Haemotology Flashcards
Scoring system used for dvt?
Components?
Wells
- cancer, paralysis/immobilisation, bedridden or surgery, local tenderness to deep veins, entire leg swollen, calf swelling >3cm, pitting oedema, collateral superficial veins, previous dvt.
- 2 if alternate diagnosis as likely as dvt
What is a low risk wells score for dvt? What should be done next?
What is a high risk wells score for dvt? What should be done next assessment wise?
=/>2
USS, if -ve repeat in a week if d dimer +ve
Treatment of a dvt?
Lmwh
Warfarin for 3 months if known cause
Warfarin for 6 months if unknown cause or recurrent
What can be done for dvts if warfarin fails?
Ivc filter
What should be done about superficial venous thrombophlebitis without risk factors? Why?
Compression stockings, nsaids
Low risk of emboli as no muscle pump and inflammation in the area
Factors that increase risk of emboli in superficial thrombophlebitis?
What should be done
No varicose veins
In the great saphenous vein
Previous dvts
Seek advice as to need of lmwh
Youve diagnosed a dvt and started treatment. What should be considered now?
Finding a cause if none is obvious (#, immobilisation etc)
Routine questioning and exam for cancer
Post anticoag look at blood clotting profile, antiphospholipid syndrome (drvvt)
Why is warfarin paradoxically procoagulant initially?
Inhibits proteins s and c
Risk factors that indicate need for thromboprophylaxis in medical and surgical patients who have reduced mobility compared to normal.
Cancer treatment Over 60 Critical care Dehydrated Thrombophillia Obese Significant comorbidity Family hx HRT or COCP Varicose veins with thrombophlebitis
When should medical patients recieve thromboprophylaxis?
Significant decrease in mobility for 3 days
Moderate decrease in mobility and risk factors
When should surgical patients recieve thromboprophylaxis?
Surgery >90mins or >60 mins lower limb
Expected significant reduction of mobility
Risk factor
Inflammatory or intra abdominal condition
#nof
What general measures can reduce risk of vte?
Encourage mobility
Reduce dehydration
Stop COCP 4 weeks prior to surgery
When are antiembolism stockings contraindicated?
Peripheral arterial disease Peripheral neuropathy Peripheral arterial bypass graft Fragile skin Dermatitis Allergy
A patient needs pharmacological vte prophylaxis and has a eGFR of 10
How is it metabolised
Risk?
UFH
Mainly by reticuloendothelial system at low doses
Risk of heparin induced thrombocytopenia
How can lmwh be reversed?
Problem with this?
Protamine
Anticoagulant in od
Fish allergy
When should lmwh be given prior to surgery? What should be checked first? When would it be a problem to administer prior to surgery?
18:00 the night before
Get anaesthetic opinion first
Epidurals and spinal catheters - must be at least 12 hours before for prophylactic dose or 24 hours before for treatment dose
Contraindications to lmwh?
Active bleeding inc ulcers
Recent haemorrhagic stroke
Hypersensitivity
Thrombocytopenia
Big complication of lmwh? When?
Heparin induced thrombocytopenia
5-21 days
When should clopidogrel not be stopped without discussion with cardiologist?
Post stent insertion
Recent stroke or acs
What anaemias tend to increase red cell distribution width?
Iron deficiency
B12 deficiency
What anaemias would increase reticulocyte count?
Haemolytic anaemia
Haemorrhage
What anaemias would decrease reticulocyte count?
Iron deficiency
Aplastic
Three physiological adaptations to anaemia?
Increased 2.3bisphosphoglycerate
Extramedullary haemopoeisis
Increased cardiac output
