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Haem Flashcards

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1
Q

Downs syndrome = which cancer?

A

ALL

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2
Q

philadelphia chromosome = which cancer?

A

ALL

CML

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3
Q

smudge cells = which cancer?

A

CLL

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4
Q

Warm autoimmune haemolytic anaemia = which cancer?

A

CLL

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5
Q

Auer rods = which cancer?

A

AML

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6
Q

What are the 3 stages of CML?

A
  1. chronic - 5yrs - high white cell count
  2. accelerated – blasts, thrombocytopenia, anaemia
  3. blast - pancytopenia
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7
Q

pain in neck when drinking = which cancer?

A

Hodgkins lymphoma

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8
Q

reed sternberg cells = which cancer?

A

Hodgkins lymphoma

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9
Q

Owls eye = which cancer?

A

Hodgkins lymphoma

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10
Q

rouleux formation = which cancer?

A

myeloma

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11
Q

Lymphoblastic leukaemias come from which cell line?

A

Lymphocytes (B)

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12
Q

CML and AML come from which cell line?

A

Myeloid (hence myeloblastic in name)

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13
Q

Chronic leukaemias come from ______ cells whereas acute leukaemias come from _______ cells

A

chronic - from well defined line

acute - from blasts

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14
Q

Lymphomas are usually from what cell line?

A

B

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15
Q

3 Causes of microcytic anaemia?

A 
T thallassaemia 
Anaemia of chronic disease 
Iron deficiency (most common)
Lead
Sideroblastic
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16
Q

3 causes of normocytic anaemia?

A 
Anaemia of chronic disease 
Aplastic 
Acute bleeding 
Hypothyroid
Haemolytic
Sickle cell
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17
Q

Cause of megaloblastic macrocytic anaemia?

A

Low vit B12

Low folate

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18
Q

3 Causes of normoblastic macrocytic anaemia?

A 
alcohol
liver dis 
hypothyroid
azathiopurine
reticular cytosis
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19
Q

what is the definition of anaemia?

A

low haemoglobin in the blood

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20
Q

what is pernicious anaemia?

A

autoimmune destruction - of parietal cells or intrinsic factor
= cannot absorb B12

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21
Q

2 causes of low folate?

A

pregnancy
lack of green veg
malabsorption
haemolysis

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22
Q

5 symptoms of anaemia?

A 
tired 
SOB
headache
dizzy
palpitations
pale
conjunctival pallor 
resp rate high
tachycardia
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23
Q

5 symptoms / signs specifically of iron deficiency anaemia?

A 
pica
hair loss
koilonychia 
angular cheilitis 
atrophic glossitis 
brittle hair / nails
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24
Q

investigations for haemolytic anaemia?

A

haemoglobin, MCV
blood film - spherocytes and polychromasia
haptoglobin (low)
lactate dehydrogenase (high)

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25
blood tests that indicate the amount of iron?
ferritin - low transferrin saturation - low total iron binding capacity - high
26
an example of an oral iron supplement? a problem with this?
ferrous sulphate | slow so not good enough for severe cases
27
4 presenting features of DVT?
``` pain unilateral swelling warmth tender discolouration phlegmasia ```
28
gold standard investigation for ?DVT?
ultrasound/doppler
29
first line investigations in DVT?
``` measure the calf D dimer (sensitive not specific) ```
30
management of DVT?
heparin warfarin apixaban recannalisation
31
what part of haemoglobin is affected in sickle cell?
beta
31
what part of haemoglobin is affected in sickle cell?
beta
32
what haemoglobin proteins to adults have?
2 alpha 2 beta
33
3 main features of sickle cell disease? & the symptoms this causes?
pain haemolysis = jaundice, gallstones anaemia = tired, dizzy, palpitations
34
3 consequences of sequestration crisis in sickle cell?
``` thrombocytopenia splenomegaly abdo pain hypovolaemic shock fibrosis of spleen infection with encapsulated bacteria ```
35
3 complications of sickle cell?
``` sequestration crisis acute chest sepsis heart failure vaso occlusion of bone (avascular necrosis, dactylitis) ```
36
what kind of anaemia in sickle cell?
normocytic
37
what test for screening newborns for sickle cell?
guthrie
38
what do you see on the blood film in sickle cell? 3
sickled RBCs target cells howell jolly bodies
39
gold standard for sickle cell?
Hb electrophoresis
40
drug for sickle cell, how does it work?
hydroxycarbamide, stimulates production of foetal haemoglobin which is unaffected
41
supportive management for sickle cell?
``` antibiotics transfusions iron chelation folic acid vaccination bone marrow transplant analgaesia oxygen ```
42
5 symptoms / signs of leukaemia?
``` tiredness failure to thrive anaemia (pallor, dizzy etc) petechiae bleeding lymphadenopathy hepatosplenomegaly infection testicular swelling ```
43
gold standard diagnosis for leukaemia?
bone marrow biopsy (trephine or liquid aspiration) shows smudge cells - not specific for CLL for CLL you would use peripheral blood flow cytometry
44
risk factors for lymphoma?
immunosupression: - wiscott aldrich - drugs eg methotrexate - HIV infection eg HIV, H pylori
45
what are the B symptoms?
fever night sweat weight loss associated with lymphoma
46
apart from B symptoms 3 other symptoms of lymphoma?
``` lymphadenopathy (rubbery non tender) fatigue itching SOB infection abdo pain splenomegaly compression syndrome eg optic nerve ```
47
gold standard diagnosis for lymphoma?
core needle lymph node biopsy
48
what staging system is used for lymphoma?
ann arbour
49
explain the classes of ann arbour staging?
1 - one lymph node or area of nodes 2 - more than one lymph node on same side of diaphragm 3 - in lymph nodes above + below diaphragm 4 - widespread, in organs
50
what is MGUS?
pre malignant myeloma - 1% progression per year excess of an antibody, no symptoms MGUS is also the name of a gene associated with myeloma
51
what is smouldering myeloma?
pre malignant | plasma cells make up 10% of bone marrow population
52
what is Waldenstroms macroglobulinaemia?
smoulding myeloma with IgM
53
what does CRAB stand for?
calcium renal anaemia bone
54
what is the monoclonal paraprotein?
the antibody that is overproduced in myeloma
55
what is the benz jones protein and where can you test to find it?
in the urine | the light chai of the monoclonal paraprotein in myeloma
56
what happens to the bones in myeloma?
lytic and circular lesions because of osteoclast activity pepperpot skull
57
what happens to the viscosity of the blood in myeloma?
viscosity increases because of all the protein in the blood = vascular eye disease but there are few platelets (because bone marrow busy making plasma cells) so bleeding, bruising, erythema
58
what technique do you use to look for the benz jones protein in urine and the monoclonal paraprotein in serum?
electrophoresis
59
what is the usual treatment for myeloma?
induction therapy (bortezamid, dexamethasone and thalidomide) followed by stem cell transplant bisphosphonates thromboembolism prophylaxis
60
where do malaria parasites go in the body?
``` mosquito saliva patients bloodstream liver blood cells bitten by mosq -- mosq saliva ```
61
3 traits that protect against malaria?
sickle cell thalassaemia G6PD deficiency
62
which species causes the most severe form of malaria?
plasmodium falciparum
63
presentation of malaria?
cyclical fever (sweats, rigors) and anaemia (jaundice) ``` hypoglycaemia myalgia vomitting hepatosplenomegaly headache fatigue ```
64
3 complications of 'complicated malaria'?
coagulation = cerebral ischaemia, resp ischaemia, ARDS vascular permeability = translocation of bacteria from bowel = sepsis AKI disseminated intravascular coagulation
65
tests for malaria?
blood film - thick - is there malaria? - thin - what species? rapid antigen diagnostic test
66
what type of anaemia in malaria?
normocytic
67
treatment for complicated malaria?
IV artesunate | quinine dihydrochloride
68
treatment for mild malaria?
proguanil | atorvaquone
69
3 causes of secondary polycythaemia?
smoking hypoxia altitude renal or hepatocellular carcinoma that is ectopically producing EPO
70
what is the most common mutation in polycythaemia? There are 2 more?
JAK 2 - most common (= EPO stimulated proliferation physiologically) MPL CALR
71
what leukaemia are myeloproliferative disorders incl polycythaemia most likely to progress into?
AML
72
There are 2 phases in polycythaemia vera, what happens in each?
first phase: increase platelets, neutrophils and RBCs = hyperviscosity of blood = DVT but also bleeding because even though there are a lot of RBCs they arent properly regulated / functional spent phase: BM cannot produce cells = low platelets, leucocytes and anaemia, fibrosis of the bone marrow, hepatosplenomegaly in an attempt to compensate
73
5 presenting features of PCV?
``` ruddy / plethoric complexion red eyes (conjunctival plethora) palmar erythema HTN hepatosplenomegaly DVT etc symptoms of anaemia eg fatigue, dizzy etc blurred vision sweating/flushing pruritis eythromyalgia ```
74
2 ways you can work out if its primary or secondary polycythaemia?
EPO: low in primary, high in secondary (secondary polycythaemia = high EPO so high RBCs etc) ABG: high pCO2 could explain the need for secondary polycythemia
75
On a blood film in PCV what would you see?
tear drop cells poikylocytosis blasts
76
management of PCV?
venesection aspirin stem cell transplant chemo
77
what are the intrinsic and extrinsic clotting pathways?
``` intrinsic = activated by platelets close to the damage extrinsic = activated by exposed tissue factor ```
78
how is von Willebrand disease inherited & what does it cause?
dominant | deficiency of vWF = abnormal bleeding
79
what is ITP?
immune system produces antibodies against platelets = destruction of platelets, rubbish clotting, purpura, bruising, bleeding treat with prednisolone, retuximab
80
what is TTP?
mutation in or autoimmunity to the protein that activates vWF multiple clots in small vessels = angiopathy and uses up the platelets
81
Heinz bodies / bite cells indicate?
G6PD deficiency
82
Investigations for haemophilia?
coagulation factor assay genetic testing PT time normal (as is extrinsic and intrinsic pathways) activated partial prothrombin time is prolonged (as is only the intrinsic and common pathway. Haemophilia affects intrinsic pathway only)
83
what is haemophilia A and B?
``` A = low factor 8 B = low factor 9 ```
84
Which leukaemia is most likely to affect young children?
ALL
85
How long do you need to be on anticoagulants for after DVT?
3 months if provoked | 6 months if unprovoked
86
low haemoglobin but high reticulocyte is ..
sickle cell hereditary spherocytosis low Hb because of increased haemolysis high reticulocytes bc body attempting to replace damaged
87
what is thalassaemia?
a defect in alpha or beta globin -- abnormally functioning Hb -- microcytic anaemia and haemolysis
88
presentation of thalassaemia?
``` prominent forehead/cheek bones due to bone marrow expansion fractures splenomegaly jaundice symptoms of anaemia failure to thrive gallstones ```
89
what is hereditary spherocytosis?
``` jaundice, anaemia and splenomegaly RBCs are more permeable to sodium aplastic crisis with parvovirus autosomal dominant inheritance north europe management = splenectomy ```
90
what condition causes jaundice, splenomegaly and anaemia especially after antimalarials/antibiotics, broad beans or infections?
G6Pd deficiency
91
are lymphoma myeloproliferative disorders?
no, myeloproliferative disorders affect the myeloid line not the lymphoid line (so some leukaemia are myeloproliferative)
92
what bleeding disorder causes raised bilirubin?
TTP | bilirubin from the body breaking down all the clots that TTP goes about making
93
3 things that myeloma is characterised by?
Malignant proliferation of plasma cells Lytic deposits in bones Presence of abnormal globulin (usually IgG or A)
94
Which cancer has gum hypertrophy?
AML
95
Treatment for Hodgkin lymphoma?
ABVD (Adriamycin, bleomycin, vinblastine, dacarbazine)
96
Treatment for non Hodgkin lymphoma?
``` R-CHOP rituximab cyclophosphamide prednisolone vincristine ```
97
Treatment for ALL and AML?
``` Chemo Radio Stem cell transplant allopurinol - for all blood/platelet tranfusion ```
98
Treatment for CML and CLL?
CML - imatinab (philadelphia) CLL - chemo and radio, nothing is curative
99
presentation of TTP?
``` neuro - eg headache confusion dysarthria fever microangiopathic haemolytic anaemia thrombocytopenia - bleeding bruising renal failure ```
100
Tests and results for TTP?
Blood smear shows fragmented erythrocytes, ie schistocytes high LDH. Indirect bilirubin level reticulocyte count is elevated Urinalysis shows proteinuria and microscopic haematuria
101
treatment for TTP?
plasma exchange IV prednisolone IV rituximab
102
presentation of DIC?
``` asymptomatic bleeding bruising petechiae SOB haemoptysis ```
103
investigations and results for DIC?
Low platelets Prolonged APTT, prothrombin and bleeding time Fibrin degradation products raised (eg. D-dimer) Blood film; Schistocytes due to microangiopathic haemolytic anaemia
104
3 presentations of 'bleeding disorders'
``` gum bleeding menorrhagia epistaxis petechiae bruising ```
105
which species of protozoa cause relapses of malaria?
p ovale | p vivax
106
What chromosomal translocation is there in myeloma?
11;14
107
Which leukaemia can undergo a Richter's transformation to malignancy?
CLL
108
3 symptoms of G6PD deficiency?
fatigue palpitations SOB pallor
109
4 things in the wells score?
heart rate over 100 haemoptysis malignancy signs of DVT
110
explain the pathophysiology of DIC?
consumptive coagulopathy tissue damage = release of tissue factor = widespread clot tissue plasminogen activator = fibrinolysis thrombosis and then fibrinolysis of those clots = bleeding
111
sepsis 6?
``` give fluuid give broad spec abx give oxygen take blood culture lactate dehydrogenase urine output ```

phase 2a (10 decks)

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