Management of Heparin-Induced Thrombocytopenia (HIT)
Switch to argatroban or danaparoid
Indication for treatment in CLL
Constitutional symptoms
Bone marrow failure
Symptoms due to LN/spleen/liver elargement
Weight loss > 10% in 6 months
AI anaemia/ thrombocytopenia not responding to prednisolone
Lymphocyte doubling in <6m, or 50% increase in 2m
Indication for use of Ibrutinib (BTK inhibitor) in CLL
TP53 mutation
Pentad of features in TTP (Thrombotic Thrombocytopenic Purpura)
- Thrombocytopenia
- MAHA (anaemia + schistocytes)
- Fever
- Fluctuating neuro signs
- Renal impairment
Causes of MAHA (schistocytes seen on film)
TTP
HUS
DIC
Pre-eclampsia
Presentation of HUS
Haemolytic anaemia (MAHA)
Thrombocytopenia
Severe AKI
Following bloody diarrhoea
AL amyloidosis presents as
Nephrotic syndrome Cardiomyopathy Peri-orbital purpura (Macroglossia) (Urine free light chains) Without features of MM
Waldenstrom’s macroglobulinaemia (lymphoplasmacytoid malignancy) presents as
Monoclonal IgM paraproteinaemia
Hyperviscosity
Systemic upset
Commonest initial treatment for CLL
Fludarabine + cyclophosphamide + rituximab (FCR)
Other options for CLL treamtent, when FCR not appropriate
Bendamustine
Chlorambucil
Anti-CD20 (obinutuzumab)
Management of AI anaemia/thrombocytopenia in CLL
Prednisolone
Treatment of Waldenstrom macrogolubulinaemia
Cyclophosphamide + dexamethasone + rituximab
Features of monoclonal gammopathy of unknown significance (MGUS)
Paraproteinaemia
Asymptomatic/neuropathy
Normal immune function
No bone lesions/renal impact
Schnitzler’s syndrome
Chronic urticaria
Monoclonal raised IgM
Features of methaemoglobinaemia
Cyanosis
Low O2 sats with normal PaO2
Ischaemia
R-CHOP is
Rituximab Cyclophosphamide Doxorubicin Vincristine Prednisolone
Management of NHL - low-grade and asymptomatic
Watch and wait
Vaccinate (flu, haemophilus, pneumococcus, meningococcus)
Chemo options for NHL
R-CHOP
FCR
Management of primary CNS lymphoma
High-dose methotrexate + dexamethasone
Imatinib is chemotherapy agent used in
CML
MALT-lymphoma
c-kit melanoma
Non-Hodgkins Lymphoma with CNS involvement
R-CHOP + intrathecal methotrexate
Curative treatment for myelofibrosis
Allogenic stem-cell transplant
Drugs used in control of myelofibrosis
Hydroxyurea
IFN-a
JAK inhibitors
Diagnostic criteria for HHT (Osler-Weber-Rendu)
Need 3 for definite diagnosis.
Epistaxis
Telangiectasia
AVMs or GI telangiectasia
1st-degree family history
