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Haematology Flashcards

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1
Q

What are the causes of microcytic anaemia?

A
  • Thalassaemia
  • Anaemia of chronic disease
  • Iron deficiency
  • Lead poisoning
  • Sideroblastic
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2
Q

What are the causes of normocytic anaemia?

A
  • Anaplastic anaemia
  • Anaemia of chronic disease
  • Acute blood loss
  • Haemolytic anaemia
  • Hypothyroidism
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3
Q

What are the causes of macrocytic anaemia?

A

Megaloblastic:
- B12 and folate deficiency

Normoblastic
- alcohol
- reticulocytosis
- hypothyroidism
- liver disease
- drugs e.g. azathioprine

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4
Q

What are the generic symptoms of anaemia?

A
  • dizziness
  • palpitation
  • fatigue
  • headaches
  • shortness of breath
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5
Q

What are the generic signs of anaemia?

A
  • Pale skin
  • conjunctival pallor
  • tachycardia
  • raised resp rate
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6
Q

What are the causes of iron deficiency anaemia?

A
  • dietary intake not sufficient
  • malabsorption e.g. cystic fibrosis
  • pregnancy
  • growth spurt
  • blood loss e.g. menorrhagia, GI loss
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7
Q

Bloods iron deficiency

A
  • microcytic
  • hypochromic
  • low iron
  • low ferritin (may be raised or normal if inflammation)
  • low transferrin
  • high total iron binding capacity
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8
Q

Bloods anaemia of chronic disease

A
  • normocytic normochromic or microcytic hypochromic
  • decreased iron
  • increased ferritin
  • normal or low total iron binding capacity
  • low transferrin
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9
Q

What is sideroblastic anaemia?

A

Deposition of iron in the mitochondria, forming a ring around the nucleus of the cell

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10
Q

What are the causes of sideroblastic anaemia?

A
  • congenital
  • myelodysplasia
  • alcohol
  • lead
  • anti TB drugs
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11
Q

bloods sideroblastic anaemia

A
  • hypochromic
  • microcytic
  • high ferritin, iron and transferrin
  • basophillic stipping
  • sideoblast prussian blue staining
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12
Q

What are the inherited types of hameolytic anaemia?

A
  • hereditary spherocytosis
  • G6PD deficiency
  • Hereditary Elliptocytosis
  • Sickle cell anaemia
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13
Q

What are the acquired forms of haemolytic anaemia?

A
  • warm type autoimmune
  • cold type autoimmune
  • prosthetic valve haemolysis
  • alloimmune: blood transfusion reaction or heamolytic disease of newborn
  • microangiopathic haemolytic anaemia
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14
Q

Presentation of hereditary spherocytosis

A
  • jaundice
  • gallstones
  • splenomegaly
  • aplastic crisis if parovirus
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15
Q

bloods hereditary spherocytosis

A
  • sphere shaped RBC
  • raised MCHC
  • raised reticulocytes
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16
Q

What is the management of hereditary spherocytosis?

A
  • folate supplements
  • splenectomy
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17
Q

What is the inheritance of hereditary spherocytosis?

A

Autosomal dominant

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18
Q

What is the inheritance of G6PD deficiency?

A

X linked recessive

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19
Q

What are the triggers for G6PD deficiency?

A
  • fava beans
  • infection
  • primaquine (anti-malarial)
  • ciprofloxacin
  • sulfonylurea
  • sulfasalazine
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20
Q

What is the management of warm type autoimmune haemolytic anaemia?

A

Steroids ± rituximab

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21
Q

immunoglobulin warm type AIHA?

A

IgG

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22
Q

immunoglobulin cold type AIHA

A

IgM

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23
Q

What are the causes of warm type AIHA?

A
  • Idiopathic
  • Autoimmune disease e.g. SLE
  • Neoplasia (lymphoma, leukaemia)
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24
Q

What are the causes of cold type AIHA?

A
  • neoplasia e.g. lymphoma
  • Infection: mycoplasma, EBV
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25
What is the cause of haemolytic anaemia with prosthetic heart valves?
Turbulence around the valve causing collision of the red blood cells with the implanted valve
26
What is microangiopathic haemolytic anaemia?
Structural deformities of the blood vessels results in haemolysis
27
What are the causes of microangiopathic haemolytic anaemia
- Haemolytic uraemic syndrome - disseminated intravascular dissemination - thrombotic thrombocytopenia purpura - SLE - cancer
28
What are the causes of vitamin B12 deficiency?
- pernicious anaemia - post gastrectomy - vegan diet - disorders of the terminal ileum (Crohn's or ileoceacal resection)
29
What is the management of vitamin B12 deficiency anaemia?
- IM hydroxocobalamin 3 times a week for two weeks then once every 3 months - Must correct B12 before folate due to degeneration of the cord
30
What chromosome alpha thalassaemia?
16
31
What chromosome beta thalassaemia?
11
32
Describe alpha thalassaemia
- if one or two alleles: hypochromic, microcytic and normal Hb - if 3: HbH disease: hypochromic, microcytic, splenomegaly - if 4: death in utero
33
Describe beta thalassaemia
- trait/minor: hypochromic, microcytic, target cell, Hb normal - Major (both genes): severe anaemia, splenomegaly, hepatomegaly and bone expansion
34
Bone expansion beta thalassaemia major
- hair on end appearance in skull - fragility fracture
35
What is the management of beta thalassaemia major?
- regular red blood cell transfusions - consider splenectomy - monitor iron, iron chelation (desferrioxamine) - folic acid
36
Schistocytes
Microangiopathic haemolytic anaemia
37
Why may the urine appear dark in haemolytic anaemia?
Haemoglobinuria in severe haemolysis, usually intravascular
38
Differentials of petechiae
- Leukaemia - Meningococcal septicaemia - Vasculitis - Henoch-Schonlein Purpura (HSP) - Idiopathic Thrombocytopenia Purpura (ITP) - Non-accidental injury
39
What is the presentation of leukaemia?
- fatigue - petechiae and abnormal bruising - fever - abnormal bleeding - hepatosplenomegaly - lymphadenopathy
40
What are the types of leukaemia?
- acute myeloid leukaemia - acute lymphoblastic leukaemia - chronic myeloid leukaemia - chronic lymphocytic leukaemia
41
Blood acute myeloid leukaemia
- blast cells - auer rods
42
Blood acute lymphoblastic leukaemia
- blast cells - no auer rods
43
Blood chronic lymphocytic lymphoma
- smear/smudge cells on blood film
44
Which leukaemias are associated with the philadelphia chromosome?
- acute lymphoblastic leukaemia - chronic myeloid leukaemia
45
What is Richter's transformation?
The transformation of chronic lymphocytic leukaemia into a high grade lymphoma
46
What is the presentation of Hodgkin's lymphoma?
- lympadenopathy: rubbery, non tender - B symtpoms: fever, weight loss, night sweats - Fatigue - itch - cough - shortness of breath - abdominal pain
47
What are the risk factors for Hodgkin's lymphoma?
- HIV - EBV - Family history - Autoimmune conditions e.g. rheumatoid arthritis
48
Hodgkin's lymphoma biopsy
Reed Sternberg cells
49
Explain the staging of hodgkin's lymphoma
- I: confined to one region of lymph nodes - II: more than one region but one side of the diaphragm - III: lymph nodes above and below the diaphragm - IV: widespread involvement including non lymphatic organs
50
What are the non-Hodgkin lymphomas?
- Burkitt - MALT - Diffuse large B cell
51
What is monoclonal gammopathy of undetermind significance?
Excess of a single type of antibody or antibody component without any other features of myeloma or cancer
52
What is smouldering myeloma?
Progression of MGUS, high levels of antibodies or antibody components. Premalignant
53
What is multiple myeloma?
Myeloma affecting multiple areas of the body
54
Bloods myeloma
- low WCC (neutropenia) - anaemia - thrombocytopenia - Rasied ESR - Raised calcium - Raised plasma viscosity
55
Specific tests for myeloma
- Bence jones proteins - serum free light chain assay - serum immunoglobulin - serum protein electrophoresis - bone marrow biopsy
56
Investigation for spread of myeloma
- MRI - CT if MRI not suitable, X ray if CT not suitable
57
What are the signs of myeloma on X-Ray?
- punched out lesions - lytic lesions - raindrop skull
58
What is the presentation of myeloma?
- Dehydration ( myeloma renal disease) - Easy bruising - reduced sight - Heart failure - Bone pain (pathological fracture, increased activity of osteoclasts)
59
What are the myeloproliferative neoplasms?
- Essential thrombocytopenia - Myelofibrosis - polycythaemia vera
60
What is the presentation of essential thrombocytopenia?
- anaemia - splenomegaly - portal hypertension - thrombosis - decreased WCC RAISED PLATELETS
61
What is the presentation of polycythaemia vera?
- splenomegaly - portal hypertension - thrombosis - Low WCC RAISED HAEMOGLOBIN
62
What is the presentation of myelofibrosis?
- anaemia - splenomegaly - portal HTN - low platelets and WCC
63
blood film myelofibrosis
- Teardrop RBCs - Poikilocytosis - blasts
64
What is the management of essential thrombocytopenia?
- Hydroxyurea - Aspirin - Chemotherapy
65
What is the management of polycythaemia vera?
- venesection - aspirin - chemotherapy
66
What is the management of myelofibrosis
- Allogenic stem cell transplant - chemotherapy
67
What are the genetic mutations associated with myeloproliferative disorders?
- JAK2 - MPL - CALR
68
What is Von Willebrand Disease?
Autosomal dominant bleeding disorder
69
What are the types of von willebrand disease?
- Type 1: decreased factor - Type 2: abnormal VWF - Type 3: total lack of VMF (type 3)
70
What are the symptoms of von willebrand disease?
- increased bleeding - monorrhagia - nose bleeds (epistaxis)
71
What are the investigations for von willebrand disease?
- Prolonged bleeding time - APTT may be prolonged - VWF function assay
72
What is the management of von willebrand disease?
- tranexamic acid - desmopression - factor VIII
73
What is the deficiency in haemophilia A?
Factor VIII
74
What is the deficiency in haemophilia B?
Factor IX
75
What is the inheritance of haemophilia A and B?
Autosomal recessive
76
What are the symptoms of haemophilia?
- excessive bruising - fatigue - recurrent or severe bleeding - musculoskeletal bleeding - presents with the swelling of joints - cutaneous purpura in acquired
77
What are the risk factors for acquired haemophilia?
- Age >60 - Autoimmune conditions - IBD - Diabetes - Malignancy
78
Investigations haemophilia
- Prolonged APTT - Plasma factor VIII and IX assay: decreased or absent - Mixing study: APTT corrected - FBC: Hb may be low - Prothrombin time, platelet aggregation studies should be normal
79
What is the treatment of haemophilia?
- Replace factor VIII or IX - If acquired: immunosuppression with prednisolone and cyclophosphamide
80
What does a low haemoglobin with a high reticulocyte count suggest?
Haemolysis or bleeding
81
Coagulation screen DIC
- ↓ platelets - ↓ fibrinogen - ↑ PT & APTT - ↑ fibrinogen degradation products
82
What is the diagnostic test for hereditary spherocytosis?
EMA binding test
83
What is the empirical antibiotic of choice for neutropenic sepsis?
Piperacillin with tazobactam (Tazocin)
84
Why are blood products irradiated?
To avoid transfusion related graft vs host disease
85
What is the presentation of idiopathic Thrombocytopenic purpura?
- petechiae, purpura - bleeding (e.g. epistaxis) - catastrophic bleed (uncommon)
86
What is the first line treatment for ITP?
Oral prednisolone
87
How long should the oral contraceptive pill be stopped before surgery?
4 weeks
88
What is the reversal agent for dabigatran?
Idarucizumab

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