Haem Flashcards
(90 cards)
1
Q
which HL carries the best prognosis
A
lymphocyte predominant
2
Q
which B symptoms indicate a worse prognosis in Lymphoma
A
night sweats
fever >38
weight loss >10% over 6 months
3
Q
which HL carries the worst prognosis
A
lymphocyte depleted
4
Q
what is a cause of post radiotherapy pancytopenia
A
myelodysplastic syndrome
5
Q
what leukaemia does myelodysplasia often transform into?
A
AML
6
Q
what anticoagulant is used in cancer patients
A
DOACs
7
Q
if a DVT is likely, what investigation should be done
A
Proximal Leg vein USS within 4 hours
8
Q
what should be done if Proximal Leg Vein USS is negative?
A
A D-dimer should be done
9
Q
What should be done if proximal leg vein USS is not available within 4 hours
A
interim anticoagulation before vein USS within 24 hours
10
Q
what if the proximal leg vein USS is negative but D-dimer is positive
A
stop interim anticoagulation
offer repeat scan in 6 to 8 days
11
Q
what should be done if Wells score is low and DVT is unlikely
A
D-dimer
12
Q
what should be done if D-dimer is positive in a low likelihood DVT
A
proximal leg vein USS within 4 hours
if this is not done, start interim anticoagulation
13
Q
what anticoagulant is used in the renally impaired for DVT
A
UFH or LMWH with VKA
14
Q
what anticoagulant is used in antiphospholipid syndrome patients with DVT
A
LMWH with VKA
15
Q
Key investigation for child suspected of leukaemia
A
Urgent FBC within 48 hours
16
Q
pentad of TTP
A
swinging fevers
neuro signs
renal failure
thrombocytopenia
haemolytic anaemia
17
Q
9 positive features of Well Score
A
active cancer
immobilisation
bed ridden
tenderness along vein
leg swollen
calf swollen
previous DVT
pitting oedema
superficial contralateral veins
18
Q
reticulocytes level in aplastic anaemia
A
LOW
19
Q
reticulocytes level in acute sequestration
A
HIGH
also seen in haemolysis
20
Q
how is a definitive diagnosis of sickle cell made
A
Hb electrophoresis
21
Q
main imaging in multiple myeloma
A
whole body MRI
22
Q
characteristic findings in SCD blood smear
A
Howell Jolly Bodies
23
Q
Waldenstroms features
A
hyperviscosity
monoclonal IgM paraprotein
cryoglobulinaemia
hepatosplenomelagy
systemic upset
24
Q
3 drugs that causes agranulocytosis
A
carbimazole
carbamezapine
clozapine
25
which amyloidosis is associated with chronic inflammation such as rheumatoid arthritis
what do they tend to present with
AA
renal disease e.g. nephrotic syndrome, proteinuria, renal failure
heptosplenomegaly
26
which amyloidosis is associated with multiple myeloma
AL
27
indirect marker of lymphoma proliferation
raised LDH
poor prognosis
28
what sort of lymphoma is associated with H.pylori
gastric MALT
29
what sort of lymphoma is associated with EBV
Burkitt's
30
what sort of lymphoma is associated with HIV
CNS lymphoma
31
what sort of lymphomas is associated with Hep C
diffuse large B-cell lymphoma and splenic marginal zone lymphoma.
32
what sort of lymphoma is associated with HTLV-1
T-cell lymphoma.
33
which conditions are associated with lymphoma [4]
coeliac disease
Sjogrens
post-transplant
AIDS
34
sickle cell crisis vs aplastic anaemia
aplastic: low reticulocytes, pancytopenia
crisis--> haemolysis: high reticulocytes to compensate
35
pathology behind sub acute combined degeneration of spinal cord
vitamin B12 deficiency caused by degeneration both the dorsal columns and corticospinal tracts (pain and temperature sensation are typically preserved)
36
Causes of basophilic stippling [6]
megablastic anaemia
myelodysplasia
thalassaemia alpha
sideroblastic anaemia
alcohol abuse
lead poisoning
37
causes of Howell Jolly Bodies
Hyposplenism
38
causes of schistocytes
MAHA: HUS, TTP, DIC
39
what does left shift mean
presence of immature cells
(including so-called band cells - neutrophils with an unlobed, band-shaped nucleus)
40
what is the significance of the number of lobes in the neutrophil nucleus
index of maturity
41
causes of left shift in neutrophils [4]
acute infection
myeloproliferative: CML, myelofibrosis, acute leukaemia
42
what does right shift mean
signifies the prevalence of hypermature neutrophils with greater than five nuclear lobes
In some cases, right shift may involve the presence of band cells, which are immature neutrophils with an unlobed, band-shaped nucleus
43
causes of right shift in neutrophils [3]
chronic infections
G-CSF
megaloblastic anaemic
44
what does the presence of reticulocytes indicate
high turnover of red cells matched by increased marrow production and release
45
causes of reticulocytosis [2]
acute bleeding
haemolysis
46
causes of target cells [3]
obstructive liver disease
haemoglobinopathies (thalassaemia and sickle cell disease)
post-splenectomy
47
causes of roleaux formation [3]
multiple myeloma
Waldenstrom's macroglobulinemia
inflammatory disorders and malignancies.
48
what is meant by a leukoerythroblastosis
A leukoerythroblastic film described to combined presence of immature (including nucleated) red blood cells and left shift (immature white cells)
49
causes of leukoerythroblastosis
marrow fibrosis or invasion, such as: primary myelofibrosis, metastatic cancer, TB and Gaucher's disease.
50
most common cause of anisocytosis
iron deficiency
51
causes of acanthocytes/spur cells
liver disease and neuroacanthocytosis (including abetalipoproteinemia and homozygous familial hypobetalipoproteinemia)
52
causes of Echinocytes or burr cells
liver disease, vitamin E deficiency, end-stage renal disease, and the haemolytic enzyme disorder pyruvate kinase deficiency.
53
difference between acanthocytes and echinocytes
Acanthocytes or spur cells are red blood cells that appear irregularly spiked on a blood film.
They are distinct from echinocytes (or burr cells) which are also spiked but with smaller projections in a more regular distribution than those seen on acanthocytes
Echinocytes or burr cells are red blood cells with small, regularly distributed projections across the cell surface. They are distinct from acanthocytes (or spur cells) which appear irregularly spiked or thorny.
54
how do you prevent painful episodes/crises in sickle cell disease
hydroxyurea
increases HbF
55
investigations for multiple myeloma
1) **Bloods**
full blood count: anaemia
peripheral blood film: rouleaux formation
urea and electrolytes: renal failure
bone profile: hypercalcaemia
2) **Protein electrophoresis**
raised concentrations of **monoclonal IgA/IgG proteins** will be present in the serum
in the urine, they are known as **Bence Jones proteins**
3) **Bone marrow aspiration**
confirms the diagnosis if the number of plasma cells is significantly raised
4) **Imaging**
historically a skeletal survey has been done to look for bone lesions
however, whole-body MRI is increasingly used and is now recommended in the 2016 NICE guidelines
X-rays: **'rain-drop skull'** (likened to the pattern rain forms after hitting a surface and splashing, where it leaves a random pattern of dark spots). Note that a very similar, but subtly different finding is found in primary hyperparathyroidism - 'pepperpot skull'
56
which blood film abnormalities may be seen in coeliac disease [2]
Howell Jolly and target cells
57
how should children with new onset purpura be managed
admitted immediately for investigations as it may be a sign of meningococcal septicaemia or acute lymphoblastic leukaemia
58
how should children with new bruising be treated
urgent FBC
59
features of acute chest syndrome [4]
dyspnoea
chest pain
pulmonary infiltrates on chest x-ray
low pO2
60
platelet transfusion threshold for clinically significant bleeding (World Health organisation bleeding grade 2- e.g. haematemesis, melaena, prolonged epistaxis)
< 30 x10^9
61
platelet transfusion threshold for patients with severe bleeding (World Health organisation bleeding grades 3&4), or bleeding at critical sites, such as the CNS.
< 100 x10^9
62
when should a platelet transfusion not be done [4]
Chronic bone marrow failure
Autoimmune thrombocytopenia
Heparin-induced thrombocytopenia, or
Thrombotic thrombocytopenic purpura.
63
Platelet level aim for most patients before/after surgery
> 50 ×10^9/L for most patients
64
Platelet level aim for patients with high risk of bleeding before/after surgery
50-75 x 10^9
65
Platelet level aim for patients having surgery at critical sites before/after surgery
> 100 x10^9
66
causes of spherocytes [2]
Hereditary spherocytosis
Autoimmune hemolytic anaemia
67
causes of Heinz Bodies [2]
G6PD deficiency
Alpha-thalassaemia
68
cause of tear drop cells
myelofibrosis
69
test for hereditary spherocytosis
EMA binding test
70
how is tranexamic acid given in major haemorrhage
IV bolus followed by slow infusion
71
medication to reduce risk of tumour lysis syndrome
allopurinol or rasburicase
72
how does MCV compare to Hb in thalassaemia
disproportionately low in comparison
73
most common inherited bleeding disorder
von Willibrand
raised aPTT and prolonged bleeding time
74
blood film features in hyposplenism (post splenectomy, coeliac)
target cells
Howell-Jolly bodies
Pappenheimer bodies
siderotic granules
acanthocytes
75
rheum conditions that cause neutropenia
SLE and RA
76
what can polycythaemia rubra vera progress to [2]
AML or myelofibrosis
77
treatment of polycythaemia vera [3]
aspirin
reduces the risk of thrombotic events
venesection
first-line treatment to keep the haemoglobin in the normal range
chemotherapy
hydroxyurea - slight increased risk of secondary leukaemia
phosphorus-32 therapy
78
Sickle cell patients should be started on long term ___________ to reduce the incidence of complications and acute crises
Sickle cell patients should be started on long term **hydroxycarbamide** to reduce the incidence of complications and acute crises
79
features of acute intermittent porphyria
management?
abdominal: abdominal pain, vomiting
neurological: motor neuropathy
psychiatric: e.g. depression
hypertension and tachycardia common
avoiding triggers
acute attacks
IV haematin/haem arginate
IV glucose should be used if haematin/haem arginate is not immediately available
80
transfusion threshold in someone with ACS
without ACS?
<80 (target 80-100)
<70 (target 70-90)
81
Ann-Arbor staging
I: single lymph node
II: 2 or more lymph nodes/regions on the same side of the diaphragm
III: nodes on both sides of the diaphragm
IV: spread beyond lymph nodes
82
cause of thrombocytopenia
Causes of severe thrombocytopenia
ITP
DIC
TTP
haematological malignancy
Causes of moderate thrombocytopenia
heparin induced thrombocytopenia (HIT)
drug-induced (e.g. quinine, diuretics, sulphonamides, aspirin, thiazides)
alcohol
liver disease
hypersplenism
viral infection (EBV, HIV, hepatitis)
pregnancy
SLE/antiphospholipid syndrome
vitamin B12 deficiency
83
purpose of irradiated blood
depleted of T-lymphocytes and used to avoid transfusion-associated graft versus host disease (TA-GVHD) caused by engraftment of viable donor T lymphocytes.
84
features of TACO
Hypertension, raised jugular venous pulse, afebrile, S3 present
85
features of TRALI
Hypotension, pyrexia, normal/unchanged JVP
86
what does cryoprecipitate contain
contains factor VIII, fibrinogen, von Willebrand factor and factor XIII
87
which leukaemia undergoes Richters transformation
what is the result of a richter's transformation
CLL
becomes a NHL
88
in a non-urgent scenario, a unit of RBC is usually transfused over _____
in a non-urgent scenario, a unit of RBC is usually transfused over **90-120 minutes**
89
is CLL associated with warm or cold autoimmune haemolytic anaemia
warm
90
The universal donor of fresh frozen plasma is ___ RhD ______ blood
The universal donor of fresh frozen plasma is **AB** RhD **negative** blood
