CP7-8 haematological emergencies Flashcards by Grace Whalley

What are some thrombosis related haematological emergencies?

DVT
PE
Thrombotic thrombocytopenic purpura (TTP)

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What are some haemolysis related haematological emergencies?

HELLP syndrome
Microangiopathic haemolyis (MAHA)

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What are some transfusion reactions which are haematological medical emergencies?

Haemolysis
Febrile non-haemolytic
Transfusion related acute lung injury
Massive transfusion
Transfusion associated circulatory overload

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What are some haemostasis related haematological emergencies?

disseminated intravascular coagulation
Heparin induced thrombocytopenia
Immune thrombocytopenic purpura
Over anticoagulated patient
Management of anticoagulated patient undergoing acute surgery

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What are some disease related haematological emergencies?

acute haemolysis
haemorrhage in patients with bleeding disorders
sickle cell crisis
mediastinal mass (SVCO)
new acute leukaemia
hyperviscosity
hypercalcaemia
spinal cord compression

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What are some treatment related haematological emergencies?

tumour lysis syndrome
cytokine release syndrome
neurological toxicity

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What are some haematological emergencies that can be caused by either disease or treatment?

neutropenic sepsis
non-neutropenic infection
AKF

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What is a normal Hb count for women?

> 115

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How might a patient with TTP present/what signs are found?

Confusion/seizures strokes
Fever
Renal failure
Low haemoglobin
Low platelet count
Recent onset headache
Pale and scattered bruising
Red cell fragments in blood
Potentially organ ischaemia due to thrombosis

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What is TTP?

A type of MAHA where there is severely reduced activity of ADAMTS13 enzyme resulting in accumulation of larger vWF. This causes intravascular thrombosis and shearing of red cells

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How is TTP acquired?

Through acquisition of autoantibody to ADAMTS13 or rarely inherited

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What is looked for in a haemolysis screen?

FBC with reticulocyte count
Bilirubin
LDH
DCT
blood film
Haptoglobin count

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What tests are done to investigate TTP?

ADAMTS13 levels
Test for Troponin
Hep B/C and HIV serology
Pregnancy test in women of childbearing potential

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What should never be given to patients with TTP?

Platelet transfusion

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How are patients treated for TTP?

Urgent plasma exchange
Suppression of antibody production
Prevention of thrombosis with aspirin and LMWH when platelets >50
Capalcizumab

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What is normal Hb in men?

> 135

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How may a patient with new leukaemia present?

Pancytopenia
Low Hb, platelets and WCC
Easy bruising
Sore mouth and gums with blood blisters
Pale rash on feet
Progressively feeling unwell

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How is a diagnosis of leukaemia confirmed?

With a bone marrow biopsy

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How is new leukaemia treated?

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antibiotics for infections
blood transfusions of RBCs and platelets when necessary
intensive chemo if patient is fit enough

How might a patient with sudden compression of spinal cord by a malignant myeloma tumour present?

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Sudden onset leg weakness
Saddle anaesthesia
Back pain and tiredness
Abdominal distension
Supra-pubic dullness
Low Hb, high Ca, more need to add

What is the medical term for losing your balance when leaning backwards?

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Retropulsion

How is spinal cord compression by malignant myeloma treated?

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steroids to reduce size
radiotherapy if largely soft tissue
occasionally surgery

How might a patient with superior vena cava obstruction present?

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Pain in chest when drinking alcohol
Facial swelling and breathlessness
Sweating and fever
Generally unwell
Distended neck veins
Plethora

What can cause superior vena cava obstruction?

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Hodgkin lymphoma

What may suggest that a patient has Hodgkin lymphoma?

Sweating Pain on drinking alcohol Young

How may a patient with tumour lysis syndrome present?

Confused Aneuric (not passing urine) Agitated Raised creatinine, uric acid, potassium and phosphate Low calcium Just started chemotherapy

What can tumour lysis syndrome lead to?

Renal failure Cardiac arrhythmia due to hyperkalaemia Low calcium can cause confusion and seizures Death if untreated

How are patients with tumour lysis syndrome treated?

IV fluids Dialysis if needed Rasburicase Treat for high potassium

How does rasburicase work?

Converts uric acid into a more soluble form

How may a patient with neutropenic sepsis present?

Fever Rigors Recent R-CHOP chemotherapy High temp Low BP High HR slightly low Hb and platelets Very low neutrophils

What initial tasks are done if neutropenic sepsis is suspected?

Septic screen for patient Give broad spectrum antibiotics

What is neutropenic sepsis?

Life threatening infection characterised by a neutrophil count <1 with a potential unobvious source of infection

If a patient has neutropenic sepsis, what procedures should be avoided?

Catheter insertion ABG Rectal or vaginal exams

How is neutropenic sepsis investigated?

Blood cultures Urine cultures FBC, renal and liver function and CRP blood tests Chest x-ray VBG for lactate levels COVID test

How might a patient with cytokine release syndrome present?

High temp Low BP Hypoxia Recent CAR-T cell infusion Flushed Rigor Tremor Confusion

What is CAR-T therapy?

Genetic modification of patient’s own T-cells to activate them and redirect them towards cancer cells.

What is cytokine release syndrome?

Exaggerated physiological response to immune therapies resulting in release of inflammatory cytokines

What are causes of cytokine release syndrome?

CAR-T therapy Some antibody therapies like Blinatumumab Some types of stem cell transplant

How is cytokine release syndrome treated?

Broad spectrum antibiotics IV fluid and oxygen Tocilizumab

How does Tocilizumab work?

Blocks IL6 reducing inflammatory response

What other syndrome/pathology can cure alongside or just after cytokine release syndrome?

Immune cell related neurological toxicity

How do patients with immune cell related neurological toxicity present?

Neurological symptoms including confusion +/- seizures +/- coma

How are patients with immune cell related neurological toxicity treated?

With steroids to suppress immune cells

What neurological assessments are used to test immune cell related neurological toxicity?

ICE ICANS

What is involved in ICE scoring?

Assessing patients orientation - do they know the year, month, the city and hospital they’re in Can patient name 3 objects they can see Can the patient follow simple commands Can a patient write a standard sentence - how does they’re handwriting change Assesses attention by seeing if patient can count backwards from 100 in 10s

What is an ICANS score?

Uses ICE score alongside consciousness assessment, if patient is having seizures, motor findings and if there is elevated ICP/cerebral oedema to grade severity

How does rasburicase work?

Converts uric acid into a more soluble form

CP7-8 haematological emergencies Flashcards

(47 cards)