BCSH Guidelines Flashcards

Question

DLBCL 2024 1st line >60yrs, Stage I/II, IPI 0

Answer 1

2x R-CHOP iPET2 If CMR give 2x R-CHOP If

Answer 2

4x R-CHOP + RT or 6x R-CHOP

Answer 3

6x R-Pola-CHP +/- RT for baseline bulk EOT PET-CT

Answer 4

Reduced intensity chemo EN disease Bulky disease (>7.5cm)

Answer 5

Testes - 6x R-CHOP + CNS prophy + RT contralateral testis Breast - 6x R-CHOP + RT + CNS prophy Gastric - 6x R-CHOP + eradicate h. pylori Intravascular - CNS directed protocol if evidence CNS disease Leg type - 6x R-CHOP + RT Bone - 6x R-CHOP + RT

Answer 6

6x R-CHOP if IPI <2 6x R-Pola-CHP if IPI >1 Consider R-CODOX-M/R-IVAC for younger high risk DA-EPOCH-R if double hit

Answer 7

R-miniCHOP (50% cyclo, doxo 25mg/m^2, vinc 1mg) R-GCVP for cardiac patient

Answer 8

Do EOT PET-CT 6 weeks post chemo and BEFORE RT or HD-MTX Review MDT Deauville 1-3 = CMR If

Answer 9

NSAA BM cellularity <25% SAA NSAA + 2/3 Retic <60 Plat <20 Neut <0.5 VSAA SAA + neut <0.2

Answer 10

NSAA CSA + horse ATG if transfusion dependent, bleeding or recurrent infections SAA/VSAA If MSD and <40 or 40-50 and fit —> upfront HSCT CSA + horse ATG + eltrombopag if no MSD CSA + horse ATG + eltrombopag if MSD and >40 ATG - patient must be stable, ideally afebrile, plt >20, prophylactic antibiotics, given in experiences centre MUD/alternative If young/fit upfront In others if failed CSA-ATG Syngeneic Consider in all Pregnant Supportive transfusion Can use CSA if needed

Answer 11

NSAA CSA + horse ATG if transfusion dependent, bleeding or recurrent infections SAA/VSAA If MSD and <40 or 40-50 and fit —> upfront HSCT CSA + horse ATG + eltrombopag if no MSD CSA + horse ATG + eltrombopag if MSD and >40 ATG - patient must be stable, ideally afebrile, plt >20, prophylactic antibiotics, given in experiences centre MUD/alternative If young/fit upfront In others if failed CSA-ATG Syngeneic Consider in all Pregnant Supportive transfusion Can use CSA if needed

Answer 12

4Ts 4 or more or ECMO or critically ill Test with screen e.g. lat-flow, ELISA Follow up e.g. chemiluminescent or functional assay at specialist centre

Answer 13

3 months full anticoag if clot 1 month full if no clot or until platelets recover Argatroban infusion if unwell and kidneys OK Biavlirudin of unwell and liver OK Fondaparinux if not unwell Convert to DOAC once fit IVIg for autoimmune or VITT

Answer 14

Use alternative if possible If need heparin eg bypass and antibody negative proceed using alternatives pre- and post-infusion If still ab positive and need eg bypass use bivalirudin PLEX + IVIg if above but can't get bivalirudin Agatroban or danaparoid for CVVHF

Answer 15

Fondaparinux but beware long half life (42 hours before regional technique)

Answer 16

Any grade with splenomegaly or symptoms

Answer 17

Baseline HIV, HepB, HepC Individualised plan TB risk Individualised herpes virus plan

Answer 18

Non-melanoma skin cancer Need individualised surveillance (i.e. those with hx skin cancer or those with actinic keratosis)

Answer 19

>200 : 20mg BD 100-200 : 15mg BD 75-99 : 10mg BD 50-74 : 5mg BD

Answer 20

Start danazol then add ruxo if platelets respond Off SpC license - low dose ruxo with monitoring

Answer 21

Disease related splenomegaly Or those resistant to ruxo

Answer 22

Consider 1st line for MF with splenomegaly and anaemia Not routinely available in UK

Answer 23

Alone or with ruxo if low EPO level

Answer 24

Alone or with ruxo if EPO doesn't work

Answer 25

Consider in iron overloaded patients being worked up for alloSCT

Answer 26

Biopsy for EMZL/NMZL Blood flow/BM biopsy for SMZL CT NTAP, PET only if HG transformation expected BMAT for SMZL/NMZL if cytopenias, not needed for gastric EMZL OGD for gastric EMZL FISH for t(11;18)

Answer 27

H pylori eradication for all OGD 3-6 months after ISRT for ongoing disease post eradication 12 month surveillance OGD in remission or asymptomatic

Answer 28

Antiviral for hep C Antibiotics for eyes Antibiotics if evidence chronic infection RT otherwise

Answer 29

R-Chlorambucil

Answer 30

R monotherapy

Answer 31

Clinical assessment Bloods inc LDH, hepB/C, HIV Histology inc Ki67, CyclinD1 (t(11;14)), SOX11 TP53 sequencing Frailty assessment CTNTAP or PET Consider BMAT for staging or if cytopenic (PET not sensitive to rule out) LP + CNS imaging if CNS symptoms

Answer 32

Need full staging workup Consider local RT

Answer 33

Rituximab + HD cytarabine containing regimen AutoSCT in CR1 Maintenance R If TP53mut then trial for consolidatoin Add inrutinib to R-CHOP part + consolidation if accessible

Answer 34

R-chemo R maintenance R-miniCHOP or similar for frail

Answer 35

W+W if low volume nodal or isolated spleen/BM/blood

Answer 36

Ibrutinib unless used 1st line Ibrutinib good for CNS relapse

Answer 37

Relapsed post CD20 + BTKi Lack of early response to BTKi in 2nd line

Answer 38

Diagnosis is based on clinical and blood film findings Coag screen normal Send pre-treatment ADMATS13 assay Do HepB/C, HIV and autoimmune screens Do pregnancy test ADAMTS13 <10 IU/dl is highly sensitive and specific

Answer 39

Emergency Time-ciritcal transfer to treatment centre Intubate in local centre if needed PLEX start within 4-8 hours Do not give platelets

Answer 40

Start Caplcacizumab on confirmation for 30 days, continue if ADAMTS13 stays low Methylpred 1g/day for 3 days PLEX with octaplas, 1.5xPV exchange Stop PLEX when plt >150 Start rituximab within 3 days Thromboprophylaxis once plt >50

Answer 41

Counsel before valve insertion if CBA Counsel as soon as become CBA

Answer 42

Tertiary centre with obs, cardio, thrombosis, cardiac surgery, neonatal and anaesthetics Counsel about risks of low adherence i.e. valve thrombosis and associated morbidity VKA best for valve but increased risk of pregnancy loss or neonatal morbidity Convert VKA to LMWH once pregnant, ideally before 6/40 LMWH throughout with 2.5mg/kg/day enoxaparin (250IU/kg/day others) + aspirin 75mg (150mg for pre-eclampsia prophylaxis) Higher dose LMWH because high rate thrombosis during transition

Answer 43

Tertiary centre with obs, cardio, thrombosis, cardiac surgery, neonatal and anaesthetics Individualised plan, documented + emergency plan For VKA - convert to LMWH 2/52 before birth (if present in labour go for CS) For LMWH - stop 24 hours before CS or when start labour If prolonged LMWH disruption consider prophylactic dose For aspirin - stop 3 days prior to delivery Restart prophylactic LMWH for first 24-28 hours post delivery VKA restart 7 days post delivery Reassess plan for next pregnancy if relevant

Answer 44

IgG, IgG, IgM AND SPEP Immunofixation (more sensitive than SPEP) blood and urine Serum freelite FBC Renal function Corrected calcium

Answer 45

M-protein >15g/L Non IgG Abnormal SFLCr Low - 0 - 2% - 20yrs Low-int - 1 - 10% 20 years High-int - 2 - 18% 20 years High - 3 - 27% 20 years

Answer 46

Int-high or high

Answer 47

All patients: repeat bloods in 6 months Thereafter yearly follow up Don’t discharge int-high or high

Answer 48

Recommended for all staff in clinical or laboratory areas involved in transfusion

Answer 49

Stop transfusion, maintaining venous access Double check ID band and label Visually inspect unit Assess patient A-E with obs If temp <2deg and/or pruritus and/or rash: continue with supportive care Fever: give paracetamol Allergic type reaction: give antihistamine (not steroids) Anaphylactic reaction: Give IM adrenaline regardless of platelet count Hypotension: Consider if this is symptom of blood or indication for blood Sustained temp >2deg with other symptoms: Think haemolysis or infection

Answer 50

FBC Renal Liver CXR if resp symptoms For moderate/severe: Return blood Repeat G+S with compatibility testing on unit (not needed for allergy symptoms alone) Culture DAT, LDH haptoglobin If DAT positive/stronger do elution Coag screen Urine for haemoglobin IgA levels Consider withdraw associated components Anti-HLA/HNA/HPA only for appropriate contexts Consider mast cell tryptase For resp symptoms not associated with allergy: O2 sats, ABG BNP (and request add-on to pre-transfusion) Echo

Answer 51

Try prophylactic paracetamol or NSAID If doesn’t work try washed components

Answer 52

Not for prophylaxis Exclude other aetiologies

Answer 53

If react to apheresis platelets, try pooled in PAS Antihistamine prophylaxis Not for routine steroids Washed units Octaplas if allergy to FFP Transfuse in suitable area

Answer 54

If history of anaphylaxis: Washed components for elective transfusion Do not delay emergency transfusion If no history: Standard components Increased monitoring

Answer 55

All but mild febrile/allergic reactions via SABRE Review within hospital transfusion team

Answer 56

Seen doctor for bleeding? 2cm bruise without trauma? Bled after dentist needing intervention? Bleeding after surgery? FHx bleeding disorder? Seen doctor for heavy periods? Prolonged PPH? 0-1: no coag screen (FBC for mod risk only) 2+: Coag screen + haem opinion

Answer 57

Venous Superficial biopsy GI tract MSK US drain

Answer 58

Low gauge arterial Embolisation Dialysis access Tunnelled line

Answer 59

High gauge arterial Aortic Tumour ablation Renal biopsy/stent TIPSS/TJ biopsy Liver biopsy

Answer 60

Low risk: none Med risk: Hb >70, plt >50, INR <2 on warfarin High risk: Med risk but INR <1.5

Answer 61

Fn >1.2g/L Plts >50 HCT >0.25

Answer 62

Hypogonadotrophic hypogonadism Hypothyroid/parathyroid Diabetes Cardiac siderosis - failure/arrythmia HCC

Answer 63

Liver iron concentration

Answer 64

Transfusional: blood at least 1 unit per 3 months Non-transfusional: NTDT, NTRIA

Answer 65

1-3 monthly

Answer 66

Baseline by age 8 2-yearly if T2* >20ms Annual if T2* 10-20ms 6 monthly if T2* <10ms

Answer 67

Baseline by age 8 T2* - do with cardiac 2-yearly if 7 mg/g Annual if 7-15 mg/g 6 monthly if >15 mg/g

Answer 68

6 monthly height and weight Annual pubertal status, OGTT, TFT, cortisol, gonad function Annual Vit D from age 2

Answer 69

Calculate rate of iron loading based on transfusions Seen by cardiology starting age 16 ECG + echo Hepatitis serology LFTS (more frequent) Increase monitoring if poor chelation

Answer 70

Cirrhosis when LIC >7mg/g HCC

Answer 71

SCD: regular top ups or if rising ferritin NTDT: ferritin >800 NTRIA: ferritin >1000

Answer 72

TDT: 10-12 units blood or ferritin >1000 (x2) NTDT: ferritin >800 or LIC >5mg/g NTRIA: chelation or venesection if ferritin >500 or LIC > 5 mg/g SCD: top up chelate as per TDT, RCEX - individualised plan

Answer 73

Age <6 SC desferrioxamine Age >6 Deferasirox-FCT (tablet) 2nd line for any Desferrioxamine + deferipone Deferasirox + desferrioxamine Deferasirox + deferipone

Answer 74

Surgical managed abortion, miscarriage, ectopic or molar Medical abortion 10-12 weeks

Answer 75

500 IU anti-D within 72 hours Kleihauer not needed

Answer 76

500 IU anti-D every 6 weeks Kleihauer every 2 weeks from 20 weeks onwards with extra anti-D as needed (then repeat after 72 hours)

Answer 77

1500 IU anti-D at 28-30 weeks

Answer 78

Do Kleihauer test Give 500 IU If Kleihauer test indicates, give more anti-D Repeat Kleihauer after 72 hours If cell salvage used: give 1500 IU anti-D, do Kleihauer

Answer 79

Do Kleihauer test Give 500 IU If Kleihauer test indicates, give more anti-D Repeat Kleihauer after 72 hours If cell salvage used: give 1500 IU anti-D, do Kleihauer

Answer 80

125 IU/ml (IM) 100 IU/ml (IV)

Answer 81

Blood derived product Consent Fever/headache Can cause allergic reaction

Answer 82

MoM - 1.5 anti-D - 4 anti-c - 7.5 (or lower if also anti-E) anti-K - any anti-other - 1/32

Answer 83

anti-c anti-D anti-K Previous history of HDFN (refer any)

Answer 84

Increased risk of needing blood Have blood ready

Answer 85

Hb DAT Bilirubin

Answer 86

Baby at risk for up to few weeks, monitor

Answer 87

Ven-O Acalabrutinib Ibru-ven Zanubrutinib Regardless of TP53 status

Answer 88

TP53 wt FCR only if IGHV mutated Ven-O Ibru-Ven TP53 mut Acalabrutinib Ven-O Ibru-ven Zanubrutinib

Answer 89

Prevenar then pneumovax Annual flu Covid

Answer 90

Prophylaxis if IgG <4g/L IVIg if no response

Answer 91

CNS-IPI 4-6 3 or more EN sites Testes, renal/adrenal, intravascular

Answer 92

Breast Uterus

Answer 93

2x cycles HD MTX >3g/m2 Intercalate or at end Add IT if testicular IT only if CrCl <50

Answer 94

Written info to patient, record updated Carry card, buy bracelet Education re travel esp malaria Vaccination up to date Register of at-risk patients locally

Answer 95

-Pneumococcus, 23 valent start at 2 then booster every 5 years -Meningococcus -Annual flu -Hib as per childrens schedule, not for older

Answer 96

Lifelong penicillin or macrolide Protects against pneumococcus if high risk Also carry supply of rescue antibiotics

Answer 97

Hospitalise urgently Prompt IV antibiotics

BCSH Guidelines Flashcards

(124 cards)