Haematology - Collated from sources such as Passmed, Zero to Finals, AMBOSS, BMJ best practice PDF

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Collated from sources such as Passmed, Zero to Finals, AMBOSS, BMJ best practice...

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Anaemia  Hb 2 osteolytic lesions  Low Hb  Low albumin

lesions = back ache, vertebral collapse, pathological fractures  Infection

for bone lesions XR spine, skull (“punched out pepper pot skull”), pelvis  Urinary BENCE JONES PROTEINS

 Radiotherapy for focal disease  Orthopaedic input if there’s vertebral collapse  Recurrent Immunoglobulin infusions  Chemotherapy

Tumour Lysis Syndrome  



Triggered by Chemotherapy or steroid use Tumour breakdown releases toxic chemicals o Uric acid o Phosphate o Potassium  Low Calcium PROPHYLAXIS IS KEY: o IV Allopurinol or Rasburicase before and during 1st few days o IV Fluids 2 days before o Loop diuretic

Neutropenic sepsis     

Neutrophil count 38 7-14 days after chemo PROPHYLAXIS = Fluoroquinolone Mx: o IV Abx without waiting for bloods  Tazocin  If still unwell after 48 hrs switch to Meropenem +/- Vancomycin  If not responding, consider fungal cause - CT

SVC obstruction   

SOB Swelling of face, neck, arms Headache o Worse in morning  Visual disturbance  Jugular venous distension  GET A CT WITH CONTRAST  Mx: o Dexamethasone + balloon venoplasty and stenting o Lie pt on side whilst awaiting surgery (relieves pressure)

Hypercalcaemia  

IV Fluids IV bisphosphonates if severe (>3.4)

Spinal cord compression  Back pain o Worse when lying down or coughing  Numbness

    

Paraesthesia Bladder/bowel dysfunction Muscle wasting T2 MRI Mx: o Immobilise pt o Dexamethasone o Urgent decompression surgery

Myeloproliferative Neoplasms Myeloproliferative Neoplasm Polycythaemia Vera

Essential thrombocytosis

Myelofibrosis

Cell type involved RBC

Platelets

Fibroblasts

Px

Investigation

Mx

Prognosis

 JAK2 mutation  >60 y/o  Hyperviscosity sx e.g. headaches, dizziness, vision changes, tinnitus, pruritis (esp after hot bath), burning in fingers/toes  Thrombosis  Facial plethora  Splenomegaly  Gout (from ^ RBC turnover)

FBC:  ^RBC’s (so ^Hb)  ^WBC’s  ^Plt’s

Venesection if low risk

--> Myelofibrosis in ~30%

       

FBC:  Plt’s >450x109

JAK2, CALR or MPL Usually clinically well Bleeding Atypical chest pain Headache Dizziness B Symptoms Bone marrow failure sx  Massive hepatosplenomegaly - causes abdo discomfort

Bone marrow shows panmyelosis Low serum EPO

WBC

--> Acute leukaemia in ~5%  Monitor FBC’s every 3 months

+ Aspirin 75mg OD Aspirin 75mg OD Hydroxyurea if high risk Blood film:  Tear drop RBC’s (nucleated) FBC:  Low Hb  ^WBC’s  ^Plt’s Bone marrow biopsy is Dx

CML

Hydroxyurea if high risk:  >60 y/o  Previous VTE (or IFNa if child-bearing age)

JAK inhibiters - Ruxolitinib Supportive e.g. transfusions, Abx, Allopurinol Bone marrow transplant is curative

Median survival 4-5 yrs...