haematology to work on COPY Flashcards

1
Q

Give 3 signs of anaemia

A
  1. Conjunctival pallor
  2. Hyper-dynamic circulation
  3. Tachycardia
  4. Systolic flow murmur
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2
Q

What are the specific signs of B12 deficiency/pernicious anaemia?

A

Inflamed tongue (glossitis), angular stomatitis, mild jaundice
Neurological - paraesthesia, psychological problems, ataxia
- dementia and visual disturbances

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3
Q

Give 3 acquired causes of haemolytic anaemia

A
  1. Autoimmune
  2. Drug induced
  3. Secondary to systemic disease
  4. Malaria
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4
Q

Give 3 chronic complications of sickle cell disease

A
  1. Renal impairment
  2. Pulmonary hypertension
  3. Joint damage
  4. growth and development problems
  5. cardiomegaly, MI
  6. hepatomegaly
  7. retinopathy
  8. impaired placental blood flow
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5
Q

Describe the treatment for sickle cell disease

A
  • Precipitating factors should be avoided - e.g. infection, dehydration, cold
  • Folic acid
  • Acute attacks:
    - IV fluids
    - Analgesia
    - Oxygen
  • Possible blood transfusions
  • Oral hydroxycarbamide to reduce frequency of crises
  • Stem cell transplant

long term management

  • hydroxyurea - increases HbF levels so is used as prophylaxis
  • pneumococcal vaccine
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6
Q

what are the clinical features of G6PD deficiency?

A
Most are asymptomatic 
Pallor
Fatigue
Palpitations
Shortness of breath
Jaundice 
Exacerbated by ingesting fava beans
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7
Q

Name 3 things that can precipitate G6PD deficiency

A
  1. Broad beans / fava beans
  2. Infection
  3. Drugs - Primaquine, sulphonamide, quinolones
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8
Q

what are the secondary causes of absolute polycythaemia?

A

hypoxia

 - Smoking
  - Lung disease
 - Cyanotic heart disease
  - High altitude 
  - obstructive sleep apnoea

Excess EPO - renal disease

alcohol

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9
Q

what are the clinical features of polycythaemia?

A
Headaches and dizziness 
Itching
Fatigue
Tinnitus
Erythromelalgia – burning sensation in fingers and toes 
Hypertension 
Angina 
Hepatosplenomegaly (distinguishes 1o from 2o)
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10
Q

What is the treatment for polycythaemia?

A
No cure
Treatment aim is to maintain normal blood count 
Venesection - relieves symptoms 
Low does aspirin 
Radioactive phosphorus in those over 70
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11
Q

What can cause decreased platelet production?

A
  1. Congenital causes (e.g. malfunctioning megakaryocytes)
  2. Infiltration of bone marrow (e.g. leukaemia)
  3. Alcohol
  4. Infection (e.g. HIV/TB)
  5. Reduced TPO
  6. Aplastic anaemia
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12
Q

What can cause increased platelet destruction?

A
  1. Autoimmune (e.g. ITP)
  2. Hypersplenism
  3. Drug related (e.g. heparin induced)
  4. DIC and TTP –> increased consumption
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13
Q

What can cause reduced platelet function?

A
  1. Congenital abnormality
  2. Medications - aspirin
  3. VWF disease
  4. Uraemia
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14
Q

Give 3 things that can cause coagulation disorders

A
  1. Vitamin K deficiency
  2. Liver disease
  3. Congenital - haemophilia
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15
Q

What is thrombotic thrombocytopenia (TTP)?

A
  • Widespread adhesion and aggregation of platelets leads to microvascular thrombosis and consumption of platelets
  • Occurs due to a reduction in ADAMTS-13 – a protease that is normally responsible for the degradation of vWF
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16
Q

What is the treatment for thrombotic thrombocytopenia (TTP)?

A
  • Plasma exchange (removed ADAMTS13 autoantibodies)
  • Splenectomy
  • IV steroids
  • IV methylprednisolone
  • IV rituximab
  • folic acid
  • platelet transfusion = contraindicated
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17
Q

Give 3 causes of immune thrombocytopenia (ITP)

A
Primary = viral infection (children)
Secondary (chronic, adults)  
  - Autoimmune conditions
  - Malignancies - CLL
  - Infections - HIV/Hep C
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18
Q

What is the management for immune thrombocytopenia (ITP)?

A
  • first line = Corticosteroid (prednisolone) or IV immunoglobulin - IV IgG
  • second line = Splenectomy or immunosuppression (rituximab)
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19
Q

Give 3 signs of haemolytic anaemia

A
  1. Pallor
  2. Jaundice
  3. Splenomegaly
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20
Q

Give 2 specific symptoms of iron deficiency anaemia

A
  1. Koilonychia - spoon nails
  2. Brittle hair and nails
  3. Atrophic glossitis
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21
Q

Give 3 causes of neutrophilia

A
  1. Infection
  2. Inflammation
  3. Cancer
  4. CML = primary cause
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22
Q

Give 3 causes of lymphocytosis

A
  1. Viral infection
  2. Inflammation
  3. Cancer
  4. CLL = primary cause
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23
Q

Give 3 causes of thrombocytosis

A
  1. Infection
  2. Inflammation
  3. Cancer
  4. Essential thrombocythaemia = primary cause
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24
Q

Give 3 causes of neutropenia

A
  1. Underproduction = marrow failure, marrow infiltration, marrow toxicity (e.g. drugs)
  2. Increased removal = autoimmune, Felty’s syndrome, cyclical
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25
Q

Give 2 causes of thrombocytopenia

A
  1. Production failure - marrow suppression, marrow failure

2. Increased removal - immune response (ITP), consumption (DIC), splenomegaly

26
Q

Give 4 risk factors for febrile neutropenia

A
  1. If the patient had chemotherapy <6 weeks ago
  2. Any patient who has had a stem cell transplant <1 year ago
  3. Any haematological condition causing neutropenia
  4. Bone marrow infiltration
  5. those on methotrexate, carbimazole and clozapine
27
Q

What is hyper viscosity syndrome?

A

Increase in blood viscosity usually due to high levels of immunoglobulins

28
Q

What 3 blood test values would be increased in someone with polycythaemia?

A
  1. Hb
  2. RCC
  3. PCV
29
Q

what are the clinical features of chronic lymphoblastic leukaemia (CLL)?

A
  • often no symptoms
  • may be anaemic
  • weight loss, sweats, anorexia
  • hepatosplenomegaly
  • enlarged, rubbery, non-tender nodes
30
Q

what are the risk factors for folate deficiency?

A
  • elderly
  • poverty
  • alcoholic
  • pregnant
  • crohn’s/coeliac
31
Q

what are the risk factors for pernicious anaemia?

A
  • female
  • elderly
  • fair hair and blue eyes
  • blood group A
  • thyroid and addison’s disease
32
Q

what is the clinical presentation of folate deficiency?

A
  • may be asymptomatic
  • may present with anaemia symptoms
  • glossitis
  • no neuropathy
33
Q

what investigations should be undertaken in folate deficiency?

A
  • blood count and film = megaloblastic, RBCs macrocytic
  • low serum and red cell folate low
  • serum bilirubin may be raised
34
Q

what is the management for acute attacks in sickle cell anaemia?

A

IV fluids
analgesia
oxygen
antibiotics

35
Q

what is the treatment for G6PD?

A
  • blood transfusion

- stop exacerbating drugs

36
Q

what investigations should be undertaken for polycythaemia?

A
  • blood count = raised WBC and platelets
  • raised Hb
  • JAK2 mutation on genetic screen
  • bone marrow biopsy - proliferation of granulocytes and megakaryocytes
  • low serum EPO
37
Q

which investigations should be undertaken for immune thrombocytopenia purpura (ITP)?

A
  • bone marrow examination = thrombocytopenia with normal/increased megakaryocytes
  • platelet autoantibodies
38
Q

what are the causes of thrombotic thrombocytopenic purpura (TTP)?

A
idiopathic
autoimmune e.g. SLE
cancer
pregnancy
drug related
39
Q

what is the management for von Willebrand’s disease?

A
  • Education on bleeding risks
  • Stop any antiplatelet drugs and NSAIDs
  • Tranexamic acid - used for minor bleeds
  • Combined oral contraceptive to control menorrhagia in women
  • Desmopressin -> increases vWF levels
  • Platelet transfusions can be helpful in some
  • Family screening should be offered
40
Q

what are the causes of aplastic anaemia?

A
  • inherited
  • idiopathic
  • benzene
  • chemotherapeutic drugs
  • antibiotics
  • infections - EBV, HIV and TB
41
Q

what investigations are undertaken for aplastic anaemia?

A
  • blood cell count
    • pancytopenia and low reticulocyte count
      bone marrow examination
    • hypocellular with increased fat spaces
42
Q

what is the treatment for aplastic anaemia?

A
  • treat cause
  • antibiotics for neutropenia
  • RBC transfusion and platelets
  • bone marrow transplant
  • immunosuppressive therapy
    - ATG and ciclosporin if under 40
43
Q

what are the investigations for von Willebrand’s disease?

A
  • FBC
  • Fibrinogen level
  • Platelet count - normal
  • Clotting screen- Plasma vWF decreased
  • Factor VIII levels - can be decreased as vWF is not present to protect it
44
Q

what are the investigations for haemophilia B?

A
  • Normal prothrombin time
  • Prolonged activated partial thromboplastin time
  • Low factor IX levels
  • Endoscopy if GI bleed suspected
45
Q

what is the treatment for malaria?

A
  • Chloroquine for non-falciparum malaria
  • Oral quinine sulphate for falciparum
  • Add IV quinine dihydrochloride for severe disease
    Do not treat those with G6PD deficiency
    Need specialist help
46
Q

what is the pathophysiology of anaemia of chronic disease?

A

● Decreased release of iron from bone marrow to developing erythroblasts
● Inadequate erythropoietin response to anaemia – decreased RBC survival

47
Q

what are the side effects of erythropoietin treatment?

A

flu-like symptoms,
hypertension,
raised platelets,
thromboembolism

48
Q

what are the main causes of aplastic anaemia?

A
  • inherited - Fanconi’s anaemia
  • idiopathic- benzene, toulene, glue sniffing
  • chemotherapeutic drugs
  • antibiotics
  • infections - EBV, HIV, TB
49
Q

what is the long term management for sickle cell anaemia?

A
  • hydroxyurea - increases the HbF levels and is used in the prophylactic management of sickle cell anaemia to prevent painful episodes
  • pneumococcal vaccine
50
Q

how is heparin treatment reversed?

A
  • proteamine
51
Q

Describe the treatment for symptomatic myeloma

A
Bone pain = analgesia 
Bisphosphonates (zolendronate)   
Blood transfusion - for anaemia
Fluids and dialysis - renal failure
Chemotherapy 
Stem cell transplant
52
Q

what are the clinical features of AML?

A
  • Anaemia -> breathlessness, fatigue, pallor
  • low WCC = Infection
  • low platelets = bleeding/bruising
  • Hepatosplenomegaly
  • Peripheral lymphadenopathy
  • Gum hypertrophy
  • Bone marrow failure and bone pain
53
Q

what are the clinical features of CML?

A
  1. Symptomatic anaemia
  2. Abdominal pain = splenomegaly
  3. Weight loss, tiredness, palor
  4. Gout - due to purine breakdown
  5. Bleeding - due to platelet dysfunction
  6. fever and sweats in absence of infection
54
Q

What is the treatment for CML?

A
  • Chemotherapy
  • Tyrosine kinase inhibitors, e.g. Imatinib - Given orally
  • Stem cell transplant
55
Q

what are the clinical features of ALL?

A
  • Anaemia = breathlessness, fatigue, pallor
  • Low WCC = Infection
  • low platelets = bleeding and bruising
  • Hepatosplenomegaly
  • Peripheral lymphadenopathy
  • CNS involvement - headache, cranial nerve palsies
  • SVC obstruction, dilated superficial chest veins
  • Bone marrow failure and bone pain
56
Q

What is the treatment for ALL?

A
  • Blood and platelet transfusion
  • Chemotherapy
  • Steroids
  • Allopurinol to prevent tumour lysis syndrome
  • Intrathecal drugs, e.g. methotrexate
  • Acute control of infections with IV antibiotics
  • Neutropenia makes this high risk
  • Stem cell transplant
57
Q

Describe the treatment for AML

A
  • Blood and platelet transfusions
  • IV fluids
  • Allopurinol to prevent tumour lysis
  • Infection control with IV antibiotics
  • Chemotherapy
  • Steroids
  • Sibling matched allogenic bone marrow transplant
58
Q

What is the diagnostic test for multiple myeloma

A

Serum/urine electrophoresis

59
Q

what is DIC?

A

pathological activation of coagulation cascade
fibrin in vessel walls
there is platelet and coagulation factor consumption

60
Q

give 3 causes of DIC?

A

sepsis
trauma
malignancy

61
Q

what is the affect of DIC on blood results

TT, PTT, APTT and fibrinogen

A

TT, PTT, APTT all increase

fibrinogen decreases

62
Q

what is the most common trigger of sickle cell crisis?

A

parvovirus B19