HAEMATOLOGY Flashcards
(114 cards)
1
Q
What are the Prognosis factors of Waldosteroms
A
Age <65 : 0 point
Age : 66-75 : 1 point
Age >75 : 2 points
Beta 2 Microglobulin >4 : (1 point)
LDH >250 : 1 point
Serum albumin < 35 (3.5) : 1 point
2
Q
What is the Mx of ITP
A
1st line - Steroids
2nd Line - Immunoglobulin Therapy
3
Q
What are the Features of MM
A
C- raised Calcium
R- Renal dysfunction
A- Anemia
B- Bleeding
B- Bone pain
I - Infection
Plamsa Cells +ve in BM
Bence Jones +ive- Urine
IgE and IgG
Can also cause Hyperviscosity
4
Q
What is the antidote for Heparin ?
( Heparin / Enoxaparin)
A
Protamine Sulfate
5
Q
What is the antidote for Edoxaban/Rivaroxan.
A
Andexanate Alfa
6
Q
What is the antidote for Dabigatran
A
Idaricumab
7
Q
What is the antidote for Warfrain
A
PCC ( for major bleeding)
Vit K ( Oral /Iv)
8
Q
How do you Investigate for PNH
A
Flow Cytometry of CD 55 and CD59 expression ( will show deficiency)
9
Q
Pt with PNH has abdominal pain, distension and deranged Liver function . What’s the Dx ?
A
Budd Chiari Syndrome
10
Q
What is the Genetic Defect of CML
A
Translocation of Chr 9:22
Philadephia Chr
11
Q
What are the features of CML
A
Low Hb, Low Platelets,
Raised WBC;
Left shift of WBC Curve
( promyelocytes, metamyelocytes and myelocytes)
Splenomegaly +++
Basophils : Elevated
12
Q
What is the Ix for Myelodysplasia/ Myelofibrosis
A
Bone Marrow biopsy
13
Q
What do you see in Bm biopsy in Myelodysplasia/ Myelofibrosis
A
MF -reticular fibrosis
Myelodisplasia - Increased Megakaryocyte component
(Sideroblast , blast cells)
14
Q
What elements are commonly Expressed by B- Lymphoma Cells
A
CD19, CD20, CD22, CD79a, CD45
15
Q
What blood picture do you see in Myelodysplasia
A
Pancytopena
( Low Hb, Low WBC - all components, Low Plts)
16
Q
What is the difference between Factor VII and Factor IX deficiency
A
Factor VII - Prolonged PT, Normal APTT
Factor IX - Prolonged APTT
17
Q
What are the features of primary polycythemia
A
Raised RBC ++, Raised WBC and Plts
Raised Hematocrit
Raised LAP ( Leucocyte alkaline phosphatase ) score
JAK-2 mutation
Splenomegaly
18
Q
what is a common cause of secondary polycythemia
A
Chronic COPD with chronic Hypoxia
19
Q
Which Ix will help you differentiate between MM and Waldestroms
A
Serum Protein Electrophoresis
( MM -Ig G and Ig E paraprotein)
Waldosteroms - Ig M Paraprotein
20
Q
What is the Best Ix for Diagnosing Fe Def anaemia
A
Serum Ferritin Levels
21
Q
What are the Features of AML
A
BM Failure; Infection; Gum Hypertrophy
Anemia; Thrombocytopenia ,
Lymphocytosis +++
More than >20% Blast cells in blood/BM ( Diagnostic)
Aur Rod cells +++ in blood film
NOTE : in ALL , there is NO Auer rod
22
Q
What is the translocation in Acute Promyelocytic Lukameia
A
t (15:17)
23
Q
What is the translation in Burkitt Lymphoma
A
t (8:14)
24
Q
What are the features of Wiskott Aldrich Syndrome ( Primary immunodeficiency. )
A
Thrombocytopenia, Eczema,
Reduced Immunoglobulins
Normal CD4 count
25
What is the Rash associated with Antiphospholipid Syndrome
Levido Reticularis
26
what is Antiphospholipid Syndrome also called as ?
Hugh Syndrome
27
What is the Mx of TTP?
plasmapheresis
28
What is the long term Mx of TTP
Long term aspirin once Plt >50
( to reduce risk of plt aggregation )
29
What are the features of TTP ?
Fever, confusion, Anemia, Thrombocytoenia, Deranged Renal Function
30
What is the pathology of TTP
Aquired Abs to ADAMTS13
31
When do you give ORAL vit K in Warfarin users
INR > 8 with no bleeding
INR 5-8 with minor bleeding
32
When do you give IV x Vitamin K in warfarin
INR >8 with major bleeding; along with PCC/FPP
33
When do you use exchange transfusion in Sickle Cell
When pt. has neurological deficits
( Stroke)
34
What are the common associations with Heriditary spherocytosis
Jaundice, Gall stones, Anemia
35
What is the Ix for Hereditary Spherocytosis
EMA Binding !
36
What is the Ix and Mx for homocistenuriuria
Ix - Urine Homocysteine Levels
Mx - Pyridoxine and Folic acid
37
What is the normal average human height in meters/ cm
1.7 metres/ 170cms
38
What is the diagnostic criteria for AML
>/= 20% Blast cells in Blood film or Bone marrow
or
<20% Blast cells , but presence of Clonal abnormalities of ;
t(8:21)q(22:22) ;
inv (16)(p13:q22) ;
t(16;16) (p13 :q22)
39
How do you differentiate MM from MGUS
MM- plasma cells >10%
MGUS - plasma cells <10%
( no evidence of end organ damage)
Both will have +ve IgG
Note: MGUS can later progress to MM ( 1%)
40
When do you use FPP over PCC in Warfarin OD
When PCC is NOT available !
41
How do you Treat Neutropenic Sepsis
Tazocin
+
GCSF can be considered
42
What is the defect in APS syndrome.
Prolonged APTT; but Clots ++
Lupus anticoagulant +ve
Failure of APTT to correct with normal plasma
Recurrent miscarriages, clots
MX : Warfarin
in Pegnancy : Aspirin +LMWH
43
What's the difference between typical and atypical HUS
Typical - preceded by Diarrhoea/gaastroenteritis
Atypical - No diarrhoea, rare, genetic, Severe mortality
44
How do you manage typical and Atypical HUS
Typical HUS -
Plasmapheresis with FFP +/- RRT
Atypical HUS
Eculizumab
45
What is the Ix to differentiate between primary and secondary polycythemia
Erythropoetin levels
( in primary, will be low )
( in secondary, will be high)
46
What is a good marker for prognosis of MM
Beta-2 microglobulin levels
Note: levels >2.5mg/l > 5 year risk of disease progression of 64%
47
What is EDTA induced thrombocytopenia
Plts low when used EDTA samples, clumping
But when used with citrate samples-plts will be normal
No MX needed
Just Repeat sample with different collecting tube
48
What are the features of HUS
Haemolytic anémia ;
Thrombocytopenia
Deranged Kidney function
In typical HUS - E.coli producing shiga toxin
Imp NOTE: in HUS; clotting profile will be normal
49
How do you differentiate between HUS and DIC
in HUS : PT is normal
in DIC- Clotting deranged
50
what is a poor prognostic factor of ALL ( Acute lymphoblastic lukaemia)
t (9;22) translocation ;
philadelphia chromosme
NOTE : this is ALL and not AML
51
Where do you see 'smudge cells' on blood film
CLL
52
What is the blood picture of CLL
Anemia, thromocytopenia
Lymphocytosis
Splenomegaly
'smudge cells' - blood film
Immunophenotyping - CD19 and CD5
53
what is the difference in the mediastinal mass between thymoma and Hodgkin's lymphoma
Thymoma- Smooth, regular borders ; encapsulated
Hodgkins - Irregular,
54
what are the features of Hyper-esinophlic syndrome
Raised esionphils
Lung inv- pulmonary infiltrates
Cardiac inv - Restrictive
Mural thrombus formation
Angioedema
Urticaria
55
What is the Mx of Hyper-esinophlic syndrome
1) High dose prednisone +/- steroid saving agents ( Cyclophosphamide/ Azathioprine)
2) If Pt. has FIP1L1/PDGFRA mutation - Imatinib
56
what is the correlation between haptoglobin and Hb
When there is increased destruction of red blood cells (RBCs), free Hb is released into the circulation. Haptoglobin binds to free Hb to form a complex, which is then cleared by macrophages in the liver. This leads to a decrease in haptoglobin levels in cases of intravascular hemolysis.
57
What is Haptoglobin and Hb correlation in different cause of anemia
Intravascular hemolysis →
↓ Haptoglobin, ↓ Hb
Extravascular hemolysis (e.g., hereditary spherocytosis) →
Mild or no decrease in haptoglobin
Non-hemolytic anemia →
Normal or slightly altered haptoglobin
Inflammation → ↑ Haptoglobin, which may mask hemolysis
58
What kind of anemia do you see in Thalassemia
Microcytic anemia
Ferritin is usually normal
59
What is the Dx of choice for CLL
Immunophenotyping ;
CD5, CD19, CD20, CD23
60
what is the difference between HIT1 and HIT 2
HIT 1-
common, wilting first 48-72 hrs,
Plts rarely fall <100
Cont. Heaprin and observe
HIT2
5-10 days after Tx
Plts < 100
Stop Tx and Switch to danaproid/ lepirudin
61
What is the drug used to prevent recurrent admissions in Sickle Cell disease with pain episodes
Hydroxyurea
( acts by increasing feral Hb production which has lower chance of sickling )
62
How do you Treat Waldosterom's syndrome with hyperviscosity symptoms
Plasmapheresis !
63
How do you Treat DIC
FFP
64
When do you use cryoprecipitate In DIC
When Fibrinogen < 1 g/l
65
What are the features of Hairy cell Lukaemia
Anemia, Thrmobyctopenia, Splenomegaly , Lymphocytosis,
'Monocytoenia'
66
What is the microscopy feature of hairy cell lukaemia in blood film
atypical lymphocytes, with multiple villous like projections !
67
If the Pt. as MALT lymphoma and biopsy is negative for H.Pylori, what is your next step?
Non invasive Ix for H.pylori such as urea breath test/ Stool antigen testing ;
If +ve
treat with triple regimen
68
What is the link between LDH and anemia
Elevated LDH levels are commonly linked to anemia, particularly in conditions where there is increased red blood cell (RBC) destruction or ineffective erythropoiesis.
Markedly high LDH → Suggests hemolysis or megaloblastic anemia.
Mild to moderate elevation → Can be seen in bone marrow disorders, hypoxic states, or chronic disease-related anemia.
Normal or low LDH → Less likely to be due to hemolysis or ineffective erythropoiesis.
69
What are the features of VWD ( Von will brand disease)
Prolonged APTT, Prolonged BT,
but normal PT
Low Factor VIII
Low Von Willibrand factors
Minor bleeding seen
NO hemarthorsis , etc
70
Wat is the Mx of VWD
Desmopressin
71
what do you do if Pt. is on warfarin with INR >10, but no bleeding as in elderly
Give Oral or IV Vit K
due to his of bleeding due to age and INR levels
72
What are the common drugs causing Haemolytic anemia
Penicillin and its derivatives; Cephalosporins;
Levodopa
Methyldopa
Quinidine
NSAIDS
73
What is the feature and mx of hairy cell lukaemia
Pancytopenia
Spenomegaly
Hairy cells on blood film
Mx: Cladribine
74
Mx of CML
Imatinib
75
Common side effect of Vincristine
Peripheral neuropathy
76
Common side effect of Doxorubicin
Myocardial toxicity
77
What is the normal commotion of HbA, HbA2 and HbF
HbA - 2 alpha, 2 beta
( majority of adults 95-98%)
HbA2 - 2 alpha, 2 delta
( Small percentage 2-3% )
HbF - 2 alpha , 2 gamma
(Very small percentage 1-2%)
78
What happens in Alpha Thalasemia Trait
2/4 Alpha globulin chain is affected
But adults Have;
HbA and HbA2, which Rach have 2 alpha chains, so do not see any drastic change and no increase in HbA2
Pt. ha asymptomatic microcytic anemia
79
What happens in Beta Thalassemia Minor
HbA is affected - 1 beta globulin chain only;
so to compensate;
HbA2 increases mildly;
So we will see
Mild drop in HbA and mild rise in HbA2
Pt. will be asymptomatic microcytic anemia
80
What happens in Beta Thalassemia Major
HbA affected - Both globulin chains are affected ;
So HbA levels are significant reduced
Symptomatic Microcytic Anemia is seen!
Hard to pick up at birth as there will be be loads of HbF
81
Sickle Cell Trait
Normocytic Anema
Hb AS I seen
82
What does prolonged APTT indicate
Factor VIII deficiency
( VWD, Hemophilia A)
83
how do you differentiate between VWD and Hemophilia A from the clotting picture
VWD - Prolonged APTT, Prolonged BT
Haemophilia A - Prolonged APTT, Normal BT
84
What is the typical feature you see in Methaemoglobinaemia
Low Sats on checking saturation
But normal Po2 on ABG
85
What are some of the drugs that canc cause Methaemoglobinaemia
Local anesthetics, sulphonamides, Nitrates
86
What are the predictors of severity of Acute chest syndrome in Sickle Cell
ABG; Po2 < 8
Increasing RR
Mulilobar Inv. on CXR
Low Plts
Decreasing Hb
Neurological Sympts
87
How do you diagnose someone with acquired haemophilia ( Aquired factor VIII deficiency )
PTT will be prolonged and will not correct even after mixing with normal plasma
88
How do you treat acquired Hemophilia
Recombinant Activated " factor VII "
Note: it binds to surface of activated plts and supports thrombin formation, bypassing the need for factor VIII
89
How do you differtiate between haemophilia and acquired haemophilia
Aquired haemophilia, PTT, does NOT correct even after mixing with normal plasma
90
What is the immediate Mx to control Pain in severe painful Sickle Cell Crisis
IV x Diamorphine
91
what is the pathology in TRALI
Reaction between Anti-HLA Abs or or Anti-granulocyte/neutrophil Antibodies in Donor blood with the Neutrophils in the Recipeints blood
92
What is the pathology in Febrile Transfusion Reactions
The Cytokines in the Donor blood reacts with the recipients blood
93
What is the Mx of ITP
Steroids - 1st line
Splenectomy if no repose to Medical mx
Note: ITP is due to IgG antiplatelet antibody
Features: Asymptomatic, spontaneous bruising, petichae, theoocytopenia
94
What is the best confirmatory test for Primary polycythemia
JAK2 testing
95
What are some causes for acquired haemophilia
Autoimmune disease,
malignancies ( Colon, pancreatic, colon, breast, Malignant melanoma)
96
What are the features of hyper-vsicosity syndrome
Triad of
Mucosal bleeding
Visual Symptoms
Neurological changes
Note:
Hyperviscosity is due to increases immunoglobulins and proteins in blood and deranged blood components of Hb/ Plts/ Clotting and plt functions is damaged
97
What is the main risk of HIT-2
In HIT-2, platelet activation induced by the immune response to the heparin-PF4 complex leads to a pro-thrombotic state, causing thrombosis despite low platelet numbers.
This is a hallmark feature of the condition and explains the paradox of thrombosis in the presence of thrombocytopenia.
98
what is the feature in lead poisoning
Micorcytic anemia ; but ferritin will be normal
Basophilic strippling
99
What is the Mx of Acute Intermittent Porphyria
IV Haem Arginate
Features:
Abdo pain ; neuro ; confusion, urine turns red on standing
ix of choice;
Urine porphobilinogen
100
What is the Mx of iron overload
Iron Chelation with S/c Desfirrioxamine
Features of overload;
Grey skin
Overlaod symptoms
Poor Glycemic. control
101
Mx of Wilsons Disease
Chelation with Penicillamine to excrete Copper
102
Where do you see a dry tap of BM
Hairy Cell Lukaemia
Features- pancytopenia
Hepatsplenomegaly
TRAP stain +ve
BM Biopsy - Fried egg appearance
103
What is the Mx of MM
Inducation Chemotherapy + Autologous Stem Cell Transplant
Chemotherapy combinations
( Bortezomib + Thalidomide + Dexamethasone)
104
What are the features of G6PD deficiency
Anemia
Low Haptloglobins
Raised LDH
Blood film - Heinz Body and bite cell
Causes:
false from infection
Flava Beans
Abe - Cipro
105
Which Immunoglobulin deficiency causes recurrent Sinusitis and fails to respond to vaccinations
IgA deficiency
106
What is the issue in Factor V laden
protein C resistance, results in pro-thrombotic state and it cannot inactive factor V
Most common cause of thrombophilia
107
What is the interaction between St. Jhons Wart and warfarin
st. Jhons wart is a cyt P450 inducers and so lowers the effect of warfarin, and pt can end up having an infarct/thrombus
108
What happens if there is
'deletion of chrome 5 '
in promyelocytic lukaemia
Worsens prognosis
109
What is ristocetin co-factor
indicates Von willibrand factor activity
It is Lower; in Von Wilibrand disease
110
Derivative of which Vitamin is used to treat Acute pro-myelocytic lukaemia
Vit A ( All Tans retinoic actid )
111
Where do you see Lack of Central Pallor in RBC's on blood film
Hereditary Spherocytosis
112
Where do you see Lymphoplasmacytoid cells in BM biopsy
Waldestroms Macroglobinameia
113
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