Haematology Flashcards
(161 cards)
1
Q
What would be blood results of anaemia of chronic disease?
A
low/normal ferritin and wide distribution of red blood cell volume
2
Q
What are side effects of ferrous sulphate?
A
Black stools, constipation, diarrhoea, nausea
3
Q
What are triggers for sickle cell crisis?
A
Infection, dehydration, hypoxia, acidosis, exposure to cold
4
Q
Why does sickle cell not present till 6 months?
A
High levels of HbF mask the effect of this until they start to fall at 6 months
5
Q
What are some complications of myeloma?
A
Hypercalcaemia, spinal cord compression, hyperviscosity, acute renal failure.
6
Q
Why are people with myeloma susceptible to other infections?
A
Possible bone marrow infiltration; immunoparesis secondary to overexpression of one immunoglobulin and underexpression of any other immunoglobulins.
7
Q
What is the treatment for CLL and how is it given?
A
Imatinib - tyrosine kinase inhibitor, oral
8
Q
CML vs CLL
A
CLL - usually an incidental finding with no symptoms
CML - will have symptoms, usually massive splenomegaly (described as sense of fullness sometimes)
9
Q
AML vs CML
A
AML - low neutrophils and platelets
CML - anaemia, raised neutrophils and platelets
10
Q
ALL blood findings
A
- Raised lymphocytes
- Low neutrophils
- Low platelets
11
Q
What is raised with beta thalassaemia major?
A
HbA2
12
Q
PT vs APTT
A
PT - extrinsic - Factors 3 and 7 (play tennis outside)
APTT - intrinsic - Factors 9,11,13 (play table tennis inside)
13
Q
New B symptoms in someone with CLL?
A
Richters transformation -> CLL transforms into aggressive large cell lymphoma
14
Q
Patients over the age of 60 who present with iron deficiency anaemia
A
Investigate for colorectal cancer -> colonoscopy
15
Q
Causes of the renal impairment in myeloma?
A
AL type amyloidosis, Bence Jones nephropathy, nephrocalcinosis, nephrolithiasis
16
Q
Isolated rise in GGT in the context of a macrocytic anaemia
A
Alcohol excess
17
Q
‘starry sky’ appearance on lymph node biopsy
A
Burkitt lymphoma - associated with EBV/HIV
18
Q
Complications of blood transfusions
A
Non-haemolytic febrile reaction: Fever and chills -> slow/stop transfusion + paracetamol
Minor allergic reaction: urticaria and pruritic -> stop transfusion and give antihistamine
Acute haemolytic reaction: fever, abdominal pain, hypotension -> stop transfusion, recheck patient identity, send blood for repeat testing
Transfusion-associated circulatory overload: hypertension, pulmonary oedema -> slow/stop transfusion + loop diuretic and oxygen
Transfusion-related acute lung injury: hypoxia, hypotension, fever -> stop transfusion, oxygen
19
Q
What is the most common clotting abnormality?
A
Von-Wilebrand disease
20
Q
What is the treatment for beta thalassaemia major?
A
Lifelong blood transfusions
21
Q
low platelets, increased clotting time and raised fibrin degradation products (FDPs)
A
DIC
22
Q
When does heparin-induced thrombocytopenia present?
A
5-14 days post op with low platelets, nothing else
23
Q
Which drugs can cause haemolytic in patients with G6PD?
A
- Ciprofloxacin
- Sulphasalazine
- Sulfonylureas
- Sulphonamides
24
Q
Hereditary spherocytosis vs G6PD?
A
HS - extra vascular haemolysis -> causes splenomegaly
G6PD - intravascular haemolysis -> normal spleen
25
Inheritance of G6PD vs HS?
G6PD - X linked recessive -> transmitted from mother
HS - Autosomal dominant
26
What can precipitate renal failure in patients with myeloma?
NSAIDs
27
unexplained nosebleeds and menorrhagia + an immune condition
Think ITP
28
IgA deficiency increases the risk of what?
Anaphylactic reactions to blood transfusions
29
Which leukaemia is associated with polycythaemia?
AML
30
Blood test findings for leukaemia?
AML: increased myeloblasts + anaemia and thrombocytopenia
ALL: increased lymphoblasts + anaemia and thrombocytopenia
CML: increased granulocytes + anaemia
CLL: increased lymphocytes (usually B cells) + anaemia
31
What are negative prognostic factors for lymphoma?
- The presence of B symptoms
- Male gender
- Being aged >45 years old at diagnosis
- High WCC, low Hb, high ESR or low blood albumin
- Lymphocyte depleted subtype
32
What infection can trigger an aplastic crisis in patients with hereditary spherocytosis?
Parvovirus
33
Which subtype of Hodgkins has the best prognosis?
Lymphocyte predominant
34
Malaria prophylaxis can trigger what?
Haemolytic anaemia in those with G6PD deficiency
35
hyper-segmented neutrophil polymorphs
Megaloblastic anaemia
36
Abdominal pain, constipation, neuropsychiatric features, basophilic stippling
Lead poisoning
37
What are irradiated blood products used for?
Reduce the risk of graft vs host disease by destroying T cells
38
What are the adverse effects of tamoxifen?
Increased risk of VTE and endometrial cancer
39
Most common organism which causes neutropenic sepsis?
Staph epidermis
40
Which drugs can cause aplastic anaemia?
- Phenytoin
- Chloramphenicol
- Cytotoxics
- Sulphonamides
41
IgM paraprotein
Waldenstrom's macroglobulinaemia
42
pain, oedema, dermatitis, ulceration, abnormal skin pigmentation, hyperpigmentation, gangrene, lipodermatosclerosis
post-thrombotic syndrome
43
When should G6PD enzyme assays be done?
At presentation and 3 months after to avoid false negatives
44
Mycoplasma infection can cause what?
Cold Autoimmune haemolytic anaemia
45
What ITU treatment could be considered for someone with sickle cell crisis
Exchange transfusion -> reduce number of sickle cells and increase normal RBC to improve oxygenation
46
What is a common complication of Burkitts lymphoma?
Tumour lysis syndrome
47
What electrolyte imbalances are seen in tumour lysis?
hyperkalaemia
hyperphosphataemia
hypocalcaemia
hyperuricaemia
acute renal failure
48
‘tear drop’ poikilocytes
Myelofibrosis
49
intense itching which usually occurs after exposure to hot water or hot and humid weather
Polycythaemia vera
50
What can be given prior to chemo to prevent tumour lysis syndrome?
Allopurinol or rasburicase
51
Beta thalasaaemia major vs trait?
Major would have profound anaemia usually Hb <60
52
Sickle cell + abdominal pain + anaemia
Sequestration crisis
53
Transfusion thresholds?
Normal patients <70
Patients with ACS <80
54
What is the treatment for ITP?
Oral steroids / IVIG if signs of major bleeding
55
Rouleaux formation
Multiple myeloma
56
Target cells and Howell-Jolly bodies
Coeliac disease -> hyposplenism
57
decrease in haptoglobin levels
Haemolysis
58
large multinucleate cells with eosinophilic nucleoli
Reed-Sternberg
59
What are complications of CLL?
- Anaemia
- Recurrent infections due to hypogammaglobulinaemia
- Warm AIHA
- Transformation into non-Hodgkins
60
High HBA2?
Beta thalassaemia
61
What is the treatment for post thrombotic syndrome?
Compression stockings
62
Complications of polycythaemia?
- Thrombotic events (patients given aspirin as prophylaxis)
- Myelofibrosis
- Acute leukaemia
63
normocytic anaemia with low serum iron, low TIBC but raised ferritin
Think anaemia of chronic disease
64
Aplastic crisis vs sequestration crisis in sickle cell?
Aplastic - reduced reticulocytes
Sequestration - increased reticulocytes
65
Thalassaemias will cause what?
Haemolysis -> raised bilirubin
66
Management of anti-phospholipid in pregnancy?
Aspirin + LMWH
67
What is the reversal agent for dabigatran?
Idarucizumab
68
Myeloma Investigations
Bloods - anaemia
Blood film - rouleaux formation
Urine protein electrophoresis - Bence Jones (IgA/IgG)
Bone marrow - Raised plasma cells
CXR/MRI - osteolytic lesions
69
What mutation would be seen in polycythaemia?
JAK-2
70
How does heparin work?
Activate antithrombin III - measure APTT
71
Elderly patient with fatigue, splenomegaly, weight loss/night sweats?
Think myelofibrosis
72
'myeloid blast' cells are suggestive of what?
AML
73
What are signs of low Hb on examination?
Pallor, tachycardia, tachypnoea, flow murmur
74
What are causes of late transfusion complications?
Iron overload, graft versus host disease, post transfusion purpura, infection
75
What is a massive blood transfusion?
Transfusion of 10 units/a patients entire blood volume within 24 hours
76
How to test for pernicious anaemia?
Intrinsic factor - most useful
gastric parietal cell antibodies
77
Pernicious anaemia predisposes to what?
Gastric cancer
78
How is haemophilia inherited?
X linked recessive
79
What is the most common inherited thrombophilia?
Factor V Leiden deficiency
80
small, single, peripherally-located, rounded inclusion in 50-60% of the erythrocytes.
Howell-Jolly body -> Hyposplenism
81
Metallic aortic valves can cause what?
Non-immune haemolytic anaemia
82
What can be given to reduce the frequency of sickle cell crises?
Hydroxycarbamide (hydroxyurea)
83
How to manage high INR in patients needing emergency surgery?
Give IV Vit K and recheck INR in 6-12 hours
If surgery cannot be postponed give 4 factor prothrombin + IV Vit K to reverse warfarin
84
What is a safe INR for surgery?
<1.5
85
What organisms are people with sickle cell susceptible to?
Strep pneumoniae
86
TACO vs TRALI
TACO - SOB and hypertension
TRALI - hypotension
87
What is the management of ITP?
Emergency: Platelet transfusion/IV Methylpred/IVIG
Platelet > 30 - Observe
Platelet <30 - Oral pred
88
What are features of blood film post splenectomy?
Howell- Jolly bodies
Pappenheimer bodies
Target cells
Irregular contracted erythrocytes
89
finger abduction weakness
Lesion at T1
90
TPP Symptoms?
1. Fever
2. Neuro symptoms
3. Renal failure
4. Anaemia
5. Low platelets
91
ITP VS TTP VS DIC
DIC will have raised PT/INR/APTT + low platelets whereas for ITP and TTP this will be normal
92
How can tumour lysis syndrome be diagnosed?
- Increased serum creatinine
- Cardiac arrhythmia
- Seizure
93
Aplastic crisis vs sequestration
Aplastic - sudden fall in Hb after parvovirus infection
Sequestration - sickling within organs such as spleen/lungs causing pooling of blood
94
Polycythaemia + sudden drop in Hb?
AML
95
Isolated rise in Hb?
Polycythaemia
96
Bite and blister cells
G6PD deficiency
97
What is the main management of sickle cell crises?
- IV analgesia, fluids + oxygen
- Consider Abx if infection and blood transfusion if Hb is low
98
ITP vs VWD?
ITP - destruction of platelets so platelet count is low with normal PT and APTT
VWD - platelets are fine but they take longer to stop bleeding so platelet count is normal, PT and APTT are prolonged
99
Hand foot mouth syndrome - sudden swelling, pain and erythema?
Think Sickle cell disease
100
How is tranexamic acid given followng major haemorrhage?
IV bolus followed by slow infusion
101
anisocytosis, macrocytosis and hyposegmentation of the neutrophils.
Myelodyplastic syndrome -> can progress to AML
102
Over how long are RBC transfused?
90-120 minutes in non urgent cases
103
Microcytic anaemia with high ferritin + transferrin saturation?
Think sideroblastic anaemia - basophilic stippling
104
Warm vs Cold AIHA?
Warm - IgG - associated with CLL
Cold - IgM (M for Mountains - cold) - associated with lyMphoma / Mycoplasma / EBV
105
What is the pathological process behind myeloma?
Clonal proliferation of plasma cells with paraprotein production
106
What is the treatment for myeloma?
- Chemo
- Bisphosphonates often given for bone protection
107
What translocation causes Philadelphia?
t(9:22) - gene BCR/ABL
108
What blood test will be raised with Hodgkins?
LDH
109
Why does sickle cell often present in >1ys?
Fetal Hb protects against sickling therefore by 1 transformation to adult haemoglobin is completed
110
What is the action of LMWH?
Anti-thrombin and anti-Xa
111
What are the best blood tests to examine synthetic liver function?
INR and albumin
112
What does cryoprecipitate contain?
Factor 8, VWF, fibrinogen and factor 13
113
What does plasma contain?
All clotting factors
114
What is the pathophysiology of DIC?
- Diffuse thrombin activation by a trigger which activates coag cascade
- This leads to platelet consumption and clotting factor consumption
115
What are triggers for DIC?
- Sepsis
- Trauma
- Malignancy
- Vasculitis
- Toxins
- Pancreatitis
116
Beta thalassaemia major vs trait?
Major - homozygous mutation, Trait - heterozygous mutation
117
What may be seen on blood film in beta thalassaemia?
- Basophilic stippling
- Microcytosis
- Hypochromic red cells
118
What should be given to patients with beta thalassaemia major with blood transfusion?
Desferrioxamine
119
What blood abnormality does warfarin cause?
Prolonged PT, normal APTT
120
Which organisms cause post splenectomy sepsis?
- Strep pneumoniae
- H influenzae
- Meningococci
121
All patients with IHD should take what?
Aspirin
122
Warfarin can rarely cause what?
Skin necrosis
123
Ileocecal resection can result in what?
Vit B12 deficiency
124
How can painful vaso-occulsive crises be diagnosed?
Clinically
125
DIC is associated with what?
Schistocytes
126
Men of any age with a Hb below 110g/L should what?
Refer for upper and lower GI endoscopy as 2 week wait
127
What is the reversal agent for heparin overdose?
Protamine sulphate
128
What is the management of heparin induced thrombocytopenia?
If anticoag needed, switch to direct thrombin inhibitors e.g. argatroban
129
Prosthetic heart valves can cause what?
Haemolytic anaemia
130
pain when exposed to cold, jaundice, anaemia?
Sickle cell
131
platelet count < 30 x 109 and clinically significant bleeding
Platelet transfusion needed
132
Raised haemoglobin, plethoric appearance, pruritus, splenomegaly, hypertension
Polycythaemia
133
Haemoarthroses (bleeding in joints) are a sign of what?
Haemophilia
134
Transfusions can cause what?
Hyperkalaemia and hypocalcaemia
135
Investigations for polycythaemia?
- FBC/Blood film
- JAK2 mutation
136
How often should sickle cell patients receive the PCV vaccine?
Every 5 years
137
Reversal for rivaroxaban and apixaban
andexanet alfa
138
Macrolides can cause what?
Drug induced neutropenia
139
Sideroblastic anaemia vs iron deficiency?
Sideroblastic - high ferritin and serum iron levels
140
What is the definitive investigation for sickle cell?
Haemoglobin electrophoresis
141
Dry tap bone marrow aspirate?
Think primary myelofibrosis
142
How is sideroblastic anaemia inherited?
X linked
143
What does rituximab target?
CD20
144
ADAMTS-13 deficiency is associated with what?
TTP
145
Blood film showing Schistocytes?
AIHA
146
Target cells with asymptomatic anaemia?
Beta thalassaemia trait
147
Non Hodgkins vs CLL
CLL - significant lymphocytosis
148
Anaemia with raised bilirubin + LDH?
Haemolytic anaemia
149
What is permissive hypotension?
A strategy in bleeding of trauma patients where you use less fluids and maintain lower BP to prevent clots
150
What are electrolyte imbalances following large blood transfusion?
- Hyperkalaemia
- Hypocalcaemia
- Iron overload
151
Blood film changes
Target cells - Iron deficiency anaemia, sickle cell, hyposplenism, liver disease
Spherocytes - spherocytosis, AIHA
Basophilic stippling - lead poisoning, thalassaemia, sideroblastic anaemia
Heinz bodies - G6PD
Schistocytes - G6PD, DIC
Pencil poilkilocytes - Iron deficiency
152
Management of AIHA
- Supportive care
- Steroids to suppress immune system
- Splenectomy in severe cases
153
What happens to EPO in polycythaemia?
Reduces
154
Schistocytes will be seen in what?
Haemolysis
155
Raised red cell distribution width?
Think mixed deficiency e.g iron and folate
156
Recurrent DVTs in someone already on a DOAC?
Increase dose, check adherence or switch to another anticoagulant e.g. warfarin
157
Increased concentration of haemltocrit is what?
Polycythaemia
158
Major haemorrhage protocol involves providing what?
Packed red cells, platelets and FFP
159
Blood oozing from a cannula site is a classic sign of what?
DIC
160
<40 year old with raised platelets but no raised Hb?
Essential thrombocytopenia
161
