Haematology Flashcards
(157 cards)
1
Q
What is alpha thalassaemia trait?
A
1/2 genes missing
2
Q
What is the management of spherocytosis?
A
Splenectomy
3
Q
What infection can be gained from RBC?
A
Pseudomonas
4
Q
What is myelofibrosis?
A
Bone marrow is replaced with fibrous tissue
5
Q
Where are the beta genes?
A
Chromosome 11 - one on each
6
Q
What is the INR target for recurrent DVT/PE?
A
3-4
7
Q
What is the presentation of ALL?
A
Fatigue
bleeding
Bruising
Infections
Splenomegaly
8
Q
What is seen on the blood film in G6PD deficiency?
A
Heinz bodies
9
Q
Which disease is the HFE gene a part of?
A
Haemachromatosis
10
Q
What do schistocytes indicate?
A
Intravascular haemolysis
11
Q
How can autoimmune haemolytic anaemias be typified?
A
Warm and cold
12
Q
What is a sickle cell crisis?
A
Episodes of tissue infarction due to vascular occlusion
13
Q
What is associated with warm AI haemolytic anaemia?
A
SLE Lymphoma Leukaemias Mefenamic acid
14
Q
What is seen on blood film in CLL?
A
‘Smear cells’, lots of small mature lymphocytes
15
Q
Which age group commonly gets CML?
A
40-60 year olds
16
Q
What is this cell?
A
Eosinophil
17
Q
What is the treatment of a painful sickle cell crisis?
A
Opiate analgesia Hydration Rest oxygen ?transfusion?
18
Q
What is this?
A
Howell-Jolly body
19
Q
What is the INR target for AF?
A
2-3
20
Q
What is priapism associated with?
A
Sickle cell anaemia
21
Q
What is polycythaemia rubra vera?
A
Increase in RBCs
22
Q
What special type of cells are seen in Hodgkins lymphoma and what do they look like?
A
Reed-Sternberg cells ‘owl’s eye’
23
Q
What is the management of essential thrombocytopenia?
A
Aspirin Hydroxycarbamide Interferon alpha
24
Q
What is seen on the blood film in myelofibrosis?
A
Tear drop RBC, leucoerythroblastic change - nucleated RB + myelocytes
25
What features are common to MPD?
Increased cell turnover - gout, fatigue, weight loss, sweats Splenomegaly - abdo pain, can't eat as much Marrow failure Thrombosis
26
What is the INR for a mechanical aortic valve?
2.5-3.5
27
What happens if HbS is exposed to hypoxia for a prolonged period?
It polymerises and sickles
28
How do you manage INR \> 5 with minor bleeding?
Stop warfarin, start when INR \<5 IV Vit K 1-3mg
29
What is hydrops fetalis?
No alphae genes
30
How do you manage a high INR with major bleeding?
Stop warfarin IV vit K 5mg FFP
31
What are the features of cold AI haemolytic anaemia?
Symptoms worse in cold Raynaud's Acrocyanosis
32
What is the best type of Hodgkins?
Lymphocyte rich
33
How long is warfarin given in an unprovoked DVT/PE?
6m
34
What is amyloidosis?
Extracellular deposition of an insoluble fibrillar protein: amyloid --\> tissue/organ dysfunction
35
Which patients does essential thrombocytopenia most commonly affect?
Those over 50
36
What is a febrile non-haemolytic transfusion reaction?
Rapid temp rise, chills, rigors
37
What is the most common adult leukaemia?
AML
38
How does clopidogrel work?
Irreversibly blocks effects of ADP on platelets
39
What is the mode of action of heparin?
Inactivation of thrombin through potentiating antithrombin III, factor Xa is also inhibited
40
What does IgM paraprotein indicate?
Waldenstrom's macroglobulinaemia
41
Which disease are auer rods present in?
AML
42
What is this cell?
Neutrophil
43
What is rituximab?
Monoclonal antibody against CD20 +ve B cells
44
Which people does hodgkins commonly affect?
Those in the 3rd and 4th decades of life
45
What is pernicious anaemia?
Autoimmune condition resulting in the destruction of gastric parietal cells leading to B12 deficiency
46
What is essential thrombocytopenia?
Uncontrolled proliferation of abnormal platelets
47
What does a pepper pot skull indicate?
Myeloma
48
How does aspirin work?
Inhibits platelet TXA2 synthesis
49
What is HbH disease?
1 alpha gene left
50
How is LMWH monitored?
Anti-Xa
51
What are the investigation findings in spherocytosis?
Spherocytes on blood film Increased osmotic fragility
52
How long is warfarin given in a provoked DVT/PE?
3 months
53
What is HbA2 made up of?
2 alpha and 2 delta chains
54
What is hereditary spherocytosis?
Autosomal dominant condition resulting in a problem with the RBC membrane leading to extravascular haemolysis
55
What is the mode of action of warfarin?
Effectively causes an inactive from of factors VII, IX, X and prothrombin to be made - unable to form catalytic complexes
56
What is this cell?
Lymphocyte
57
What positive effects does aspirin have on patients?
Decreases MI risk in patients with angina Decreases stroke risk in patients who've had a TIA
58
How is G6PD transmitted?
X-linked disorder
59
What is the management of pernicious anaemia?
Lifelong B12 injections
60
What is the anaemia in alpha thalassaemia trait?
Microcytic hypo chromic mild anaemia
61
What is the INR target for DVT prophylaxis/treatment?
2-3
62
What are the features of HbH?
Splenomegaly +/- jaundice
63
How is amyloidosis diagnosed?
Congo red staining: apple green birefringence SAP scan Biopsy of rectal tissue
64
What is the management of acute haemolytic transfusion reaction?
ABCDE Stop transfusion Send everything back to lab
65
How does dipyridamole work?
Decreases platelet aggregation by increasing cAMP levels
66
How long does it take for warfarin to fully work?
4-5 days
67
What does lecuoerythroblastic change indicate?
Sepsis
Haemorrhage
Myelofibrosis
68
How is severe HbH managed?
Splenectomy +/- transfusions
69
What is this cell?
Basophil
70
What do nucleated red blood cells indicate?
Myeloma
Leukaemia
Lymphoma
71
How long is warfarin given in AF?
Life-long
72
What are the features of warm autoimmune haemolytic anaemia?
Anaemia Jaundice Splenomegaly
73
What does Bence-jones protein indicate?
Myeloma
74
How long is warfarin given in a calf DVT?
6 weeks
75
What is the prognosis of hydrops fetalis?
Most die in utero
76
What is the management of myelofibrosis?
Supportive: blood transfusions Allogeneic STC transplant JAK2 inhibitors Splenectomy
77
What does rouleaux indicate?
Diabetes
Myeloma
CTDs
78
What is the management of polycythaemia rubra vera?
Venesection Hydroxycarbamide
79
Where are the alpha genes?
Chromosome 16 - two on each
80
What is pernicious anaemia associated with?
Atrophic gastritis + PMH of other AI disorders
81
What is the presentation of AML?
Anaemia
Malaise
Infections
Bleeding
Skin Infiltration
Short history
Gum hypertrophy
82
What are the features of Hodgkins?
Painless lymphadenopthy - alcohol induces pain
Resp symptoms
Pruritis
Splenomegaly
Swingin fever
83
What are these?
Rouleaux
84
When does a delayed haemolytic transfusion reaction occur?
5-10 days after transfusion
85
What is the management of warm AI haemolytic anaemia?
Steroids Azathioprine Rituximab Splenectomy
86
What is the older people leukaemia?
CLL
87
What infection can be gained from platelets?
Staph, strep, salmonella
88
How are alpha thalassaemias diagnosed?
HPLC/DNA testing
89
What are the FBC changes in myelofibrosis?
Anaemia Leucocytosis Thrombocytosis
90
What is associated with cold AI haemolytic anaemia?
Lymphoma Mycoplasma Leukaemia EBV
91
What type of reaction is an urticarial transfusion reaction?
Mast cell IgE reaction
92
How do you manage an INR \> 8 with no bleeding?
Stop warfarin until INR \<5 PO Vit K 1-3mg
93
What investigations are done for polycythaemia rubra vera?
Look for other causes JAK2 status
94
What is the long term treatment of sickle cell anaemia?
Hyposplenism - prophylactic penicillin, vaccination Folic acid supplementation Hydroxycarbamide
95
When is G6PD deficiency asymptomatic until?
Infection Acidosis Fava beans
96
What is the test for autoimmune haemolytic anaemias?
Coombs test
97
What are the symptoms in sickle cell anaemia?
Depend on site and severity Pain may be extremely severe Sites: digits, bone marrow, lung, spleen, and CNS
98
What is this cell called?
target cell
99
When should myeloproliferative disorders be considered?
Increased granulocytes Increased RBCs Increase platelets Eosinophilia Splenomegaly No reactive explanation
100
What is AML associated with?
Radiation
Down's
Benzene
CML
101
How is warfarin monitored?
INR
102
What cells are seen in ALL?
Blast cells of B cell origin
103
How do you manage INR 5-8 with no bleeding?
Withhold 1-2 doses Decrease maintenance dose
104
What is the most common cancer in children?
ALL
105
What is Schilling's test done for?
B12 deficiency
106
What are the blood changes in CML?
High WCC
Increased basophils
107
What does a positive Shumm's test indicate?
Intravascular haemolytic anaemia
108
Which leukaemia is more responsive to chemo?
ALL
109
How does CLL present?
Lymphadenopathy
Anaemia
Chest infection
110
When is LMWH monitored?
In renal failure and pregnancy
111
What is the translocation in CML?
t(9;22) - Philadelphia chromosome
112
What are the features of a delayed haemolytic transfusion reaction?
Less acute than AHR Unexplained fall in Hb Jaundice Renal failure Increase in bilirubin and LDH
113
What is the management of cold AI haemolytic anaemia?
Rituximab
114
What are the features of essential thrombocytopenia?
Thrombosis Bleeding ( increasing levels of platelets causes and acquired von willebrand)
115
How is warfarin reversed?
Vitamin K
116
What is haemarthrosis a sign of?
Haemophilia - problem with secondary haemostasis
117
What do platelets look like on a blood film?
Little purple specs
118
Which antibodies is an acute haemolytic transfusion reaction associated with?
IgM
119
What is Hodgkins disease associated with?
EBV
Immunosuppression
120
What happens in myelofibrosis?
Massive splenomegaly --\> left upper quadrant pain, portal hypertension, weight loss, night swears, fever
121
Which is the worst type of Hodgkins lymphoma?
Lymphocyte depleted
122
How is pernicious anaemia diagnosed?
Macrocytic anaemia --\> hypersegmented neutrophils, macrovalocytes Auto-antibodies: Anti gpc, anti IF
123
What does this blood film show?
Leucoerythroblastic change
124
What do target cells indicate?
Sickle cell anaemia
Thalassaemias
125
Roughly what % of myeloblasts are in AML?
30%
126
What are precipitants of sickle crises?
Hypoxia Dehydration Infection Cold exposure Stress
127
Top differential:
Young boy with reduced factor 8 and a raised aPTT
Haemophilia A
128
What is HbF made up of?
2 alpha and 2 gamma chains
129
What are the features of acute haemolytic transfusion reaction?
Pyrexia Dizziness Shock Pallor Feeling as though something is wrong Cyanosis
130
What does a Howell-Jolly body indicate?
Spleen problems
131
What are the three phases of CML?
Chronic
Accelerated
Blast crisis
132
What are the signs and symptoms of polycythaemia rubra vera?
Headache Dizziness Stroke Plethora Itchy after hot shower Hepato and splenomegaly
133
What mutation causes sickling disorders?
Point mutation in codon 6 of beta global gene
134
What is the INR target for a mechanical mitral valve?
3-4
135
Which factors does heparin affect?
prevents activation of 2, 9, 10, 11
136
What factors does warfarin affect?
Synthesis of 2, 7, 9, 10
137
What factors are affected in DIC?
1, 2, 5, 8, 11
138
What are the clotting test results in haemophilia?
Increased APTT, normal PT, normal bleeding time
139
What are the clotting test results in von willebrands?
Increased APTT, normal PT, increased bleeding time
140
What are the clotting test results in vit K deficiency?
Increased APTT, Increased PT, normal bleeding time
141
What is APS characterised by?
thromboses, recurrent foetal loss and thrombocytopenia
142
How is APS managed in pregnancy?
Low dose aspirin, LMWH when fetal heart seen
143
What are the features of aplastic anaemia?
normochromic, normocytic anaemia,
leukopenia (with lymphocytes relatively spared),
thrombocytopenia
144
What is basophilic stoppling associated with?
Lead poisoning, thalaessemia, sideroblastic anaemia, myelodysplasia
145
What are Burr cells associated with?
Uraemia, pyruvate kinase deficiency
146
When does an acute haemolytic transfusion reaction occur?
Minutes after transfusion is started
147
What is an acute haemolytic transfusion reaction due to?
ABO incompatability leading to massive intravascular haemolysis
148
What are the features of an acute haemolytic transfusion reaction?
Fever, abdo pain, chest pain, agitation, hypotension
149
What is the management of an acute haemolytic transfusion reaction?
Stop transfusion, generous fluid resus, inform the lab
150
What is a non-haemolytic febrile reaction due to?
white blood cell HLA antibodies often as a result of previous sensitisation (pregnancies, transfusions)
151
When does an anaphylactic transfusion reaction occur?
Within minutes of starting transfusion
152
How should a simple urticarial rash be treated from transfusion reaction?
Stop transfusion, give antihistamine - transfusion may be continued when symptoms resolve
153
How should a severe anaphylactic transfusion reaction be managed?
Stop transfusion, IM adrenaline, consider antihistamines, bronchodilators and steroids
154
What is the mode of action of dabigatran?
Direct thrombin inhibitor
155
What is the mode of action of apixaban and rivaroxaban?
Direct factor Xa inhibitor
156
What is the mode of action of tranexamic acid?
reversibly binds to lysine receptor sites on plasminogen or plasmin
157
What is the key features of Waldenstrom's macroglobulinaemia?
monoclonal IgM paraproteinaemia
