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Phase 2 v2 > Haematology > Flashcards

Haematology Flashcards

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1
Q

What is the clinical presentation of anaemia in general?

A

Anaemia:

  • Fatigue
  • Low energy
  • Pallor
  • Dyspnoea on exertion.
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2
Q

What are the specific clinical signs/symptoms of iron deficiency anaemia?

A

Signs:

  • Restless leg syndrome.
  • Glossitis
  • Angular stomatitis.
  • Nail spooning/flattening.

Symptoms:

  • Unusual cravings for non-food items.
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3
Q

What is the histological presentation of:

Iron deficiency anaemia?

Pernicious anaemia?

Folate-deficiency anaemia?

Haemolytic anaemia?

Sickle cell anaemia?

A

IDA - Microcytic, hypochromic.

PA - Macrocytic megaloblastic.

FDA - Macrocytic megaloblastic.

HbA - Normocytic, normochromic.

HbS - Sickled cells

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4
Q

What are the main risk factors for iron deficiency anaemia?

A
  • Pregnant.
  • Vegan/vegetarian.
  • Menorrhagia.
  • Coeliac.
  • Excessive NSAID use (causes peptic ulcers).
  • CKD (low erythropoietin).
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5
Q

What are the diagnostic tests for iron deficiency anaemia?

A
  • Low serum iron and low serum ferretin.
  • FBC: Low Hb
  • MCV: Low
  • MCHC: Low
  • Blood smear: Microcytic, hypochromic.
  • Low reticulocytes.
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6
Q

What is the treatment for iron deficiency anaemia?

A
  • 1st line: Ferrous sulfate (orally).
  • 2nd line: IV iron (used if ferrous sulfate is intolerated or the individual has IBD.)
  • RBC transfusion. Used if the individual begins to present with symptoms of CV compromise (chest pain, dyspnoea on rest).
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7
Q

What is pernicious anaemia?

A
  • Autoimmune disorder.
  • Destruction of the parietal cells of the stomach (that secrete IF) and production of intrinsic factor antibodies.
  • Causes malabsorption of B12, as If is required for the cotransportation process used for B12 absorption.
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8
Q

What are the specific signs/symptoms of pernicious anaemia?

A

B12 deficiency - Neurological problems:

Abnormal gait

Decreased vibration sense

Peripheral neuropathy

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9
Q

What are the risk factors for pernicious anaemia?

A
  • Vegan.
  • Over 65.
  • Metformin.
  • PPI (omeprazole) or H2 antagonist (famotidine).
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10
Q

What are the investigations used to confirm diagnosis of pernicious anaemia?

A

FBC - MCV increased.

Blood film - Shows macrocytic, megaloblastic RBCs with hypersegmented neutrophils. (SAME AS FOLATE-DEFFICIENCY ANAEMIA).

Intrinsic factor antibody test - Presence of these antibodies proves pernicious anaemia.

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11
Q

What is the treatment for pernicious anaemia?

A
  • Give hydroxocobalamin, a B12 analogue (1st line)
  • If there are neuro symptoms, refer to neurology/haematology.
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12
Q

What are the risk factors for folate-deficiency anaemia?

A
  • Pregnancy/lactation.
  • Old age.
  • Chronic alcohol abuse.
  • Low folate diet.
  • FH.
  • Coeliac disease.

Use of certain drugs:
- Trimethoprim.
- DMARDS (sulfasalazine, methotrexate).
- Anticonvulsants.
(therefore these drugs are contraindicated in pregnancy).

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13
Q

What are the signs/symptoms specific to haemolytic anaemia?

A

Limited specific signs.

Potentially there will be:

  • Jaundice (due to increased bilirubin from RBC breakdown).
  • Splenomegaly.
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14
Q

What are the investigations used to diagnose folate-deficiency anaemia?

A
  • FBC. Raised MCV and MCHC.
  • Blood film. Macrocytic, megaloblastic cells with hypersegmented neutrophils.
  • Serum folate: 1st line screening tool.
  • RBC folate: Gold standard. More sensitive than serum folate, but more expensive/complex.
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15
Q

What are the signs/symptoms specific to folate deficiency anaemia?

A
  • NO NEUROLOGICAL SYMPTOMS (would be seen in B12 deficiency anaemia).
  • Potentially glossitis, and angular stomatitis if severe.
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16
Q

What is the treatment for folate-deficiency anaemia?

A
  • Folic acid oral (1st line).
  • Consider RBC transfusion if severely anaemic.
  • Women planning/currently pregnant should be taking folic acid to reduce risk of neural tube defects.
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17
Q

What is haemolytic anaemia?

A

A number of conditions that occur due to increased destruction of RBCs.

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18
Q

What type of anaemia is haemolytic anaemia?

A
  • Normocytic usually.
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19
Q

What are the differentials for haemolytic anaemia?

A
  • Blood loss.
  • Transfusion reaction.
  • Underproduction anaemia. Caused by reduced production of RBCs rather than increased breakdown. Will therefore have a low reticulocyte count (would be high in haemolytic anaemia).
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20
Q

What are the risk factors for haemolytic anaemia?

A
  • FH.
  • Autoimmune disorders (especially SLE).
  • CLL
  • Cephalosporins.
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21
Q

What are the investigations used to diagnose haemolytic anaemia?

A

FBC - Reduced Hb

MCHC - Increased MCHC due to high amount of reticulocytes.

Reticulocyte count - raised

Blood film - Generally normocytic, but presence of abnormal RBC’s can help diagnose the specific type of haemolytic anaemia.

Coomb’s test - If positive indicates an autoimmune cause of haemolytic anaemia.

Consider ANA if SLE suspected.

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22
Q

What is the treatment for haemolytic anaemia?

A

Blood transfusions + folic acid.

  • If coomb’s test +ve, give prednisolone (reduces production of autoantibodies that drive RBC breakdown in autoimmune haemolytic anaemia).
  • If caused by a drug (commonly cephalosporins) give prednisolone and discontinue the drug.
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23
Q

What is sickle cell anaemia?

A
  • Hereditary deformation of RBC’s as a result of faulty Hb molecule formation.
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24
Q

What is the clinical presentation specific to sickle cell anaemia?

A
  • Vaso-occlusion. Early childhood acute pain in the hands and feet due to small vessel occlusion.
  • In adults, pain in the long bones, ribs, spine and pelvis too.
  • OFTEN SYMPTOMS OF ANAEMIA DO NOT APPEAR AS HbS HAS A LOW OXYGEN AFFINITY.
  • If they do appear, anaemic symptoms are:
  • Tiredness
  • Fatigue
  • Dyspnoea
  • Palpitations
  • Headache
  • Faintness
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25
What is the pathophysiology of sickle-cell anaemia?
- Changes in sequence of haemoglobin subunit causes faulty structure. - Distorts erythrocyte shape, making them sickle shaped. - Sickle cell RBC's block vessels easily, and are easily destroyed.
26
What is the investigation used for sickle cell anaemia?
- Usually identified in neonatal screening. - Otherwise, identified by presence of sickle cells on blood film.
27
What is the treatment for sickle cell anaemia?
- Anaphylactic penicillin until 5 years old (children). Because they are at substantially increased risk of invasive pneumococcal infection. **- Hydroxycarbamide**. Manages the pain. - Potentially blood transfusion. - Bone marrow stem cell transfusion if disease severe - still a very new treatment.
28
What is the alternative name for folic acid?
B9
29
What is a DVT?
- Development of a blood clot in a major deep vein.
30
What is the clinical presentation of a DVT?
- Calf swelling. - Localised pain and redness.
31
What are the risk factors for a DVT?
- Bedridden. - Cancer. - Older age. - Recent long-haul travel. - Hypercoagulation disorder.
32
How is the likelihood of a DVT assessed and subsequently what tests are done?
Use Well's score: - If Well's \<2: Do a D-dimer. If +ve, move on to venous ultrasound. - If Well's ≥2: Straight to venous ultrasound.
33
What is the treatment for a DVT?
- Apixiban (anticoagulant) for at least 3 months.
34
What is the main complication associated with DVT?
Pulmonary embolism (PE).
35
What is polycythaemia vera?
- A Philadelphia chromosome -ve myeloproliferative disorder. - Characterised by erythrocytosis. - Often also causes thrombocytosis, leukocytosis and splenomegaly.
36
What genetic mutation is commonly linked to polycythaemia vera?
- JAK2 mutation.
37
When is polycythaemia vera considered?
- Patient over 40 presenting with thrombosis/haemorrhage.
38
What are the signs/symptoms of polycythaemia vera?
Signs: - Thrombosis (MI, stroke, DVT, PE) - Erythromelalgia (red fingers, palms and toes). - Splenomegaly. Symptoms: - Headache. - Pruritus. - Fatigue.
39
What are the investigations used for polycythaemia vera, and what are the usual findings? What is the genetic test used?
- FBC: Raised Hb, WCC, platelets. - Low erythropoietin (-ve feedback to erythrocytosis). - Genetic test for JAK2 mutation: +ve.
40
What is the treatment for polycythaemia vera?
- Low dose aspirin. - Phlebotomy (500ml of blood replaced with saline 2x per week). IF HIGH RISK: Hydroxycarbamide (cytoreductive therapy).
41
What are the two main platelet disorders I need to be aware of?
- Immune thrombocytopenic purpura (ITP) - Thrombotic thrombocytopenic purpura (TTP)
42
What is immune thrombocytopenic purpura?
- Haematological disorder characterised by an ISOLATED low platelet count (thrombocytopenia).
43
What are the key signs/symptoms for immune thrombocytopenic purpura?
Symptoms: Fatigue. Signs: Bleeding (esp. gums), bruising, petechiae (small purple/red spots on the skin).
44
What are the investigations used and the findings in suspected ITP?
- FBC. Isolated low platelets (thrombocytopenia). NOTE: If history involves heavy bleeding, Hb may also be slightly low. However, this is not a requirement for diagnosis. - Blood smear. No evidence of myelodysplasia.
45
What is the treatment for ITP?
- Corticosteroids (prednisolone).
46
What is thrombotic thrombocytopenic purpura?
- Thrombocytopenia AND haemolytic anaemia.
47
What are is the diagnostic pentad for TTP?
Characteristic pentad: - Thrombocytopenic purpura. - Microangiopathic haemolytic anaemia. - Acute renal insufficiency. - Neurological abnormality. - Fever.
48
What are the investigations/results for suspected TTP?
FBC: Low platelets (thrombocytopenia) and low haemoglobin (anaemia). Blood smear: schistocytes present (red blood cell fragments due to the microangiopathic anaemia). Raised urea/creatinine: Acute renal insufficiency. Urine analysis: Proteinuria.
49
What is the treatment for TTP?
- Plasma exchange. - Prednisolone (corticosteroids).
50
What are the 4 main types of leukaemia?
- ALL. Acute lymphoblastic leukaemia. - CLL. Chronic myeloblastic leukaemia. - AML. Acute myeloid leukaemia. - CML. Chronic myeloid leukaemia.
51
What are the key defining characteristics of ALL?
- Childhood leukaemia. (Under 20). - Cancer of lymphoid progenitors.
52
What are the key defining characteristics of CLL?
- Smudge cells on blood film. - Cancer of B-cells (lymphoblastic lineage).
53
What are the key defining characteristics of AML?
- Auer rods inside myeloblasts on blood film. - Develops when CML progresses. - Cancer of myeloid progenitors.
54
What are the key defining characteristics of CML?
- Philadelphia chromosome strongly associated. - Eventually progresses to AML. - Cancer of myeloid progenitors.
55
What are the key investigations used when leukaemia is suspected?
- FBC + differential. - Blood smear. - Bone marrow biopsy.
56
What are the generic symptoms for leukaemia? What are the two symptoms that can differentiate leukaemia from other cancers?
- Weight loss. - Fatigue. - Fever. - Pallor. KEY SYMPTOMS SUGGESTIVE OF LEUKAEMIA RATHER THAN OTHER CANCER: - Petechiae. - Abnormal bleeding.
57
What are the treatments used for leukaemia? (2 specific named drugs)?
- Rituximab (immunotherapy). CD20-targeting monoclonal antibody. Used for ALL, CLL. - Imatinib (tyrosine kinase inhibitor). Used for CML. - Stem cell transplant is an option for all leukaemia. - Chemotherapy and immunotherapy are mainstays of treatment.
58
What is haemophillia?
- Bleeding disorder that results from the deficiency of a coagulation factor.
59
What is the difference between haemophilia A and B?
Haemophilia A - reduction/absence of factor VIII. Haemophilia B - reduction/absence of factor IX.
60
What is the inheritance pattern of haemophilia?
- X linked recessive.
61
What is the typical clinical presentation of haemophilia?
- Male w/ family history - Recurrent and/or severe bleeding. - Epistaxis - Gum bleeding. - Easy bruising.
62
What are the investigations used for haemophilia?
- aPPT (intrinsic pathway measure). Will be raised. - Factor VIII/IX assay. Will show decrease/absence of one of the factors, and differentiate types A and B.
63
What is the treatment for haemophilia?
- Factor VIII (type A) or factor IX (type B) concentrate given once daily.
64
What is malaria?
A parasitic infection of the erythrocytes, usually caused by plasmodium falciparum.
65
How is malaria transmitted?
- Female mosquito bites. - Can also be transmitted via blood transfusion/organ transplant.
66
What is the typical clinical presentation of malaria?
- RECENT TRAVEL HISTORY. - Fever - Chills - Headache - Arthralgia/myalgia.
67
What diagnostic testing is used for malaria?
- Rapid diagnostic testing (skin-prick) is first line, as it is cheap and quick. However, only reliable in testing for P. Falciparum, not other types of plasmodium. - Light microscopy with giemsa stained blood film. GOLD STANDARD.
68
What is the treatment for malaria?
- Piperaquine infusion (anti-malarial drug).
69
What is multiple myeloma?
- Malignant disease of the bone marrow plasma cells.
70
What is the clinical presentation of multiple myeloma?
REMEMBER "CRAB": - hyperCalcaemia - Renal impairment - ANAEMIA - BONE PAIN
71
What are the risk factors for MM?
- Abnormal free light-chain ratio. - FH - Radiation exposure.
72
What is the epidemiology of multiple myeloma?
- Peak presentation at 70 years old.
73
What are the investigations used for multiple myeloma?
- Bone marrow biopsy. Will show plasma cell infiltration in the bone marrow (gold standard).
74
What is the treatment for multiple myeloma?
Chemotherapy (Thalidomide) + dexamethasone (corticosteroids). - Stem cell transplant (if illegible).
75
What are the two types of lymphoma and how are they differentiated?
- Hodgkins lymphoma. Containts Reed-sternberg cells. - Non-hodgkins lymphoma. Doesn't contain Reed-sternberg cells.
76
What is the clinical presentation of lymphoma? What are aspects of clinical presentation are specific to HL?
Low grade lymphoma may be asymptomatic. Presentation: - LYMPHADENOPATHY. - Fever - Fatigue - Weight loss - Night sweats Specific to HL: - Pruritus. - Alcohol-triggered lymph node pain. - MORE COMMON IN YOUNG ADULTS THAN NHL.
77
What are the key investigations for suspected lymphoma?
- FBC with differential. Thrombocytopenia (Low Platelets), leukocytosis (Increased WCC). LOW HAEMOGLOBIN IF HODGKINS. - Lymph node biopsy. Differentiates between HL and NHL. - Full body CT. Look for metastases. - Lactate dehydrogenase. Level of elevation is an important prognostic factor.
78
What is the treatment for non-Hodgkins lymphoma?
- Chemo with R-CHOP regimen. - Rituximab, cyclophosphamide, Doxorubicin, vinicristine and prednisolone.
79
What is the treatment for Hodgkins lymphoma?
- Chemo (ABVD regiment). - Radiotherapy.

Phase 2 v2 (14 decks)

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