*Massive Transfusion Protocol*
*1)labs (order them, but don't delay treatment while you wait)*
* Type & crossmatch.
* CBC, INR, PT, PTT, fibrinogen (TEG if available).
* Electrolytes, Ca/Mg/Phos, ionized calcium.
* VBG or ABG if concern for significant acidemia.
*2)activate MTP and communicate with blood bank*
* call the blood bank.
*3)consider additional fibrinogen (e.g., cryoprecipitate)*
* Consider 1:1:1:1 ratio of PRBC : FFP : Platelets : Cryo.
* Fibrinogen may be especially important in obstetric hemorrhage.
*4)calcium*
* 1-2 gram Ca chloride or 3-6 grams Ca gluconate per MTP round (6 units PRBC).
* Follow iCa if possible, target normal to mildly elevated iCa (e.g., ~1-3 mM).
*5)tranexamic acid*
* Consider 1 gram IV, if difficulty achieving hemostasis.
* May continue infusion at a rate of 1 gram over 8 hours – especially in obstetric or early traumatic hemorrhage.
*6)IV desmopressin (DDAVP)*
* Consider in renal failure, thrombocytopenia, or antiplatelet drugs.
* Dose is 0.3 mcg/kg (max 21 mcg) IV.
*7)review anticoagulant medications & consider reversal*
* Warfarin or DOAC
*8)avoid acidosis*
* For intubated patients, adjust ventilator to optimize pH.
*9)avoid hypothermia*
* Use warmed fluids if possible.
* Follow temperature, consider pre-emptive warming (e.g., with heated air blankets).
*10)hemodynamics*
* Target lower than typical MAP, pending source control.
* Stop MTP when patient is hemodynamically stable.
*1)labs (order them, but don't delay treatment while you wait)*
* Type & crossmatch.
* CBC, INR, PT, PTT, fibrinogen (TEG if available).
* Electrolytes, Ca/Mg/Phos, ionized calcium.
* VBG or ABG if concern for significant acidemia.
*2)activate MTP and communicate with blood bank*
* call the blood bank.
*3)consider additional fibrinogen (e.g., cryoprecipitate)*
* Consider 1:1:1:1 ratio of PRBC : FFP : Platelets : Cryo.
* Fibrinogen may be especially important in obstetric hemorrhage.
*4)calcium*
* 1-2 gram Ca chloride or 3-6 grams Ca gluconate per MTP round (6 units PRBC).
* Follow iCa if possible, target normal to mildly elevated iCa (e.g., ~1-3 mM).
*5)tranexamic acid*
* Consider 1 gram IV, if difficulty achieving hemostasis.
* May continue infusion at a rate of 1 gram over 8 hours – especially in obstetric or early traumatic hemorrhage.
*6)IV desmopressin (DDAVP)*
* Consider in renal failure, thrombocytopenia, or antiplatelet drugs.
* Dose is 0.3 mcg/kg (max 21 mcg) IV.
*7)review anticoagulant medications & consider reversal*
* Warfarin or DOAC
*8)avoid acidosis*
* For intubated patients, adjust ventilator to optimize pH.
*9)avoid hypothermia*
* Use warmed fluids if possible.
* Follow temperature, consider pre-emptive warming (e.g., with heated air blankets).
*10)hemodynamics*
* Target lower than typical MAP, pending source control.
* Stop MTP when patient is hemodynamically stable.
Hemoglobin Electrophoresis fellows.pdf
2.3 MB
Understanding Hb Electrophoresis
By Dr. Aburahman Nasiri
By Dr. Aburahman Nasiri
🧬 WHO 2025 Diagnostic Criteria – PV, ET, PMF🔴
Polycythemia Vera (PV)
🔹 Major:
1️⃣ Hb >16.5 g/dL (men) / >16.0 g/dL (women) OR Hct ↑ (>49% ♂ / >48% ♀)
2️⃣ BM: Hypercellular → trilineage growth (erythroid, myeloid, megakaryocytic) with pleomorphic MKs 🔬
3️⃣ JAK2 V617F / exon 12 mutation 🧪
🔹 Minor: Subnormal EPO ↓
✅ Dx = All 3 Major OR (first 2 Major + Minor)🟠
Essential Thrombocythemia (ET)
🔹 Major:
1️⃣ Platelets ≥450 ×10⁹/L 🩸
2️⃣ BM: Proliferation of enlarged, hyperlobulated megakaryocytes 🔬
3️⃣ Not CML, PV, PMF, MDS, or other myeloid neoplasm ❌
4️⃣ JAK2 / CALR / MPL mutation 🧬
🔹 Minor: Other clonal marker OR exclude reactive thrombocytosis
✅ Dx = All 4 Major OR (first 3 Major + Minor)🟣
Primary Myelofibrosis (PMF)
🔹 Major:
1️⃣ BM: Megakaryocyte atypia + reticulin/collagen fibrosis (≥2 overt, >1 pre-PMF) 🌲
2️⃣ Not CML, PV, ET, or MDS ❌
3️⃣ JAK2 / CALR / MPL mutation (or other clonal marker) 🧬
🔹 Minor (≥1):
Anemia 😴
↑ WBC ≥11 ×10⁹/L
Splenomegaly 🫛
LDH ↑ 🔥
Leukoerythroblastosis 🧪
✅ Dx = All 3 Major + ≥1 Minor
💡 Exam Pearls 📝
PV hallmark → ↑RBC mass + JAK2
ET hallmark → Isolated thrombocytosis + driver mutation
PMF hallmark → Fibrosis + splenomegaly + cytopenias
Always rule out reactive causes first 🧾
📚 Reference: WHO 2016/2022, ASCO-SEP 2025, ASH-SAP 9th Ed.
Polycythemia Vera (PV)
🔹 Major:
1️⃣ Hb >16.5 g/dL (men) / >16.0 g/dL (women) OR Hct ↑ (>49% ♂ / >48% ♀)
2️⃣ BM: Hypercellular → trilineage growth (erythroid, myeloid, megakaryocytic) with pleomorphic MKs 🔬
3️⃣ JAK2 V617F / exon 12 mutation 🧪
🔹 Minor: Subnormal EPO ↓
✅ Dx = All 3 Major OR (first 2 Major + Minor)🟠
Essential Thrombocythemia (ET)
🔹 Major:
1️⃣ Platelets ≥450 ×10⁹/L 🩸
2️⃣ BM: Proliferation of enlarged, hyperlobulated megakaryocytes 🔬
3️⃣ Not CML, PV, PMF, MDS, or other myeloid neoplasm ❌
4️⃣ JAK2 / CALR / MPL mutation 🧬
🔹 Minor: Other clonal marker OR exclude reactive thrombocytosis
✅ Dx = All 4 Major OR (first 3 Major + Minor)🟣
Primary Myelofibrosis (PMF)
🔹 Major:
1️⃣ BM: Megakaryocyte atypia + reticulin/collagen fibrosis (≥2 overt, >1 pre-PMF) 🌲
2️⃣ Not CML, PV, ET, or MDS ❌
3️⃣ JAK2 / CALR / MPL mutation (or other clonal marker) 🧬
🔹 Minor (≥1):
Anemia 😴
↑ WBC ≥11 ×10⁹/L
Splenomegaly 🫛
LDH ↑ 🔥
Leukoerythroblastosis 🧪
✅ Dx = All 3 Major + ≥1 Minor
💡 Exam Pearls 📝
PV hallmark → ↑RBC mass + JAK2
ET hallmark → Isolated thrombocytosis + driver mutation
PMF hallmark → Fibrosis + splenomegaly + cytopenias
Always rule out reactive causes first 🧾
📚 Reference: WHO 2016/2022, ASCO-SEP 2025, ASH-SAP 9th Ed.
9780826184412_Handbook_of_Hematologic_Maligna_David_A_Sallman,_MD;Ateefa.pdf
50.8 MB
HANDBOOK OF
HEMATOLOGIC
MALIGNANCIES 📕📍
HEMATOLOGIC
MALIGNANCIES 📕📍
Forwarded from Study Medicine 📖🩺
Algorithm_for_the_initial_treatment_of_immune_thrombotic_thrombocytopenic.pdf
102.3 KB
initial treatment of immune thrombotic thrombocytopenic purpura (TTP)