Haem Flashcards
(160 cards)
1
Q
Define anaemia.
A
Low haemoglobin concentration due to reduced cell mass, or increased plasma volume
2
Q
Give 4 causes of macrocytic anaemia
A
B12/folate deficiency
Alcohol excess/ liver disease
Hypothyroidism
Reticulocytosis
3
Q
Give 2 causes of megaloblastic macrocytic anaemia.
A
Folate deficiency
B12 deficiency
4
Q
What mutation is the philadelphia chromosome?
A
A translocation of part of chromosome 9 to chromosome 22.
5
Q
What distinguished Hodgkin’s Lymphoma from NHL?
A
Reed-Sternberg cells
6
Q
What electrolyte abnormalities are seen in tumour lysis syndrome?
A
Hypocalcaemia, hyperkalaemia, hyperuricaemia, hyperphosphataemia
7
Q
What is tumour lysis syndrome?
A
Electrolyte and metabolite abnormalities that occur after starting cancer treatment
8
Q
Why does tumour lysis syndrome occur?
A
The rapid breakdown of large numbers of cells released electrolytes
9
Q
What is the treatment of tumour lysis syndrome?
A
IV fluids
Allopurinol - to reduce uric acid
Phosphate binder - aluminium hydroxide
Dialysis for electrolyte rebalance
10
Q
What would confirm acute lymphoid leukaemia on a blood film?
A
More than 20% blast cells
11
Q
Why does febrile neutropenia occur?
A
Complication of cancer treatment
12
Q
What is the criteria for the diagnosis of febrile neutropenia?
A
Fever >38
Absolute neutrophil count < 1
13
Q
Why do patients with myeloma experience bone loss?
A
Myeloma leads to the release of cytokines that stimulate osteoclasts and inhibit osteoblasts
14
Q
What is rituximab used to treat?
A
Chronic lymphocytic leukaemia, some non-Hodgkin lymphomas
15
Q
What type of drug is rituximab?
A
Monoclonal antibody
16
Q
What receptor does rituximab target?
A
CD20 proteins on the surface of B cells
17
Q
What is the most common cause of B12 deficiency?
A
Pernicious anaemia
18
Q
What tests can be done for pernicious anaemia?
A
Intrinsic factor levels and parietal cell antibodies
19
Q
How long do stores of vitamin B12 last?
A
2-5 years
20
Q
What is the most common cell of origin for NHL?
A
B cells
21
Q
What symptoms are seen in hypocalcaemia?
A
Mnemonic - CATs go numb
C - convulsions
A - arrhythmias
T - tetany (muscle spasms)
Numbness
Prolonged QT
22
Q
What signs are seen in hypocalcaemia?
A
Chovstek’s sign and Trosseau’s sign
23
Q
What is Chovstek’s sign?
A
A twitch of the facial muscles when touching a patient’s cheek (in front of the ear)
24
Q
What is Trosseau’s sign?
A
Flexion of the wrist when a blood pressure monitor is inflated
25
What blood results are seen in haemolytic anaemia?
Decreased haptoglobin
Normocytic anaemia
Increased reticulocytes
26
What kind of anaemia can G6PD deficiency cause?
Haemolytic anaemia - normocytic anaemia
27
Give 4 causes of polycythemia.
JAK2 mutation, alcohol, living at altitude, obstructive sleep apnoea
28
Which cause of polycythemia is a primary cause?
JAK2 mutation
29
What condition are auer rods associated with?
Acute myeloid leukaemia
30
What is the treatment of uncomplicated malaria?
Oral hydroxychloroquine + primaquine
31
What is black water fever?
A complication of malaria as a result of haemolysis
32
What is seen in blackwater fever?
Dark urine
33
What is the first line treatment for severe malaria?
IV artesunate
34
What changes would be seen on a blood film in iron deficiency anaemia?
Hypochromic red blood cells, microcytic cells
35
What type of anaemia is chronic disease associated with?
Microcytic or normocytic
36
What is the most common form of anaemia?
Iron deficiency anaemia
37
What is the first line treatment of iron deficiency anaemia?
Oral iron supplements
38
What is sideroblastic anaemia?
Anaemia where the body produces enough iron but is unable to incorporate it into haemoglobin
39
What is the first line treatment of sideroblastic anaemia?
Pyridoxine (vitamin B6)
40
What medication is used as prophylaxis for sickle cell crisis?
Hydroxycarbamide
41
What are xanthoma?
Fatty yellow spots under the eyes
42
What is the precursor condition to myeloma?
MGUS (monoclonal gammopathy of undetermined significance)
43
What blood and urine results would be seen in myeloma?
Blood - roleaux formation of RBCs
| Urine - Bence-Jones proteins
44
What is the most common cause of polycythemia rubra vera?
JAK2 mutation
45
Give 4 symptoms of polycythemia rubra vera.
Itching
Haemorrhage
Thrombosis
Dizziness
46
What condition are Heinz bodies seen in?
G6PD deficiency
47
How is G6PD deficiency inheritied?
X-linked recessive
48
What enzyme is deficient in Gilbert's syndrome?
UDP glucoronosyltransferase
49
When is jaundice typically seen in Gilbert's syndrome?
Current infection, exercise or fasting
50
What is the treatment for normocytic anaemia or anaemia of chronic disease?
EPO injection
51
What treatment options are there for vitamin B12 deficiency?
Oral B12, IM hydroxocobalamine
52
What drug is contraindicated in G6PD deficiency?
Nitrofurantoin
53
What condition are bite cells associated with?
G6PD deficiency
54
Give 4 causes of thrombocytopenia.
Myeloma
Heparin
Toxins (including alcohol)
Viral infection (e.g HIV, TB)
55
What age is CML commonly seen?
40-60
56
What age group is CLL seen in?
Elderly
57
What age typically are myeloma patients?
>70
58
What is the gold standard test for sickle cell anaemia?
Hb electrophoresis
59
What is the first line treatment of chronic myeloid leukaemia?
Tyrosine kinase inhibitor
60
Give an example of a tyrosine kinase inhibitor
Imatinib
61
What is the first line treatment of myeloma?
VAD chemotherapy
62
What makes up VAD chemotherapy?
Vincristine
Adriamycin
Doxorubicin
63
What is the pathophysiology of hereditary spherocytosis?
A defect in the red cell membrane make the cell more permeable to sodium ions
64
What is the infective stage of malaria?
Sporozoites
65
What happens after a person is infected with malaria?
The sporozoites are transported to the liver and mature into schizonts
66
What happens after sporozoites have matured into schizonts?
The schizonts rupture and release merozoites
67
What are trophozoites?
The form of malaria found after merozoites infect the red blood cells of its host
68
What are auer rods associated with?
Acute myeloid leukaemia
69
What are roleaux formation RBCs associated with?
Multiple myeloma
70
What type of cells is ALL associated with?
Blast cells
71
What are smudge cells associated with?
Chronic lymphocytic leukaemia
72
What is the action of tyrosine kinase inhibitors?
Inhibits replication of eosinophils, basophils and neutrophils
73
What condition are Howell-Jolly bodies seen in?
Hyposplenism
74
How long is a course of apixaban in provoked DVT?
3 months
75
How long is a course of apixaban in unprovoked DVT?
6 months
76
What is a poor prognostic factor in ALL?
High white cell count
77
What chemotherapy treatment is used in Hodgkin's lymphoma?
ABVD chemotherapy
78
What gene is associated with myeloma?
MGUS
79
In which type of lymphoma is the affected lymph node sore after drinking alcohol?
Hodgkin's lymphoma
80
What condition are Kayser-Fleischer rings found in?
Wilson's disease
81
Which clotting factor is deficient in haemophilia A?
Factor VIII
82
What is the inheritance pattern of haemophilia A?
X-linked recessive
83
What clotting factor is deficient in haemophilia B?
Factor IX
84
What is deficient in beta thalassemia?
Beta haemoglobin
85
What is HbA2?
Haemoglobin consisting of two alpha chains and two delta chains
86
When is HbA2 increased?
In beta thalassemia, to compensate for the lack of HbA
87
What is HbA composed of?
Two alpha chains and two beta chains
88
What type of anaemia presents with a low haemoglobin and high reticulocyte count?
Sickle cell anaemia
89
What virus has an association with developing Hodgkin's lymphoma?
EBV
90
What is the presentation of haemolytic uraemic syndrome?
Thrombocytopenia, anaemia, and kidney failure
91
What can cause haemolytic uraemic syndrome?
Shiga toxin from E. coli
92
What type of anaemia is seen in sickle cell disease?
Normocytic anaemia - haemolytic anaemia
93
What is cyroprecipitate?
A portion of plasma rich in clotting factors
94
What condition is roleaux formation associated with?
Myeloma
95
In which condition are Bence-Jones proteins seen in the urine?
Myeloma
96
What type of cells does myeloma affect?
Plasma cells
97
What investigations might be done in myeloma patients?
X-ray spine
Serum immunoglobulins
Serum-free light chain assay
98
Where is B12 absorbed?
Terminal ileum
99
Where is iron absorbed?
Duodenum
100
Where is folate absorbed?
Jejenum
101
What type of crisis in sickle cell anaemia causes severe pain?
Vaso-occlusive crisis
102
Which people are likely to have less severe malaria?
Those with sickle cell trait
103
What can trigger a sickle cell crisis?
Stress and dehydration due to infection
104
What is the management of a vaso-occlusive crisis?
Keep warm
IV fluids
Simple analgesia
105
Name 3 other sickle cell crises (other than vaso-occlusive).
Acute chest syndrome
Splenic sequestration crisis
Aplastic crisis
106
What factor deficiency causes haemophilia B?
Factor IX
107
What factor deficiency causes haemophilia A?
Factor VIII
108
What type of anaemia is seen in thalasseamia?
Microcytic
109
What condition are auer rods associated with?
Acute myeloid leukaemia
110
What is the most appropriate investigation for DVT?
Well's score
111
What is the most appropriate investigation if Well's score is low?
D-dimer
112
What is the most appropriate investigation if Well's score is high?
Doppler ultrasound
113
Give 3 causes of lymphadenopathy.
Malignancy
Sarcoidosis
Infection
114
What cells are involved in CLL?
B cells
115
What are the FBC findings in CLL?
- Anaemia
| - Lymphocytosis
116
What is found on a blood film in CLL?
Smear cells/smudge cells
117
What is Richter's syndrome?
Transformation of CLL into Non-Hodgkin's lymphoma
118
What type of anaemia is commonly seen in colorectal cancer?
Iron deficiency anaemia
119
Give three signs of thrombocytopenic purpura.
Easy bruising
Purpura
Menorrhagia
Gum bleeding
120
What age group is primary thrombocytopenic purpura commonly seen in?
2-6
121
What might primary thrombocytopenic purpura be preceeded by?
Infection (chicken pox/measles) or immunisation
122
What is the classic history of secondary thrombocytopenic purpura?
Adults, more often seen in women, seen in autoimmune diseases such as SLE and thryoid disease, as well as CLL
123
What is the first line management of thrombocytopenic purpura?
Corticosteroids - prednisolone
124
What is the second line management of thrombocytopenic purpura?
Splenectomy
125
What are the signs and symptoms of malaria?
Signs:
- Blackwater fever
- Anaemia
- Hepatosplenomegaly
Symptoms:
- Fatigue
- Sweats/chills
- Fever
126
What types of malaria can cause relapses?
Plasmodium vivax
| Plasmodium ovale
127
What chromosomal abnormality is associated with multiple myeloma?
Translocation of chromosome 11 to chromosome 14
128
What blood film abnormality is associated with chronic lymphocytic leukaemia?
Smudge cells
129
What is the treatment of CLL?
Chemotherapy
| Rituximab
130
What kind of chemotherapy is used in Hodgkin's lymphoma?
ABVD
131
Give 4 symptoms of G6PD.
Fatigue, palpitations, shortness of breath, pallor
132
What are bite cells associated with?
G6PD deficiency
133
What is the function of G6PD?
It protects red blood cells against oxidative damage
134
What makes up the wells score?
Previous DVT
Immobility more than 3 days or surgery in last 4 weeks
Clinical signs or symptoms of DVT
Haemoptysis
Malignancy with active treatment in last 6 months
135
Give 3 differentials of polycythemia.
Acute dehydration
| Chronic hypertension
136
What is the inheritance pattern of haemophilia C?
Autosomal recessive
137
What factor is deficient in haemophilia C?
Factor XI
138
What is prothrombin time?
A measure of the extrinsic pathway of the coagulation cascade
139
Which factors make up prothrombin time?
2, 5, 7 and 10
140
What is activated partial thromboplastin time?
Assesses the intrinsic pathway of the coagulation cascade
141
Which factors contribute to the APTT?
1, 2, 5, 8, 9, 10, 11, 12
142
What is bleeding time?
A laboratory test to assess platelet function
143
What is fibrin degradation products commonly used to diagnose?
Disseminated intravacular coagulation
144
What is D-dimer?
A breakdown product of crosslinked fibrin
145
What is the treatment of haemophilia?
Replace the deficient factor by giving plasma
146
What is the most common cause of microcytic anaemia worldwide?
Iron deficiency
147
What is the initial management of haemochromatosis?
Therapeutic phlebotomy until ferritin levels come back to normal
148
What is the maintenance management of haemochromatosis?
Desferrioxamine
149
What is the level of serum and urine copper in wilson's disease?
High urinary copper
| Low serum copper
150
What is ceruloplasmin?
The molecule that binds copper to transport it
151
What is the level of ceruloplasmin in wilsons disease?
Low ceruloplasmin
152
What condition are bite cells associated with?
G6PD deficiency
153
What condition are smudge cells associated with?
Chronic lymphocytic leukaemia
154
Give an example of a tyrosine kinase inhibitor.
Imatinib
155
Which factors does the intrinsic pathway include?
1, 2, 9, 10, 11, 12
156
Which measure of coagulation corresponds to the intrinsic pathway?
APTT
157
Which measure of coagulation corresponds to the extrinsic pathway?
Prothrombin time
158
Which factors does the extrinsic pathway include?
1, 2, 7, 10
159
What blood investigation will be prolonged in haemophilia?
Activated partial prothrombin time
160
What causes normocytic anaemia?
Anaemia of chronic disease
Haemolytic anaemia
Aplastic anaemia
Acute blood loss
