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3rd yr clinical > Haematology > Flashcards

Haematology Flashcards

1
Q

What are the causes of Microcytic anaemia

A

TAILS
Thalassaemia
Anaemia of chronic disease
Iron Def anaemia
Lead poisoning
Sideroblastic anaemia

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2
Q

What are the causes of normocytic anaemia

A

3 A’S 3H’s
Acute blood loss
Anaemia of chronic disease
Aplastic anaemia
Haemolytic anaemia
Hypothyroidism

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3
Q

What are the causes of macrocytic anaemia

A

Megaloblastic
-B12 def -Folate def

Normoblastic
Alcohol Reticulocytosis (haemolytic anaemia/ blood loss)
Hypothyroid
Liver diseaase
Drugs (azathioprine)

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4
Q

What blood findings would be present for haemochromatosis (Iron Overload)

A

High ferritin and Transferrin levels with love TIBC

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5
Q

What is the management of iron deficiency anaemia

A

New iron def in adult- colonoscopy and OGD for malignancy

Oral iron- ferrous fumarate/sulphate

Iron infusion

Blood transfusion

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6
Q

What are the features of pernicious anaemia

A

Vit b12 def - macrocytic anaemia
-Antibodies produced against intrinsic factor/partieal cells
-Neuro symptoms

-Diagnosed using intrinsic factor antibodies

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7
Q

What is the management of pernicious anaemia

A

IM hydroxycobalamin initially
Oral cyancobalamin/ twice orly injections

Treat B12 deficiency THEN treat folate deficiency - if you don’t in this order will cause combined degeneration of the cord

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8
Q

What is the test for autoimmune haemolytic anaemia

A

Positive direct Coomb’s test

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9
Q

What are the features of hereditary spherocytosis

A

Most common inherited haemolytic anaemia

Fragile, sphere RBCs, autosomal dominant

Anaemia, jaundice, gallstones, splenomegaly

Parovirus B19- aplastic crisis
High MCHC and raised reticulocyte count

Treatment: Folate supplementation, blood transfusions and splenectomy

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10
Q

What are the features of hereditary ellipocytosis

A

Ellipse shaped RBCs, autosomal dominant
Same management and presentation as spherocytosis

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11
Q

What are the features of G6PD deficiency

A

x linked recessive
Acute episodes of haemolytic anaemia triggered by infection, drugs or broad beans
Triggered by ciprofloxacin, gliclazide, sulfasalazine

Neonatal jaundice, Heinz bodies on film

Diagnose with G6PD assay

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12
Q

What are the features of autoimmune haemolytic anaemia

A

Warm - more common - usually idiopathic

Cold- secondary to lymphoma, lupus, leukaemia, infections (EBV,CMV, HIV, mycoplasma)

Management
Blood transfusions
Pred
Rituximab
Splenectomy

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13
Q

What are the features of micoangipathic haemolytic anaemia

A

-RBC destroying as they go through small vessels
Secondary to underlying condition
-Haemolytic uraemia syndrome
-DIC
-Cancer
-Thrombotic thromboctopenic purpura
-SLE

Schistocytes on film

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14
Q

What are the features of thalassaemia

A

Autosomal recessive
Causes haemolytic anaemia

-Microcytic anaemia
-Can have iron overload

Alpha thalassamia - not as bad

Beta thalassaemia- defects on Chr 11
Minor- just trait
Intermedia- microcytic anaemia, monitoring and transfusions

Major- severe- failure to thrive in childhood, increased fracture risk
-Regular transfusions, iron chelation, splenectomy, bone marrow transplant

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15
Q

What are the features of sickle cell anaemia

A

-HbS variant
-Tested for at 5 days old

Autosomal recessive affects beta globin on chromosome 11

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16
Q

What is vaso-occulsive crisis

A

Painful crisis- most common sickle cell crisis
Sickle shaped cells block capillaries
Pain and swelling hands and feet
Fever and pripism (constant erection)

17
Q

What is splenic sequestration crisis

A

Painful and enlarged spleen as RBC block the flow though
Emergency- can cause hypovolaemic shock
Management supportive- blood transfusions, fluid rhesus

18
Q

What is aplastic crisis

A

Temporary absence of new RBCs
Parovirus B19
Supportive management- transfusions etc

19
Q

What investigations are needed for suspected leukaemia

A

FBC within 48 hrs
Bone marrow biopsy- gold standard
Lymph node biopsy

20
Q

What are the features of acute lymphoblastic leukaemia

A

children and young
Associated with downs syndrome
B lymphocytes

21
Q

What are the features of chronic lymphocytic leukaemia

A

B-lymphocytes
Over 60s
Associated with warm haemolytic anaemia
Richters transformation to lymphoma
Smear/smudge cells

22
Q

What are the features of chronic myeloid leukaemia

A

3 phases
Chronic, blast and accelerated
Associated with philadelphia chromosome

My long trip to philadelphia

23
Q

What are the features of acute myeloid leukaemia

A

Blast cell overgrowth - neutrophils, eosinophils, basophils
Can be from polycythaemia ruby vera/ myelofibrosis
Auer rods and blast cells

my air

24
Q

What is Tumour lysis syndrome

A

Chemicals released when cells are destroyed during chemo
-High uric acid (AKI)
-High potassium (Arrthymias)
-High phosphate
-Low calcium

25
Q

What are the features of lymphoma

A

Hodgkin’s - one disease 20-25 or 80
-Associated with HIV,EBV, RA/Sarcoid, FH
-Pain when drinking alcohol
-Reed sternberg cells

Non-Hodgkin’s- many diseases
Burkitt lymphoma- associated with EBV and HIV
MALT- lymphoma - H.pylori
Diffuse Cell lymphoma - rapid growing mass in older people

Chemo and radio usually successful

26
Q

What are the features of myeloma

A

Cancer affecting production of antibodies- paraproteins

Bence jones proteins- free light chains in urine

CRAB
Calcium elevated - affects kidneys
Renal Failure
Anaemia
Bone lesions/pain - increased osteoclast activity

Pathological fractures

Bone marrow biopsy to confirm

X-ray changes- Pepper pot skull, abnormal fractures

Chemo Bortzomib, thalidomide, dexamethasone

27
Q

What is hyperviscocity syndrome

A

Plasma viscosity increases when more protein in blood (thicker)
Emergency
Bleeding
Visual symptoms/ eye changes
Neuro complications
Heart Failure

28
Q

What is myelofibrosis

A

-Proliferation of a single cell causes fibrosis of bone marrow (scar tissue)
Anaemia, leukopenia and thrombocytopenia

Bone marrow makes less RBCs so RBCs produced in other places- liver and spleen- hepatomegaly and splenomegaly

Tear dropped RBCs
Anisocytosis (varied RBC size)
Blasts (immature WBC/RBC)

29
Q

What is the treatment for myleoproliferative disorders - polycythaemia vera, myleofibrosis etc

A

Chemo- hydroxycarbamide
JAK2 inhibitors- ruxotinib

Aspirin in PV and thrombocythaemia

30
Q

What are the causes of thrombocytopenia (low plts)

A

Production problems
Viral infections- EBV, CMV, HIV
B12 def/ folic acid def
Liver failure
Leukaemia
Myleodysplastic syndrome
Chemo

Destruction problems
Alcohol
Immune thrombocytopenia purpura
Heparin induced thrombocytopenia
Haemolytic uraemia syndrome

31
Q

What is immune thrombocytopenia purpura

A

antibodies created against plts and are destroyed
purpura
Non blanching rash
Care- monitor Plt counts and BP

Management
Prednisolone
IV immunoglobulins
Thrombopoietin receptor agonists
Rituximab
Splenectomy

32
Q

What is thrombotic thrombocytopenia purpua

A

Thombi develop in small vessels
Tissue ischaemia and end organ damage
AADAMTS13
Inherited or autoimmune condition

33
Q

What is heparin induced thrombocytopenia

A

PF4 antibodies against Plts 5-10 days after starting heparin

34
Q

What are the features of VWD

A

Most common inherited bleeding disorder
Autosomal dominant

Management
Desmopressin
Tranexamic acid
VWF infusion

35
Q

What are the features of haemophilia

A

A- actor VIII def
B- factor XI def

X-linked recessive

Management
Clotting factors infusion

36
Q

What is antiphospholipid syndrome

A

Associated with factor V leiden
Recurrent VTW
Blood test for antiphospholipi antibodies

Give warfarin if they have a VTE not a DOAC- Inr BETWEEN 2-3

37
Q

What is Budd-Chiara syndrome

A

Obstruction to outflow of blood from liver due to thrombosis in hepatic veins in liver

Happens in hypercioagulabe states (myeloproliferative disorders)

38
Q
A

3rd yr clinical (22 decks)

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