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Phase 4 - GR > Haematology > Flashcards

Haematology Flashcards

1
Q

3 classic Sx of anaemia?

A

fatigue, dyspnoea, faintness

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2
Q

When is anaemia severe? name 2 signs ?

A

< 8g/dL

Tachycardia
Flow murmur
Cardiac enlargement
Increased cardiac output

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3
Q

what transports iron?

A

transferrin

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4
Q

where is iron stored

A

ferritin, haemosiderin

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5
Q

Name 3 things on presentation with Fe deficiency anaemia

A

Pallor
Nail changes - Koilonychia (spoon), brittleness
Hair loss
Mouth changes - Angular stomatitis, atrophic glossitis

Classic 3
Fatigue
Faintness
Dyspnoea

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6
Q

What are the general causes of iron deficiency

A

Inadequate intake
Poor absorption
Excessive loss
Excessive iron requirement

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7
Q

Name 3 Ix in Iron deficiency anaemia and 2 things seen on bloods

A

Hb <13g/dL (men), <12g/dL (women)
MCV - microcytic
Peripheral blood smear
Iron studies - Low iron / ferritin

Ix for cause
Coeliac (malabsorption), H. pylori (basically eats iron), endoscopy (bleed or Malab)

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8
Q

Why might ferritin be unexpectedly high in iron deficiency

A

It is an acute phase protein so will increase if inflammation, infection and malignancy

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9
Q

2 key DDx for iron deficiency anaemia

A 
chronic disease 
sideroblastic anaemia (bone marrow produces sideroblasts rather than normal erythrocytes)
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10
Q

mx of iron deficiency

A

oral replacement - ferrous sulphate

consider transfusion

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11
Q

SE of ferrous sulphate

A

constipation, black stools, vomit

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12
Q

When would you think this pt has sideroblastic anaemia

A

microcytic hypochromic anaemia NOT responding to iron

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13
Q

Pathology and What causes sideroblastic anaemia

A

Ineffective erythropoesis - cant incorporate iron into Hb

Congenital - inherited XLSA (x-linked)

Acquired - MDS (myelodysplastic syndrome), myeloma, PRV, pyridoxine (B6) deficiency

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14
Q

name 3 Ix in sideroblastic anaemia. Make sure you know the last one

A

Hb - low
MCV - microcytic
Peripheral blood smear
Iron studies - Iron / ferritin high

Marrow aspirate - Perinuclear ring of iron granules with Prussian Blue

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15
Q

Mx of sideroblastic

A 
iron chelation (gets rid of excess iron in body) - desferrioxamine 
Avoid alcohol / vit c (increase iron absorption)
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16
Q

What happens in b thalassaemia

A

Inherited microcytic anaemia caused by mutation in beta-globin gene

-ineffective erythropoesis
Erythroid hyperplasia

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17
Q

2 Effects of erythroid hyperplasia in b thalassaemia?

A

Bony changes - skull bossing, vertebral….

hepatosplenomegaly

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18
Q

Name 3 Ix in b thalassaemia

A 
FBC 
Peripheral blood smear 
Hb anaylsis 
LFT 
Xray skull for skull bossing
Abdo USS for hepatosplenomegaly
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19
Q

b thal mx points

A

genetic councelling
transfusion
Iron chelation

splenectomy
Bone marrow transplant

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20
Q

name 3 complications of thalassaemia

A

thrombotic
iron overload - heart arrhythmia, pituitary, pancreas

transfusion reactions

transfusion infections

splenectomy comps

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21
Q

Reticuloendothelial causes of haemolysis

A

Macrophages of liver

Spleen

Accelerated red cell destruction due to immune targeting by antibodies

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22
Q

Name 3 hereditary causes of haemolytic anaemia

A

Glucose 6 phosphate dehydrogenase deficiency

Hereditary spherocytosis,

Sickle cell anaemia, thalassaemia

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23
Q

Test for immune mediated haemolytic anaemia

A

direct antiglobulin +ve (Coombs’ positive)

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24
Q

Name 3 causes of non immune mediated haemolytic anaemia

A

Infection (e.g. malaria), trauma,

microangiopathic haemolytic anaemia (DIC, TTP, HUS, HELLP)

hypersplenism, liver disease

Paroxysmal nocturnal haemoglobinuria

trauma - eg mechanical heart valve

complement mediated lysis

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25
Q

Dx of Paroxysmal nocturnal haemoglobinuria

A

urinary haemosiderin

People with this condition have paroxysmal episodes of haemolytic due to things like infection

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26
Q

3 Ix in haemolytic anaemia

A

FBC - low Hb
Unconjugated bilirubin
Urinanalysis - haemaglobinuria
Peripheral blood film

Direct coombs test = test antibodies ON red blood cells

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27
Q

In haemolytic anaemia there is increased breakdown - what do you see in blood (and one other place) as a result of this?

A

Increased bilirubin, increased urobilinogen [not blood obvs], increased LDH

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28
Q

In haemolytic anaemia there is increased production - what do you see as a result of this?

A

Increased MCV as there are increased reticulocytes (bigger)

marrow hyperplasia

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29
Q

How might you differentiate between Extravascular or intravascular haemolytic anaemia

A

Intravascular - increased free plasma Hb and decreased haptoglobin, increased haemoglobinuria (no blood cells)

Extravascular - splenomegaly

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30
Q

What supplement is usually given in haemolytic anaemia

A

folic acid

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31
Q

How does G6PDD present? Triggers?

A

Presents with prolonged neonatal jaundice

In older:
Jaundice
Pallor
Dark urine (suggests intravascular haemolysis)
Nausea, vomiting, dehydration, AKI (haemoglobin precip)

Infection
Broad beans
Certain drugs (causing oxidative stress) e.g. sulphonamides, *cephalosporins

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32
Q

mx of G6PDD

A

Fluid intake
folic acid
blood transfusion if severe anaemia
renal support if needed

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33
Q

what is anaemia of chronic disease

A

Anaemia and evidence of immune system activation

  • decreased RBC production + decreased survival
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34
Q

Whats seen on lab studies of anaemia of chronic disease?

A 
Normocytic normochromic/microcytic hypochromic
Low reticulocyte count
Low serum iron
Low TIBC
Low transferrin saturation
Elevated ferritin
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35
Q

1 test that can differentiate anaemia of chronic disease and iron deficiency

A

ferritin - increased in ACD

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36
Q

How does aplastic anaemia present?

What is it?

A

Autoimmune destruction of RBCs.

Neutropenia - infections

Anaemia - fatigue, pallor, dyspnoea, faintness

Thrombocytopenia - bleeding, bruising

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37
Q

Name 2 associations with aplastic anaemia

A

pregnancy, coeliac, SLE, paroxysmal nocturnal haemoglobinuria

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38
Q

Seen on bone marrow biopsy of aplastic anaemia

A

Hypocellular marrow with no abnormal cell population

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39
Q

2 parts of Non pharma mx of aplastic anaemia

A

MASSC risk assessment if NP< 0.5
[risk of febrile neutropenia]

Full barrier nursing

Avoid IM injections

Look for infection

Check bloods and cultures

Vitals 4 hourly

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40
Q

Medical Mx of aplastic

A

allogeneic BM transplant
+ RBC and Pt transfusion
+ ABX

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41
Q

2 issues with crescent shaped Hb in sickle cell

A

Disrupt blood flow and break (haemolysis)

  • Painful crises
  • Organ damage
  • Increased vulnerability to infection

Cause varying degrees anaemia

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42
Q

what triggers sickle cell crisis?

A

CHIDS:

Cold
Hypoxia (extreme exercise)
Infection
Dehydration
Stress
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43
Q

3 areas affected in exam land by sickle cell crisis?

A

Acute chest syndrome: pneumonia like syndrome (due to sickling in pulmonary vasculature) - chest pain, fever, dyspnoea, tachypnoea

Bone infarction and avascular necrosis femoral head

Acute abdomen - mesenteric ischaemia

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44
Q

When is sickle cell usually Dx? Mx at this point?

A

newborn screening - blood spot

pneumococcal vaccine and penicillin prophylactically

genetic counselling
parental education

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45
Q

mx of sickle cell crisis

A 
cross match 
analgesia 
O2 
IV vluids 
Abx -broad 
Blood if needed
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46
Q

Chronic Mx of sickle cell

A

Supportive

  • Pain
  • Pneumococcal vaccination and penicillin prophylaxis
  • Trigger avoidance
  • Folic acid if severe haemolysis

Hydroxyurea - Increases fetal Hb production

Repeat transfusions if Hb <10g/dL

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47
Q

Name 3 comps of sickle cell

A 
crisis 
anaemia 
liver - jaundice / gallstones 
iron overload from transfusion 
leg ulcers
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48
Q

What causes megaloblastic anaemia?

A

B12/folate deficiency + drugs (hydroxyurea)

This causes defective DNA synthesis which also leads to leukopenia and thrombocytopenia

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49
Q

Where is folate found naturally

A

green veg
nuts
liver

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50
Q

4 causes of folate deficiency

A

Poor diet - eg alcoholic , poverty

Increased demand - eg pregnancy renal disease

Malabsorption - coeliac/ tropical spure

Drugs, alcohol and methotrexate

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51
Q

signs of folate deficiency

A

Headache - hallmark of megaloblastic
Anaemia
Pallor, fatigue, dyspnoea, faintness, tachycardia, heart murmur

Gi
Loss of appetite/wt loss

Skin
glossitis, exfoliative dermatitis

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52
Q

Mx of folate deficiency

A

oral folic acid

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53
Q

What do you get with b12 deficiency

A

macrocytic anaemia with peripheral neuropathy and neuropsych complaints

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54
Q

foods rich in b12

A

meat, fish, dairy

[vegans always lacking]

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55
Q

which cell and what do they produce is needed for b12 absorption

A

parietal - intrinsic factor

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56
Q

neuro sx of b12 deficiency

A

Subacute degeneration of spinal cord

[peripheral neuropathy, demetia, ataxia, paraethesia]

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57
Q

triad of signs Subacute degeneration of SC?

A

Upgoing plantars
Loss knee jerk
Loss ankle jerk

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58
Q

mouth signs b12 deficiency

A

Glossitis (painful), angular cheilitis

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59
Q

mx of b12 deficiency if severe (pancytopenia + anaemia + neurological)

A 
IM hydroxycobalamin (cobalamin = b12)
oral folic acid

blood transfusion
admit neuro / haem

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60
Q

Mx of b12 deficiency if no neuro o

A

IM hydroxycobalamin

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61
Q

What is pernicious anaemia

A

Autoimmune atrophic gastritis -> Atrophy of gastric mucosa with failure of IF and acid production due to autoantibodies to IF

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62
Q

Association wit pernicious anaemia? increased risk of ?

A

AI diseases - thyroid, DM, vitiligo….

Gastric Ca

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63
Q

Specific Ix for pernicious

A

IF antibody

antiparietal antibody

Schilling test (radio b12)

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64
Q

What is leukaemia

A

Excess of abnormal white cells in peripheral blood - myeloid or lymphoid

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65
Q

Acute leukaemia 3 Sx categories?

A

Tumour related:
Bone pain, fever, lethargy, night sweats, wt loss

BM sx
Anaemia
thrombocytopenia
neutropenia

Circulating cell sx
headache, lyphadenopathy, hepatosplenomegally

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66
Q

Dx of AML

A

Bone marrow blasts > 20% or peripheral blood

[may be complication of chemotherapy]
[?most common in old age]

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67
Q

Ix in AML name 3

A

FBC - leukocytosis, neutropenia

Peripheral blood film - blasts + auer rods

Bone marrow biopsy - blasts >20%

CXR - pulm infiltrates

Coagulation

UE, LFT, Coagulation

68
Q

name 2 DDx of AML

A

ALL
myelodysplastic syndrome
aplastic anaemia

69
Q

What is tumour lysis syndrome? electrolytes?

A

Electrolyte and metabolic disturbance due to breakdown of large number leukaemic cells

(hyperuricaemia, hyperphosphataemia, hyperkalaemia, hypocalcaemia, renal impairment)

70
Q

Mx of tumour lysis syndrome?

A

IV fluids
allopurinol

[haemodyalysis if needed]

71
Q

Drug for leukoreduction in AML?

A

Hydroxycarbamide

72
Q

2 parts Mx AML ?

A

Chemo - [Cytarabine and daunorubicin (don’t think need to know)]
Allogenic transplant at first remission

73
Q

Dx of ALL

A

Bone marrow blasts > 20%, blood smear leukaemic lymphoblasts

74
Q

Chromosomal association with ALL

A

Philadelphia chromosome - translocation (9,22

75
Q

ALL affects CNS. How present?

A

CNS infiltration by leukaemoid cells presents as papilloedema, nuchal rigidity and meningismus

May also have a focal neurology (CN 3, 4, 6, 7)

76
Q

ALL ix

A

FBC -

peripheral blood film

coagulation pannel

bone marrow biopsy

CXR , LP

UE, LFT, renal

77
Q

seen on CXR of ALL

A

Mediastinal widening

78
Q

Name 3 Comps of ALL

A

Tumour lysis syndrome
Neutropenic sepsis
Pancytopenia
Chemotherapy side effects

79
Q

Name 3 parts of acute Mx for ALL

A

Supportive care:
-Hydration - [electrolyte abnormalities]
-Allopurinol - [for acute tumour lysis syndrome (increased urate)]
-Prophylactic antimicrobials -Think bacterial/viral/fungal (aciclovir + fluconazole + ciprofloxacin)
Transfusions - RBC + platelets (if pt<10 x 10^9)

Induction chemotherapy (kill leukaemic cells) +- tyrosine kinase inhibitor (imatinib)
Intrathecal methotrexate (for CNS disease)
80
Q

CML genetics

A

Philadelphia chromosome/
BCR-ABL fusion gene

Confirms Dx

81
Q

mx of CML

A

Tyrosine kinase inhibitor (imatinib / dasatinib)

allogeneic haematopoeitic stem cell transplant

high-dose induction chemotherapy

82
Q

Cell in CLL? what happens?

A

B lymphocytes avoid apoptosis -> invade liver spleen and bone marrow

->
Lymphadenopathy, hepatosplenomegaly, BM suppression

83
Q

most common leukaemia of old age? trigger?

A

CLL

Pneumonia

84
Q

Sx of CLL

A

Anaemia
SOB / fatigue…

Infiltration -
Lymphadenopathy , splenomegaly

B sx 
Fever
Night sweats
Weight loss
[Fatigue, Chills]
85
Q

name 3 Ix in CLL

A

FBC - lymphocytosis , low hB, low pt

Peripheral blood film - smudged cells (damage to lymphocytes in prep)

Flow cytometry
CD5, CD19, CD23 positive

CT
Hepatosplenomegaly, retroperitoneal, mediastinal lymph nodes

86
Q

Mx of CLL

A

chemotherapy: [rituximab + cyclophosphamide + fludarabide]

+/-stem cell transplant

87
Q

2 comps and their Mx in CLL

A

Hypogammaglobulinaemia

  • cant produce antibodies
  • > give monthly IVIg

Autoimmune haemolytic anaemia
-> pred

88
Q

Difference between lymphomas and leukaemia

A

Lymphomas are solid, leukaemias are circulating

89
Q

Most common type of non-hodgkins ? what can it produce?

A

is diffuse large B-cell lymphoma (mainly from B cell lines)

May produce immunoglobulins. [T cells can travel to extranodal sites e.g. skin and CNS]

90
Q

Associations with NHL

A 
AI disorders (Sjogren’s, RA, SLE, coeliac), 
immunodeficiency
91
Q

How does NHL present?

A 
Lymphadenopathy 
Dry cough - mediastinal mass / pneumonia 
Bone marrow
spenomegaly 
GI

B Sx
Night sweats
Fever
Weight loss

92
Q

3 Ix in NHL

A

FBC - Thrombocytopenia (liver or BM), or pancytopenia (BM)

Lymph node biopsy - (for flow cytometry - tumour surface markers and cytogenetics)

LDH - high

CT/MRI - staging

93
Q

NHL how might you provide
CNS prophylaxis?
Antimicrobial?

A

intrathecal methotrexate

ciprofloxacin + aciclovir + fluconazole

94
Q

HL from what cells?
most common presentation?
what cells are seen?

A

Arises from mature B cells

Most commonly presents with cervical or supraclavicular lymphadenopathy (painless)
-B symptoms in 30% of patients

Presence of Reed-Sternberg cells (large, multinucleated

95
Q

HL aetiology?

A

Immunodeficiency
EBV

AI - SLE

96
Q

Often get mediastinal adenopathy in HL -> name 3 sx?

A

Dry cough
Dyspnoea
Chest pain
Superior vena cava syndrome (facial and upper limb oedema, dilated vessels)

97
Q

What is multiple myeloma? how is it therefore diagnoses?

A

Clonal proliferation of plasma cells in the bone marrow associated with monoclonal element (Ig or Ig fragment) in serum or urine

-> Diagnosis by serum and urine protein electrophoresis

98
Q

Most common presentation of MM

A 
Bone pain (esp back pain!)
Anaemia

[Fatigue
Infections
Hypercalcaemia
Renal impairment]

99
Q

Key protein in MM

A

M-protein - monoclonal component

100
Q

Which organs / features involved in MM

A

CRAB
Calcium elevation

Renal insufficiency

Anaemia (Hb < 10g/dL

Bone disease - lytic or osteopenic

101
Q

2 Ix you should do in all over 50 with back pain?

A

serum protein electrophoresis

ESR

102
Q

Sx groups in MM

A

Osteolytic lesions (backache / fractures)

Anaemia, neutropenia, thrombocytopenia from BM infiltration

Recurrent infections

Renal impairment

103
Q

What causes renal impairment in MM

A

Deposition of Tamm-Horsfall protein in loop of henle

104
Q

gold standard Ix in MM

A

Serum/urine electrophoresis

105
Q

bar Serum/urine electrophoresis, what other Ix might you do MM? name 3

A

Skeletal survey

BM aspiriate
Blood film

FBC, ESR, UE, Ca

106
Q 
MM mx of comps...
Bone disease?
anaemia?
spinal cord compression?
hyperviscosity -> reduced cognition / blurred vision?
AKI?
Infection?
A

Bone disease: Hypercalcaemia + pain - bisphosphonates + analgesics

Anaemia - blood transfusion/EPO

Spinal cord compression - dexamethasone

Hyperviscosity (reduced cognition/blurred vision) - plasmapheresis

AKI - rehydration/ preserve good hydration

Infection - antibiotics + pneumonia/flu vaccine

107
Q

What is polycythaemia? 2 cause categories

A

increased proportion of haemoglobin in the blood

Relative - decreased plasma volume
e.g dehydration, smoking, obesity

Absolute - increased RBC
Eg polycythaemia vera, altitude, chronic lung disease

108
Q

PRV -> More RBCs (also WBC and pt a bit). What comps?

A

Hyperviscosity -> thrombosis, haemorrhage

progress -> myelofibrosis and acute leukaemia

109
Q

genetics of PRV

A

JAK2

110
Q

Sx categories of PRV

A

Hyper-viscous
- headache, visual change, dizzy, red/full apperance

Thrombosis /bleeding

Bath
Pruritus after hot bath, erythromelalgia (pain) + redness of fingers, palms, heels toes

111
Q

3 key Ix in PRV

A

FBC Raised haemoglobin, raised haematocrit, raised WBC, raised Pt

JAK2 gene mutation screen (e.g. PCR)

BM biopsy

112
Q

in Polycythaemia Vera treatment aims to keep a low haematocrit and reduce the risk of thrombosis…
What drug?
what other mx?

A

hydroxycarbamide [Reduces number of blood cells produced by bone marrow - So also used in CML]
(+aspirin)

Management of CV risk factors (DM, hyperlipidaemia, HTN, smoking)

113
Q

Differentiate PV and CML

A

PV has no philadelphia chromosome

Neutrophil alkaline phosphatase is raised in PV but decreased in CML

114
Q

3 characteristics of myelodysplastic syndrome?

A

dysplastic changes in one or more cell lineages

ineffective hematopoiesis

likely to develop AML

115
Q

How does Myelodysplastic syndrome present

A

anaemia
neutropenia
thrombocytopenia

116
Q

Name 3 Ix in Myelodysplastic syndrome

A

FBC

Blood film - diamorphic blood cells

Ferritin, B12, renal function, LFT,

CXR

ECG

BM biopsy

117
Q

What anaemia described …
[Congenital dysmorphic features (what?)
Pancytopenic bone marrow failure
Susceptibility to cancer ]

Age?

A

faconi

[Sounds Italian - think of darker skin, italian hand shape which has a weird thuumb and in shape of triangle and could be a odd shaped heart - DIS SHIT TENUOUS]

Triangular faces
Cafe au lait + hyperpigmented skin
Cardiac and renal malformations
Abnormal thumbs

<7 - similar to aplastic/AML/Myelodysplastic

118
Q

what regulated production of patelets?

A

thrombopoeitin

from liver

119
Q

When does ITP usually occur?

A

children with a preceding viral illness

120
Q

3 Ix in ITP

A

FBC

Peripheral smear - Rule out other cause

BM biopsy

121
Q

how can ITP be differentiated from
Thrombocytopenia due to liver disease?
TTP?
DIC?

A

Thrombocytopenia due to liver disease or alcohol - raised GGT, alk phos

TTP - may have neurological changes or fever + anaemia

DIC - prologed PT and aPTT

122
Q

Mx of severe bleeding in itp

A

IVIG
Pred
pt transfusion

123
Q

Mx of chronic ITP

A

rituximab + splenectomy

124
Q

Thrombotic thrombocytopenic purpura is a medical emergency (95% fatal) What are the pentad of Sx ?

A

[Fuck Renal HTN]

Fever
Renal failure		
Haemolytic anaemia
Thrombocytopenia
Neurological change
125
Q

What causes TTP

A

Absence of VWF cleaving protein (ADAMTS-13)

[platelet aggregation in microvasculature (brain, kidney, heart)
+Haemolysis]

126
Q

seen on peripheral blood smear of TTP

A

Microangiopathic blood film with schistocytes (RBC fragments)

127
Q

Mx of TTP ? what not?

A

Urgent plasma exchange + prednisolone + aspirin

DO NOT GIVE PLATELETS

128
Q

Which drug commonly used to target antibpdy production

A

rituximab

129
Q

Pres of DIC

A

Symptoms/signs of systemic collapse: oliguria, hypotension, tachycardia

Bleeding: bruising, purupura

130
Q

2 things you transfuse in DIC

A

Platelet transfusion

FFP - replace coagulation factors

131
Q

can girls get haemophilia? Where is bleeding commonly \/ age of presentation?

A

no - x linked recessive-

muscles and joints

toddlers

132
Q

When does WVD present? how?

A

teens

Bleed into mucus membranes and skin

133
Q

Haemophilia Avs B

A 
A = F8 deficient
B = F9 deficient
134
Q

What should you avoid with haemophilia

A

IM injections, aspirin and NSAIDS

135
Q

What can be given in mild haem A ?

A

desmopressin (IV) -> stimulates endogenous release F8 + VWF

136
Q

genetic VWD

A

AD chromosome 12

Presentation - menorrhagia, telangiectasia, bruising and bleeding, gum bleeding

137
Q

mx VWD

A

IV demopressin

severe - + F8

138
Q

HHT is? other name?

A

hereditary haemorrhagic telangiectasia

Osler-Weber-Rendu

139
Q

Vit K needed for synthesis of what factors

A

1972

140
Q

What is prolonged in liver disease

A

PT time

141
Q

What happens in the coagulation cascade

A

Series of proteolytic enzymes that circulate in inactive state which are sequentially activated

Generate thrombin that cleaves fibrinogen creating fibrin = clot

142
Q

In endothelium damage what do platelets adhere to?

A

collagen and VWF and GP1b

143
Q

2 drugs affecting platelet function ?

2 for coagulation

A

Aspirin and clopidogrel affect platelet function

Heparin and warfarin affect coagulation cascade

144
Q

Aspirin mech?

A

Irreversibly inhibits COX1

145
Q

Clopidogrel mech?

A

Irreversible P2Y12 antagonist

146
Q

warfarin Mech

A

a vitamin K antagonist - prolongs PT

147
Q

Eg of noac and mech?

A

FXa inhibitors - apixaban, rivaroxiban

148
Q

Name some RFs of DVT

A 
Antiphospholipid syndrome
Cancer
Slow flow - sickle cell, PRV
Nephrotic syndrome
Obesity
Pregnancy
Sedentry 
Protein C/S deficiency
149
Q

what 2 Ix before transfusion

A

Group and screen

Cross match

150
Q

Name 3 comps of transfusion

A

infection

Acute
Acute haemolytic reaction
Febrile, non-haemolytic reaction
Allergic/anaphylactic reactio

Delayed
Iron overload
Delayed haemolytic reaction
Transfusion-associated graft vs host disease

151
Q

2 main comps of splenectomy

A

thrombocytosis - platelets peak at 7-10 days - could give aspirin prophylactic
infection

152
Q

What prophylax in splenectomy

A

ABx
phenoxymethylpenicillin + or macrolides (azithromycin/clarithromycin

Pneumococcal vaccine and influenza vaccine

153
Q

blood test to differentiate ALL and AML

A

nuclear staining for TdT - only in Lymphoblasts
[not in lymphocytes or myleoblasts]

myeloperoxidase in myeloblasts
[seen as auer rods]

154
Q

Key features of subtype monoblast AML

A

infiltrates gums

often no myeloperoxidase

155
Q

Key features of megakaryoblast AML

A

often no myeloperoxidase

associated with downs

156
Q

What is myelodysplastic syndrome ? usual cause of death?

A

blast buildup in bone marrow but not >20%
->can progress to AML

Cytopenia -> infection + bleeding

157
Q

Key difference in cells between acute and chronic leukemia

A

Chronic - partial maturation

acute - no maturation

158
Q

Seen on blood smear of CML vs CLL

For Dx?

A

CML - increased granulocytes and monocytes

CLL - smudge cells - due to immature B cells being damaged

Dx:
phildelphia chromosome = CML
Chromosomal defects in CLL

159
Q

How long for effects of change / initiation in warfarin?

What should you co prescribe when initiating warfarin?

A

3 days

[If initiating give 3 days of LMWH]

160
Q

What is beriplex also called

A

prothrombin complex concentrate

161
Q

Staging tool for lymphoma

A

Ann Arbor scale

162
Q

Sickle cell crises

A

Veno-occlusive - Eg Long bones, GI, priaprism

Acute chest

Aplastic - preceded by parvovirus b19

Sequestration - massive spleen, decreased Hb, Hypovolaemic shock

163
Q

HL Vs NHL in age ?

A

HL - younger - 20-34

50% EBV positive

164
Q

Key associations with CML ?

A

Gout - purine breakdown

Abdo distension

165
Q

If you were going to give 1 drug for CML what would it be?

A

Imatinib

166
Q

Which leukaemia has rule of 3rds?

A

CLL

167
Q

DKA 5 aspects of Mx

A 
fluids 
insulin 
detrose 
LMWH 
Kcl if needed

Phase 4 - GR (22 decks)

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