Haematology Flashcards by Hamish Halliday

What can Myeloid stem cell become?

Platelets
RBC
Basophil, Neutrophil, Eosinophil, Macrophage

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What can lymphoid stem cell become?

B cell
T cell
NK cell

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What is a reticulocyte?

An immature red blood cell

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Lifespan of a RBC?

3 months

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What are target cells on a blood film seen in?

Iron deficiency anaemia
Post-splenectomy

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What are Heinz Bodies on a blood film seen in?

G6PD
Alpha-thalassameia

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What are Howell-Jolly bodies on a blood film seen in?

Post-splenectomy
Severe anaemia

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What are Howell-Jolly bodies?

Blobs of DNA material is seen in RBC. This should be removed by spleen.

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When are there high levels of reticulocytes?

Haemolytic anaemia

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What are schistocytes?

Fragments of RBC

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What are schistocytes and causes?

Fragments of RBC due to trauma

Causes:
- Haemolytic uraemic syndrome
- Disseminated intravascular coagulation (DIC)
- Thrombotic thrombocytopenia purpura
- Metal heart valves
- Haemolytic anaemia

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What are sideroblasts and what do they indicate?

Sideroblasts are immature RBC

Indicate myelodysplasic syndrome

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What are smudge cells on a blood film seen in?

Chronic lymphocytic leukaemia

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What are spherocytes on a blood film seen in?

Spherocytes are spherical red blood cells

Seen in autoimmune haemolytic anaemia or hereditary spherocytosis

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Causes of microcytic anaemia acronym?

TAILS

T – Thalassaemia
A – Anaemia of chronic disease
I – Iron deficiency anaemia
L – Lead poisoning
S – Sideroblastic anaemia

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Causes of normocytic anaemia causes?

3As and 2Hs

A – Acute blood loss
A – Anaemia of Chronic Disease
A – Aplastic Anaemia
H – Haemolytic Anaemia
H – Hypothyroidism

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Macrocytic megaloblastic anaemia causes?

B12 deficiency
Folate deficiency

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Macrocytic normoblastic anaemia causes?

Alcohol
Reticulocytosis - new RBC turnover
Hypothyroidism
Liver disease
Drugs such as azathioprine

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Ix of iron deficient anaemia if no clear cause?

OGD - oesophago-gastroduodenoscopy
+
Colonscopy

(look for cancer of GI tract)

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Mx of iron deficient anaemia?

Oral iron (ferrous sulfate) for 3 months
Iron infusion - avoid in sepsis
Blood transfusion

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Iron studies in iron deficient anaemia?

Serum ferritin Low
TIBC High
Transferrin High

However, high/normal ferritin can’t rule out iron deficient anaemia could be concurrent inflammation and inflammation increases ferritin

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Causes of B12 deficienct?

Insufficient dietary intake
Pernicious anaemia

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What is pernicious anaemia?

Antibodies attack the parietal cells or intrinsic factor which are responsible for B12 absorption

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Ix for pernicious anaemia?

Intrinsic factor antibody
Gastric parietal cell antibody

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Mx of B12 deficinecy?

If dietary insufficiency -> oral replacement iwth Cyanocobalamic If pernicious anaemia -> IM hydroxycobalamin

Why always mx B12 deficiency before folate deficinecy?

Treating patients with folic acid when they have a B12 deficiency can lead to subacute combined degeneration of the cord

Features of haemolysis? (3)

Anaemia Splenomegaly Jaundice

What does a positive direct coomb's test indicate?

Autoimmune haemolytic anaemia

Mx of hereditary spherocytosis?

Folate supplementation + splenectomy

Jaundice after broad beans, infections or antimalarial mx?

G6PD deficiency

Ix to diagnose globin abnormalities?

Haemoglobin electrophoresis (Diagnostic test for thalassaemia & sickle-cell disease)

Iron studies in thalasaemia?

Serum ferritin High Transferrin High TIBC High

What is thalassaemia?

Reduced globin chain synthesis

Sickle cell disease + parvovirus?

Aplastic crisis - sudden fall in haemoglobin Reduced reticulocyte count

What is sequestration crisis?

Sickle cell crisis where sickling within organs such as lungs or spleen -> blood pooling Increased reticulocyte count & anaemia

Sickle cell crisis triggers?

Infection Dehydration Deoxygenation (High altitude)

Mx of sickle cell crisis?

Analgesia Rehydrate Oxygen Consider: - Antibiotics - Blood transfusion - Exchange transfusion

General mx of sickle cell disease?

Avoid dehydration and triggers Antibiotic prophylaxis - Penicillin V (phenoxymethylpenicillin) Hydroxycarbamide can increase HbF production

Leukaemia Ix & Dx?

Ix - FBC within 48hours Dx - Bone marrow biopsy

Where is a bone marrow biopsy normally taken from?

Iliac crest

Blood film of ALL?

Blast cells No B- or T-cells Lots of lymphocyte precursors

Who gets ALL?

Children <5years of adults >45 Down syndrome Philadelphia chromosome

Px of ALL

Pancytopenia: Anaemia - lethargy and pallor Neutropenia - infections Thrombocytopenia - easy brusiing, petechiae Hepatosplenomegaly Fever Bone pain

Blood film of chronic lymphocytic leukamia

Smear or smudge cells

FBC of CLL?

Lymphocytosis - raised WCC Anaemia Thrombocytopenia

What are Auer rods seen in?

Acute myeloid leuakemia

FBC of Chronic myeloid leukemia?

Lots of neutrophils, RBC, platelets

What is Richter's transformation?

CLL -> Lymphoma (non-Hodgkin's lymphoma) Patient with CLL becomes unwell very suddently

What is tumour lysis syndrome?

Release of uric acid from cells being destroyed by chemotherapy -> AKI

S/e of bleomycin?

Lung fibrosis

Chronic myeloid leukaemia mx?

1. Imatinib (tyrosine kinase inhibitor) Others: - Hydroxyurea - Interferon-alpha - Allogenic bone marrow transplant

What is a Reed-sternberg cell seen in?

Hodgkin's lymphoma

Lymphoma with alcohol-induced pain in the node?

Hodgkin's lymphoma

Diagnostic test of lymphoma?

Lymph node biopsy

Staging system for Hodgkin's and Non-Hodgkins lymphoma?

Ann Arbor staging

B symptoms of lymphoma?

Fever Weight loss Night sweats

Non-Hodgkin's lymphoma associated with EBV, malaria and HIV?

Burkitt lymphoma

Non-Hodgkin's lymphoma associated with H.pylori infection?

MALT lymphoma

Mx of Hodgkin's lymphoma?

Chemotherapy is mainstay +/- Radiotherapy

Mx of non-Hodgkin's lymphoma?

Watchful waiting Chemo +/- radiotherapy Rituximab - monoclonal antibodies

Microscopy appearance of Burkitt's lymphoma?

"Starry sky" appearance

What are the three myeloproliferative disorders?

Primary myelofibrosis Polycythaemia vera Essential thrombocythaemia

What is myelofibrosis?

When proliferation of a cell line -> fibrosis of bone marrow

What is extramedullary haematopoiesis?

When the bone marrow is replaced with scar tissue the production of blood cells (haematopoiesis) starts to happen in other areas such as the liver and spleen -> Hepatomegaly & Splenomegaly

What is raised in polycythaemia vera?

Haemoglobin (Erythroid cells - RBC)

What is raised in primary thrombocythemia?

Raised platelet count (Megakaryocyte)

What are the FBC findings in Myelofibrosis?

Anaemia Leukocytosis or leukopenia Thrombocytosis or thrombocytopenia

What would a blood film of myelofibrosis show?

Teardrop-shaped RBCs Poikilocytosis - RBCs varied in size Blasts - immature red and white cells

Dx for myeloproliferative disorders?

Bone marrow biopsy Bone marrow aspiration is normally dry due to scar tissue

Mx of primary myelofibrosis?

Allogenic stem cell transplant Chemotherapy Supportive

Mx of polycythaemia vera?

Venesection Aspirin Consider chemotherapy

Mx of primary thrombocythaemia?

Aspirin Chemotherapy

Haematology Flashcards

(72 cards)