Corrections Flashcards by Esme Cosham

Is eosinophilia more commonly associated with non-HL or HL?

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What happens in myelofibrosis?

Bone marrow gets replaced with connective tissue (fibrosis).

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What is the JAK2 mutation associated with?

Myeloproliferative disorders, such as:

1) polycythemia vera

2) essential thrombocythemia

3) primary myelofibrosis

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What is the most suitable mx option for epistaxis where the bleed site is difficult to localise?

Anterior packing (followed by referral to ENT for posterior packing)

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Cause of a severe drop in Hb and reticulocyte suppression in sickle cell?

Parvovirus infection —> causes aplastic crisis (temporary arrest of red cell production in bone marrow, hence low reticulocytes)

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What is a typical cause of thrombocytopenia after surgery?

Heparin induced thrombocytopaenia

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Post-splenectomy patients are often given prophylactic penicillin V.

What organism does this protect them against?

What organism does it not protect them against?

Protects them against Strep. pneumoniae

Does not protect them against Hib (due to the production of beta-lactamases by the organism)

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Well’s score results for PE vs DVT?

PE: ≥4.5 (likely)

DVT: ≥2 (likely)

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As a first line investigation, what should all people with iron deficiency anaemia be screened for?

Coeliac disease

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DVT investigation: if proximal leg US is negative but D-dimer is positive?

Stop anticoagulation and repeat scan in 1 week (as still as risk of developing a clot)

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Mx of gastric MALT lymphoma?

H. pylori eradication

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What is the Richter’s transformation?

CLL can transform to high-grade lymphoma (Richter’s transformation), making patients suddenly unwell.

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What type of leukaemia is the Richter’s transformation seen in?

CLL

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What are some contraindications for a platelet transfusion?

1) Chronic bone marrow failure

2) Autoimmune thrombocytopenia

3) HIT

4) TTP

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What is used in the mx of CML?

Tyrosine kinase inhibitors e.g. imatinib

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Haptoglobin levels in intravascular haemolysis?

Reduced

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What is given to patients with polycythaemia vera to reduce the risk of thrombotic events?

Aspirin

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What finding is most likely on a blood film in multiple myeloma?

Rouleaux formation (appear as stacks of RBCs)

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What medication can be used in sickle cell to prevent further crises?

Hydroxyurea

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What condition does APS most commonly occur 2ary to?

SLE

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1ary vs 2ary prevention of clots in APS?

1ary –> low dose aspirin

2ary –> warfarin (ie. APS patients have lifelong warfarin post DVT/PE instead of DOAC)

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What mutation is present in sickle cell?

Single point mutation in beta globin gene on chromosome 11.

Results in amino acid replacement from glutamic acid to valine (HbS).

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What hypersensitivity reaction is seen in ITP?

Type II

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What is free Hb in the plasma bound by?

Haptoglobin (hence why haptoglobin levels are low in haemolysis)

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What is aplastic crisis in sickle cell?

Temporary cessation of erythropoesis, resulting in severe anaemia. Pts may present with high output HF 2ary to anaemia.

What investigation is required for diagnosis of sickle cell?

Hb electrophoresis

Normally no treatment is required in ITP. What are some cases where treatment may be required?

1) pt is actively bleeding 2) severe thrombocytopenia (<10)

What is hair on end skull a sign of?

Chronic haemolysis (so expansion of medullary cavities)

What type of gallstones are seen in sickle cell?

Pigmented (as a result of raised unconjugated bilirubin from RBC breakdown)

What may be seen on a peripheral blood smear in sickle cell?

Howell Jolly bodies –> basophilic nuclear remnants of RBCs

What shoold be monitored in HSP?

BP & urinalysis (for renal involvement)

What 4 bacteria are those with sickle cell particularly susceptible to?

1) Neisseria meningitidis 2) Strep. pneumoniae 3) Hib 4) Salmonella

What 4 bacteria are those with sickle cell particularly susceptible to?

Hair on end appearance

Where does extramedullary haematopoesis most commonly occur in sickle cell?

In the liver

Mx of acute chest syndrome in sickle cell?

Same as vaso-occlusive crisis i.e. analgesia & O2 PLUS antibiotics & transfusion

When is hydroxyurea given in sickle cell?

from 9 months of age (except in pregnancy)

In beta-thalassaemia major, what is required alongside repeated transfusions?

Desferrioxamine (to prevent complications of iron overload)

How does SLE affect neutrophils?

Commonly causes neutropenia

For a patient undergoing an elective splenectomy, when is the optimal time to give the pneumococcal vaccine?

2 weeks before the surgery This timing allows for optimal antibody response to develop before the patient becomes functionally asplenic.

Does the COCP form part of the Wells score?

What is seen on a blood film in megaloblastic anaemia (e.g. B12/folate deficiency)?

Hypersegmented neutrophils

What is seen on a peripheral blood film in myeloma?

Rouleaux formation

What investigation confirms the diagnosis of myeloma?

Bone marrow aspiration --> raised plasma cells

What lifelong mx is indicated in beta-thalassaemia major?

Lifelong blood transfusions

Mx of APS in pregnancy?

Aspirin + LMWH (the addition of aspirin is recommended to reduce the risk of pre-eclampsia as APS is a high risk feature)

Whtat class of medication can precipitate renal failure in patients with myeloma?

NSAIDs

What type of Hodgkin's lymphoma carries the best prognosis?

Lymphocyte predominant

Lymph node pain when drinking alcohol is very specific for what?

Who is benign ethnic neutropaenia common in?

Black African and Afro-Caribbean ethnicity

Mx of polycythaemia vera?

1) aspirin 2) venesection 3) chemo e.g. hydroxyurea

What is there a risk of progression to in polycythaemia vera?

1) myelofibrosis (5-15%) 2) AML (5-15%) - risk increased with chemotherapy treatment e.g. hyroxyurea

Features of lead poisoning?

- abdominal pain - peripheral neuropathy (mainly motor) - neuropsychiatric features - fatigue - constipation - blue lines on gum margin

What is seen on a blood film in lead poisoning?

Basophilic stippling

What is irradiated blood depleted of?

T-lymphocytes

Purpose of irradiated blood?

Used to avoid transfusion associated graft vs host disease

Skull XR findings in myeloma?

'raindrop' skull appearance --> well defined lytic lesions (punched out lesions)

Is SLE a cause of autoimmune haemolytic anaemia?

Yes

Where is iron predominantly absorbed?

Duodenum & proximal jejunum

Where is B12 absorbed?

Terminal ileum (e.g. affected by an ileocaecal resection)

What deficiency can an ileocaecal resection result in?

B12 deficiency

What age should prompt a very urgent (within 48h) FBC to investigate for leukaemia?

0-24y

What features should prompt a very urgent FBC to investigate for leukaemia in children & young people?

- Pallor - Persistent fatigue - Unexplained fever - Unexplained persistent infections - Generalised lymphadenopathy - Persistent or unexplained bone pain - Unexplained bruising - Unexplained bleeding

What is the most common inherited thrombophilia?

Factor V Leiden (activated protein C resistance)

In a non urgent scenario, how quickly is a unit of RBC transfused?

90-120 mins

In an urgent scenario, how quickly can a unit of RBC be transfused?

STAT

What is the underlying pathophysiology in acute haemolytic transfusion?

RBC destruction by IgM-type antibodies

What platelet level should you aim for before surgery or an invasive procedure (e.g. biopsy)?

>50: most patients 50-75: high risk of bleeding >100: if surgery at critical site

Describe Reed Sternberg cells

Large cells with a bilobed nucleus and prominent eosinophilic inclusion-like nucleoli.

Blood film findings in myelofibrosis?

'tear drop' poikilocytes

Bone marrow biopsy in myelofibrosis?

Unobtainable ('dry tap')

When is LMWH initiated in APS in pregnancy?

Once foetal heartbeat is seen on US

Blood film findings in iron deficiency anaemia?

- target cells - 'pencil' poikilocytes

Blood film findings in hyposplenism e.g. coeliac, post-splenectomy?

- target cells - Howell-Jolly bodies - acanthocytes - siderotic granules - Pappenheimer bodies

Presentation of acute intermittent porphyria?

1) abdominal: abdominal pain, vomiting 2) neurological: motor neuropathy 3) psychiatric: e.g. depression 4) hypertension and tachycardia common

2 indications for tolvaptan?

1) ADPKD (slow kidney function decline) 2) Hyponatraemia 2ary to SIADH

What medication is often used in the management of non-Hodgkin's lymphoma?

Rituximab

What should ALL patients be screened for before treatment with rituximab?

Hep B It can cause reactivation of HBV in those with prior exposure

Exposure to pesticides is an important risk factor for what cancer?

NHL

What is seen on a blood film in EBV?

Atypical lymphocytes

What investigation is required to confirm a diagnosis of spinal stenosis?

MRI

What is given to patients with polycythaemia vera to reduce the risk of thrombotic events?

Aspirin

Risk factors for NHL?

- elderly - caucasians - viral infection (EBV) - FH - pesticides & solvents - chemo or radiotherapy - immunodeficiency e.g. HIV, diabetes, transplant - autoimmune e.g. SLE, coeliac