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medicine can be fun > Haem > Flashcards

Haem Flashcards

1
Q

what is polycythaemia vera

A

myeoloproliferative disorder causing excessive cell production

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2
Q

what gene mutation is associated with polycythaemia vera

A

JAK2 mutation

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3
Q

3 features of polycythaemia vera

A
  • pruritus after hot bath
  • splenomegaly
  • hyperviscosity
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4
Q

bloods for polycythaemia vera

A
  • FBC (high haematocrit)
  • ESR
  • U&Es & LFTs
  • JAK2 mutation
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5
Q

how do you investigate polycythaemia if JAK2 negative

A

red cell mass
serum erythropoietin

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6
Q

how do you manage polycythaemia vera

A

venesection + aspirin

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7
Q

what are the three types of anaemia and how are they classified

A
  • microcytic (low MCV)
  • normocytic (normal MCV)
  • macrocytic (high MCV)
    based on MCV
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8
Q

list two causes of microcytic anaemia

A
  • iron deficiency (most common)
  • thalassaemia
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9
Q

what are features of a mixed anaemia

A
  • iron deficiency features (low ferritin, high TIBC)
  • normocytic MCV
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10
Q

list four causes of normocytic anaemia

A
  1. anaemia of chronic disease (hospital)
  2. aplastic anaemia
  3. haemolytic anaemia
  4. CKD (low erythropoietin)
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11
Q

what do you see in FBC in aplastic anaemia and what virus is associated with it

A
  • pancytopenia
  • low reticulocytes
  • parvovirus
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12
Q

list two causes of megaloblastic anaemia

A

B12 and folate deficiency

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13
Q

what are the causes of non-megaloblastic macrocytic anaemia

A

AMHLF (alcoholics may have liver failure)
- alcohol
- myelodysplasia
- hypothyroidism
- liver disease
- folate/B12

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14
Q

what are the symptoms of anaemia (Asya’s acronym)

A

PALE
- pallor
- absent minded
- lethargy (tired)
- exertional dyspnoea

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15
Q

two signs of severe anaemia

A

tachycardia and tachypnoea

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16
Q

what are the three causes of iron deficiency anaemia

A
  1. reduced uptake
    • malnutrition, vegetarian
    • coeliac, IBD
  2. increased loss
    • bleed (colon cancer, ulcer NSAIDs)
    • menstruation
  3. increased requirements
    • pregnancy
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17
Q

3 signs of iron deficiency anaemia

A
  • conjuctival pallor
  • angular stomatitis
  • koilonychia
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18
Q

what do you see in the blood film in iron deficiency anaemia

A
  • hypochromic cells
  • anisopoikilocytosis
  • pencil cells
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19
Q

what do you see in the bloods in iron deficiency anaemia

A
  • low ferritin
  • high TIBC
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20
Q

what do you want to do for males and post-menopausal females with unexplained iron deficiency anaemia

A
  • endoscopy to investigate GI bleed
  • 2ww referral to gastroenterologist
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21
Q

3 ways to manage iron deficiency anaemia

A
  • treat the cause
  • oral ferrous sulphate for 3 months
  • iron rich diet (dark leafy veg, meat)
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22
Q

what causes anaemia of chronic disease

A
  • autoimmune, infection
  • chronic inflammation decreases ferroportin so less iron uptake and more iron storage
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23
Q

what do you see in the bloods in anaemia of chronic disease

A
  • high/normal ferritin
  • low TIBC
  • MCV can be low or normal
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24
Q

what is the pathophysiology of haemolytic anaemia

A
  • increased red cell breakdown
  • increased red cell production
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25
Q

how do you classify haemolytic anaemia

A

based on the site of haemolysis
- intra-vascular (transfusion, G6PD, microangiopathic)
- extra-vascular (haemoglobinopathies, sickle cell)

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26
Q

three causes of hereditary haemolytic anaemia

A
  1. enzyme defects (G6PD deficiency)
  2. membrane defects (hereditary spherocytosis)
  3. haemoglobin issues (sickle cell, thalassaemia)
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27
Q

what do you see on the blood film of G6PD deficiency

A

Heinz bodies

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28
Q

what is the pathophysiology and associations of G6PD deficiency

A
  • oxidant damage caused by Fava beans (Heinz beans)
  • males only
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29
Q

what do you see on the blood film for hereditary spherocytosis

A

spherocytes

30
Q

what is the pathophysiology of hereditary spherocytosis

A

round cells get trapped in the spleen

31
Q

what are acquired causes of haemolytic anaemia

A
  • Coombs positive:
    • autoimmune
    • transfusion reaction
  • Coombs negative
    • microangiopathic (HUS, DIC, TTP)
32
Q

antibodies associated with warm and cold autoimmune haemolytic anaemia

A
  • warm: IgM
  • cold: IgG
33
Q

what are four features of HUS

A
  • thrombocytopenia
  • AKI
  • haemolysis
  • abdominal pain
34
Q

what is the epidemiology and cause of HUS

A
  • children
  • E Coli
35
Q

what are the three features of TTP

A
  • HUS
  • fever
  • CNS issues
36
Q

two specific signs of haemolytic anaemia

A
  • jaundice (dark urine, yellow sclera)
  • splenomegaly
37
Q

what are three signs of haemolysis seen in bloods

A
  • high reticulocytes
  • high LDH
  • high bilirubin
38
Q

what is a sign of intravascular haemolysis seen in bloods

A

low haptoglobin

39
Q

pathophysiology behind B12 and folate deficiency anaemia

A
  • B12 and folate needed for DNA synthesis
  • delayed nuclear maturation compared to the cytoplasm so megaloblastic cells
40
Q

where is folate found and how long does it last in the blood

A
  • green leafy vegetables
  • lasts for 4 months
41
Q

4 causes of folate deficiency

A
  • increased requirement (pregnancy)
  • malabsorption (coeliac, IBD)
  • drugs (methotrexate)
  • alcohol
42
Q

where is B12 found and how long does it last in the blood

A
  • meat
  • lasts for 4 years
43
Q

2 causes of B12 deficiency

A
  • pernicious anaemia
  • vegan
44
Q

what is pernicious anaemia and what is its epidemiology

A
  • autoimmune atrophic gastritis
  • most common B12 deficiency
  • young females
45
Q

what is a characteristic sign of pernicious anaemia

A

Lemon tinge skin

46
Q

what are 2 symptoms of B12 deficiency

A
  • glove and stocking paraesthesia
  • hyporeflexia
47
Q

what do you see on the blood film of megaloblastic anaemia

A

hypersegmented neutrophils

48
Q

antibodies for pernicious anaemia

A
  • intrinsic factor (most specific)
  • anti-parietal cell
49
Q

how to manage folate and B12 deficiency

A
  • hydroxocobalamin (B12) + folic acid tablets
  • prophylactic folate in pregnancy
  • always remember to treat B12 before folate
50
Q

what is the treatment for pernicious anaemia

A
  • IM B12 injections
  • 3 per week for 2 weeks then every 3 months
51
Q

complication of pernicious anaemia

A

gastric cancer

52
Q

what is the epidemiology of Hodgkin’s lymphoma

A

bimodal (30 and over 70 yrs)

53
Q

what are 2 associations with Hodgkin’s lymphoma

A
  • HIV
  • EBV
54
Q

what are the symptoms of Hodgkin’s lymphoma

A
  • supraclavicular painless neck lump that’s painful after alcohol
  • B symptoms: fever, weight loss, night sweats
55
Q

what is the significance of B symptoms in Hodgkin’s lymphoma

A
  • they appear later so indicate poor prognosis
56
Q

what are two features seen in the bloods in Hodgkin’s lymphoma

A
  • eosinophilia
  • high LDH
57
Q

what is the diagnostic investigation and finding for Hodgkin’s lymphoma

A
  • lymph node biopsy
  • Reed-Stenberg cells (mirror nuclei)
58
Q

what is the management for Hodgkin’s lymphoma

A

chemotherapy

59
Q

what is tumour lysis syndrome and how do you prevent it

A
  • complication of chemotherapy for lymphoma
  • high potassium, low calcium
  • allopurinol prophylaxis
60
Q

what is the epidemiology for non-Hodgkin’s lymphoma

A

old and white

61
Q

what are 3 associations with non-Hodgkin’s lymphoma

A
  • HIV
  • EBV
  • Sjogren’s
62
Q

what are 2 features of non-hodgkin’s lymphoma

A
  • painless lump in the neck, axilla
  • organ involvement (hepatomegaly)
63
Q

what is seen in the bloods for non-Hodgkin’s lymphoma

A

neutropenia

64
Q

what is a characteristic feature of Burkitt lymphoma

A

lump in the jaw

65
Q

what is seen in the lymph node biopsy for Burkitt lymphoma

A

starry sky appearance

66
Q

what is sickle cell disease and what is its epidemiology

A
  • abnormal haemoglobin HbS is fragile so it breaks and gets stuck, blocking vessels
  • African, chromosome 11
67
Q

how does sickle cell disease present

A
  • usually asymptomatic
  • acute painful crises such as dactylitis from the cold
  • sequestration crisis causing splenomegaly
  • gallstones due to high bilirubin
68
Q

what do you see in the FBC and blood film for sickle cell disease

A
  • FBC: high reticulocytes
  • blood film: Howell Jolly bodies
69
Q

how do you investigate an acute crisis of sickle cell

A

clinical no investigation needed

70
Q

what is the diagnostic investigation for sickle cell disease

A

haemoglobin electrophoresis

71
Q

how do you manage an acute painful crisis of sickle cell

A
  • sats: oxygen
  • antibiotics
  • pain: analgesia
  • cannula: fluids
72
Q

what is a long term way to prevent recurrent sickle cell crises

A

hydroxycarbamide

medicine can be fun (12 decks)

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