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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
neutropenic infection tx
piperacillin with tazobactam
26
long term management for sickle cell anaemia
hyrdoxyurea (inc HbF levels, prophylactic) pneumococcal polysaccharide vaccine every 5 years
27
diagnostic criteria for myeloma
1 major and 1 minor or three minor criteria in an individual who has signs and symptoms of multiple myeloma
28
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)
29
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.
30
warm AHA tx
treat underlying cause 1st line: steroids +/- rituximab
31
DOACs endin in ban MOA
direct factor xa inhibitors. eg apixaban
32
DOACs ending in tran MOA
direct thrombin inhibitor eg. dabigatran
33
patients without ACS transfusion threshold and targets
70g/l hb target: 70-90
34
how long should a patient be transfused for in a non urgent scenario
over 90-120 minutes
35
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)
36
Cml tx
fatal without stem cell/bone marrow transplant in chronic phase 1st line: Tyrosine kinase inhibitor- imatinib- mainstay Hydroxyurea Interpheron-alpha
37
essential thrombocythaemia tx (3)
low - moderate risk: aspirin +/- hydroxy high risk: aspirin + hydroxy (or other cytoreductive therapy eg interpheron alpha)
38
myelofibrosis tx
supportive (blood transfusion, abx, plateteletsetc) allogenic stem cell transplant in a few splenectomy JAK2 inhibitors
39
length of anticoagulation for venous thromboembolism
provoked: 3 months unprovoked: 6 months
40
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)
41
dabigtran reversal agent
IV idarucizumab
42
rivaroxaban and apixaban reversal agent
IV andexanet alfa
43
haemophillia b tx
factor IX replacement for big bleeds or prophlactically if severe and avoid aspirin and contact sports
44
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.
45
sickle cell crisis tx
Oxygen, IV fluids, opiates. transfuse if Hb low abx if you suspect infection
46
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
47
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
48
AML general management
chemo Antibiotic prophylaxus Blood products Bone marrow transplant- risk jnc with increasing age etx
49
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
50
management of High INR and major bleed
(INR >5) stop anticoags, IV vit K, prothombin complex
51
management of high inr: minor bleed
stop anticoag, IV vit K, repeat INR 24 hours later- may need further vit K
52
management of INR>8 with no bleeding
stop anticoags IV/oral vit K repeat INR after 24 hours
53
management of INR 5-8 (no bleeding)
withold 1-2 doses of anticoag review maintenance dose
54
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
55
post splenectomy vaccination
pneumococcal every 5 years infulenza yearly haemophilllus influenza b type- once meningitis c vax- once
56
post splenectomy antbiotic prophylaxis
phenoxymethylpenicllin (clarith or eryth if allergic)
57
what does rituximab target
monoclonal antibody targeting CD20 ( CD20, is important in the maturation of B cells into plasma cells)

year 3. (33 decks)

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