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Haematology Flashcards

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1
Q

What is cancer-associated thrombosis linked to

A

Lower life expectancy

Delayed cancer treatment

Decreased quality of life

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2
Q

What are the patient-related risk factors for cancer-associated thrombosis

A

Comorbidities

Varicose veins

Prior VTE

Hereditary thrombophilias

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3
Q

What are the tumour-related risk factors for cancer-associated thrombosis

A

Site of cancer (very high risk - stomach, pancreas, brain, high risk - lung, haem, gynae, renal, bladder)

Grade of tumour

Stage

Time since cancer diagnosis

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4
Q

What are the treatment-related risk factors for cancer-associated thrombosis

A

Chemotherapy (especially platinum-based)

Anti-angiogenesis agents

Hormone therapy

Surgery

Radiotherapy

Blood transfusion

Central venous catheter

Immobility and hospitalisation

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5
Q

What are the biomarkers for cancer-associated thrombosis

A

Haematological biomarkers (platelets, haemoglobin, leukocytes)

D-dimer, P-selectin

Thrombin generation potential

MP-tissue factor activity

CRP

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6
Q

What are the guidelines around cancer-associated thrombosis

A

LMWH for 3-6 months (as secondary prevention)

DOACs (if low risk of bleeding)

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7
Q

Explain the European co-operative oncology group (ECOG) performance stats

A

0 - fully active, no restrictions

1 - restricted physically strenuous activity

2 - ambulatory and capable of self care

3 - capable of limited self care, in bed/chair >50% of waking hours

4 - completely disabled

5 - dead

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8
Q

What are the characteristic features of myeloma

A

Plasma cell accumulation in bone marrow

Monoclonal proteins in serum/urine

Tissue damage

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9
Q

What is the defining feature of Hodgkin lymphoma

A

Reed-Sternberg cells (neoplastic B cells)

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10
Q

What type of anaemia do you tend to get in Hodgkin lymphoma

A

Normocytic, normochromic

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11
Q

How does the grade of lymphoma affect treatment outcomes

A

High grade - aggressive, possible to cure

Low grade - responds well to treatment, treat rather than cure

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12
Q

What is leukaemia

A

Cancer of particular lines of stem cells in bone marrow

Excessive production of a single type of abnormal white blood cell (suppression of other cell lines)

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13
Q

What do you find in the blood results of patients with leukaemia

A

Pancytopenia (anaemia, leukopenia, thrombocytopenia)

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14
Q

What are the peak ages of presentation for the different types of leukaemia

A

ALL - 5 - 45

CLL - > 55

CML - > 65

AML - > 75

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15
Q

How might a patient with leukaemia present

A

Fatigue

Fever

Failure to thrive (in children)

Pallor

Petechiae and abnormal bruising

Abnormal bleeding

Lymphadenopathy

Hepatosplenomegaly

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16
Q

What are the differentials for a non-blanching rash

A

Non-accidental injury

Leukaemia

Meningococcal septicaemia

Vasculitis

Henoch-Schonlein purpura

Idiopathic thrombocytopenia purpura

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17
Q

What are the investigations needed for a patient with suspected leukaemia

A

FBC (within 48 hrs)

Blood film

Lactate dehydrogenase (not specific)

Bone marrow biopsy (needed for definitive diagnosis, aspiration/trephine)

Chest X-ray

Lymph node biopsy

Lumbar puncture

Staging CT/MRI

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18
Q

What is acute lymphoblastic leukaemia

A

Malignancy in lymphocyte precursor cells

Acute proliferation of a single type of lymphocyte (usually B cells)

Get pancytopenia

Most common cancer in children

Associated with Down’s syndrome

Blood film (blast cells)

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19
Q

What is chronic lymphocytic laukaemia

A

Chronic proliferation of a single type of well-differentiated lymphocytes (usually B cells)

Presentation: often asymptomatic, infection, anaemia, bleeding, weight loss

Causes warm autoimmune haemolytic anaemia

Can transform into high grade lymphoma (Richter’s transformation)

Blood film - smudge/smear cells

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20
Q

What are the phases of chronic myeloid leukaemia

A

Chronic phase - lasts around 5 years, asymptomatic

Accelerated phase - abnormal cells take over bone marrow, symptomatic (anaemia, thrombocytopenia, immunocompromised)

Blast phase - high proportion of blast cells and blood , severe symptoms, often fatal

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21
Q

Which genetic abnormality is associated with CML

A

Philadelphia chromosome

9:22 translocation

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22
Q

What is acute myeloid leukaemia

A

Most common acute leukaemia in adults

Sometimes due to transformation from a myeloproliferative disorder

Blood film - high proportion of blast cells, Auer rods in cytoplasm

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23
Q

What is the management for leukaemia

A

MDT support

Chemotherapy

Steroids

Radiotherapy

Bone marrow transplant

Surgery

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24
Q

What is lymphoma

A

Cancer of lymphocytes in lymphatic system

Cancer cells proliferate in lymph nodes

Get lymphadenopathy

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25
What is the age distribution of Hodgkin lymphoma
Bimodal (20, 75)
26
What are the risk factors for developing Hodgkin lymphoma
HIV EBV Autoimmune conditions (rheumatoid arthritis, sarcoidosis) Family history
27
How might a patient with Hodgkin lymphoma present
Lymphadenopathy (non-tender, rubbery) Pain in lymph nodes when drinking alcohol B symptoms Other: fatigue, itching, shortness of breath, abdominal pain, recurrent infections
28
What are the investigations for a patient with Hodgkin lymphoma
LDH Lymph node biopsy (Reed-Sternberg cells - abnormally large B cells, multiple nuclei and nucleoli) Staging CT/MRI
29
Explain the Ann Arbor staging
For lymphomas Stage 1 - 1 lymph node area Stage 2 - Multiple lymph node areas, one side of diaphragm Stage 3 - Multiple lymph node areas, both sides of diaphragm Stage 4 - Widespread, extra-nodal involvement
30
What is the management for Hodgkin lymphoma
Chemotherapy (risk of leukaemia and infertility) Radiotherapy (risk of other cancers, damage to tissue, hypothyroidism)
31
What are some common types of Non-Hodgkin lymphoma
Follicular (most common low-grade type) Burkitt MALT (associated with H pylori infection) Diffuse large B cell
32
What are the risk factors for developing non-Hodgkin lymphoma
HIV EBV H pylori Hep B, Hep C Exposure to pesticides Family history
33
What are the management options for non-Hodgkin lymphoma
Watchful waiting Chemotherapy Monoclonal antibodies (usually rituximab) Radiotherapy Stem cell transplant
34
What is myeloma
Cancer of plasma cells (B cells that produce antibodies) Multiple myeloma: myeloma affecting multiple areas around the body Can get infiltration of bone marrow (anaemia, neutropenia, thrombocytopenia)
35
What is monoclonal gammopathy of undetermined significance (MGUS)
Excess in 1 type of antibody/antibody component without features of myeloma/cancer Often incidental finding Needs routine monitoring Can become myeloma
36
What is the pathophysiology of myeloma
Genetic mutation causing rapid and uncontrolled multiplication of cancerous plasma cells One type of immunoglobulin massively high (monoclonal paraprotein)
37
What is myeloma bone disease
Increased osteoclast activity, suppressed osteoblast activity (imbalance in bone metabolism) Commonly in: skull, spine, long bones, ribs Osteolytic lesions in bone (get pathological fractures) Hypercalcaemia (bone reabsorption)
38
What causes myeloma renal disease
Immunoglobulins blocking flow through tubules Hypercalcaemia Dehydration Medications (bisphosphonates)
39
Why do you get hyperviscosity in myeloma
Extra proteins in blood, make it more viscous Get: easy bruising, easy bleeding, loss of sight (vascular eye disease), purplish palmar erythema, heart failure
40
What are the risk factors for developing myeloma
Older age Male Black ethnicity Family history Obesity
41
What are the investigations for myeloma
Everyone over 60 with: bone pain, unexplained fractures FBC (low WCC) Calcium (raised) ESR (raised) Plasma viscosity (raised) Serum protein electrophoresis Urine Bence-Jones proteins, serum-free light chain assay, serum immunoglobulins Bone marrow biopsy Staging CT/MRI Skeletal survey (punched out lesions, lytic lesions, raindrop skull)
42
What is involved in the management of myeloma
MDT support Chemotherapy plus: bortezomid, thalidomide, dexamethasone Stem cell transplant VTE prophylaxis Managing bone disease: bisphosphonates (suppress osteoclast activity), radiotherapy, orthopaedic surgery, cement augmentation
43
What are the complications of myeloma
Infection Pain Renal failure Anaemia Hypercalcaemia Peripheral neuropathy Spinal cord compression Hyperviscosity
44
What is the mnemonic for the effects of myeloma
CRAB Calcium high Renal impairment Anaemia Bone disease
45
What are myeloproliferative disorders
Due to uncontrolled proliferation of a single type of stem cell Bone marrow cancers 3 main types: primary myelofibrosis, polycythaemia vera, essential thrombocythaemia Can progress to AML Associated mutations: JAK2, MPL, CALR
46
What is primary myelofibrosis
Proliferation of haematopoietic stem cells
47
What is polycythaemia vera
Proliferation of erythroid cells
48
What is essential thrombocythaemia
Proliferation of megakaryocytes
49
What is myelofibrosis
Can be caused by any of the myeloproliferative disorders Proliferation of cell lines causes fibrosis in bone marrow (in response to cytokines, replaced by scar tissue) Start to get extramedullary haematopoiesis (in liver or spleen, get portal hypertension and spinal cord compression)
50
How might a patient with a myeloproliferative disorder present
Often initially asymptomatic B symptoms Signs of underlying complication: anaemia, splenomegaly, portal hypertension, low platelets, thrombosis, raised RBCs, low WCC Key signs of polycythaemia vera: conjunctival pallor, 'ruddy' complexion, splenomegaly
51
What are the investigations needed for myeloproliferative disorders
FBC: myeloma (anaemia, leukocyte disturbances, platelet disturbances), polycythaemia vera (high Hb), primary thrombocythaemia (high platelets) Blood film (tear-shaped RBCs in myelofibrosis) Bone marrow biopsy Genetic testing
52
What is the management for primary myelofibrosis
Monitoring (for mild, asymptomatic disease) Allogenic stem cell transplant Chemotherapy Supportive management
53
What is the management for polythaemia vera
Venesection Aspirin (reduce thrombus formation) Chemotherapy
54
What is the management for thrombocythaemia
Aspirin (reduce thrombus formation) Chemotherapy
55
What is non-small cell lung cancer
80% of lung cancers Includes: adenocarcinomas, large-cell carcinomas
56
What is small cell lung cancer
20% of lung cancers Contain neurosecretory granules (release neuroendocrine hormones, can get paraneoplastic syndromes) Poor prognosis
57
How might a patient with lung cancer present
Shortness of breath Cough Haemoptysis Finger clubbing Recurrent pneumonia Weight loss Lymphadenopathy (usually supraclavicular)
58
What investigations are needed for lung cancer
Chest X-ray Staging CT PET CT Bronchoscopy Histology
59
What chest X-ray signs can be suggestive of lung cancer
Hilar enlargement Peripheral opacity (visible lesion) Pleural effusion Lung collapse
60
What are the extra-pulmonary manifestations of lung cancer
Recurrent laryngeal nerve palsy (hoarse voice) Phrenic nerve palsy (shortness of breath) SVCO (Pemberton's sign) Horner's syndrome (ptosis, anhidrosis, miosis) SIADH (ectopic ADH from cancer, get hyponatraemia) Cushing's syndrome (ectopic ACTH) Hypercalcaemia (ectopic PTH) Limbic encephalitis Lamberton-Eaton myasthenic syndrome
61
What is limbic encephalitis
Small cell lung cancer causes production of antibodies against brain Symptoms: short-term memory loss, hallucinations, confusion, seizures
62
What is Lambert-Eaton myasthenic syndrome
Antibodies produced against small cell lung cancer Also target motor neurones Reduced tendon reflexes Proximal muscle weakness (extraocular muscles - diplopia/ptosis, slurred speech, dysphagia)
63
What is mesothelioma
Malignancy of mesothelial cells of pleura Strong link to asbestos inhalation (up to 45 year latency) Very poor prognosis (usually palliative)
64
What is the management of lung cancer
MDT discussion Surgery (lobectomy, segmentectomy, wedge resection) Radiotherapy (curative in NSCLC if early enough) Chemotherapy (adjuvant or palliative) Endobronchial stenting/debulking (palliative)

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