q

non hodgkins lymphoma high grade tx

A

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

47
Q

hodgkins lymphoma tx

A

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
48
Q

AML general management

A

chemo
Antibiotic prophylaxus
Blood products
Bone marrow transplant- risk jnc with increasing age etx

49
Q

If a DVT is unlikely management

A

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

50
Q

management of High INR and major bleed

A

(INR >5)
stop anticoags, IV vit K, prothombin complex

51
Q

management of high inr: minor bleed

A

stop anticoag, IV vit K, repeat INR 24 hours later- may need further vit K

52
Q

management of INR>8 with no bleeding

A

stop anticoags
IV/oral vit K
repeat INR after 24 hours

53
Q

management of INR 5-8 (no bleeding)

A

withold 1-2 doses of anticoag
review maintenance dose

54
Q

antiphospholipid syndrome tx

A

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

55
Q

post splenectomy vaccination

A

pneumococcal every 5 years
infulenza yearly
haemophilllus influenza b type- once
meningitis c vax- once

56
Q

post splenectomy antbiotic prophylaxis

A

phenoxymethylpenicllin

(clarith or eryth if allergic)

57
Q

what does rituximab target

A

monoclonal antibody targeting CD20

( CD20, is important in the maturation of B cells into plasma cells)

year 3. (32 decks)

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