Protamine max 50mg IV 1mg for 100units UFH 8 hours S/E: anaphylaxis, Brady, hypotension

Haem/Onc Flashcards by Michael Dunne

Triggers for G6PD deficiency

Favs beans
Drugs (Sulfa, nitrofurantoin, aspirin, methylene blue)
Ketoacidosis
Infection

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Investigations G6PD

FBC and film (Heinz bodies)
Coombes (negative)
High LDH
Low haptoglobin
High unconjugated bilirubin

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Treatment G6PD

Treat precipitate
IV Fluids
Oral folate
Admission

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MAHA causes

DIC
TTP
HUS
HELLP
Malignant hyperthermia
Wegeners

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Sickle cell precipitants

Infection
Dehydration
Hypoxia
Acidosis

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Symptoms of Sickle Cell

Vaso-occlusive crisis
Acute chest syndrome 
Priapism
Splenic sequestration
Haemolytic crisis
Infection (salmonella OM)
Infarction (brain, bone, eye, kidney)

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Explain acute chest syndrome and management

Diffuse infiltrates with cough, SOB and fever AFTER crisis from pneumonia, PE, ARDS or fluid overload

Treatment: empiric antibiotics (SHiN cover) & plasma exchange (treatment for all complications of sickle cell)

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Vaso-occlusive crisis management and prevention

Warm
Oxygen
Fluids
Analgesia
Consider plasma exchange

Prevent:
Hydroxyurea
Bone marrow transplant

Never use tPA or heparin (NOT CLOT)

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Pernicious anaemia features

Blood: Howell Jolly Bodies, high MCV, low B12
Neuro: dementia, depression, subacute degeneration of spinal cord
GI: carcinoid and adenocarinoma

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Aplastic Anaemia causes and bloods

GVHD
Ionised radiation
Fanconi Syndrome (renal failure)
Pregnancy

Drugs:
Chloramphenicol
Phenylbutazone
Anticonvulsants

Inv:
Pancytopaenia with low reticulocytes

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Intrinsic haemolytic anaemia

Enzyme: G6PD def, pyruvate kinase def
Membrane: spherocytosis
Hb: Sickle Cell

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Extrinsic Haemolysis

Autoimmune: Coombs +
Mechanical: MAHA, prosthetic valve
Env: burns, toxins, infection
Splenic sequestration

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Sideroblastic anaemia causes

Isoniazid toxicity
Pyridoxine def
Lead poisoning
Alcohol

Tx: Pyrodoxine

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Mechanism of HIT

Platelet factor 4 binds to heparin to inactivate it as part of metabolism.
If develop PF4-heparin complex antibodies (HS III) binds to platelets forming clots (consumptive coagulopathy)

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APLS antibodies and RF for high risk of clots

Anti B2 glycoproteins
Lupus anticoagulant
Anticardiolipin

RF
Presence of anti B2 glycoproteins
High antibody levels
IHD RF (smoking, DM, lipids, HTN)

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Management of APLS:
No SLE
SLE
Arterial clot
Venous clot
Pregnancy
Refractory

No SLE: aspirin
SLE: hydroxychloroquine
Arterial: warfarin and aspirin
Venous: warfarin
Pregnancy: heparin and aspirin
Refractory: hydroxychloroquine, IVIG

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Indications for thrombophlebitis screen

Unprovoked DVT and <45yrs
2nd unprovoked DVT
DVT pregnancy
Recurrent miscarriages or stillbirth
Family hx
Atypical DVT site (arm)
DVT and HIV

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HASBLED Score

HTN 160
Ab renal (200), LFT (Bili 2, AST 3)
Stroke
Previous bleed
Labile INR
ETOH/drugs
Drugs that bleed (anticoagulants)
Age >65

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LMWH benefits to heparin

Single daily dose
No monitoring
Less HIT
Better anti-Xa activity
SC delivery (not IV)

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Reversing heparin

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Protamine max 50mg IV

1mg for 100units UFH <3 hours
1mg per 1mg LMWH <8 hours
0.5mg for LMWH >8 hours

S/E: anaphylaxis, Brady, hypotension

Petechia causes

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Mechanical: coughing, vomiting, pressure
Thrombocytopaenia
Infection: meningococcal, IE, RMSF
Vasculitis
Platelets dysfunction (vWD, renal failure)

Thrombocytopenia causes

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Production: aplastic anaemia, chemo, leukaemia
Destruction: ITP, DIC, TTP, HUS
HELLP
Splenic sequestration
Drugs: quinine, heparin, NSAIDS, phenytoin, paracetamol, abciximab
Elimination: Bleeding, ECMO

ITP causes and high risk factors

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Causes:
Viral illnesses EBV, HIV, CMV, hep C

RF: old (>60), low plt, liver failure, on anticogaulation

ITP treatment

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Steroids
Plt if <10 or <30 and bleeding
IVIG
Splenectomy

TTP

``` ADAMTS-13 deficiency BRAIN FART (fever, anaemia, renal failure, thrombocytopaenia) ``` MAHA (schistocytes, LDH) Tx: plasma exchange, FFP, steroids ``` Triggers: Shigella/Salmonella OCP Pregnancy Cancer ```

HUS

Kids, bloody diarrhoea, renal failure, MAHA Shigella/Ecoli Strep (atypical) EBV, VZV Cancer Toxin mediated Supportive with dialysis only

DIC bloods

``` Sky high Ddimer High aPPT High INR Low Plt Low fibrinogen ```

Difference in plt vs factor bleed

Bruising Immediate Holes (nose, menses, gums, haematuria, GI bleeding) Factor: Deep (muscle, joint, head, retroperioneal) Delayed onset Congenital

Cryo contents

``` 150units of Fibrinogen Factor 8 Factor 13 vWF ``` All in 30mls

FFP

``` 250mls Everything 250 units Factor 8 Thawed Matched ```

Haemophilia A Mild, moderate, severe % per factor

Mild 5-10% Moderate 1-5% Severe less than 1% 1 unit increases 2% (1:1 in Haemophilia B)

Classification of bleeding severity in haemophilia

Very mild: no factor, nose bleed Mild: 12u/kg: haematuria, mucosal Mod: 25u/kg: deep lac, trauma to nose, early haemarthrosis Severe: deep muscle, headstrike, dental extraction

Acute porphyria features

Disproportionate abdo pain Confusion & focal deficits Painful blistering skin

Prophyria dx and tx

Urinary porphobilirubin Tx: IV fluids Haemin Liver transplant

Role of tryptase

Confirm anaphylaxis (>5ug/L) Dx mastocytosis 75% sensitive

Causes angioedema

``` C1 esterase def Meds: ACEI, tPA Idiopathic Acquired C1ED (sepsis, DIC, ECMO) Infection Allergic reaction ```

Management angioedema

Icatibant 30mg SC C1 esterase conc 20u/kg FFP TXA

Difference in angioedema/urticaria

Sub dermal and submucosal Skin, mucosa, GI, lips Delayed onset 1-2 days Painful, not itchy Urticaria: Itchy, rapid, skin only Epidermis and dermis

4 causes of pericardial effusion in malignancy

Malignancy itself Radiation Chemo Low albumin

SVC syndrome features

Symptoms: SOB, headache in bending, chest pain, dysphasia Signs: Permbertons, oedema, flushing, distended upper body veins, right pleural effusion 25%

SVC obstruction management

``` Sit up Lower limb IVC Oxygen Steroids Radiotherapy/Stenting ```

MASCC Criteria

``` Age <60 Asymptomatic Normotensive Solid tumour No dehydration No fever in hospital Haem cancer with no prev fungal infection ```

Features of hyperviscosity syndrome

Mucosal bleeding Visual disturbance Reduced GCS

Tumour Lysis Syndrome components

High uric acid High K High phosphate Low calcium

Risk factors for TLS

``` High tumour burden Cytotoxic chemo Renal impairment Dehydrated High uric acid (gout) ```

Treatment TLS

``` Fluids (200ml/hr) Dialysis Insulin & Dextrose Calcium only if unstable Allopurinol Rasburicase Alkalination of urine ```

Different system features of paraneoplastic

``` Metabolic (ca, SIADH, ADH) NMJ: lambert eaton CT: HPOA, clubbing Haem: thrombosis, DIC Renal: nephrotic Skin: acanthodians nigiricans ```

High risk for Fleischer nodules

``` Smoker Old Hx cancer Fam hx lung cancer Environmental (asbestos) ```

Haem/Onc Flashcards

(48 cards)