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Haematology

Haematology. RJG Cuthbert Belfast City Hospital. Erythrocyte Sedimentation Rate. Rouleaux. ESR. Max. in mm in 1 hour @ 20 o C± 3 o C) Males Females 17 - 50 yrs 10mm 12 mm 51 - 60 years 12 mm 19 mm 61 - 70 years 14 mm 20 mm > 70 years 30 mm 35 mm. Indications.

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Haematology

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  1. Haematology RJG Cuthbert Belfast City Hospital

  2. Erythrocyte Sedimentation Rate Rouleaux

  3. ESR Max. in mm in 1 hour @ 20oC± 3oC) MalesFemales 17 - 50 yrs 10mm 12 mm51 - 60 years 12 mm 19 mm 61 - 70 years 14 mm 20 mm > 70 years 30 mm 35 mm

  4. Indications • Diagnostic evaluation: • Inflammatory disorders • Neoplasm • Infectious disorders • Monitor diseaese: • Temporal arteritis • Polymyalgia rheumatica • Inflammatory arthritis

  5. Coagulation Screen • Platelet count • Prothrombin time • Activated partial thromboplastin time • Thrombin clotting time or fibrinogen

  6. Kallikrein HMW kininogen TFTF/VIIa X IX XIIaXII IXa VIIIa The Coagulation Cascade Xa Va II IIa Fibrin Fibrinogen

  7. Indications • History: • Recurrent epistaxis • Recurrent spontaneous bruising • Unexplained menorrhagia • Unexplained prolonged bleeding after invasive procedures or childbirth • Family history

  8. Indications • Acute bleeding • Warfarin – INR only • Liver & renal disease: • Acute/chronic bleeding • Invasive procedures • Obstructive jaundice • Severe sepsis – DIC • Paracetamol overdose

  9. Not Required • Routine pre-op, etc • Take a history • Routine acute medical admission • Take a history • Warfarin

  10. Sample Collection Over-filled Correct Under-filled

  11. D-dimers

  12. Indications • Suspected DIC • Assessment of thrombolytic therapy • Suspected DVT or PE • only used with a clinical risk prediction model

  13. Not indicated • DVT/PE assessment: • Within 4 weeks of surgery • Trauma cases • Acute/chronic infection • Pregnancy • Sole test for positive diagnosis of DVT/PE

  14. Heparin-induced Thrombocytopenic Thrombosis • Patients receiving any heparin preparation including heparin/saline flushes: • New acute thrombotic problems • Thrombocytopenia

  15. Action based on score • High (6-8): Send test and treat without result • Intermediate (4–5): Wait for test result • Low (0–3): No need to test • Contact haematology if puzzled

  16. Thrombophilia Screen • Inherited: • Anti-thrombin deficiency • Protein C deficiency • Protein S deficiency • APC resistance • Factor V Leiden • Prothrombin G20210A • Acquired: • Lupus anticoagulant

  17. TF/VIIa TFPI Anticoagulant Proteins X IX IXa VIIIa PC Xa AT PS Va II IIa Fibrin Fibrinogen

  18. Indications: • Recurrent DVT/PE < 40 years • Spontaneous DVT/PE < 40 years • Recurrent DVT/PE & strong family history

  19. Not indicated • DVT after • trauma, surgery, immobility, cancer • pregnancy, oral contraceptive pill, HRT • Single episode of DVT/PE >40 years • Arterial thrombosis • Lupus anticoagulant – selected cases

  20. Timing of Investigation • Unreliable results: • Acute thrombosis, pregnancy, OCP, HRT, anticoagulants • Early diagnosis does not influence acute management • Avoid testing during: • Acute thrombotic event • Other acute intercurrent illness • Pregnancy • OCP, HRT, or anticoagulants

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