- Pallor - Fatigue - Gingivitis - Splenomegaly

- Incidental finding - Splenomegaly, bruising - B symptoms (fever, night sweats, weight loss) - Abdominal fullness - Gout

- FBC - Peripheral blood smear - U&Es - Aspiration and trephination -> Flow cytometry, cytogenetics (Philadelphia), molecular (PCR studies)

- Fatigue, dizziness, palpitations - Severe & unusual bone pain - Fever - Dyspnoea (mass symptoms if large thymic mass)

- FBC - Peripheral blood smear - U&Es - CLOTTING - Aspiration and trephination -> Flow cytometry, cytogenetics (Philadelphia), molecular (PCR studies) Imaging - CXR (mediastinal mass) - Echocardiogram

Haematology Flashcards by Matt Quinn

AML translocation

8:21

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AML Epidemiology

Older people (mean age 70)

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AML histology

1) 20% blasts in marrow
2) Large myeloblasts
3) Auer Rods - crystallised myeloperoxidase

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AML presenting

Pallor
Fatigue
Gingivitis
Splenomegaly

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AML Investigations

Bone Marrow aspiration and trephination

FBC
Clotting Screen 
Blood film
CXR, ultrasound
ECG 
Echo

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AML Management

Inpatient chemotherapy

Stem cell transplant

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CML translocation

Philadelphia chromosome (9;22)

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CML epidemiology

Older people 60-65

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CML presentation

Incidental finding
Splenomegaly, bruising
B symptoms (fever, night sweats, weight loss)
Abdominal fullness
Gout

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CML investigations

FBC
Peripheral blood smear
U&Es
Aspiration and trephination -> Flow cytometry, cytogenetics (Philadelphia), molecular (PCR studies)

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CML management

1) Tyrosine kinase inhibitors

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ALL epidemiology

Children & 40+

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ALL risk factors

Down’s syndrome
EBV
Genetic

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ALL translocation

Philadelphia poor prognosis

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ALL presenting

Fatigue, dizziness, palpitations
Severe & unusual bone pain
Fever
Dyspnoea (mass symptoms if large thymic mass)

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ALL investigations

FBC
Peripheral blood smear
U&Es
CLOTTING
Aspiration and trephination -> Flow cytometry, cytogenetics (Philadelphia), molecular (PCR studies)

Imaging

CXR (mediastinal mass)
Echocardiogram

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Goals of chemotherapy in ALL

To eliminate more than 99% of the initial burden of leukaemic cells.
To restore rapidly normal haematopoiesis.
To restore previous performance status.

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Special management after remission in ALL

CNS prophylaxis - intrathecal chemotherapy

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CLL presentation

Often incidental

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CLL epidemiology

Older people

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CLL management

Watch and wait

Chemo

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CLL special progression

Study These Flashcards

5% transform into DBCL - all lymph nodes should be checked at examination

CML monitorings (CML!!)

Study These Flashcards

Monitor cytogenetic response throughout

treatment – FISH looking at % of PH+ cells

CLL histology

Study These Flashcards

Smudge cells

When to treat CLL

- doubling of lymphocyte count in 6 months - marrow failure - recurrent infections - massive or progressive splenomegaly - systemic symptoms - immune mediated cytopenias

CML additional treatment (CML!!)

Stem cell transplant - graft versus host - veno-occlusive disease

CLL management

Chemotherapy if active disease | Stem cell transplant

Causes of massive (>8cm) splenomegaly in all people

CML Malaria Lymphatic filiriasis Cirrhosis

Causes of massive splenomegaly in young people

- Glandular fever - Haemolytic disease -thallasaemias - ALL

What considerations need before starting hydroxycarbamide

hepatic and renal function | fertility and contraception

How to measure CML remission

Haematologic remission (normal FBC count, physical examination, ie no organomegaly). Cytogenetic remission (normal chromosome returns with 0% Ph-positive cells). Molecular remission (negative PCR result for the mutational BCR-ABL m-RNA).

Three phases of CMLA

Chronic Accelerated Blast phase

What to do if treatment with imatinib but no cytogenetic remission?

Different TKI

How to investigate anaemia

FBC B12, folate, ferritin Coagulation screen

What medication to give in AML before definitive treatment

hydration, allopurinol blood transfusion aciclovir & anti-fungal hydroxycarbamide

AML prognosis (3)

age, cell type and the burden of the diseas

AML remission in younger patients (young adult & child)

In younger patients, complete remission rates of at least 80% may be reached, with five-year overall survival about 40%.

Myeloma presentaiton

Calcium metabolism Renal problems Anaemia Bone pain

Myeloma investigations

``` Myeloma screen - serum PROTEIN electrophoresis - serum free light chain Urine microscopy - Bence jones protein ```

Myeloma disease response measurement

Paraproteins

Multiple myeloma vs asymptomatic myeloma vs MGUS

``` MM - >10% bone marrow plasma cells - >30g/l monoclonal protein -> CRAB symptoms Asymptomatic -> as above but no CRAB symptoms MGUS -> <10% bone marrow plasma cells -> <30g/l monoclonal protein -> No CRAB ```

Management MM

Young - autologous bone marrow transplant | Elderly - melphalan and steroids

Hodgkin's lymphoma key bits

- Lymphadenopathy - Pain with alcohol - Mediastinal mass - B symptoms Fever, night sweats, weight loss - Anne Arbor staging - younger patients

Key considerations in management of young HL

fertility

What scan used in HL

PET scan

Four types NHL

Low grade/indolent - Follicular, MALT High grade/agressive - DBCL, Burkitt's

Polycythaemia rubra vera presentation

- routine - fatigue, itchyness - thrombosis (stroke/DVT) - Budd chiari

What is Budd chiari

Hepatic vein thrombosis resulting in RUQ pain, ascites,

Three causes of secondary polycythaemai

COPD EPO use Eisenmenger syndrome

Mutation associated with PCRV

JAK2

Other myelodysplastic syndrome

Essential thrombocythaemia | Myelofibrosis

How to manage PCRV

Aspirin Phlebotomy Hydroxycarbamid

Essential thrombocythaemia symptoms

Bleeding + thrombosis

Essential thrombocythaemia management

Hydroxycarbamide

Haematology Flashcards

(54 cards)