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Phase 2a - Haemotology COPY > Haemotology Conditions A > Flashcards

Haemotology Conditions A Flashcards

1
Q

Deep Vein Thrombosis - Description

A

blood clot in deep veins (esp. legs)

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2
Q

Deep Vein Thrombosis - Risk Factors (Change in Blood Flow) (4)

A

circulatory stasis

1) surgery
2) leg fracture —> plaster of Paris
3) long haul flight
4) obesity

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3
Q

Deep Vein Thrombosis - Risk Factors (Change in Blood Vessel) (2)

A

endothelial damage

1) smoking
2) hypertension

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4
Q

Deep Vein Thrombosis - Risk Factors (Change in Blood Constituents) (6)

A

1) pregnancy
2) oral contraceptive
3) hormone replacement therapy
4) dehydration
5) polycythaemia
6) inherited thrombophilia

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5
Q

Deep Vein Thrombosis - Signs (7)

A

1) calf warmth (calor)
2) calf tenderness (dolor)
3) calf erythema (rubor)
4) calf swelling (tumor)
5) fever (mild)
6) pitting oedema
7) Tender palpable cord (superficial venous thrombosis)

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6
Q

Deep Vein Thrombosis - Complications (1)

A

1) pulmonary embolism

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8
Q

Deep Vein Thrombosis - Diagnosis (Well’s Score) (9)

A

≥2 DVT likely —> imaging, <2 DVT unlikely —> D-dimer

1) active cancer
2) differential calf swelling (>3cm)
3) swelling of entire leg
4) pitting oedema
5) prominent superficial veins
6) localised deep venous system pain
7) paralysis, paresis, recent cast immobility
8) recent bed rest >3 days or major surgery with 12 weeks
9) previous DVT

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9
Q

Deep Vein Thrombosis - Management (2/3/0)

A 
conservative
1) compression stockings
2) physical activity
medical
1) treat underlying cause
2) LMW heparin
3) warfarin
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10
Q

Malaria - Description

A

infection by Plasmodium genus

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11
Q

Malaria - Causes (5)

A

1) Plasmodium falciparum
2) Plasmodium ovale
3) Plasmodium vivas
4) Plasmodium malariae
5) Plasmodium knowlesi

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12
Q

Malaria - Symptoms (7)

A

1) fever (inc. rigor)*
2) headache
3) myalgia
4) fatigue
5) abdominal pain
6) vomiting
7) diarrhoea

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13
Q

Malaria - Signs (4)

A

1) hepatomegaly
2) splenomegaly
3) jaundice
4) dark urine (black water fever)

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14
Q

Malaria - Complications (Severe Falciparum) (5)

A

1) sepsis
2) anaemia
3) cerebral pathology
4) acute respiratory distress syndrome
5) acute kidney injury

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15
Q

Malaria - Investigations (2/0)

A

initial

1) blood smear microscopy (Giemsa stain)
2) parasite antigen rapid diagnostic test

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16
Q

Malaria - Management (3/2/0)

A 
conservative
1) insect repellent
2) bed nets
3) long-sleeved clothes
medical
1) chloroquine
2) artesunate (severe falciparum)
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17
Q

Anaemia - General Description

A

decreased blood haemoglobin concentration

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18
Q

Anaemia - Causes (Microcytic) (2)

A

1) iron deficiency (most common)

2) thalassaemia

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19
Q

Anaemia - Causes (Normocytic) (6)

A

1) chronic disease (2nd most common)
2) combined haemanitic deficiency (Fe + B9)
3) pregnancy
4) blood loss
5) kidney disease
6) sickle cell disease

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20
Q

Anaemia - Causes (Macrocytic) (6)

A

1) B9 deficiency
2) B12 deficiency (inc. pernicious)
3) liver disease (inc. alcohol)
4) hypothyroidism
5) bone marrow failure
6) chemotherapy

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21
Q

Anaemia - General Symptoms (7)

A

1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication

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22
Q

Anaemia - General Signs (3)

A

may be absent even if severe

1) pallor
2) tachycardia
3) functional systolic ejection murmur

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23
Q

Anaemia - General Investigations (8)

A

1) FBC
2) B9
3) B12
4) ferritin
5) U&E
6) LFT
7) TSH
8) blood film

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24
Q

Anaemia - General Complications (2)

A

1) heart failure

2) infection risk

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25
Q

Anaemia - General Management (0/1/0)

A

medical

1) treat underlying cause

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26
Q

Iron Deficiency Anaemia - Description

A

decreased blood haemoglobin concentration due to iron deficiency

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27
Q

Iron Deficiency Anaemia - Causes (6)

A

1) poor dietary intake
2) malabsorption (e.g. Coeliac disease, Crohn’s disease)
3) GI bleed
4) menorrhagia
5) pregnancy
6) hookworm (most common WW)

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28
Q

Iron Deficiency Anaemia - Symptoms (7)

A

1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication

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29
Q

Iron Deficiency Anaemia - Signs (8)

A

may be absent even if severe

1) pallor
2) tachycardia
3) functional systolic ejection murmur
4) brittle hair
5) brittle nails
6) koilonychia (spoon shaped nails)
7) atrophic glossitis (tongue papillae atrophy, i.e. smooth tongue)
8) angular cheilitis (mouth corner ulcers)

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30
Q

Iron Deficiency Anaemia - Complications (3)

A

1) heart failure
2) infection risk
3) pregnancy problems

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31
Q

Iron Deficiency Anaemia - Investigations (2/0)

A

initial

1) FBC (microcytic anaemia)
2) iron studies (low iron, low ferritin)

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32
Q

Iron Deficiency Anaemia - Management (1/3/1)

A 
conservative
1) high dietary iron (e.g. red meat, spinach)
medical
1) treat underlying cause
2) ferrous sulphate (PO —> IV)
3) ascorbic acid (increases absorption)
surgery
1) red cell transfusion (2nd line)
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33
Q

Folate Deficiency Anaemia - Description

A

decreased blood haemoglobin concentration due to folate deficiency

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34
Q

Folate Deficiency Anaemia - Causes (5)

A

1) poor dietary intake (poverty, alcohol, elderly)
2) malabsorption (e.g. Coeliac disease, Crohn’s disease)
3) pregnancy
4) increased cell turnover (e.g. malignancy, inflammatory disease, haemolysis, dialysis)
5) antifolate drugs (e.g. methotrexate, trimethoprim)

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35
Q

Folate Deficiency Anaemia - Risk Factors (5)

A

1) poverty
2) Coeliac disease, Crohn’s disease
3) alcohol
4) pregnancy
5) elderly

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36
Q

Folate Deficiency Anaemia - Symptoms (7)

A

1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication

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37
Q

Folate Deficiency Anaemia - Signs (4)

A

may be absent even if severe

1) pallor
2) tachycardia
3) functional systolic ejection murmur
4) atrophic glossitis (tongue papillae atrophy, i.e. smooth tongue)

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38
Q

Folate Deficiency Anaemia - Complications (3)

A

1) heart failure
2) infection risk
3) pregnancy problems (spina bifida)

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39
Q

Folate Deficiency Anaemia - Investigations (2/3)

A

initial
1) FBC (macrocytic anaemia)
2) blood film (hypersegemented neutrophils)
consider
1) serum folate (low)
2) erythrocyte folate (low)
3) bone marrow biopsy (megaloblastic marrow)

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40
Q

Folate Deficiency Anaemia - Management (0/3/0)

A

medical

1) treat underlying cause
2) folic acid + B12 supplement (4 months)
3) prophylactic folic acid (pregnancy)

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41
Q

Haemolytic Anaemia - Description

A

decreased blood haemoglobin concentration due to erythrocyte haemolysis

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42
Q

Haemolytic Anaemia - Causes (6)

A

1) hereditary spherocytosis (most common in Northern Europeans)
2) glucose-6-phosphate dehydrogenase deficiency
3) α thalassaemia
4) β thalassaemia
5) sickle cell disease
6) autoimmune haemolytic anaemia

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43
Q

Haemolytic Anaemia - Pathophysiology (5)

A

1) premature breakdown of erythrocytes
2) increased erythropoesis by bone marrow to compensate (up to 6-8 times)
3) premature reticulocytes are released by bone marrow
4) premature breakdown of erythrocytes exceed compensation
5) anaemia

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44
Q

Haemolytic Anaemia - Symptoms (7)

A

1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication

45
Q

Haemolytic Anaemia - Signs (3)

A

may be absent even if severe

1) pallor
2) tachycardia
3) functional systolic ejection murmur

46
Q

Haemolytic Anaemia - Complications (4)

A

1) heart failure
2) infection risk
3) cholelithiasis
4) jaundice

47
Q

Haemolytic Anaemia - Investigations (5/0)

A

initial

1) FBC (macrocytic anaemia, reticulocytosis)
2) blood film
3) LFT (high unconjugated bilirubin)
4) urine urobilinogen (high)
5) stool stercobilinogen (high)

48
Q

Haemolytic Anaemia - Management (0/1/0)

A

medical

1) treat underlying cause

49
Q

Acute Lymphoblastic Leukaemia - Description

A

malignant proliferation of lymphoblasts

50
Q

Acute Lymphoblastic Leukaemia - Risk Factors (5)

A

1) <6 years old
2) radiation exposure (inc. radiotherapy)
3) chemotherapy
4) Down’s syndrome
5) Klinefelter’s syndrome

51
Q

Acute Lymphoblastic Leukaemia - Pathophysiology (4)

A

1) malignant proliferation of lymphoblasts
2) decreased space and energy for proliferation of other cells in bone marrow (bone marrow failure)
3) decreased functional blood cells in blood
4) increased non-functional blast cells in blood

52
Q

Acute Lymphoblastic Leukaemia - Symptoms (7)

A

1) fatigue
2) fever
3) headache
4) palpitations
5) dyspnoea
6) epistaxis
7) menorrhagia

53
Q

Acute Lymphoblastic Leukaemia - Signs (6)

A

1) lymphadenopathy
2) hepatomegaly
3) splenomegaly
4) pallor
5) petechiae/purpura/ecchymoses
6) mouth ulcers

54
Q

Acute Lymphoblastic Leukaemia - Complications (2)

A

1) pancytopenia

2) cranial nerve palsy

55
Q

Acute Lymphoblastic Leukaemia - Investigations (2/1)

A

initial
1) FBC (anaemia, leucocytosis, neutropenia, thrombocytopenia)
2) blood film (lymphoblasts)
consider
1) bone marrow biopsy* (>20% lymphoblasts)

56
Q

Acute Lymphoblastic Leukaemia - Management (1/3/3)

A

conservative
1) Hickman line (permanent cannula in main vessel to easily take blood and administer drugs and fluids)
medical
1) prophylactic antibiotics, antivirals, antifungals
2) chemotherapy
3) allopurinol (prevent tumour lysis syndrome)
surgery
1) red cell transfusion
2) platelet transfusion
3) bone marrow stem cell transplant (after 1st remission)

57
Q

Chronic Lymphocytic Leukaemia - Description

A

malignant proliferation of B lymphocytes

58
Q

Chronic Lymphocytic Leukaemia - Risk Factors (3)

A

1) >60 years old
2) radiation exposure (inc. radiotherapy)
3) male

59
Q

Chronic Lymphocytic Leukaemia - Pathophysiology (4)

A

1) malignant proliferation of B lymphocytes
2) decreased space and energy for proliferation of other cells in bone marrow (bone marrow failure)
3) decreased functional blood cells in blood
4) increased non-functional blast cells in blood

60
Q

Chronic Lymphocytic Leukaemia - Symptoms (6)

A 
1) asymptomatic (often incidental FBC finding)
severe
2) fatigue*
3) dyspnoea*
4) fatigue (inc. rigor, sweats)
5) anorexia
6) weight loss
61
Q

Chronic Lymphocytic Leukaemia - Signs (3)

A

1) lymphadenopathy
2) hepatomegaly
3) splenomegaly

62
Q

Chronic Lymphocytic Leukaemia - Complications (3)

A

1) pancytopenia
2) hypogammaglobulinaemia —> infection risk
3) autoimmune haemolytic anaemia

63
Q

Chronic Lymphocytic Leukaemia - Investigations (2/0)

A

initial

1) FBC (anaemia, leucocytosis, lymphocytosis, neutropenia, thrombocytopenia)
2) blood film (smudge cells)

64
Q

Chronic Lymphocytic Leukaemia - Management (0/2/2)

A 
medical
1) IV IgG
2) chemotherapy/radiotherapy
surgery
1) blood transfusion
2) bone marrow stem cell transplant
65
Q

Acute Myeloid Leukaemia - Description

A

malignant proliferation of common myeloid progenitors/myeloblasts

66
Q

Acute Myeloid Leukaemia - Risk Factors (5)

A

1) >65 years old
2) radiation exposure (inc. radiotherapy)
3) chemotherapy
4) Down’s syndrome
5) Klinefelter’s syndrome

67
Q

Acute Myeloid Leukaemia - Pathophysiology (4)

A

1) malignant proliferation of common myeloid progenitors/myeloblasts
2) decreased space and energy for proliferation of other cells in bone marrow (bone marrow failure)
3) decreased functional blood cells in blood
4) increased non-functional blast cells in blood

68
Q

Acute Myeloid Leukaemia - Symptoms (7)

A

1) fatigue
2) fever
3) headache
4) palpitations
5) dyspnoea
6) epistaxis
7) menorrhagia

69
Q

Acute Myeloid Leukaemia - Signs (6)

A

1) lymphadenopathy
2) hepatomegaly
3) splenomegaly
4) pallor
5) petechiae/purpura/ecchymoses
6) mouth ulcers

70
Q

Acute Myeloid Leukaemia - Complications (3)

A

1) pancytopenia
2) infection risk
3) disseminated intravascular coagulation

71
Q

Acute Myeloid Leukaemia - Investigations (2/1)

A

initial
1) FBC (anaemia, leucocytosis, neutropenia)
2) blood film (Aurer rod blast cells)
consider
1) bone marrow biopsy* (>20% blast cell infiltration)

72
Q

Acute Myeloid Leukaemia - Management (1/3/3)

A

conservative
1) Hickman line (permanent catheter in main vessel to easily take bloods and administer drugs and fluids)
medical
1) prophylactic antibiotics, antivirals, antifungals
2) chemotherapy
3) allopurinol (prevent tumour lysis syndrome)
surgery
1) red cell transfusion
2) platelet transfusion
3) bone marrow stem cell biopsy

73
Q

Chronic Myeloid Leukaemia - Description

A

malignant proliferation of basophils/eosinophils/neutrophils

74
Q

Chronic Myeloid Leukaemia - Risk Factors (3)

A

1) 65-74 years old
2) radiation exposure (inc. radiotherapy)
3) male

75
Q

Chronic Myeloid Leukaemia - Pathophysiology (4)

A

1) malignant proliferation of basophils/eosinophils/neutrophils
2) decreased space and energy for proliferation of other cells in bone marrow (bone marrow failure
3) decreased functional blood cells in blood
4) increased non-functional blast cells in blood

76
Q

Chronic Myeloid Leukaemia - Symptoms (3)

A

1) fatigue
2) fever (inc. rigor, sweats)
3) weight loss

77
Q

Chronic Myeloid Leukaemia - Signs (1)

A

1) splenomegaly

78
Q

Chronic Myeloid Leukaemia - Complications (1)

A

1) pancytopenia

79
Q

Chronic Myeloid Leukaemia - Investigations (2/1)

A

initial
1) FBC (anaemia, leucocytosis, thrombocytosis/penia)
2) blood film (almost all maturing/mature myeloid cells)
consider
1) bone marrow biopsy* (granulocytic hyperplasia)

80
Q

Chronic Myeloid Leukaemia - Management (0/1/1)

A

medical
1) chemotherapy (PO imatinib)
surgery
1) bone marrow stem cell transplant

81
Q

Hodgkin’s Lymphoma - Description

A

malignant proliferation of lymphocytes

82
Q

Hodgkin’s Lymphoma - Types (2)

A

1) classical Hodgkin’s lymphoma (95%, Reed-Sternberg cells)

2) nodular lymphocyte predominant Hodgkin’s lymphoma (5%, popcorn cells)

83
Q

Deep Vein Thrombosis - Investigations (2/1)

A 
initial
1) LFTs (normal)
2) D-dimer (Wells’<2, negative excludes)
consider
1) proximal duplex ultrasound* (Wells’≥2 or positive D-dimer)
84
Q

Hodgkin’s Lymphoma - Risk Factors (7)

A

1) 13-19 years old
2) >65 years old
3) male
4) family history (esp. siblings)
5) Epstein-Barr virus
6) autoimmune (e.g. SLE)
7) immunocompromised

85
Q

Hodgkin’s Lymphoma - Symptoms (3)

A

1) weight loss
2) general B symptoms (weight loss, night sweats, fatigue, malaise)
3) Easy bruising

86
Q

Hodgkin’s Lymphoma - Signs (5)

A

1) lymphadenopathy
2) hepatomegaly
3) splenomegaly
4) anaemia
5) enlarged abdomen

87
Q

Hodgkin’s Lymphoma - Complications (4)

A

chemotherapy/radiotherapy complications

1) secondary malignancy
2) thyroid pathology (e.g. hypothyroidism)
3) heart pathology (e.g. ischaemic heart disease)
4) lung pathology (e.g. lung fibrosis)

88
Q

Hodgkin’s Lymphoma - Investigations (1/5)

A

initial
1) lymph node biopsy* (Reed-Sternberg/popcorn cells)
consider
1) bone marrow biopsy (Reed-Sternberg/popcorn cells)
2) FBC (anaemia, worse prognosis)
3) serum lactate dehydrogenase (high)
4) high CRP + ESR
5) chest, abdomen, pelvis CT (Ann Arbor classification)

89
Q

Hodgkin’s Lymphoma - Classification (Ann Arbor) (6)

A

I) one lymph node group
II) multiple lymph node groups same side of diaphragm
III) multiple lymph node groups either side of diaphragm
IV) spread beyond lymph nodes (e.g. liver, bone marrow)
A) no B symptoms (except pruritus)
B) B symptoms (e.g. weight loss, fever, night sweats)

90
Q

Hodgkin’s Lymphoma - Management (0/5/0)

A 
medical
medical
1) radiotherapy
chemotherapy (ABVD)
2) adriamycin
3) bleomycin
4) vinblastine
5) dacarbazine
91
Q

Non-Hodgkin’s Lymphoma - Description

A

malignant proliferation of lymphocytes

92
Q

Non-Hodgkin’s Lymphoma - Risk Factors (7)

A

1) >50 years old
2) male
3) family history
4) Epstein-Barr virus
5) hepatitis C
6) Helicobacter pylori
7) immunocompromised

93
Q

Non-Hodgkin’s Lymphoma - Symptoms (2)

A

1) weight loss

2) fever (inc. night sweats)

94
Q

Non-Hodgkin’s Lymphoma - Signs (3)

A

1) lymphadenopathy
2) hepatomegaly
3) splenomegaly

95
Q

Non-Hodgkin’s Lymphoma - Complications (2)

A

1) chemotherapy/radiotherapy complications (e.g. secondary malignancy)
2) tumour lysis syndrome (Burkitt’s lymphoma)

96
Q

Non-Hodgkin’s Lymphoma - Investigations (1/5)

A

initial
1) lymph node biopsy* (non-Reed-Sternberg cells)
consider
1) bone marrow biopsy (non-Reed-Sternberg cells)
2) FBC (anaemia, worse prognosis)
3) serum lactate dehydrogenase (high)
4) high CRP + ESR
5) chest, abdomen, thorax CT (Ann Arbor classification)

97
Q

Non-Hodgkin’s Lymphoma - Classification (Ann Arbor) (6)

A

I) one lymph node group
II) multiple lymph node groups same side of diaphragm
III) multiple lymph node groups either side of diaphragm
IV) spread beyond lymph node groups (e.g. liver, bone marrow)
A) no B symptoms (except pruritus)
B) B symptoms (e.g. weight loss, fever, night sweats)

98
Q

Non-Hodgkin’s Lymphoma - Management (0/6/0)

A 
medical
1) radiotherapy
chemotherapy (R-CHOP)
2) rituximab
3) cyclophosphamide
4) hydroxy-daunorubicin
5) oncovin
6) prednisolone
99
Q

Non-Hodgkin’s Lymphoma - Management (Course) (6)

A 
low grade
1) none may be needed
2) radiotherapy
high grade (early)
3) chemotherapy (3 months R-CHOP)
4) radiotherapy
high grade (late)
5) chemotherapy (6 months R-CHOP)
6) radiotherapy
100
Q

Myeloma - Description

A

malignant proliferation of plasma cells

101
Q

Myeloma - Risk Factors (3)

A

1) old (peak 70 years old)
2) Afro-Caribbean
3) family history

102
Q

Myeloma - Symptoms (3)

A

1) fatigue
2) weight loss
3) bone pain

103
Q

Myeloma - Complications (7)

A

1) pancytopenia
2) anaemia (normocytic)
3) chronic kidney disease
4) hypercalcaemia
5) osteopenia
6) fractures
7) spinal cord compression

104
Q

Myeloma - Investigations (4/5)

A 
initial
1) serum/urine electrophoresis*
2) FBC (anaemia)
3) U&amp;E (high urea, high creatinine)
4) serum Ca2+ (high)
consider
1) bone marrow biopsy* (plasma cell infiltration)
2) blood film (Rouleux formation)
3) β2-microglobulin (high, worse prognosis)
4) x-ray (‘punched-out’ lytic lesions)
5) Bence-Jones proteins
105
Q

Myeloma - Management (1/4/1)

A 
conservative
1) high fluid intake (3L/day)
medical
1) analgesia (bone pain, avoid NSAIDs (CKD))
2) bisphosphonates (bone pain, reduce fractures)
3) prophylactic antibiotics
4) chemotherapy
surgery
1) haemodialysis (CKD)
106
Q

Myeloma - Management (Chemotherapy) (6)

A 
fit - VAD 6 cycles
1) vanblastine
2) adriamycin
3) dexamethasone
unfit - CTD 8 cycles
4) cyclophosphamide
5) thalidomide
6) dexamethasone
107
Q

Hodgkin’s Lymphoma - Management (Course) (2)

A

1) I-A to II-A —> short course

2) II-B to IV-B —> long course

108
Q

Cobalamin Deficiency Anaemia (B12 deficiency) - Neurological Signs (7)

A

1) Irritability
2) Depression
3) Psychosis
4) Dementia
5) Paraesthesia
6) Peripheral neuropathy
7) Subacute combined degeneration of the spinal cord

Phase 2a - Haemotology COPY (3 decks)

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