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

 

Podcasts

Tohidi, Ibrahim.  (2015). Transfusion reactions. [podcast].  Available at: https://onthewards.org/transfusion-reactions/ [Accessed 20 January 2015]

Tohidi, Ibrahim.  (2015).  Febrile neutropaenia. [podcast].  Available at: https://onthewards.org/febrile-neutropaenia/ [Accessed 24 February 2015]

Abadir, Ed.  (2015).  Anticoagulation 2: heparin. [podcast].  Available at:  https://onthewards.org/anticoagulation-2-heparin/  [Accessed 30 April 2015]

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]