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
  • Weight
  • 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

 

Helpful resources

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

 

onthewards podcasts

An approach to anaemia with Shafqat Inam

An approach to the management of bleeding disorders with Shafqat Inam

Haematological problems in obstetric patients with Shafqat Inam

Thrombocytopaenia with Shafqat Inam

Thrombosis and thrombophilia with Shafqat Inam