Editor: Shafqat Inam
Contributors: Stephanie Anderson, Ahmed Alcheikh, Edward Abadir
Reviewed: Caroline Dix, James Edwards
In a hurry? Make sure you know
- Full blood count (recent, preferably that day)
- Vital signs and temperature
What history should JMOs know/collect?
- History of bleeding or bruising
- History of deep venous thrombosis or pulmonary embolism – provoked or unprovoked? Superficial or deep? How long ago was the VTE?
- What anticoagulant the patient is on, indication and the time of last dose
- Contraindications to anticoagulation?
- Any new drugs which have been started
- History of haematological malignancy and treatment
- Regarding derangements in full blood count: new or chronic, trend of any abnormalities, correlation with previous results outside of hospital is also valuable
- What haematologist (if any) the patient is known to/has seen in the past
What examinations and investigations should JMOs perform/collect results of?
- Vitals, especially temperature
- Haematological examination if relevant (lymphadenopathy, splenomegaly, hepatomegaly)
- Full blood count and differentials including the neutrophil count
- Creatinine clearance (based on weight) – required for most anticoagulants
What additional information would impress you?
- Details of recent chemotherapy treatment, including timing
- Previous blood counts and/or scan results
What are common mistakes/omissions made by JMOs?
- Use your online local resources for reversal of anti-coagulation that are available on your hospital intranet.
- Haematology can assist you in how to reverse coagulation but typically cardiology should be consulted regarding risks/ benefits of reversal in patients in atrial fibrillation and/or mechanical valves
An update of consensus guidelines for warfarin reversal
Huyen A Tran, Sanjeev D Chunilal, Paul L Harper, Huy Tran, Erica M Wood and Alex S Gallus, on behalf of the Australasian Society of Thrombosis and Haemostasis. Med J Aust 2013; 198 (4): 198-199. DOI: 10.5694/mja12.10614. Abstract available from https://www.ncbi.nlm.nih.gov/pubmed/23451962
Abadir, Ed. (2015). Anticoagulation 1: warfarin. [podcast]. Available at: https://onthewards.org/anticoagulation-1-warfarin/ [Accessed 30 April 2015]
Abadir, Ed. (2015). Anticoagulation 3: new oral anticoagulants. [podcast]. Available at: https://onthewards.org/anticoagulation-3-new-oral-anticoagulants/ [Accessed 1 May 2015]
Inam, Shafqat. (2016). An approach to anaemia. [podcast]. Available at: https://onthewards.org/an-approach-to-anaemia/ [Accessed 8 March 2016]
Inam, Shafqat. (2016). An approach to the management of bleeding disorders. [podcast]. Available at: https://onthewards.org/thrombosis-and-thrombophilia/ [Accessed 2 May 2016]
Inam, Shafqat. (2016). Thrombosis and thrombophilia. [podcast]. Available at: https://onthewards.org/thrombosis-and-thrombophilia/ [Accessed 15 May 2016]
Inam, Shafqat. (2016). Haematological problems in obstetric patients. [podcast]. Available at: https://onthewards.org/haematological-problems-obstetric-patients/ [Accessed 20 September 2016]
Inam, Shafqat. (2017). Thrombocytopaenia. [podcast]. Available at: https://onthewards.org/thrombocytopaenia/ [Accessed 15 March 2017]