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Haematology Flashcards

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1
Q

Causes of iron-deficiency anaemia?

A

Blood loss
Inadequate dietary intake
Poor intestinal absorption- coeliac
Increased iron requirements- pregnancy

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2
Q

Blood picture of iron-deficiency anaemia?

A

Microcytic anaemia (low Hb, low MCV, low iron)
High TIBC

Blood film anisopoikilocytosis: (red blood cells of different sizes and shapes) , target cells, ‘pencil’ poikilocytes

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3
Q

Causes of macrocytic anaemia?
Megaloblastic
Normoblastic

A

Megaloblastic causes of macrocytic anaemia:
vitamin B12 deficiency
folate deficiency
secondary to methotrexate

Normoblastic causes of macrocytic anaemia:
alcohol
liver disease
hypothyroidism
pregnancy
reticulocytosis
myelodysplasia
drugs: cytotoxics

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4
Q

Causes of macrocytic anaemia?
FAT RBC

A

F- folate deficiency
A- alcohol
T- thyroid (hypo)

R- reticulocytotic
B- B12 deficiency
C- cytotoxic drugs (methotrexate)

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5
Q

Causes of microcytic anaemia?

A

iron-deficiency anaemia
thalassaemia*
congenital sideroblastic anaemia

anaemia of chronic disease (more commonly a normocytic, normochromic picture)

lead poisoning

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6
Q

Causes of normocytic anaemia?

A

anaemia of chronic disease
CKD
aplastic anaemia
haemolytic anaemia
acute blood loss

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7
Q

Definitive diagnosis for sickle cell disease?

A

haemoglobin electrophoresis

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8
Q

What factor is deficient in haemophilia A and B?

A

A- factor VIII (8)- more common prevalence
B- factor IX (9)

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9
Q

Features of haemophilia?

A

haemoarthroses
haematomas
prolonged bleeding after surgery or trauma

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10
Q

Blood picture of haemophilia?

A

Prolonged APTT
Normal bleeding time, PT, PTT

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11
Q

Diagnosis for haemophilia?

A

factor 8/9 assays

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12
Q

Blood picture of VWD?

A

Normal PT and PTT
Prolonged APTT and bleeding time
Normal platelets
vWF assay to confirm level, severity, type

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13
Q

In who is VWD more common in?

A

Equal frequency among men and women, but women are more likely to experience symptoms due to the increased bleeding it causes during their menstrual periods, pregnancy, and childbirth.

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14
Q

Symptoms of VWD?

A

Excess or prolonged bleeding from minor wounds
Excess or prolonged bleeding post-operatively
Easy bruising
Menorrhagia
Epistaxis
GI bleeding

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15
Q

Management for VWD?

A

Medication and transfusions

First-line: Desmopressin

Acute bleeds:
-Desmopressin if not already taken
-Tranexamic acid- minor bleeding or prior to surgery on its own or as an adjunctive therapy to desmopressin or concentrates
-VWF-FVIII concentrates should be used if the above are unsuccessful and bleeding is persistent

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16
Q

Management of haemophilia?

A

Minor bleeds in haemophilia A- desmopressin
Tranexamic acid
Major bleeds: recombinant factor 8/ 9

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17
Q

Contraindications in haemophilia?

A

NSAIDs
Aspirin
IM injections

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18
Q

Which leukaemia has the Philadelphia chromosome mutation?

Translocation between chromosome 9 and 22 leading to formation of the BCR-ABL1 fusion gene

A

Chronic myeloid leukaemia (CML)

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19
Q

Chronic myeloid leukaemia (CML) symptoms?

A

Massive splenomegaly
Bleeding

If WBC very high can cause:
Visual disturbance
Confusion
Priapism
Deafness

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20
Q

ALL symptoms?

A

anaemia: lethargy and pallor
neutropenia: frequent or severe infections
thrombocytopenia: easy bruising, petechiae
bone pain (secondary to bone marrow infiltration)
splenomegaly
hepatomegaly
fever is present in up to 50% of new cases (representing infection or constitutional symptom)
testicular swelling

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21
Q

In which leukaemia are Auer rods seen?

A

Acute myeloid leukaemia

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22
Q

Which leukaemia shows smudge cells on blood film?

A

Chronic lymphocytic leukaemia

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23
Q

Risk factors for developing Hodgkin’s lymphoma?

A

HIV
EBV

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24
Q

Diagnostic cells on lymph node biopsy for Hodgkin’s lymphoma?

A

Reed-Sternberg cells are diagnostic:

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25
Symptoms for Hodgkin's lymphoma?
Lymphadenopathy- 75% -(cervical/supraclavicular) > axillary > inguinal -usually painless, non-tender, asymmetrical -Alcohol-induced lymph node pain is characteristic of Hodgkin's lymphoma but is seen in less than 10% of patients -B-symptoms (NS, fever, weight loss) -Palpable abdominal mass - hepatomegaly, splenomegaly, lymph nodes -Testicular mass
26
Diagnostic investigation for Non-Hodgkin's lymphoma? and others
Excisional node biopsy is the diagnostic investigation of choice CT CAP- staging HIV- performed as risk factor for NHL FBC + blood film- normocytic anaemia and rule out other malignancy ESR/ LDH- prognostic indicator
27
Diagnostic tests for Hodgkin's lymphoma?
FBC- normocytic anaemia, eosinophilia LDH- raised Lymph node biopsy- Reed-Sternberg cells diagnostic
28
Features of myeloma? CRABBI
C- calcium/ hypercalcaemia (N&V, confusion) R- renal (light chain deposition within the renal tubules causing dehydration/ thirst) A- anaemia (fatigue and pallor) B- bleeding (thrombocytopenia) B- bones (pathological fractures) I- infection
29
Investigations for myeloma and what it shows? Bloods Protein electrophoresis BM aspiration Imaging
Bloods FBC: anaemia peripheral blood film: rouleaux formation U&Es: renal failure bone profile: hypercalcaemia Protein electrophoresis: raised concentrations of monoclonal IgA/IgG known as Bence Jones proteins Bone marrow aspiration: confirms the diagnosis if the number of plasma cells is significantly raised Imaging Whole-body MRI X-rays: 'rain-drop skull'
30
Causes of thrombocytosis?
Acute phase reactant: infection, surgery, IDA Malignancy Essential thrombocytosis- myeloproliferative Hyposplenism
31
Management for thrombocytosis?
hydroxyurea (hydroxycarbamide) is widely used to reduce the platelet count interferon-α is also used in younger patients low-dose aspirin may be used to reduce the thrombotic risk
32
Management for sickle-cell anaemia? Crisis Long-term
Crisis management analgesia- opiates rehydrate oxygen consider antibiotics if evidence of infection blood transfusion exchange transfusion: if neurological complications Longer-term management hydroxyurea pneumococcal vaccine every 5 years
33
Investigations for Pernicious anaemia?
FBC- macrocytic anaemia, hypersigmented polymorphs on blood film B12 and folate Abs- anti intrinsic factor antibodies: sensitivity is only 50% but highly specific for pernicious anaemia (95-100%)
34
Management for Pernicous anaemia?
IM B12 replacement 3 injections per week for 2 weeks followed by 3 monthly treatments of vitamin B12 injections folic acid supplementation if neurological features: more frequent doses
35
Complications of pernicious anaemia?
increased risk of gastric cancer
36
Points for managing B12 deficiency?
if a patient is also deficient in folic acid then it is important to treat the B12 deficiency first to avoid precipitating subacute combined degeneration of the cord
37
What is a thrombotic crisis (painful-crisis) in sickle-cell perciperated by?
painful crises or vaso-occlusive crises: -precipitated by infection, dehydration, deoxygenation (high altitude)
38
What is acute chest syndrome in sickle-cell?
vaso-occlusion within the pulmonary microvasculature via RBCs → infarction in the lung parenchyma causes dyspnoea, chest pain, low O2 pulmonary infiltrates on chest x-ray Managed with: pain relief respiratory support- oxygen therapy antibiotics: infection may precipitate acute chest syndrome and the clinical findings (respiratory symptoms with pulmonary infiltrates) can be difficult to distinguish from pneumonia transfusion: improves oxygenation
39
What causes aplastic crisis in sickle-cell and features?
caused by infection with parvovirus Features: sudden fall in haemoglobin bone marrow suppression causes a reduced reticulocyte count
40
What is Sequestration crises in sickle-cell?
Sickling within organs such as the spleen or lungs causes pooling of blood with worsening of the anaemia Associated with an increased reticulocyte count + splenomegaly
41
Poor prognostic factors for ALL?
age < 2 years or > 10 years WBC > 20 * 109/l at diagnosis T or B cell surface markers non-white ethnicity male sex
42
Investigations for ALL?
FBC: leucocytosis, normal/low WBC, anaemia, thrombocytopenia BM biopsy: diagnostic, allows immunophenotyping LP: assessed for CNS involvement
43
Chronic myeloid leukaemia treatment?
imatinib = tyrosine kinase inhibitor
44
What antibodies are tested in B12 deficciency?
Serum Intrinsic factor antibodies
45
Which imaging modality should be used to stage the extent of Hodgkin's lymphoma?
PET/CT
46
Acute haemolytic transfusion reaction symptoms? + what management?
Fever, abdominal pain, hypotension Stop transfusion Confirm diagnosis + send to lab (coombs, cross-match) Fluid resus
47
Itching, urticaria during a transfusion indicates?
Minor allergic reaction Temporarily stop transfusion Antihistamine Monitor
48
Febrile non-haemolytic reaction features? + what management?
Fever Chill Slow/ stop transfusion Paracetamol Monitior
49
Anaphylactic reaction during a transfusion features? + what management?
Hypotension, wheezing, SOB, angioedema Stop transfusion IM adrenaline ABCDE Fluids Oxygen Bronchodilators
50
Transfusion-related acute lung injury (TRALI) in a transfusion features? + what management?
respiratory distress, hypoxia, and non-cardiogenic pulmonary oedema within 6 hours of transfusion Slow/ stop transfusion Consider IV loop diuretics- furosemide Oxygen
51
Transfusion-related circulatory overload (TACO) reaction in a transfusion? + what management?
shortness of breath, tachycardia, hypertension, and pulmonary oedema Stop transfusion Oxygen Supportive care
52
Which one of the is the most common type of Hodgkin's lymphoma?
nodular sclerosing
53
What blood product is linked higher risk of bacterial contamination? Contaminants?
Platelet transfusions are at particular risk of bacterial contamination as they are stored at room temperature Staphylococcus epidermidis and Bacillus cereus.
54
What What blood product is linked higher risk of transmitting viral agents?
RBCs HIV, HBV, and HCV
55
What medication should sickle-cell patients be started on to reduce frequency of painful episodes and life-threatening illness.
Hydroxycarbamide reduces the frequency of painful episodes. However, it can also increase your risk of infections. It is advised not to be taken in pregnancy. Hydroxycarbamide essentially makes your red blood cells bigger, stay rounder and more flexible. Therefore, less likely to turn into a sickle shape. This is achieved by increasing a special kind of haemoglobin called haemoglobin F.
56
What does the presence of Howell-Jolly body mean?
Howell-Jolly bodies suggest hyposplenism which can occur in Sickle cell disease due to splenic infarctions.
57
What would a typical myeloma blood screen show?
high calcium normal/high phosphate normal alkaline phosphate
58
How is Hodgkin's lymphoma diagnosed?
Excision biopsy Staging using PET/ CT scan
59
What anaemia can methotrexate cause?
Methotrexate therapy may result in a megaloblastic macrocytic anaemia secondary to folate deficiency
60
What features are associated with a worse prognosis in Hodgkin's lymphoma?
B' symptoms in Hodgkin's lymphoma are associated with a poor prognosis: weight loss > 10% in last 6 months fever > 38ºC night sweats
61
Common cause of Burkitt's lymphoma?
EBV Microscopy findings- 'starry sky' appearance Management: Chemotherapy-but risk of tumour lysis syndrome
62
Definitive diagnosis of sickle cell disease?
haemoglobin electrophoresis

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