Haem Flashcards by S B

what is the life span of red blood cells

120 days

How well did you know this?

Not at all

Perfectly

what is ferritin in relation to infection

acute phase protein

will increase in infection and malignancy

How well did you know this?

Not at all

Perfectly

what is DDx for microcytic anaemia

iron deficiency - low ferritin, low iron, TIBC high = Tx with ferrous sulphate 200mg / 8h PO

thalassemia - is the under production or no production of one globin chain

sideroblastic (rare) - consider when patient not responding to iron

How well did you know this?

Not at all

Perfectly

what is DDx for normocytic anaemia

acute haemorrhage
anaemia of chronic disease
bone or renal failure 
hypothyroidism 
pregnancy

How well did you know this?

Not at all

Perfectly

what is DDx for macrocytic anaemia

B12/folate deficiency

cytotoxic and anti-folate

alcohol excess = most common

reticulocytosis

myelodysplastic syndrome

marrow infiltrations

hypothyroidism (may ask be normocytic)

How well did you know this?

Not at all

Perfectly

what are potential side effects of blood transfusions

bacterial contamination

Febrile/allergic reactions [non-haemolytic febrile transfusion reaction]

fluid overload

TRALI = transfusion related acute lung injury

incompatibility (ABO, Rh)

How well did you know this?

Not at all

Perfectly

what is mx for blood transfusions

stop transfusion

confirm identity and blood

ABCDE

tell haematologist/anaesthetist

retain unit transfusion

give furosemide/chlorphenamine/oxygen

How well did you know this?

Not at all

Perfectly

summary of AML

marrow failure, fast progression, organic infiltration (classically gum hypertrophy)

most common form in adults

may present with pancytopenia

Mx = chemotherapy

How well did you know this?

Not at all

Perfectly

Ix [and buzzword] for AML

Marrow Biopsy = >30% blasts is diagnostic

[buzzword = Auer Rods]

How well did you know this?

Not at all

Perfectly

summary of ALL [and buzzword]

B or T cells implications - marrow failure, fast progression, organic infiltration

Blast cells seen on bone marrow biopsy = diagnostic [buzzword = Philadelphia chromosome]

Ix shows = leukocytosis,

TK activity seen [targeted with IMATINIB]

most common in kids - peak age 2-5

How well did you know this?

Not at all

Perfectly

summary of CML [and buzzword]

[buzzword = Philadelphia chromosome. Translocation of Chr 9 on Chr 22]

occur more frequently in men 40-60 years of age

insidious [weight loss, sweat, tiredness, fever] with possible spelnomeglay

Tx = TK activity seen [can be targeted with Imatinib]

How well did you know this?

Not at all

Perfectly

summary of CLL [and buzzword]

mature B cells, most common leukaemia seen in older patients

often asymptomatic = lymphadenopahy, splenomegaly, hepatomegaly

increased WCC with late features of marrow infiltration and autoimmune haemolysis. Patient at risk of RECURRENT INFECTIONS.

Ix = immunophenotyping

Mx = chemotherapy, radiotherapy

How well did you know this?

Not at all

Perfectly

what are the risks of leukaemia

increased risk of infection, bleeding, hyper viscosity

Tumour lysis syndrome

DIC = consumption of platelets

How well did you know this?

Not at all

Perfectly

what are the two types of lymphoma

Hodgkins

Non-Hodgkins

How well did you know this?

Not at all

Perfectly

what is lymphoma due to

malignant lymphocytes producing lymphadenopathy

How well did you know this?

Not at all

Perfectly

what is the buzzword for Hodgkins lymphoma

Reed-Sternberg cells

How well did you know this?

Not at all

Perfectly

how does Hodgkins lymphoma present

Present with painless rubbery enlarge lymph nodes but note ‘B’ symptoms as prognostically significant

How well did you know this?

Not at all

Perfectly

Mx of Hodgkins lymphoma

chemoradiotherapy

How well did you know this?

Not at all

Perfectly

how is the Histological diagnosis of lymphoma done

Ann-Arbor Staging (radiological), relative to spread beyond diaphragm or lymph tissue

How well did you know this?

Not at all

Perfectly

what is Non-Hodgkins associated with

Association with HIV/EBV, immunodeficiency (Burkitt’s)

High grade are usually more aggressive but often curable; low grade are indolent, widely disseminated and often incurable

How well did you know this?

Not at all

Perfectly

what is myeloma

abnormal proliferation of plasma or lympho-plasmacytic cells leading to immunoglobulin (Ig) or fragment secretion

classification based on immunoglobulin (most common IgG)

How well did you know this?

Not at all

Perfectly

buzzword for myeloma

Bence Jones protein in urine

How well did you know this?

Not at all

Perfectly

Sx of myeloma

Osteolytic bone lesions

Marrow infiltration of plasma cells (pancytopenia) and associated infections

Renal impairment secondary to BJPs

How well did you know this?

Not at all

Perfectly

Ix for myeloma

Bone survey -

radiological lytic lesions;

serum/urine electrophoresis (monoclonal banding)

marrow biopsy

How well did you know this?

Not at all

Perfectly

Mx for myeloma

Supportive, chemotherapy (including thalidomide)

63 year old woman, progressive tired and fatigue, numbness and unsteadiness in her feet. Family history of thyroid problems. Conjunctivae pale, sclerae are yellow. Evident symmetrical distal weakness affecting her arms and legs and sensory loss in her hands and feet bilaterally, with severe loss of joint position sense. ?diagnosis Hb, platelet, WCC = low Macrocytic Anaemia High bilirubin = ?haemolysis LFTs = normal

would check B12 and Folate B12 deficiency

A 73-year-old man presents with an uncomfortable enlarging ulcer over his left calf of 6 weeks’ duration. He is known to have type 2 diabetes mellitus (dietary- controlled), and after complaining to his GP of being tired, he recently had blood samples sent for analysis: Hb = low MCV = slightly high WCC = low normal B12 and folate = normal Anaemic = where is likely source of anaemia

Bone marrow - pancytopenia = bone marrow problem

A 24-year-old man presents to his GP with an intermittent fever and rigors over the past 3 days. This has been present on and off for 3 days. Upon questioning, he states he’s previously had hepatitis and glandular fever. He drinks alcohol and smokes but denies intravenous drug abuse. The only medicines he is on are malaria prophylaxis for a recent trip to Nigeria 3 weeks prior. On examination he looks unwell however is haemodynamically stable. He has a tender right upper quadrant but otherwise has no other examination findings. ``` Hb = low MCV = slightly high Platelets = low Bilirubin = raised ```

?malaria = causes intravascular haemolytic anaemia

how to tell the difference between iron deficiency anemia and anemia of chronic disease

look at TIBC is high in iron deficiency is low/normal in chronic disease

A couple attend the GP practice seeking advice as they are currently pregnant with their first son. The father suffers from haemophilia A and is worried about the risk of passing this disease onto his son. The mother is not a carrier and has no family history of any disorders. What is the percentage chance of the baby inheriting haemophilia A?

0% There is no male-to-male transmission in X-linked recessive conditions

blood cells seen in hyposplenism

howell-jolly bodies target cells pappenheimer bodies

blood cells seen in iron deficiency anaemia

target cells | pencil "poikilocytes"

what do "tear-drop" poikilocytes suggestive

myelodysplasia

what do schistocytes suggest

intravascular haemolysis

what do hypersegmented neutrophils suggest

megaloblastic anaemia

what can cause ginigival hyperplasia

AML Drugs = phenytoin, CCB, ciclosporin

what is seen on blood film suggestive of G6PD deficiency

Heinz bodies Bite cells Blister cells

what is seen on blood film suggestive of hereditary spherocytosis deficiency

spherocytes

where is B12 absorbed in the body

ileum

where is folate absorbed in the body

duodenum | jejunum

what is common in hereditary spherocytosis that is not common in G6PD

splenomegaly

old person, iron deficiency anaemia, investigations?

1st line = sigmoid colonoscopy 2nd line = endoscopy

side effects of ferrous sulphate

black stool/green diarrhoea N+V stomach cramps

what is direct coombs test an investigation for

intravascular haemolysis

what cells makes platelets

megakarycytes

what cells makes macrophages

monocytes

what does neutrophilia and neutropenia mean

neutrophilia = high number of neutrophils neutropenia = low number of neutrophils

antibodies seen in pernicious anaemia and treatment

anti gastric parietal cells anti intrinsic factor Tx = B12 injections [hydroxycobalamin]

what is Jak 2 mutation associated with

PCV ET Idiopathic myelofibrosis

what does a prolonged PT time suggest

problem with TF or Factor VIIa (factor 7)

what does a prolonged APTTq time suggest

problem with Factor 8 or 9

what is used to measure warfarin affect and why and what is the antidote

PT = as warfarin affects factor 7 the most antidote = vitamin K

what is used to measure heparin affect and why and what is the antidote

APPT = works by making anti-thrombin better cleared through kidneys antidote = protamine sulphate

Blood results [INR, APTT, PT Time, Bleeding time] - heparin

INR = normal APTT = prolonged PT = prolonged Bleeding time = normal

Blood results [INR, APTT, PT Time, Bleeding time] - warfarin

INR = aiming for 2-3 APTT = normal PT = prolonged Bleeding time = increased

Blood results [INR, APTT, PT Time, Bleeding time] - DIC

INR = prolonged APTT = prolonged PT = prolonged Bleeding time = prolonged

Blood results [INR, APTT, PT Time, Bleeding time] - liver disease

INR = prolonged APTT = prolonged PT = normal/prolonged Bleeding time = normal/prolonged

Blood results [INR, APTT, PT Time, Bleeding time] - V Willebrand Disease

INR = normal APTT = prolonged PT = normal Bleeding time = prolonged

Blood results [INR, APTT, PT Time, Bleeding time] - Haemophilia

INR = normal APTT = prolonged PT = normal Bleeding time = normal

mx of patient on warfarin with major bleed

Stop warfarin Give IV Vit K 5mg Give Prothrombin complex [or FFP if not available]

mx of patient on warfarin with INR >8 and minor bleed

Stop warfarin Give IV Vit K 1-3mg Restart warfarin when INR < 5

mx of patient on warfarin with INR >8 and no bleed

Stop warfarin Give PO Vit K 1.5mg Restart warfarin when INR < 5

mx of patient on warfarin with INR 5-8 and no bleed

Withhold 1 or 2 doses of warfarin reduce subsequent maintenance dose

what antibiotic can interact with warfarin

clarithromycin = raises INR cranberry juice can also raised INR

what marrow disorder can transform to AML

myelodysplasia

buzzword for CLL and what can it progress to

smear or smudge cells on blood film non-hodgkins lymphoma

buzzword for CML

Philadelphia chromosome

buzzword for AML

Auer rods

when does incidence of PCV peak, what is basic pathology and what are symptoms

6th decade - increase in red cell volume hyperviscosity pruritus, typically after a hot bath splenomegaly haemorrhage

tx of PCV

1st line = venesection | = plus aspirin

what is ET

Essential thrombocytosis is one of the myeloproliferative disorders Megakaryocyte proliferation results in an overproduction of platelets.

Sx of ET

platelet count > 600 * 109/l both thrombosis (venous or arterial) and haemorrhage burning sensation in the hands

what is IMF and what are the symptoms of it

Myelofibrosis - get scarring of the bone marrow Sx = elderly person with signs of anaemia, massive splenomegaly, hypermetabolic symptoms: weight loss, night sweats Ix = teardrop polikocytes

what is von willebrand disease

most common inherited bleeding disorder - autosomal dominant characteristically behaves like a platelet disorder

Sx of Von Willebrand disease and what is seen on Ix and Mx

epistaxis menorrhagia Ix = prolonged bleeding time and APTT Mx = tranexamic acid for mild bleeding

what inheritance is Haemophilia and what does this mean

X-Linked Dad who has the condition can not pass it on too his son

what is deficient in Haemophilia A

Factor 8

what is deficient in Haemophilia B and what is it also called

Factor 9 Christmas Disease

Sx of haemophilia and what is seen on Ix

haemoarthroses, haematomas prolonged bleeding after surgery or trauma Ix = prolonged APTT = bleeding time, thrombin time, prothrombin time normal

Ix for hereditary spherocytosis

EMA binding

Haem Flashcards

(80 cards)