haem/ onc Flashcards
WHat is the most common cause of inherited thrombophilia? ie clotting
Activated protein C resistance (Factor V Leiden) i
Length of tx for unprovoked vs provoked DVT? How do you classify each?
Unprovoked DVT = no RF OR RF cannot be easily removed eg cancer, thrombophilia. Treat for 6 months
provoked = removal factor eg post-op, HRT, COCP, flying, pregnant, immobile. Treat for 3 months
What is myelofibrosis? What is associated with this condition on blood film? Mx?
a myeloproliferative disorder
‘tear-drop’ poikilocytes on blood film
This occurs because they are ‘squeezed’ through the fibrotic tissue in bone marrow in myelofibrotic disorders.
mx with immunosuppression
What is the most common inherited bleeding disorder? What is found on ix for this?
Von Willebrand’s disease (low von willebrand factor which is needed for platelet aggregation)
AD inheritance
Ix:
prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin
What is tumour lysis syndrome? How is it prevented?
breakdown of tumour cells –> release of chemicals from the cell.
Causes high K + high PO4, and low Ca
patients are higher risk should receive either allopurinol or rasburicase
What is Polycythaemia vera? How does it present? Mx?
Excess RBC and often also excess WBC and plarelets.
Strong association (95%) with JAK2
Presents: itching after bath, spleenomegaly, hyperviscosity, HTN, haemorrhage (low platelets), low ESR
Mx: If asx treat with aspirin + venesection, if sx then immunosuppress
Describe SCLC? What features may it have? mx?
arise from APUD* cells
ADH → hyponatraemia
ACTH → Cushing’s syndrome
Lambert-Eaton syndrome: antibodies to voltage gated calcium channels causing myasthenic like syndrome
If VERY early disease (T1-2 with no nodal or mets) then surgery, otherwise poor prognosis, for chemo/ radiotherapy
What blood results would you see in IDA?
Total iron-binding capacity (TIBC) + transferrin levels are typically raised in iron-deficiency anaemia
Iron and ferritin are low
When would you do a d-dimer post wells score?
If scores 1 but DVT still seems likely - if negative ruled out, if positive USS needed
What would you see on FBC for SCD?
Sickle cell disease causes a normocytic anaemia with raised reticulocyte count - due to haemolysis
What do you see on bloods in DIC?
Often occurs with sepsis/ trauma
Low platelets and low coagulation factors (all coagulation factors are depleted), low fibrinogen (as microvascular clotting), raised d-dimer
schistocytes (sheared blood cells) - also see in TTP and HUS
When do you see elliptocytes?
These are rod/ pencil shaped erythrocytes seen in IDA, thalassaemia
When are heinz bodies seen?
Alpha thalassemia
G-6-PD deficiency
When are howell-jolly bodies seen?
characteristic of decreased splenic function, such as post-splenectomy/ severe haemolytic anaemia/ coeliacs disease
herediatry spherocytosis
What is Hereditary haemorrhagic telangiectasia?
ABnormal blood vessels form —> telangiectasia, epistaxis and chronic bleeding occur –> IDA
Adverse effects of following agents:
Cyclophosphamide
Bleomycin
Anthracyclines (e.g doxorubicin)
Fluorouracil (5-FU)
Vincristine, vinblastine
Cisplatin
methotrexte
Cyclophosphamide:Haemorrhagic cystitis/ tranitional cell carcinoma, myelosuppression
Bleomycin: lung fibrosis
Anthracyclines (e.g doxorubicin): cardiomyopathy
Fluorouracil (5-FU): Myelosuppression, mucositis, dermatitis
Vincristine: peripheral neuropathy
Cisplatin: Ototoxicity, peripheral neuropathy, nephropathy, low magnesium
Methotrexate: Myelosuppression, mucositis, liver fibrosis, lung fibrosis
What do clotting screens look like for liver failure?
In liver failure, all clotting factors are low except for factor VIII which is raised. Both PT and APTT can be prolonged.
What do clotting screens look like for Haemaphilia A and B?
APTT grossly elevated
PT and bleeding time normal
Haemophilia A would have low levels of factor VIII but the other clotting factors are not affected. Haemophilia B would have factor IX deficiency.
What does clotting screen look like in VWB?
Von Willebrand disease would have low levels of Von Willebrand factor but the other factors are not affected. Factor VIII may be low or normal.
What cancer is associated with acanthosis nigricans?
gastrointestinal adenocarcinoma
Which cancer is associated with pityriasis rotunda?
myeloma
Which cancer is assoiated with superficial thrombophlebitis?
pancreatic carcinoma
aplastic vs sequestrian vs thromotic crisis in SCD?
Aplastic crises
caused by infection with parvovirus
sudden fall in haemoglobin
bone marrow suppression causes a reduced reticulocyte count
Sequestration crises
sickling within organs such as the spleen or lungs causes pooling of blood with worsening of the anaemia
associated with an increased reticulocyte count
Thrombotic crises
precipitated by infection, dehydration, deoxygenation
painful vaso-occlusive crises should be diagnosed clinically
infarcts occur in various organs including the bones (e.g. avascular necrosis of hip, hand-foot syndrome in children, lungs, spleen and brain
When are aeur rods seen on blood film?
These needle-shaped inclusions found within the cytoplasm of myeloid blasts indicate AML
