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Haem Flashcards

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1
Q
  1. What is the lifespan of a RBC ?
A
  • 3 months
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2
Q
  1. What is the lifespan of a platelet ?
A
  • 10 days
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3
Q
  1. What condition is anisocytosis associated with ?
A
  • Myelodysplastic syndrome
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4
Q
  1. What condition are target cells associated with ?
A
  • Iron deficiency anaemia
  • Post-splenectomy
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5
Q
  1. What condition are Heinz bodies associated with ?
A
  • G6PD deficiency
  • Alpha-thalassemia
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6
Q
  1. What conditions are reticulocytes associated with ?
A
  • Haemolytic anaemia
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7
Q
  1. What is normal hemoglobin ranges for men and women ?
A
  • 130-180g/L Men
  • 120 – 165g/L Women
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8
Q
  1. What is the normal MCV range ?
A
  • 80-100 femtolitres
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9
Q
  1. What can cause microcytic anaemia ?
A
  • Thalassemia
  • Anaemia of chronic disease
  • Iron deficiency
  • Lead poisoning
  • Sideroblastic anaemia
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10
Q
  1. What can cause normocytic anaemia ?
A
  • Haemolytic anaemia
  • Hypothyroidism
  • Acute blood loss
  • Aplastic anaemia
  • Anaemia of chronic disease
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11
Q
  1. Megaloblastic anaemia ?
A
  • B12 deficiency
  • Folate deficiency
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12
Q
  1. Normoblastic macrocytic anaemia ?
A
  • Reticulocytosis e.g. .due to haemolysis
  • Alcohol abuse
  • Hypothyroidism
  • Liver disease
  • Drugs e.g. azathioprine
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13
Q
  1. A 28 yo presents with tiredness and hair loss. Blood results should a hypochromic microcytic anaemia. What is the diagnosis ?
A
  • Iron deficiency anaemia
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14
Q
  1. What clinical signs appear with iron deficiency anaemia ?
A
  • Koilonychia (abnormally thin nails)
  • Angular chelitis
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15
Q
  1. What is the initial diagnostic test for iron deficiency anaemia ?
A
  • Serum ferritin
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16
Q
  1. What are possible underlying causes of iron deficiency anaemia ?
A
  • Inadequate dietary iron
  • Inadequate iron absorption e.g. coeliac
  • Increased iron requirement e.g. pregnancy
  • Bleeding e.g. heavy periods or GI cancer
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17
Q
  1. What is management of iron deficiency anaemia when the cause isn’t clear ?
A
  • Urgent OGD and colonoscopy to exclude GI cancer
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18
Q
  1. What condition are smudge cells associated with ?
A
  • Chronic lymphocytic leukaemia
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19
Q
  1. What treatment options are available for iron deficiency anaemia ?
A
  • Oral iron (ferrous sulfate)
  • Iron infusion
  • Blood transfusion (if very low)
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20
Q
  1. What condition is +ve intrinsic factor antibodies associated with ?
A
  • Pernicious anaemia
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21
Q
  1. Where is intrinsic factor produced ?
A
  • Parietal cells of the stomach
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22
Q
  1. What is the key symptom associated with pernicious anaemia ?
A
  • Peripheral neuropathy
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23
Q
  1. How does pernicious anaemia present ?
A
  • Anaemia features – lethargy, pallor and dyspnoea
  • Neurological features – pins and needles, weakness, ataxia and paresthesia
  • Neuropsychiatric features – memory loss, poor concentration, confusion, depression and irritability
  • Mild jaundice + pallor = lemon tinge
  • Atrophic glossitis
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24
Q
  1. How is pernicious anaemia treated and which medication is given first and why ?
A
  • Intramuscular hydroxycobalamin injections (IM B12)
  • Folic acid supplementation may be required
  • Treat B12 first as treating folate first can cause subacute combined degeneration of the spinal cord
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25
25. What is autoimmune haemolytic anaemia ?
- When antibodies develop against RBC cells causing haemolysis - What activates the antibodies depends on the temperature - 2 types – hot or cold haemolytic anaemia
26
26. What is warm autoimmune haemolytic anaemia ?
- The MC - Haemolysis caused by IgG - Haemolysis tends to occur in extravascular sites like the spleen - Can be caused by SLE, lymphoma, CLL and methyldopa (idiopathic)
27
27. How is warn autoimmune haemolytic anaemia managed ?
- Treatment of underlying disorder - Steroids (+/- rituximab) are 1st line
28
28. What is cold autoimmune haemolytic anaemia ?
- The antibody in cold AIHA is usually IgM and causes haemolysis best at 4 deg C. - Haemolysis is mediated by complement and is more commonly intravascular. - Features may include symptoms of Raynaud's and acrocynaosis. - Patients respond less well to steroids
29
29. What can cause cold autoimmune haemolytic anaemia ?
- Neoplasia: e.g. lymphoma - Infections: e.g. mycoplasma, EBV
30
30. What is found on blood films of autoimmune haemolytic anaemia ?
- Raised reticulocytes - Schistocytes
31
31. What are inherited causes of haemolysis ?
- Hereditary spherocytosis - Hereditary elliptocytosis - Thalassaemia - Sickle cell anaemia - G6PD deficiency
32
32. What condition causes defective globin chains ?
- Thalassaemia
33
33. What types of thalassaemia are there ?
- Alpha thalassaemia - Beta thalassaemia
34
34. What is the inheritance pattern of thalassaemia ?
- Autosomal recessive
35
35. How would thalassaemia present in the abdomen, sclera, conjunctiva and FBC ?
- Splenomegaly - Jaundice - Pallor - Microcytic anaemia
36
36. What is the diagnostic test for thalassaemia ?
- Haemoglobin electrophoresis
37
37. What management is there for thalassaemia ?
- Blood transfusion - Splenectomy
38
38. Why is serum ferritin monitored in thalassemia ?
- Risk of iron overload
39
39. What is a potential cure for thalassemia ?
- Bone marrow transplant
40
40. What is the name for when you have one sickle cell gene ?
- Sickle cell trait
41
41. What antibiotic is given as prophylaxis in children with sickle cell ?
- Penicillin V
42
42. What medication stimulates Hbf production ?
- Hydroxycarbamide
43
43. What is a potential cure of sickle cell ?
- Bone marrow transplantation
44
44. What types of sickle cell crises are there ?
- Acute chest syndrome - Vaso-occlusive crisis - Splenic sequestration crisis - Aplastic crisis
45
45. A 75 yo presents with fatigue, pallor and abnormal bruising. What is the diagnosis ?
- Acute myeloid leukaemia
46
46. What are the types of leukaemia ?
- Acute myeloid leukaemia - Acute lymphoblastic leukaemia - Chronic myeloid leukaemia - Chronic lymphocytic leukaemia
47
47. What causes bruising in acute myeloid leukaemia ?
- Thrombocytopenia (low platelet)
48
48. What is the diagnostic test for acute myeloid leukaemia ?
- FBC for initial - Bone marrow biopsy is definitive
49
49. What type of leukaemia is associated with Philadelphia chromosome ?
- ALL and CML
50
50. What type of leukaemia is associated with smudge cells ?
- CLL
51
51. What type of leukaemia is associated with myelofibrosis ?
- AML
52
52. What type of leukaemia is associated with Richter’s transformation ?
- CLL
53
53. What are the main treatments for leukaemia ?
- Chemotherapy - Steroids
54
54. What is the cause of increased uric acid in leukaemia ?
- Tumour lysis syndrome
55
55. A 24 yo presents with enlarged rubbery non-tender lymph nodes. Pain is worse with alcohol use. What is the diagnosis ?
- Hodgkins lymphoma
56
56. What viruses are associated with Hodgkins lymphoma ?
- HIV - Epstein-Barr
57
57. What is the diagnostic test for Hodgkins lymphoma ?
- Lymph node biopsy
58
58. What is the special cell seen on histology in Hodgkins lymphoma ?
- Reed-Sternberg cells
59
59. What is the staging system used in Hodgkins lymphoma ?
- ANN Arbor has been replaced by Lugano classification
60
60. What is the main treatments for Hodgkins lymphoma ?
- Chemo and radio
61
61. What type of lymphoma is associated with EPV ?
- Burkitt Lymphoma
62
62. What type of lymphoma is associated with H.pylori ?
- Malt lymphoma
63
63. What type of lymphoma is associated with a rapidly growing painless mass ?
- Diffuse large B-cell lymphoma
64
64. A 67 yo presents with vague symptoms of weight loss, tiredness and bone pain. What is the most likely diagnosis ?
- Multiple myeloma
65
65. What are the key features of multiple myeloma ?
- CRAB - Calcium elevated - Renal failure - Anaemia - Bone lesions/bone pain
66
66. What are the initial lab tests for multiple myeloma ?
- Serum protein electrophoresis - Serum-free light chain assay - Urine Bence-Jones protein
67
67. What test is used to confirm the diagnosis of multiple myeloma ?
- Bone marrow biopsy
68
68. What would the skull look like on X-ray of multiple myeloma ?
- Raindrop skull
69
69. What is 1st line chemo in multiple myeloma ?
- Bortezomib - Thalidomide - Dexamethasone
70
70. A 62 yo presents with itching, bruising and excessive sweating. His Hb is 208g/L. What is the diagnosis ?
- Polycythaemia vera
71
71. From what cell line are RBCs produced ?
- Erythroid cells
72
72. What is the key gene mutation in polycythaemia vera ?
- JAK2
73
73. What is the diagnostic test for polycythaemia vera ?
- Bone marrow biopsy
74
74. What is the key complication of polycythaemia vera ?
- Thrombosis
75
75. What is the key management of polycythaemia vera ?
- Venesection - Aspirin - Chemotherapy
76
76. What myeloproliferative disorders are there ?
- Polycythaemia vera - Primary myelofibrosis - Essential thrombocythemia
77
77. What can potential myeloproliferative disorders potentially malignantly transform into ?
- Acute myeloid leukaemia
78
78. A 50yo women with 2 weeks of bruising rash and nosebleeds presents with a platelet count of 16x10(9)/L. What is the diagnosis ?
- Immune thrombocytopenia purpura
79
79. How is immune thrombocytopenia purpura treated ?
- Steroids - IV immunoglobulins - Rituximab - Splenectomy
80
80. What can cause low platelets ?
- B12 or folate deficiency - Alcohol - Heparin induced thrombocytopenia - Thrombotic thrombocytopenic purpura
81
81. A 28 yo women with a history of heavy periods and epistaxis presents. Her mother had a hysterectomy at 40 for heavy periods. What is the most likely diagnosis ?
- Von Willebrand disease
82
82. What can cause abnormal or prolonged bleeding ?
- Thrombocytopenia - Von Willebrand disease - Haemophilia A or B - Disseminated intravascular coagulopathy
83
83. What treatment is required for Von Willebrand disease ?
- Desmopressin - Von Willebrand factor infusion - Factor 8 infusion
84
84. What is the underlying pathology in haemophilia ?
- A  Factor 8 deficiency - B  Factor 9 deficiency
85
85. A 32 yo with a history of 3 miscarriages presents with a swollen and tender leg. What is the diagnosis ?
- DVT
86
86. What difference in leg circumference is significant in deep vein thrombosis ?
- >3cm
87
87. A 32 yo with a history of 3 miscarriages presents with a swollen and tender leg. What is likely the underlying cause of the DVT ?
- Antiphospholipid syndrome
88
88. In antiphospholipid syndrome. What is the test, treatment and treatment in pregnancy ?
- Test = antiphospholipid antibodies - Treatment = long term warfarin - Pregnancy = low molecular weight heparin and aspirin
89
1. What is disseminated intravascular coagulopathy
- Dysregulation in the process of coagulation and fibrinolysis resulting in widespread clotting with resultant bleeding
90
2. What is the pathophysiology of DIC
- Tissue factor (TF) is present on many cell types and not normally in contact with general circulation but is exposed to after vascular damage - Upon activation TF binds with coagulation factors that then trigger the extrinsic pathway (Via F7) which subsequently triggers the intrinsic pathway (12 to 11 and 9) of coagulation
91
3. What can DIC ?
- Sepsis - Trauma - Obstetric complications e.g. haemolysis, elevated liver FT, low platelets (HELLP) syndrome
92
4. What does a typical blood picture look like in DIC ?
- Decreased platelets and fibrinogen - Increased PT, APTT and fibrinogen degradation products - Schistocytes due to microangiopathic haemolytic anaemia
93
5. What is thrombotic thrombocytopenic purpura ?
- A condition where tiny thrombi develop through the small vessels using up platelets. As the problem is in the small vessels it is described as a microangiopathy causing: - Thrombocytopenia, purpura and tissue ischaemia with end organ damage
94
6. What is the pathogenesis of Thrombotic thrombocytopenic purpura ?
- Abnormally large and sticky multimers of von Willebrand’s factor cause platelets to clump within vessels - In TTP there is a deficiency of ADAMTS13 (a metalloprotease enzyme) which breakdowns ('cleaves') large multimers of von Willebrand's factor - overlaps with haemolytic uraemic syndrome (HUS)
95
7. What are features of thrombotic thrombocytopenic purpura ?
- Rare – typically adult females - Fever - Fluctuating neuro signs (microemboli) - Microangiopathic haemolytic anaemia - Thrombocytopenia - Renal failure
96
8. What are potential causes of thrombotic thrombocytopenic purpura ?
- Post-infection e.g. urinary, GI - Pregnancy - Drugs: ciclosporin, oral contraceptive pill, penicillin, clopidogrel and aciclovir - Tumours - SLE - HIV
97
9. How is thrombotic thrombocytopenic purpura treated ?
- Guided by haematologist - This may involve plasma exchange, steroids and rituximab
98
10. What is Immune thrombocytopenia purpura ?
- A condition where antibodies are created against platelets leading to their destruction and thrombocytopenia - It is characterised by purpura which are non-blanching lesions caused by bleeding under the skin
99
11. How can immune thrombocytopenia purpura be managed ?
- Prednisolone (steroids) - IV immunoglobulins - Thrombopoietin receptor agonists e.g. avatrombopag - Rituximab - Splenectomy
100
12. Why is rituximab useful in autoimmune disease ?
- B cells produce antibodies - Reducing B cell numbers reduces inflammation
101
13. What is heparin-induced thrombocytopenia ?
- The development of antibodies against platelets in response to heparin (usually unfractionated heparin but can also occur with low-molecular-weight heparin) - Heparin-induced antibodies target protein on platelets called platelet factor 4 (PF4)
102
14. What is the pathophysiology of heparin-induced thrombocytopenia ?
- HIT antibodies bind to platelets activating the clotting system causing a hypercoagulable state and thrombosis - They also break down platelets causing thrombocytopenia - There is then a counterintuitive situation where a patient is on heparin, has a low platelet count, and develops abnormal blood clots
103
15. When does heparin-induced thrombocytopenia usually occur ?
- The condition typically presents around 5-10 days after starting treatment with heparin
104
16. How is heparin-induced thrombocytopenia managed ?
- Stopping heparin and using an alternative anticoagulant guided by a specialist e.g. fondaparinux or argatroban
105
1. What would the blood results be in terms of prothrombin time, APTT, bleeding time and platelet count for a patient on warfarin ?
- PT – prolonged - APTT, bleeding time and platelet count – normal
106
2. What would the blood results be in terms of prothrombin time, APTT, bleeding time and platelet count for a patient on aspirin ?
- Prothrombin time, APTT and platelet count normal - Prolonged bleeding time
107
3. What would the blood results be in terms of prothrombin time, APTT, bleeding time and platelet count for heparin ?
- Prothrombin time – normal but can be prolonged - APTT and platelet count – normal
108
4. What would the blood results be in terms of prothrombin time, APTT, bleeding time and platelet count for DIC ?
- Prothrombin time, APTT, bleeding time – prolonged - Platelet count – low

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