Random facts - haem Flashcards
What diseases are Schistocytes found in?
Microangiopathic haemolytic anaemias (MAHA)
Disseminated intravascular coagulation (DIC)
Thrombotic thrombocytopenic purpura (TTP)
Haemolytic uraemic syndrome (HUS)
What diseases are Heinz bodies found in?
G6PD deficiency and alpha thalassaemia
What diseases are Howell-Jolly bodies found in?
Hyposplenism or following splenectomy
What diseases are Spherocytes found in?
hereditary spherocytosis and autoimmune haemolytic anaemia
What diseases are the Target cells found in?
iron deficiency anaemia, sickle cell disease, thalassaemia, and hyposplenism
What should be done in the case of major bleeding in a patient on anticoagulants with a high INR?
(1) Stop anticoagulants
(2) Administer IV vitamin K
(3) Give prothrombin complex (preferred over FFP)
What is the management for minor bleeding in a patient with a high INR?
(1) Stop anticoagulants
(2) Administer IV vitamin K
(3) Repeat INR after 24 hours
(4) Further vitamin K may be needed
What should be done for a patient with an INR > 8 but no bleeding?
(1) Stop anticoagulants
(2) Administer IV or oral vitamin K
(3) Repeat INR after 24 hours
How should a patient with an INR > 5 but no bleeding be managed?
(1) Withhold 1-2 doses of anticoagulant (2) Review the maintenance dose of the anticoagulant
What would Initiation of ciprofloxacin do?
It would lead to increased levels of warfarin, thus increasing its effect. This would increase the INR and increase the risk of bleeding
A 69-year-old man is seen in the anticoagulation clinic for a routine INR check. He takes warfarin 8mg daily for AF but he recently forgot to collect his repeat prescription and so missed 2 days. In an attempt to correct this, he took 3 tablets of warfarin in one morning.
His INR comes back as 5.4 but he is haemodynamically stable and reports no episodes of bleeding. What would be the best step next in management?
Hold warfarin for 1-2 days until INR <5 and decrease the dose
An 81-year-old man is brought in by ambulance to A&E with a head injury. He informs you that he takes warfarin for atrial fibrillation. He also reports feeling nauseous.
CT head demonstrates a subdural haemorrhage.
His INR is found to be 4.5.
What is the most appropriate pharmacotherapy to reverse the effects of warfarin in this patient?
IV vitamin K and prothrombin complex concentrate
A 45-year-old man presents with fatigue, pallor, and dizziness. He describes occasional tingling and numbness in his lower limbs. A blood film is ordered to assess his condition further.
What is this describing and what blood film findings are most associated with the likely underlying cause?
vitamin B12 deficiency anaemia
= Hypersegmented neutrophils and macrocytic red blood cells
Cabot rings suggests what. What investigations do you do for this disease?
Pernicious anaemia
= Methylmalonic acid and anti-intrinsic factor antibody
A 42-year-old man with G6PD deficiency presents to the emergency department with acute onset shortness of breath shortly after taking ciprofloxacin, prescribed by his GP for a lower urinary tract infection. A blood count and film are reviewed.
The blood film shows a population of red blood cells of normal size and morphology (with scattered cytoplasmic Heinz bodies); and a population of larger, immature red cells.
The blood film has a blue tinge to it. What is the single best description of the presence of these immature red cells?
Reticulocytosis
A 65-year-old alcoholic is brought to A&E following a collapse in the street. He is resuscitated successfully and started on the trust’s detoxification protocol. His observations are now stable. He is examined by the A&E registrar who notes clubbing, scattered spider angiomas on the patient’s precordium, and a distended abdomen with shifting dullness but no palpable liver edge. Routine blood tests are sent.
The blood count shows a macrocytic anaemia. Examination of the film reveals evidence of non-megaloblastic macrocytosis (no reticulocytes) and acanthocytes.
What is the single most likely cause of this patient’s blood results? And why?
Chronic liver disease
= This patient has strong clinical evidence of chronic liver disease secondary to alcoholism
A 72-year-old man presenting to his GP with fatigue and recurrent respiratory tract infections (including a recent course of antibiotics for suspected bacterial pneumonia) is found to have nucleated red blood cells, immature neutrophils and tear drop poikilocytes on blood film.
On examination he is well, but an enlarged spleen is noted extending from the left hypochondrium as far as the right iliac fossa.
What is the single most likely underlying diagnosis?
Primary myelofibrosis
What is a non-specific abnormality which may be seen in patients post-splenectomy?
Target cells
A 28-year-old female attends the cardiology clinic for a routine follow-up. She suffered from severe infective endocarditis aged 24, requiring mitral valve replacement with a mechanical valve. Routine bloods, including a peripheral blood film, are taken.
Which finding would be expected based on her history?
Schistocytes
A 26-year-old man involved in a road traffic accident undergoes a successful emergency splenectomy for a traumatic splenic rupture. During his post-op recovery on the surgical ward, he has daily blood tests
What finding would you expect to see on his blood film? and why?
Howell-Jolly bodies
= are seen when the spleen is absent or not functioning properly
