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MSRA > Haematology > Flashcards

Haematology Flashcards

(51 cards)

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1
Q

Tumour lysis syndrome electrolytes

A

High uric acid, K, PO4
Low Ca
AKI

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2
Q

TLS prevention

A

IV fluids
Allopurinol or rasburicase in higher risk

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3
Q

TLS lab grading

A

Cairo-Bishop score, 2 of following within 3d pre or 7d post-chemo
uric acid > 475umol/l or 25% increase
potassium > 6 mmol/l or 25% increase
phosphate > 1.125mmol/l or 25% increase
calcium < 1.75mmol/l or 25% decrease

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4
Q

Clinical TLS criteria

A

Lab criteria +
Cr 1.5x upper normal
Cardiac arrhythmia/sudden death
Seizure

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5
Q

Massive splenomegaly causes

A

myelofibrosis
chronic myeloid leukaemia
visceral leishmaniasis (kala-azar)
malaria
Gaucher’s syndrome

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6
Q

CML genetics

A

95% have Philadelphia chromosome
Translocation between chromosome 9 and 22, BCR-ABL gene has tyrosine kinase activity

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7
Q

CML presentation

A

Abdo discomfort/splenomegaly
Weight loss
Night sweats
Anaemia/lethargy
Increased granulocytes at different maturation stages

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8
Q

CML Mx

A

Imatinib
Hydroxyurea
Interferon-alpha
Allogeneic bone marrow transplant

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9
Q

Sickle cell thrombotic crisis

A

Precipitated by dehydration, infection, deoxygenation e.g. altitude
Painful vaso-occlusive, clinical dx
Can get infarct of organs including bone

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10
Q

Sickle cell acute chest syndrome cause and presentation

A

Vaso-occlusion of pulmonary vasculature
Dyspnoea, chest pain, low pO2, pulmonary infiltrates CXR

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11
Q

Sickle cell acute chest Mx

A

Analgesia + o2 therapy
Abx only if infection precipitates/suspected

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12
Q

Sickle cell sequestration crisis

A

Sickling within organs e.g. spleen/lungs caused worsening anaemia
High reticulocyte count

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13
Q

CMV -ve blood indications

A

Granulocyte transfusions
Intrauterine transfusion
Neonates (up to 28d post-delivery)
Elective pregnancy transfusions

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14
Q

Irradiated blood indications

A

Stops GVHD as depletes T cells

Granulocyte transfusions
Intrauterine transfusion
Neonates (up to 28d post-delivery)
Bone marrow/stem cell transplant
Immunocompromised
Hodgkin’s lymphoma at any point
HIV

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15
Q

Hereditary spherocytosis presentation

A

Most common hereditary haemolytic anaemia in north Europe - AD
Jaundice, gallstones
Splenomegaly

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16
Q

Hereditary spherocytosis Ix

A

Blood film, family hx and raised MCHC diagnostic
If equivocal, can do EMA binding test and cryohaemolysis test

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17
Q

Hereditary spherocytosis Mx

A

Acute haemolytic crisis - Supportive, transfusion if needed
Longer term folate replacement + splenectomy

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18
Q

DIC precipitants

A

Sepsis
Trauma
Obstetric complications
Malignancy

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19
Q

DIC bloods

A

Low plt, fibrinogen
High PT+APTT, fibrin degradation products
Schistocytes due to microangiopathic haemolytic anaemia

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20
Q

DVT Ix

A

2 level wells, 1 is unlikely, 2+ is likely

Unlikely -> D-dimer
Likely -> leg vein doppler within 4h or DOAC until scan
If d-dimer raised and -ve scan, re-scan in 6-8d

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21
Q

VTE anticoagulation

Study These Flashcards
A

DOAC unless:
Poor renal function
Antiphospholipid

3mths provoked
3-6mths provoked with Ca
6mths unprovoked

22
Q

IDA bloods

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A

Ferritin, iron and transferrin saturation all decreased
TIBC increased
Transferrin absolute increased

23
Q

What is Gaisbock syndrome

Study These Flashcards
A

Stress polycythaemia:
Polycythaemia
Hypertension
No splenomegaly/leukocytosis/thrombocytosis

24
Q

Differentiate between true and relative polycythaemia

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A

Total red cell mass >35ml/kg in men, >32 in women

25
Haemophilia A presentation and bloods
Factor VIII deficiency Haemarthroses Prolonged APTT, normal PT and plt and bleeding time
26
von Willebrand presentation and tests
Easy bruising frequent nosebleeds, most common inherited clotting disorder Impaired plt aggregation Marginally dec factor VIII as vWF stabilises VIII Therefore slightly prolonged APTT
27
Tamoxifen SEs
VTE Endometrial Ca
28
Polcythaemia rubra vera most common cause
JAK2 mutation
29
JAK2 -ve PRV dx
RBC>25% raise or HCT>0.6 in men/0.52 in women No JAK2 mutation No cause of 2ry polycythaemia Plus one of: Palpable splenomegaly Acquired genetic abnormality in haematopoietic cells Or 2 of: Thrombocytosis Neutrophilia Radiological splenomegaly Low EPO/endogenous erythoid colonies
30
Most common inherited thrombophilia and 2nd
Factor V Leiden (Activated protein C resistance) Prothrombin gene mutation 2nd
31
AML subtypes
French-American-British classification (FAB) MO - undifferentiated M1 - without maturation M2 - with granulocytic maturation M3 - acute promyelocytic M4 - granulocytic and monocytic maturation M5 - monocytic M6 - erythroleukaemia M7 - megakaryoblastic
32
APML features
Chromosome 15, 17 translocation causing PMR-RAR-alpha gene fusion Auer rods with myeloperoxidase staining on blood film Good prognosis
33
AML poor prognosis if
>60yrs >20% blasts after 1 round chemo Chromosome 5 or 7 deletions
34
Hodgkin's lymphoma features
Reed-Sternberg cells Non-tender lymphadenopathy painful on drinking EtOH
35
Heparin reversal agent
Protamine sulphate
36
Dabigatran reversal agent
Idarucizumab
37
37
When to use cryoprecipitate in bleeding
Low fibrinogen
38
When to stop COCP pre-op
4wks
39
Paraproteinaemia causes
Benign: MGUS Transient following infection Malignant: Myeloma Waldenstrom macroglobulinaemia Amyloidosis B-cell lymphoproliferative disorders e.g. CLL, non-Hodgkin's
40
Post-thrombotic syndrome features
Following DVT: Painful heavy calves Varicose veins Venous skin changes Pruritis Swelling
41
Post-thrombotic syndrome Mx
Compression stockings Elevate leg
42
What is ITP caused by
Autoantibodies to glycoprotein IIb/IIIa or Ib-V-IX complex
43
ITP Mx
Pred IVIG if active bleeding or urgent procedure needed
44
What is Evan's syndrome
ITP with AIHA
45
EBV blood result
Neutropenia
46
Sickle cell crisis mx
Analgesia Fluids O2 Abx if evidence of infection Blood transfusion if severe anaemia, symptomatic or optimising for procedure/pregnancy Exchange transfusion if acute vaso-occlusive crisis (rapidly reduces HbS %)
47
Cryoprecipitate contains
Factor VIII + XIII Fibrinogen VWF
48
PCV Mx
Aspirin for risk of thrombosis Venesection 1st line Chemo - hydroxyurea (risk of 2ry leukaemia)
49
Hodgkin's lymphoma staging
Ann Arbor, now Lugano (same but with PET CT findings) Stage I - 1 lymph node/site II - 2+ lymph nodes/sites on same side of diaphragm III - above crossing diaphragm IV - Beyond lymph nodes
50
Hodgkin's lymphoma mx
ABVD chemo (doxorubicin, bleomycin, vinblastine, dacarbazine) or BEACOPP which has higher toxicity but less remission Radiotherapy Haematopoietic stem cell transplant

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