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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

Haematology

RJG Cuthbert

Belfast City Hospital

slide3

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

indications
Indications
  • Diagnostic evaluation:
    • Inflammatory disorders
    • Neoplasm
    • Infectious disorders
  • Monitor diseaese:
    • Temporal arteritis
    • Polymyalgia rheumatica
    • Inflammatory arthritis
coagulation screen
Coagulation Screen
  • Platelet count
  • Prothrombin time
  • Activated partial thromboplastin time
  • Thrombin clotting time or fibrinogen
slide6

Kallikrein

HMW kininogen

TFTF/VIIa

X

IX

XIIaXII

IXa

VIIIa

The Coagulation

Cascade

Xa

Va

II

IIa

Fibrin

Fibrinogen

indications1
Indications
  • History:
    • Recurrent epistaxis
    • Recurrent spontaneous bruising
    • Unexplained menorrhagia
    • Unexplained prolonged bleeding after invasive procedures or childbirth
    • Family history
indications2
Indications
  • Acute bleeding
  • Warfarin – INR only
  • Liver & renal disease:
    • Acute/chronic bleeding
    • Invasive procedures
  • Obstructive jaundice
  • Severe sepsis – DIC
  • Paracetamol overdose
not required
Not Required
  • Routine pre-op, etc
    • Take a history
  • Routine acute medical admission
    • Take a history
    • Warfarin
slide10

Sample Collection

Over-filled

Correct

Under-filled

indications3
Indications
  • Suspected DIC
  • Assessment of thrombolytic therapy
  • Suspected DVT or PE
    • only used with a clinical risk prediction model
not indicated
Not indicated
  • DVT/PE assessment:
    • Within 4 weeks of surgery
    • Trauma cases
    • Acute/chronic infection
    • Pregnancy
  • Sole test for positive diagnosis of DVT/PE
heparin induced thrombocytopenic thrombosis
Heparin-induced Thrombocytopenic Thrombosis
  • Patients receiving any heparin preparation including heparin/saline flushes:
    • New acute thrombotic problems
    • Thrombocytopenia
action based on score
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
thrombophilia screen
Thrombophilia Screen
  • Inherited:
    • Anti-thrombin deficiency
    • Protein C deficiency
    • Protein S deficiency
    • APC resistance
    • Factor V Leiden
    • Prothrombin G20210A
  • Acquired:
    • Lupus anticoagulant
slide18

TF/VIIa

TFPI

Anticoagulant Proteins

X

IX

IXa

VIIIa

PC

Xa

AT

PS

Va

II

IIa

Fibrin

Fibrinogen

indications4
Indications:
  • Recurrent DVT/PE < 40 years
  • Spontaneous DVT/PE < 40 years
  • Recurrent DVT/PE & strong family history
not indicated1
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
timing of investigation
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