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Flashcards in Haem Deck (46):
1

Which cells are affected in Myeloma?

Plasma cells

2

Which two types of immunoglobulin are released in myeloma?

IgG and IgA.

3

What is MGUS?

Monoclonal Gammopathy - progressive build up of M protein (monoclonal protein). Over years this can result in other conditions such as other blood cancers.

4

Give three symptoms of myeloma?

- Back ache (vertebral collapse and spinal compression).
- Bone fractures
- Infections
- Weight loss
- Neurological (due to high calcium).

5

What are some of the clinical signs of myeloma?

'CRAB'
- Calcium (elevated)
- Renal failure
- Anaemia
- Bone lesions

6

What type of anaemia does myeloma cause?

Macrocytic (impaired production in bone marrow).

7

What is the most common early investigation done if myeloma is suspected?

X-ray (looking for osteolytic lesions).

8

What is ESR?

Erythrocyte Sedimentation Rate
- A measure of inflammation.

Time for RBCs to sediment out of a blood sample is quicker if there is inflammation as the cells clump together. Therefore, shorter ESR = more inflammation.

9

Why might you avoid giving a patient with myeloma NSAIDs for analgesia?

Risk to renal system.

Myeloma causes renal impairment in 20% of cases and NSAIDs also can damage the kidneys.

10

What are Rouleaux?

Linear aggregates of RBCs which is often a sign of blood disorders like myeloma and lymphoma as well as diabetes (contributes to retinopathy).

11

What are an enlarged tongue and bruising around the eyes a classic sign of?

Amyloidosis.

12

What cells are primarily involved in lymphoma?

Lymphocytes

13

What are the symptoms of lymphoma?

- Lymphadenopathy [75% cases]
- Fever
- Night Sweats
- Weight Loss
- Fatigue
- Anaemia

14

What is meant by B symptoms?

Systemic symptoms:
- Night sweats
- Fever
- Weight loss

Indicative of cancer.

15

What constitutes worrying weight loss?

+10% body weight in 6 months without trying/an alternative explanation.

16

What is pancytopenia?

Reduction in RBC, WBC and platelets.

17

What is a common site of extra-nodal disease in lymphoma?

Mucosa Associated Lymphoid Tissue (MALT) involvement.

18

What investigations would you perform to help diagnose lymphoma?

- History & Examination
- Lymph node biopsy
- Bone marrow biopsy
- Blood film
- CT/PET (staging/spread).

19

Histologically, what differentiates Hodgkin from Non-Hodgkin Lymphoma?

Reed-Sternberg cells = Hodgkins.

20

How do you sub-categorise Non-Hodgkin Lymphoma?

Low-Grade (indolent, often incurable).

High Grade: Aggressive (often curable) - 'kill or cure'

21

Give an example of a common paediatric high grade NH-lymphoma.

Burkitt's lymphoma.

NB: Burkitt's Lymphoma has a characteristic jaw lymphadenopathy.

22

What is the treatment of lymphoma?

- Radiotherapy (if focal)
- Chlorambucil (if diffuse)
- R-CHOP

23

What drugs are included in R-CHOP chemotherapy?

Rituximab
Cyclophosphamide
Hydroxydaunorubicin
Vincristine (Oncovin)
Prednisolone

24

What type of drug is Rituximab?

Monoclonal Antibody used to treat cancer and some immune disorders.

Targets CD20 surface protein on B lymphocytes.

25

Which has a better prognosis, Hodgkin's lymphoma or Non-Hodgkin's?

Hodgkin's

26

What is meant by Thrombocytopenia?

Low platelet count

27

What is meant by thrombocythemia?

Elevated platelet count

'Essential thrombocythemia' (increased bone marrow production).

OR the result of bleeding or trauma e.g. surgery,

28

What is ITP?

Idiopathic Thrombocytopenic Purpura

Autoimmune destruction of platelets (via IgG), causing purpuric rash

29

Which age group(s) tend to get Hodgkin's?

Biphasic
25-30 yos and +55

30

What are the 4 stages of Lymphoma?

Stage 1: Local; single node.

Stage 2: Two or more nodes all above or below diaphragm.

Stage 3: Two or more nodes on both sides of the diaphragm.

Stage 4: Widespread. Multiple organs with or without lymph node involvement.

31

What are the 4 types of leukaemia?

Acute Lymphocytic Leukaemia (ALL)

Acute Myeloid Leukaemia (AML)

Chronic Lymphocytic Leukaemia (CLL)

Chronic Myeloid Leukaemia (CML)

32

Which type of leukaemia is most common in children?

Acute Lymphocytic Leukaemia (ALL)

'ALL children get this kind'.

33

Which type of leukaemia is most common in adults?

Chronic Lymphocytic Leukaemia (CLL)

NB: Acute forms of leukaemia affect children. AML affects both children and adults.

34

Give 3 symptoms of leukaemia.

- Bleeding/Bruising
- Gum hypertrophy
- Infection
- Fatigue (flu-like)
- Night Sweats
- Weight loss

NB: Symptoms tend to come on quickly around 2 weeks.

35

Give 3 clinical features of leukaemia.

- Splenomegaly
- Hepatomegaly
- Petechiae (pinprick bleeds)
- Dyspnoea (short breath)
- Anaemia
- Infections
- Hyperviscosity

36

What investigations would you do for someone with leukaemia?

- FBC
- Coagulation screen
- Bone marrow biopsy
- X-ray
- Cytogenetic screening
- Lymph node biopsy
- Flow cytometry

37

What is flow cytometry?

Using a laser to analyse physical and chemical characteristics of a liquid as it flows through a narrow tube.

38

Define anaemia

Low Hb concentration in the blood.

39

How is anaemia sub-categorised?

Microcytic
Normocytic
Macrocytic

Depends on Mean Cell Volume (MCV)

40

What is normal range for MCV?

76-96 femtometers

41

Give three causes of microcytic anaemia.

- Iron Deficiency
- Chronic infection
- Thalassaemia
- Sideroblastic anaemia

42

Give three causes of normocytic anaemia

- Chronic disease
- Acute Blood Loss
- Renal Failure

43

Give three causes of macrocytic anaemia?

- B12 of folate
- Hypothyroidism
- Alcohol
- Bone cancer

44

What is normal Haematocrit?

47% for men
42% for women

Avg. for adult (44%).

45

What is the normal range for Hb?

13 - 16.5 g/dl

46

What is sideroblastic anaemia?

Ineffective erythropoiesis

NB: Wont respond to iron treatment!