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Y4 Medicine > Haematology > Flashcards

Haematology Flashcards

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1
Q

Transmission of which type of infection is most common following platelet transfusion?

A

Bacterial

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2
Q

Which drugs can reduce the risk of tumour lysis syndrome

A

Allopurinol or Rasburicase

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3
Q

Which haematological malignancy is most strongly associated with the mutation (t(9:22))

A

CML
(Philadelphia chromosome)
- Also found in 30% of ALL cases

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4
Q

How often should sickle cell patients receive the pneumococcal vaccine?

A

every 5 years

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5
Q

When does heparin induced thrombocytopenia typically occur

A

5-14 days after heparin exposure

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6
Q

Blood findings in DIC

A

Decreased Hb
Decreased Platelets
Decreased Fibrinogen
Increased APTT
Increased FDP

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7
Q

Which blood products have the highest risk of bacterial infection

A

Platelets

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8
Q

Transfusion of platelets is contraindicated in which conditions?

A

Chronic bone marrow failure
TTP
Autoimmune thrombocytopenia
Heparin induced thrombocytopenia

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9
Q

MOA of aspirin

A

irreversibly inhibits COX to reduce the production of thromboxane from arachidonic acid, therefore reducing platelet aggregation

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10
Q

MOA of Apixaban

A

Directly inhibits factor Xa preventing the formation of thrombin from prothrombin

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11
Q

Complications of polycythemia vera

A

AML
Myelofibrosis
Thrombotic events:
Stroke
Splenic infarct –> Ruptured spleen (rare)
Kidney stones (due to high uric acid)

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12
Q

Metabolic abnormalities in tumor lysis syndrome

A

Hyperkalemia
Hypophosphatemia
Hypocalcemia

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13
Q

Labatory findings in beta thalassemis major

A

Increased HbA2
Increased HbF
Absent HbA

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14
Q

Classic skull Xray findings in myeloma and difference from hyperparathyroidism and pagers disease

A

Patchy bone reabsorption
Rain-drop skull - random pattern of dark spots.
Hyperparathyroidism gives ‘Pepperpot skull’ (random dark and light spots)
Pagets disease gives a thickened vault + osteoporosis circumscripta.

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15
Q

Tear drop poikilocytes are seen in which condition

A

Myelofibrosis

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16
Q

First line treatment for ITP

A

Oral prednisolone

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17
Q

Metabolic differences between Myeloma, Bony metastasis, Pagets disease, Osteomalacia + Hyperparathyroidism

A

Myeloma = Normal ALP, Raised Calcium & Raised phosphate
Bony mets = Raised ALP, Calcium & Phosphate
Osteomalacia = Normal ALP, Decreased calcium, phosphate & Vit D.
Pagets disease = Isolated ALP rise
hyperparathyroid = Raised ALP, Raised calcium, Decreased phosphate

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18
Q

Management of non-haemolytic febrile transfusion reaction

A

Paracetamol

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19
Q

Treatment of neutropenic sepsis

A

Tazocin

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20
Q

Sideroblastic anemia investigation findings

A

Hypochromic microcytic anemia
Bloods = High ferritin, High Transferrin, normal iron
Basophilic stippling of RBCs

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21
Q

Causes of sideroblastic anaemia

A

Anti-TB meds
Myelodysplasia
Alcohol
Lead

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22
Q

Which type of Hodgkins lymphoma carries the best prognosis

A

Lymphocyte predominant

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23
Q

What type of transfusion reaction is more common in patients with IgA deficiency

A

Anaphylaxis

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24
Q

Which drugs need to be avoided in G6PD deficiency (due to risk of hemolysis)

A

Sulph drugs
Sulphonamide, Sulphonylureas (E.g Glipizide) + Sulfalazine

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25
Causes of Microcytic anaemia
Thalassemia Anemia of chronic disease Iron deficiency anemia Lead poisoning Sideroblastic anemia
26
Causes of normocytic anemia
Acute blood loss Aplastic anemia Anemia of chronic disease Haemolytic anemia Hypothyroidism
27
Causes of microcytic anemia
Normoblastic = Reticulocytosis + Alcohol + Liver disease + Azathioprine Megaloblastic = Pernicious or Folate deficiency
28
Which medication can cause Megaloblastic microcytic anemia
Methotrexate as it causes a folate deficiency
29
Causes of iron deficiency
Pregnancy Iron losses - GI bleed, Cancer, Menorrhagia Malabsorption - PPIs, Coeliac, Crohns
30
Blood findings in iron deficiency anemia
High TIBC + Low transferrin
31
Management of IDA
Refer for investigations if high risk (OGD/Colonoscopy). Oral ferrous sulfate 200mg TDS IV cosmofer if malabsorption (anaphylaxis risk)
32
Investigations for pernicious anemia
Bloods: Megaloblastic microcytic anemia IF antibody Gastric parietal cell antibody
33
Hereditary causes of haemolytic anemia
Hereditary spherocytosis Hereditary elliptocytosis G6PD deficiency Thalassemia Sickle cell
34
Acquired causes of haemolytic anemia
Warm/cold AHA Alloimmune Paroxysmal nocturnal haemoglobinuria Microangiopathic haemolytic anemia Prosthetic heart valves
35
Sx and Invx for spherocytosis
Sx = Jaundice + Gallstones + Splenomegaly + Aplastic crisis (during parvovirus) + Fhx Invx; - blood films shows spherocytes - Diagnosis = EMA binding test
36
G6PD deficiency
X linked recessive mutation resulting in a defect in the G6PD enzyme. Makes RBCs more prone to oxidative stress.
37
Triggers of haemolysis in G6PD deficiency
Infection Drugs - sulph drugs + antimalarials Flava beans
38
Blood film findings in G6PD Deficiency
Heinz bodies, Bite cells + blister cells
39
Diagnosis of G6PD Deficiency
G6PD enzyme assay at presentation + 3 months after
40
Warm AHA
More common. Occurs at body temperature. Can be secondary too CLL. Caused by IgG antibody Features = extravascular haemolysis (splenomegaly)
41
Treatment of AHA
Steroids +/- Rituximab
42
Cold AHA
Occurs at cold temperatures (<10 degrees). Usually secondary to SLE/EBV/CMV/HIV/Lymphoma/Leukemia Caused by IgM antibodies Features = intravascular haemolysis + Raynaud's
43
Paroxysmal nocturnal haemoglobinuria
Complement driven destruction of RBCs Sx = red urine in the morning Tx = Eculizumab (Inhibits C5) Bone marrow transplant is curative
44
Causes of Microangiopathic haemolytic anemia
DIC HUS TTP SLE Cancer
45
A mutation on which chromosome causes sickle cell
Chromosome 11
46
What medication can be given to prevent the occurrence of sickle-cell crises
Hydroxycarbamide - increases production of HbF
47
Complications of sickle cell
Increased risk of infection Stroke Avascular necrosis of large joints pulmonary HTN Priapism Acute chest syndrome Sickle-cell crises CKD
48
Splenic sequestration crisis presentation
Acutely enlarged + painful spleen Severe anemia Hypovolemia
49
Presentation of Aplastic crises (sickle cell)
Aplastic anemia Commonly following slapped cheek/parvovirus
50
Beta-thalassemia cause
Recessive mutation on chromosome 11
51
Alpha thalassemia cause
Recessive mutation on chromosome 16
52
Thalassemia diagnosis
Hb Electrophoresis
53
Invx for sideroblastic anemia
FBC = microcytic hypo chromic anemia Iron = raised ferritin + iron + transferrin Blood film = basophilic stippling of RBCs
54
Causes of aplastic anemia
Idiopathic Fanconis anemia Cytotoxics, chloramphenicol, sulphur drugs, gold Benzene Parvovirus B19 & Hepatitis
55
Acute myeloid leukaemia
Most common adult acute leukemia Raised WCC + Thrombocytopenia + reduced reticulocytes Blood film shows Auer rods + blast cells
56
Acute Lymphoid leukaemia
Most common paediatric leukaemia (age 2-4yrs) RF = Downs syndrome / Philadelphia chromosome
57
Chronic myeloid leukaemia
Massive splenomegaly! RF = philadelphia chromosome Increase in granulocytes at different stages + occasionally thrombocytosis (likely to have raised everything) % Blasts in blood/marrow >30%. Tx = imatinib
58
CLL
Common in adults >55yrs RF = TP53 Mutations / Trisomy 12 Lymphadenopathy main feature Blood film = smudge/smear cells
59
Complications of CLL
Richter's transformation / Warm AHA / Hypoglobulinemia (recurrent infections)
60
Hodgkins lymphoma
Characterised by presence of Reed-Sternberg cells Classically presents with painful lymphadenopathy after drinking
61
Most common type of Hodgkins lymphoma
Nodular sclerosing
62
Types of non-hodgkins lymphoma
Diffuse large B cell - most common. Rapidly growing mass in pt >65yrs Burkitts lymphoma = starry sky appearance. associated with EBV. Tumor lysis syndrome MALT lymphoma - in stomach. associated with H.pylori T cell lymphoma in intestines - Coeliac disease
63
Staging system for lymphoma
Ann Arbor
64
Features of myeloma
Calcium high Renal failure Anemia Bone disease Hyperviscosity / Infections
65
Blood film findings in myeloma
Rouleux formation
66
Urinary marker of myeloma
Bence jones proteins
67
Chemotherapy for myeloma
Bortezomib + thalidomide + dexamethasone
68
Features of polycythemia vera
Conjunctival plethora Facial plethora (ruddy complex) Splenomegaly Raised Hb Intense itch after hot water JAK 2 mutation
69
Features of essential thrombocythemia
Raised platelets Characteristic burning sensation in hands
70
Investigations for myeloproliferative disorder
Blood film = Tear drop poikilocytes Bone marrow aspiration = Dry tap JAK2, MPL & CALR gene testing
71
Immune Thrombocytopenia purpura (ITP)
Thrombocytopenia + normal bone marrow Cause = autoantibodies against Glycoprotein Ib-V-IX complex
72
Treatment of ITP
Can observe in children Prednisolone +/- IV immunoglobulin if acute
73
Presentation of TTP
Pentad: Microangiopathic haemolytic anemia + Purpura + Renal insufficiency + Neurological symptoms + Fever
74
Von Willebrand disease
Most common inherited bleeding disorder Caused by autosomal dominant mutation resulting in vwf deficiency
75
Difference in presentation between Von-willebrand and haemophilia
VWD behaves like a platelet disorder so causes epistaxis + menorrhagia whereas haemophilia causes spontaneous bleeding such as hemarthrosis or intracerebral bleeds. Also VWD can occur in females whereas haemophilia is X linked
76
Haemophilia A
Deficiency of factor VIII 90% of haemophilia
77
Haemophilia B
Deficiency of factor IX
78
Types of Thrombophilia
Inherited; - prothrombin gene mutation - Factor V leiden (most common) - Protein C deficiency - Protein S deficiency - Antithrombin III deficiency Acquired; - Antiphospholipid syndrome - COCP
79
Which type of inherited thrombophilia causes the greatest increased risk of VTE
Antithrombin III deficiency
80
Features or Antiphospholipid syndrome
Recurrent thrombosis + miscarriage
81
Bleomycin
MOA = Cytotoxic antibiotic. Works on G2 phase + mitosis SE = Pulmonary fibrosis (lower zone)
82
Methotrexate
Antimetabolite - Folic acid antagonist. Works by inhibiting dihydrofolate reductase. SE = Myelosupression, Lung fibrosis, Liver damage. Requires monitoring of LFTs, U&Es, FBC etc
83
Doxarubicin
Anthracycline MOA = Inhibits topoisomerase II therefore preventing transcription SE = Cardiomyopathy
84
Cisplatin
Platinum compound. MOA = Creates cross-links between guanine molecules which blocks replication + transcription Uses = mainly ovarian / lung cancer / colon cancer SE = Ototoxicity + Nephrotoxicity
85
Cyclophosphamide
Aklylating agent moa = prevents DNA replication + blocks DNA repair Use = Leukemia / lymphoma SE = Haemorrhagic cystitis
86
Vincristine / Vinblastine
Vinca alkaloids MOA = binds to tubulin + inhibits microtubule formation during mitosis thus preventing cell division. (M phase arrest of mitosis) SE = Peripheral neuropathy + myelosuppression

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