Haem 3 Flashcards by Aisha Mujahid

malignant haemopiesis is what

increased number of dysfunctional cells that have lost the normal haemopoiteic reserve

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one or more of what is in malignant haemopoiesis

increased proliferation
lack of differentiation
lack of maturation
loss of apoptosis

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acute leukaemia

abnormal proliferation and lack of maturation

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ix for acute leukaemia

excess of blasts >20% in either peripheral blood or bone marrow
decreased/ loss of normal haemopoietic reserve

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ALL is a malig disease of what
most common what
symptoms

malig disease of lymphocytes
most common childhood cancer
very severe bone pain, BM failure : infections, bleeding, anaemia
increased WCC, venous obstruction, CNS involvement

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AML in who 
may be what of two 
similar to what 
subgroups 
occurs after treatment of what 
ix

>60s
may be denovo or decondary 
similar to ALL
DIC or gum infiltration 
alkylating agents 
auer rods

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what can be done as ALL and AML look the same sometimes

BM aspirate immunophenytyping

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myeloproliferative disorders is what

clonal haemopoietic stem cell disorders with an increase production of one or more haemopoitetic cells - in contrast to acute leukaemia maturation is relatively preserved

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common features of myeloproliferative disorders

asymp
gout
weight loss
fatigue
sweats 
splenomegaly
thrombus in unusual place - no reactive explanation

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CML is what

over production of grnaulocutes

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pattern of CML

prolif of myeloid cells, chronic phase with intact maturation 3-5y, accelerated phase, blast crisis (acute leukaemia)

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when is fatal of CML

fatal without stem cell/BM transplant in chronic phase

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ix for CML

normal or low Hb
leucocytes/neurtrophilia
myeldoi precursors
eosinophilia, basophilia, thrombocytosis

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philapdelphia

9+22 -> tyrosine kinase which causes abnormal phosphorylation - signalling leading to haematological changes in CML

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treatment of CML

imatinib

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PRV is overproduction of what

overproduction of RBCs

high Hb/hc accompanied by erythrocytes

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ddx of secondary polycythaemia

chronic hypoxia, smoking, erytho secreting tumour

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ddx of pseudopolycythaemia

dehydration, diuretics, obesity

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aquagenic pruritus

polycythaemia ruba vera

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ix for PRV

FBC
film
JAK2 mutation
px with secondary won’t have splenomegaly

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JAK2

kinase

activation of erythropoiesis in absence of ligand

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treatment of PRV

venesection to haemocrit <0.45
aspirin to reduce thromb risk
hydroxycarbomide - oral chemo

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essential thrombocytopenia

high can lead to what

uncontrolled production of abnormal platelets

at high levels can lead to VW dx

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symp of ET

MPD symp and bleeding (unpredictable risk of surgery)

microvascular occlusion

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ix for ET

exclude reactive thrombosis JAK2 in 50% CALR in rest MPL mutation characteristic bone marrow appearance

treatment for ET

aspirin hydoxycarbamide anagrelide interferon alpha last line

myelofibrous idiopathic

marrow failure, marrow fibrosis, extra medullary haemopoesis, leukthrombin film

tear dropped shaped RBC

myelofibrosis

when else can you get myelofibrosis

post polycythaemia or ET

BF in ET

tear dropped shaped RBC and leucoerythroblastic dry aspirate fibrate on trophine biopsy JAK2 or CALR mutation

what are the causes of a leukoerythroblastic film

reactive - sepsis marrow infiltration - cancer myelofibrosis

treatment of myelofibrosis

transfusion, AB, allogenic SC tranplant, splenectomy | JAK2 inhibitors

CLL is the commonest what

leukaemia

CLL who

65-75

what is CLL

clonal expansion os small lymphocytes

symp of CLL

``` asymp recurrent infection anaemia splenomegaly lymphocytes >5x109/L ```

what is pancytopenia

anaemia thrombocytopenia neutropenia

decreased production

inherited bone marrow failure arise due to to defects in DNA repair/ribosome falcon;s

fanconi's symp | what happens in it

short, skin abnormalities, radial ray abnormalities, hypogenitilia, endocrine, GI, haem, renal unable to repair inter stand cross links

fanconi's 97% | 52%

BM failure by 20yo | leukaemia by 40yo

acquired primary BMF

aplastic anaemia myelodysplastic dysplasia acute leukaemia

aplastic anaemia

AI attack against haemopoetic stem cells | hypocellular

myelodysplastic dyaslsoa

hypercellular mass ineffective haemopoiesis 20-30% risk of AML

acute leukaemia

prevention of normal haemopoiesis

secondary BMF

drug - chemo, chloramphenicol alcohol, B12 and folate infiltrative - malignancy, lymphoma, viral (HIV), storage disease

increased destruction

hypersplenism | portal htn, CCF, fieltys, splenic lymphoma

clinical features of pan

anaemia - fatigue, SOB CDV compromise, neutropenia infections - bleeding symp depending on cause

ix for for pan

FBC, film, B12/folate LFTs - hyersplenism HIV/virology AB tests (SLE)

test for fanconis

chromosome fragility test

hypocellular pan | hypercellular pan

aplastic | MDS, B12/folate, hypersplenism

rx for pan

``` malig - chemo congenital - transplan idiopathic aplastic anaemia - immunosuppression supportive transfusions ABs ```

normla splenic RC mass RC transit platelets pool

5% fast 20-40%

hyposplenic RC mass RC transit platelets pool

40% slow 90%

hodgkins symptoms

``` painless cervical LD mediastinum spread - cough hepatospleno B symp pruritus and alcohol related pain ```

burkitts translocation

8 and 14

burrkitts lymphoma

very high grade

mantle cell

similar tp low grade hodgkins but very aggressive and incurable with chemo

marginal zone NHL

low grade

other types of B cell NHL

follicular diffuse large b cell - commonest world wide lymphplasmocytic lymphoma

major haemorrhage protocol what does the blood bank send

4 units of RBC 4 frozen plasma 1 platelets

``` ongoing bleeding after transfusion management ix what should be given RBC how cryprecipitate when consider further what ```

repeat blood samples transfuse further RBC:FFP 2:1 (1:1 in trauma) cryoprecipitate if fibrinogen <1 (<2 in obstetric haem) consider further platelets

``` management if bleeding stopped after transfusion Hb ATTP and PT platelets fibrinogen use what ```

``` Hb>80 AtPP and PT ration <1.5 platelets >50 fibrinogen >1.5 (>2 in obstetrics) use blood warmer ```

when should you assume neutropenic sepsis

if received chemo within past 3 weeks, temp >=38 or clinical evidence of significant sepsis SIRS>=2

standard risk px

neutropenia and sepsis and SEWS score <6

standard risk px treatment

piperacillin/tazobactam PA teioplanin and aztreonam if anaphylaxis or angiooedema Teicoplanin and ciprofloxacin

high risk px

neutropenic and severe septic/septic shock or SEWS >=6

high risk px treatment

pipercillin/tazobactem and gentamicin PA - teicoplanin and aztreonam and gent if anaphylaxis or angiooedema teicplanin and ciprofloxacin and gentamicin

when should AB be started in neutropenic sepsis

within 1hr | don't wait for blood culture results

Haem 3 Flashcards

(68 cards)