Blood

Question 1

Ix if ? Fe deficiency anaemia

Answer 1

FBC (microcytic, hypochromic)
- MCV <80

Serum ferritin (<30 micrograms/L)

Transferrin saturation (<16%)

Reticulocytes (low)

Blood film (pencil cells)

Coeliac serology

Question 2

when is 2ww gastric referral needed for Fe deficiency anaemia?

Answer 2

> 60 years old

<50 years old + persistent rectal bleeding

Question 3

When is a non-cancer gastro referral needed for Fe deficient anaemia

Answer 3

ALL men + post-menopausal women (unless overt non-GI bleeding)

> 50 + anaemia or FH of colorectal cancer

Pre-menopausal women <50 with persistent Fe deficient anaemia despite treatment.

Question 4

Treatment of Fe deficient anaemia

Answer 4

200mg PO ferrous sulphate, 2-3x per day.

Hb should rise by 10g/L/week.

Continue for 3 months after iron stores normalise.
Take with food (SE: nausea, GI upset)

Question 5

When is IV iron indicated?

Answer 5

Oral route contraindicated

Oral route ineffective (e.g. inadequate mobilisation of Fe stores in CKD).

Question 6

Febrile non-haemolytic transfusion reaction + management

Answer 6

Fever
Rigors/chills
Headache + anxiety
Tachypnoea

STOP transfusion
paracetamol
restart transfusion slowly

Question 7

Anaphylaxis transfusion reaction + management

Answer 7

angioedema
hypotension
tachycardia
pruritis
hypotension 

STOP transfusion

0.5mg adrenaline IM
100mg chlorphenamine
200mg hydrocortisone
5mg salbutamol nebs

Question 8

Bacterial contamination of blood transfusion + management

Answer 8

fever/rigors
hypotension

STOP transfusion
call haem

blood cultures
broad spectrum antibiotics

Question 9

TRALI + management

Answer 9

Sudden onset SOB
tachycardia
fever
hypotension

STOP transfusion
Oxygen
Treat ARDS (O2, CPAP, NIV)
Remove donor from pool

Question 10

TACO + management

Answer 10

Fluid overload
Pulmonary oedema
hypertension

STOP transfusion
Sit up
oxygen
diuretics