Haematology Flashcards
What is the most common single malignancy in childhood?
ALL
What are the presenting complaints of ALL
Malaise Weightloss Fever Myalgia,arthralgia Lymphadenopathy Hepatosplenomegaly Anaemia,thrombocytopenia Leucopenia or leucocytosis
The aetiology of ALL is unclear but in the pathogenisis of ALL what two events are crucial?
Maturation arrest
Loss of control of proliferation
What are the most common side effects of cyclophosphamide?
Haemorrhagic cystitis Myelosuppression Alopecia Anorexia Nasal congestion
What is used to reduce the incidence of haemorrhagic cystitis when giving cyclophosphamide?
Cyclophosphamide end product is acrolein which is toxic to the bladder. Concurrent administration of “Mesna” inactivates acrolein in the urine.
What are the common side effects of dactinomycin?
Myelospression Nausea Vomiting Oral mucositis Oesophagitis Pharyngitis Diarrhoea Fever Malaise Myalgia Alopecia Acne Rash
What is the core drug used in ALL maintenance therapy?
Mercaptopurine
What are the side effects of mercaptopurine?
Myelosuppression Hepatotoxicity N&V Mucusitis Rash Diarrhoea Hypoglycaemia
What are the three mechanisms which cause acute renal failure after a transfusion reaction?
- Renal vasoconstriction caused by toxic substance released from haemolysed blood.
- Circulatory shock from loss of circulating blood cells
- Renal tubular blockage from haemoglobin precipitation in the renal tubules.
What is this cell and what does it indicate?
Reed-Sternberg Cell.
Note “owls eye” appearance
Pathognomonic of Hodgkins Lymphoma.
It is the malignant cell.
Outline the Ann Arbor staging system with Cotswald modification adapted for NHL.
Stage I
- single lymph node region (stage I)
- single extralymphatic organ or site (stage IE)
Stage II
- two or more involved lymph node regions on the same side of the diaphragm (stage II)
- localized involvement of an extralymphatic organ or site (stage IIE).
Stage III
- lymph node involvement on both sides of the diaphragm (stage III),
- localized involvement of an extralymphatic organ or site (stage IIIE) or spleen (stage IIIS), or both (stage IIIES).
Stage IV
- diffuse or disseminated involvement of one or more extralymphatic organs (eg, liver, bone marrow, lung), with or without associated lymph node involvement.
- The presence or absence of systemic symptoms should be noted with each stage designation. (A = asymptomatic; B = presence of fever (>38 degrees C), sweats, or weight loss >10 percent of body weight over six months.)*
The acute lymphoblastic form of NHL is derived from the same T-and B-lineage lymphoid cells as ALL.
What is the difference in pre-B-cell and T-cell derivation?
In ALL, 80% are pre-B-cell derived and 20% T-cell derived.
The reverse is true of NHL.
2008A Q3
In an otherwise well toddler with significant nutritional iron deficiency anaemia, what is the expected time interval between commencing iron therapy and a reticulocytosis becoming evident on a blood film?
A. 3 days.
B. 7 days.
C. 14 days.
D. 30 days.
E. 60 days.
A. 3 days.
What is cold agglutin disease?
Usually IgM antibodies (rarely IgG or IgA) directed against polysaccharides antigens on RBCs. Binding of antibodies activates the classical pathway of the complement cascade.
On exposure to cold, RBC destruction due to cold agglutins - haemolytic anaemia.
Regularly occurs with M. Pneumoniae and Infectious Mononucleosis. Can occur with lymphoma.
Detected by direct Coombs test.
Treatment - avoid cold, rutiximab (monoclonal anti CD 20 antibody), plasmapheresis (if severe or for surgery)
What are warm agglutins?
IgG antibodies that react with protein antigens on RBCs at body temperature.
Usually idiopathic
Can be due to viral infxn, autoimmune disease, immune deficiency, immune system malignancies,
Diagnosis by anitigen or complement on RBC with direct Coombs test.
Treatment best with corticosteroids, splenectomy if poor response.
Anaemic pt with abdo pain and recent use of trimethoprim-sulfamethoxazole. Blood film below.
Outline diagnosis
G6PD
G6PD deficiency leads to two syndromes;
- episodic haemolytic anaemia, and
- chronic non-spherocytic haemolytic anaemia.
- Inducers include fava beans, infections and drugs such as Trimethoprim-sulfamethoxazole.
- Acute haemolysis is noted by marked drop in haemoglobin and haematocrit.
- Haemolysis evident on the blood film. Bite cells are visible, representing reticulocytosis.
- Diagnosis is by G6PD activity. Prevention of haemolysis involves avoidance of inducers. Supportive treatment is removal of inducing agent +/- blood transfusions.
