hematology incorrects Flashcards
75 YO woman recieveing 3rd unit of blood. sats 90%, bibasal inspiratory crackles, occasional wheeze
treated with oxygen
next step in management?
IV furosemide!!!
patient is fluid overloaded
what pathogen commonly causes neutropenic sepsis in cancer patients?
Coagulase-negative, Gram-positive bacteria such as Staphylococcus epidermidis
usually due to indwelling lines
A 28-year-old lady comes into your clinic. She expresses concern that her periods are getting heavier and that her nosebleeds are becoming more frequent. On examination, she is well and afebrile and has a non-blanching rash on the flexor surface of the arms. Past medical history includes diagnosis of asthma and lupus. A blood test reveals the following:
ITP can be clinically diagnosed with an isolated thrombocytopenia.
Many patients may present with anaemia and purpura due to the blood loss and low platelets.
APTT is typically increased in both haemophilia A, VWD and vitamin K. TTP is a serious condition with anaemia, fever, purpura and cerebral dysfunction.
A 25-year-old man with a history of sickle cell disease presents to the emergency department with severe chest pain, fever, and shortness of breath. His oxygen saturation is 88% on room air, and a chest X-ray shows new pulmonary infiltrates.
After initiating oxygen therapy and analgesia, what is the most appropriate next step in managing this patient?
exchange transfusion!!!
indications include: acute vaso-occlusive crisis (stroke, acute chest syndrome, multiorgan failure, splenic sequestration crisis.reduces number of HBs
blood transfusion given for symptomatic anemia and antibiiotics as infection can trigger ACS but an exchange transfusion would be the most appropriate immediate next step
name a recreational drug that can cause methemylglobulinemia
nitrates
what is the antibiotic of choice for neutropenic sepsis?
piperacillin with tazobactam - tazocin
in immunocompormised patients, what blood product poses the greatest risk?
platelets
highest risk of bacterial contamination
person presents with lymphocytosis and neutropenia following treatment for suspected recurrent tonsillitis.
most likely cause?
glandular fever also known as infectious mononucleosis) caused by the Ebstein-Barr virus. An increase in the number of circulating activated T and B lymphocytes seen in the virus causes lymphocytosis. Neutropenia can also be caused by the virus, however, the aetiology is not fully understood.
lymphoma would cause high lymphocytes but not neutropenia
a tonsillar abscess would cause high neutrophils
ITP
Investigations?
first line treatment?
antiplatelet autoantibodies (usually IgG)
bone marrow aspiration shows megakaryocytes in the marrow. This should be carried out prior to the commencement of steroids in order to rule out leukaemia
treatment = oral prednisolone!!
splenectomy if platelets < 30 after 3 months of steroid therapy
what is the platelet transfusion threshold?
a platelet count of <30 x 10 9 with clinically significant bleeding
e.g. haematemesis, melaena, prolonged epistaxis)
< 100 x 10 9) for patients with severe bleeding, or bleeding at critical sites, such as the CNS.
no bleeding = threshold of 10 x 109
why does SLE cause neutropenia?
autoimmune destruction of neutrophils
distingusih between the crises in sickle cell anemia and how they present
sequestration crises - worsening of anemia or SOB due to pooling of rbcs - INCREASED reticulocytes
aplastic crises - REDUCED reticulocyte coubt
hemolytic crises - rare - pain and jaundice
polycythemia vera may progress to what malignancies?
acute myeloid leukemia!!!! or myelofibrosis
A 55-year-old woman presents to the emergency department with new-onset dysuria. She denies any cough, shortness of breath, nausea or vomiting, or changes in bowel habits. She has a medical history of breast cancer currently being treated with doxorubicin and cyclophosphamide.
On examination, her temperature is 38.1ºC,
What is the best next step in her management?
immediate IV tazocin
fever + chemo = neutoropenic sepsis risk
uti may well be source but must treat neutropenic sepsis first
patient did not report blood in urine
what are the typical lab values in DIC caused by HELLP
s low platelets, low fibrinogen, prolonged PT, prolonged activated partial thromboplastin time (APTT), and raised fibrinogen degradation products.
what must the platelets be above to proceed with a surgery or an invasive procedure?
50 x10^9
if not give platelet transfusion first
hodgkins lymhopma, swelling in neck
first line investigation?
lymph node biopsy
ct scan of chest and abdomen and PET scan are only used later
prophylaxis fpr tumour lysis syndrome?
allopurinol!! or rasburicase
patient who is on apixaban has hemorhagic stroke
what is the most appropriate medication to prescribe for this patient?
Adexanet alfa = reverses Apixaban and rivaroxaban
digabatran is reversed using idarucizumab!
hodgkins lymphoma can present with normal lymphocyte count!
you may just notice anemia and esoinophilia + swelling in neck
differentiate the finidings in beta thalessemia trait vs beta thalessemia major
in beta thalessemia trait, hemoglobin rarely drops below 90 even though symptomatic anemia present
in beta thalessemia major, profound anemia, often less than 60
what type of anemia does coeliac disease cause?
microcytic anemia
iron deficiency due to reduced absorption
Venous thromoboembolism - length of anticoagulation
provoked (e.g. recent surgery): 3 months
unprovoked: 6 months
rivaroxaban, digabatran are options. if allergic give warfarin
alteplase is a thrombolytic used in emergency situations not long term
taco vs trali findings
febrile hemolytic reaction vs non febrile acute hemolytic reaction
anaphylactic reaction findings
Transfusion Associated Circularory Overload: Hypertension!!, raised jugular venous pulse, afebrile, S3 present, pulmonary edema may occur
Transfusion Related Acute Lung Injury: Hypotension!!!, pyrexia!!, normal/unchanged JVP, pulmonary infiltrates/inspiratory crepitations!!! due to non cardiogenic pulmonary edema
hypotension and abdominal pain help distinguish acute hemolytic reaction (the diagnosis) from febrile no-hemolytic reactio
expiratory wheeze, vs pulmonary crepitations in TRALI. anaphylactic reaction also has quicker onset eg in minutes and also causes hypotension like trali
A 67-year-old man presents to his GP with bleeding after brushing his teeth. Five years ago, he completed his final radiotherapy course of 55Gy (gray) units in 20 fractions for bladder cancer.
blood tests show pancytopenia?
most likely diagnosis?
pancytopenia 5 years post chemo/radiotherapy -> myelodysplastic syndrome
(can present with fatigue, shortness of breath, weakness, pallor, splenomegaly, easy bruising/bleeding, petechiae and sometimes bone pain. T)
contrast to myelofibrosis which would also present with b symptoms and hepatospleenomegaly
A 28-year-old female is attends the gynaecology unit for a D+C following an incomplete miscarriage. She has previously had recurrent pulmonary embolic events. After the procedure she is persistently bleeding. Her APTT is 52 (increased).
most likely diagnosis?
anti-phospholipid syndrome
A 70-year-old coal miner presents with 3 weeks of haematuria and bruising. He is normally fit and well. He is on no medications. His results reveal:
Hb 9.0
WCC 11
Pl 255
PT 16 (normal)
APTT 58 (increased)
Thrombin time 20 (normal).
acquired hemophilia
factor 8 acquired disorder
The elderly, pregnancy, malignancy and autoimmune conditions are associated with acquired haemophilia. Prolonged APTT is key to the diagnosis. Management involves steroids.
what comprises cyroprecipitate?
factor VIII!!!, fibrinogen, von Willebrand factor and factor XIII
how does itp present
treatment?
petiechia or episataxis + low platelets
oral pred !! - ITP is a destructive pathology of platelets so platelet transfusions have little to no effect
sometimes presents with massive bleeding eg intracranial
name a cancer that is more likely to cause tumour lysis syndrome
burkitts lymphoma
cancers with high wcc essentially
target cells and what else can be seen on blood film in coeliac disease?
howell jolly bodies
due to hyposplenism
name conditions with low platelet count where platelet traqnsfusions are contraindicated
Chronic bone marrow failure
Autoimmune thrombocytopenia - oral prednisolone to treat
Heparin-induced thrombocytopenia, or
Thrombotic thrombocytopenic purpura - this is treated with corticosteroids
