Tuesday, January 19, 2010

Discussion Points for Intensive Course Final Year MMed 2010

Intensive Course Discussion for the topic of Hematology and Oncology Emergencies.

Discussion Points:

1. Describe the differences between intrinsic and extrinsic pathway of coagulation

2. Discuss on the clinical uses of blood and blood products
- Whole Blood
- Packed Red Blood Cells
- Platelets
- Fresh Frozen Plasma
- Cryoprecipitate

Discuss on which of the above products require cross matching, ABO compatibility prior to transfusion.

CLICK here to download a copy of Practice Guidelines For Blood Transfusion

3. Discuss on transfusion trigger
- What level of hemoglobin do you take when deciding on transfusing patients

4. Discuss on the various levels of platelet counts you would use in making decision whether to transfuse platelets to the patients.

Discuss on why platelet is usually not given to patients with ITP, TTP, untreated DIC & thrombocytopenia associated with septicemia

5. Define massive transfusion

6. List down the major complications of transfusion

7. Describe in details of the following specific drugs affective hemostasis
- aspirin
- clopidogrel

8. Discuss on the following changes in the 2009 Focused Update: ST-Segment-Elevation MI and Percutaneous Coronary Intervention (updating the 2004 Guideline and 2007 Focused update) [DOWNLOAD the Focused Update 2009 here]:

In regard to thienopyridines:
- Relying on data from the TRITON–TIMI 38 trial, the guideline authors now recommended prasugrel as an option for antiplatelet treatment before PCI (except in STEMI patients with a history of stroke or transient ischemic attack).

- More emphasis is given to the alternative of an increased clopidogrel loading dose (600 mg instead of 300 mg)

- Despite a recent FDA advisory (click here to read the advisory), the guideline authors declined to make a specific recommendation about the concurrent use of clopidogrel and proton-pump inhibitors.

9. Discuss on the following oncologic emergencies:
- neutropenic sepsis
- tumor lysis syndrome

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