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2A - Stuff i just cannot remember > Haematology > Flashcards

Haematology Flashcards

1
Q

DVT risk factors

A

Virchow’s Triad.

Immobility, dehydration, oestrogen (pill, preg), clotting disorders, varicose v, trauma, infection, malignancy

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2
Q

Virchow’s Triad

A

Stasis of blood flow

Hypercoagulability

Vessel wall injury

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3
Q

Myeloma bloods

A

Monoclonal Antibodies + Bence-Jones proteins

IgG >30 g/L
Plasma cells >10%

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4
Q

Chronic Myeloid Leukaemia bloods

A

Low Hb, High platelets, High WBCs

:: ^myeloblast cell turnover > differentiate into basophils, neutrophils, eosinophils.

Leucocytosis :: ^^WBC proliferation

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5
Q

Iron deficiency anaemia presentations

A

= microcytic anaemia

  • brittle hair/nails
  • Koilonychia
  • Pale conjunctivae
  • Systolic flow murmur
  • pica cravings (esp kids)
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6
Q

Presentations of anaemia 2o to hypothyroidism

A

= macrocytic anaemia

  • reduced reflexes (also in B12 deficiency)
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7
Q

Acute management of Acute Coronary Syndrome

A

Aspirin + Ticagrelor
GTN
Morphine
LMW Heparin/Fondaparinux

PCI within 12hr

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8
Q

Acute management of DVT + pharmacology

A

Rivaroxaban - inhibits factor Xa, Fondaparinux - inhibits factor X

LMW Heparin if PREG - inhibits anti-thrombin III

IVC Filter (if bleeding).

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9
Q

DVT presentations

A

Asymmetric calf swelling, localised pain, red skin, vein dilation

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10
Q

What is thrombocytopenia?

Outline the pathophysiology of Idiopathic thrombocytopenic purpura and Thrombotic thrombocytopenic purpura

A

low platelets

ITP - IgG targeted by Macrophage’s Fc_Receptor

TTP - Low ADAMTS-13 > Platelet consumption

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11
Q

Pt presents with painless lymphadenopathy. There is some pain after drinking alcohol.

Likely diagnosis? Risk factors? Management?

A

Hodgkin’s Lymphoma

RF: Young, high socioeconomic class

Mx: ABVD Chemo

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12
Q

Non-Hodgkin’s Lymphoma: Types, Risk Factors, Management

A

EBV - Burkitt’s/ AIDS-related

H. pylori - MALT

Mx: HAART + R-CHOP-21 + Rituximab

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13
Q

Pt presents with pruritus, vision loss, headache and fatigue. They recently suffered a thrombotic event.
They complain of episodes burning pain in their feet and hands (erythomelalgia)

Likely diagnosis?

A

Absolute Polycythaemia

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14
Q

Pt presents with pruritus, vision loss, headache and fatigue. They recently suffered a thrombotic event.
They complain of episodes burning pain in their feet and hands (erythomelalgia)

Their face is ruddy and genetic tests show a JAK2 mutation.

Likely diagnosis?

A

Absolute Secondary Polycythaemia - Polycythaemia Rubra Vera

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15
Q

Gold standard investigation for Malaria

A

Giemsa-stained blood film - Plasmodium falciparum

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16
Q

Management of Malaria

A

Artemisinin Combination Therapy (ACT)

Quinines, Artesunate, Primaquine

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17
Q

Splenomegaly in the context of haematology can indicate

1)
2)
3)

A

1) Lymphoma
2) Leukaemia
3) Myeloproliferative disorders

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18
Q

Erythromelalgia indicates…

A

Polycythaemia Rubra Vera + essential thrombocytosis

= “dusky” extremities + burning pain with hot temperatures.

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19
Q

An IgG paraprotein spike in the context of haematology indicates…

A

Multiple myeloma

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20
Q

Macroglossia in the context of haematology indicates…

A

Amyloidosis

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21
Q

JAK2 mutations are associated with…

A

Polycythaemia Rubra Vera

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22
Q

Middle-age patient presents with massive splenomegaly and his toe is very painful and hot to touch.

A blood film is requested.

Likely diagnosis? What may genetic testing find? What may his blood film reveal?

A

Chronic Myeloid Leukaemia

Blood film - ^^mature myeloid cells , basophils, eosinophils

Genetics: Philadelphia chromosome

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23
Q

Pt presents with anaemia, bleeding and recurrent infections. Examination reveals hepatomegaly, splenomegaly and gum hypertrophy.

Likely diagnosis? Biopsy findings?

A

SnS = BM Failure + BM infiltration

Acute Myeloid Leukaemia

Biopsy: Auer Rods + Blast cells

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24
Q

5 yr old presents with fatigue and easy bruising. They have had recurrent infections this year. The child complains of a sore back.

Examination reveals painless lymphadenopathy and meningism.

Likely diagnosis? Biopsy?

A

Acute Lymphoblastic Leukaemia

Biopsy: Leukaemic Lymphoblastic Cells!

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25
Q

Child under 6 with features of BM infiltration + Lymphadenopathy?

A

Acute Lymphoblastic Leukaemia

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26
Q

Features of Bone Marrow Failure

A

Anaemia - fatigue
Abnormal bleeding
Abnormal bruising (low platelets)

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27
Q

Pt presents with wt loss, tiredness, fever and sweating.

Exam reveals massive splenomegaly, bleeding and gout.

Diagnosis?

A

Chronic Myeloid Leukaemia

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28
Q

Rouleaux formations are associated with…due to…

A

associated with Multiple Myeloma

Due to Raised ESR

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29
Q

Imatinib uses

A

Chronic Myeloid Leukaemia

Imatinib = Tyrosine Kinase Inhibitor

(TK induced by philadelphia c/s mut)

30
Q

Rituximab uses

A

= monoclonal Ab

  • NHL (Non Hodgkin’s Lymphoma)
  • CLL (Chronic Lymphocytic Leukaemia)
31
Q

Lenalidomide uses

A

= Chemotherapy

Multiple Myeloma

32
Q

58-F is becoming increasingly tired and has lost 2 stone. She initially put these fown to the menopause, but has recently developed mouth ulcers and pins and needles in the feet.
She is mildly jaundiced.

Likely diagnosis? Management?

A

Pernicious anaemia - autoimmune condition

  • anaemia
  • peripheral neuropathy
  • lemon skin (mild jaundice + pallor)
  • mouth ulcers
  • depression
  • dementia

Mx: B12 injections

33
Q

Polycythaemia management

A

Venesection

34
Q

7-F has a known haematological malignancy. Parents bring her to A&E as she is red in the face and her chest veins are dilated.

Her facial features include a small chin, slanted eyes and drooping of the left side of the face.

Likely haem diagnosis?

A

Acute Lymphoblastic Leukaemia

  • young kids
  • Down’s syndrome RF
  • anaemia, bleeding, infection
  • hepatosplenomegaly, peripheral lymphadenopathy
  • SVC obstruction, facial nerve palsy
35
Q

Red face, dilated chest veins

A

SVC Obstruction

36
Q

Haemophilia B is associated with which clotting factor?

A

Factor 9

37
Q

Haemophilia A is associated with which clotting factor?

A

Factor 8

A before B, 8 before 9

38
Q

Define primary and secondary polycythaemia. Give examples of both.

A

Primary polycythaemia: RBC over production, eg Polycythaemia Rubra Vera

Secondary polycythaemia = RBC production upregulated, eg due to: chronic hypoxia (lung disease, smoking, low FiO2, COPD).

39
Q

56-M is overweight and smokes 30 cigarettes a day. He has COPD and HTN.

He presents with a swollen red calf and is diagnosed with DVT. You notice he has red palms and soles.

Likely diagnosis?

A

Secondary Polycythaemia, secondary to hypoxia from smoking + COPD

40
Q

Smudge cells are associated with

A

Chronic LYMPHOCYTIC leukaemia

41
Q

76-M presents with urinary frequency, haematuria and night sweats. He reports 2 stone recent wt loss.

DRE reveals a hard craggy mass.

Likely diagnosis? Investigations? Management?

A

Prostate Cancer

1L: DRE, urine dipstick

Gold: Transrectal US Biopsy (TRUS Biopsy)

GnRH agonist (analogue)  - Goserelin, Leuprolide
Androgen antagonist - Biclutamide
42
Q

Factors that raise PSA

A

Acute urinary retention
Recent ejaculation
PR Examination

BPH!!
Prostate cancer

Infection
- urinary tract, prostate

43
Q

Prostate cancer management for:

  • low grade
  • high grade
A

Low Gleason grade:
1. Active surveillance

High Gleason grade:

  1. Radiotherapy
  2. Laparoscopic prostatectomy
44
Q

Management of METASTATIC prostate cancer

A

HORMONAL Mx:

  1. GnRH agonist (analogue)
    a) Goserelin
    b) Leuprolide
  2. Androgen antagonist ADJUNCT
    a) Bicalutamide
    b) Enzalutamide
  3. GnRH antagonist
    a) Degarelix
45
Q

Pharmacology + SE of hormonal management of prostate cancer

A

GnRH Agonist (Goserelin) > OVER stimulate pituitary > paradoxical blockade of LH & FSH

Problem = transient ^^testosterone > makes disease worse

SO…

add Androgen antagonist (Biclutamide)

SE: low libido, infertility, wt gain, osteoporosis, anaemia

46
Q

Aplastic crisis

A

CLL transforms into NHL

47
Q

Myelofibrosis pathophysiology and features

A

Myeloproliferative disorder –>

Clonal BM disorder chd by deposition of fibrous scar tissue (too many cells > BM compensates and kills itself off - fibrosis - to reduce output)

  • Pancytopenia
  • tear drop cells
  • DRY tap (:: all fibrotic)
  • MASSIVE splenomegaly
48
Q

Myelodysplasia pathophysiology and features

How many progress to AML?

A

= pre-cancerous stage

BM disorder > pancytopenia + production of functionally immature blood cells

1/3 progress to AML

49
Q

Blast crisis

A

Chronic leukaemia becomes acute leukaemia

  • outputting a huge number of abnormal cells
50
Q

Amyloidosis

A

protein aggregates deposit in body tissues

  • proteinuria
  • purpura (eyes)
  • Carpal tunnel
  • peripheral neuropathy
  • glossitis
51
Q

Management of major bleeding

A

Stop anticoagulants

IV Prothrombin Complex Concentrate/FFP + IV Vitamin K

52
Q

Management of minor bleeding

A

Stop anticoagulants

IV Vitamin K

Repeat INR after 24Hr

53
Q

Management of no bleeding with INR >8

A

Stop anticoagulants

IV/Oral Vitamin K

Repeat INR after 24Hr

54
Q

Management of no bleeding with 8>INR>5

A

Withhold 1-2 doses anticoagulant

Review maintenance dose of anticoagulant

55
Q

What is INR? When is it used

A

International Normalised Ration - measure of blood coagulation.

Used in pts

  • on Warfarin
  • at high risk of thromboembolic events - prosthetic valve, AF
  • being treated for DVT/PE
56
Q

Name the 4 products which are readily transfusable

A

1 - Red Blood Cells

2 - Fresh Frozen Plasma (coagulopathy)

3 - Platelets (1 pool from 4 donors. LS 10 days)

4 - Cryoprecipitate (= thawed FFP. Massive bleed + low fibrinogen)

57
Q

Cryoprecipitate components

A

Fibrinogen
Factor VIII
Von Willebrand Factor

58
Q

Management of a patient with a massive bleed and low fibrinogen

A

Cryoprecipitate

59
Q

Management of a patient with Coagulopathy

A

Fresh Frozen Plasma

60
Q

Whole blood transfusion indications

A

Major trauma, eg military trauma patients who need resus

Rapid corrects of acidosis, hypothermia, coagulopathy

61
Q

Red blood cell transfusion indications

A

Acute haemorrhage

Chronic anaemia

62
Q

Platelet transfusion indications

A

Thrombocytopenia + bleeding

Severe thrombocytopenia (prophylaxis)

63
Q

Granulocyte transfusion indications

A

Neutropenic cancer patients developing bacterial sepsis AND unresponsive to ABX for 24-48Hr

64
Q

Fresh Frozen Plasma indications

A

DIC
Liver disease - coagulation factor deficiency

Major trauma/ haemorrhage

Urgent warfarin anticoagulation

65
Q

Cryoprecipitate indications

A

Von Willebrand Disease

Severe Hypofibrinaemia

66
Q

IV Immunoglobulin transfusion indications

A

Immuno-thrombocytopenia

Guillain-Barre Syndrome

Autoimmune Haemolytic Anaemia

67
Q

Antithrombin III transfusion indications and side effects

Normal action of antithrombin III

A

Congenital Antithrombin III deficiency - increased risk of thrombosis

AT III inhibits factors IIa, Xa, IXa, XIa

68
Q

Antithrombin III deficiency homozygosity vs heterozygosity

A

Homozygosity = In Utero death

Heterozygosity = increased risk of VTE 50-fold

69
Q

Factor VIIa transfusion indications

A

Haemophilia A and B

70
Q

Most common inherited thrombophilia

Pathogenesis

A

Factor V Leiden

= mutation in clotting factor V > becomes resistant to inactivation by protein C

71
Q

Protein C deficiency epidemiology

Protein C usual pathophysiology

A

Higher prevalence in Southeast Asian patients

Protein C inactivates Factor V and VIII

72
Q

Inherited thrombophilia

A

Factor V Leiden
Protein C Deficiency
Antithrombin III deficiency

2A - Stuff i just cannot remember (19 decks)

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