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Haematology Flashcards

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1
Q

What different information can you get from bone marrow aspirate v trephine

A

aspirate = myeloid:erythroid, orderly/complete maturation, presence of abnormal cells

trephine = cells:fat, no of diff cells present, presence of abnormal infiltrates, changes to stroma/bone

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2
Q

Which area does a leukaemia affect

A

bone marrow

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3
Q

Which area does a lymphoma affect

A

lymph nodes

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4
Q

What is the difference between acute and chronic haematological malignancies?

A

acute = cell growth arrested at early stage of differentiation`

chronic = cell growth arrested at later stage of development. already partially developed

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5
Q

What are the features of ALL

A 
most common in children 2-4y
infection
bleeding/brusing
tiredness
bone pain (secondary to bone marrow infiltration)
splenomegaly
hepatomegaly
testicular swelling
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6
Q

What are the risk factors for ALL

A

genetics

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7
Q

What investigations need to be done in ALL

A

FBC, clotting, LDH, U+E LFT
blood film
bone marrow aspirate and trephine
immunophenotyping

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8
Q

what is the management of ALL

A

remission induction - chemo
maintenance
CNS prophylaxis

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9
Q

What are the features of AML

A 
most common 50-60y
anaemia: pallor, lethargy, weakness
neutropenia: whilst white cell counts may be very high, functioning neutrophil levels may be low leading to frequent infections etc
thrombocytopenia: bleeding
splenomegaly
bone pain
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10
Q

What conditions can progress into AML

A

Myelodysplastic syndrome
aplastic anaemia
myelofibrosis

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11
Q

What investigations need to be done in AML

A

FBC, clotting, LDH, U+E, LFTs
blood film
bone marrow aspiration

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12
Q

what is the management of AML

A

induction
post remission consolidation
stem cell transplantation

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13
Q

Which cells are affected in CLL

A

monoclonal proliferation of well-differentiated lymphocytes which are almost always B-cells

immature, unreactive, accumulate in bone marrow, don’t die when they should

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14
Q

What are the features of CLL

A 
often none
constitutional: anorexia, weight loss
bleeding, infections
lymphadenopathy more marked than CML
splenomegaly
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15
Q

What investigations need to be done in CLL

A 
FBC 
blood film
bone marrow aspirate and trephine
lymph node biopsy
immunophenotyping
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16
Q

What cells are seen on a blood film in CLL

A

smear/smudge cells

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17
Q

What is the genetic abnormality present in most CML

A

philadelphia chromosome
translocation between 9 and 22
BCR-ABL gene codes for a fusion protein which has tyrosine kinase activity in excess of normal

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18
Q

Which cells are affected in CML

A

myeloproliferative disorder of haemopoeitic stem cells affecting one or all cell lines - erythroid, platelet, myeloid

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19
Q

Describe the phases of CML

A

chronic - 4-5y. asymptomatic, immune system fine

accelerated - 15-29% blasts in the marrow/blood, low platelets, RBC and granulocytes

blastic - >=30% blasts in blood/marrow plus severe constitutional symptoms

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20
Q

What are the features of CML

A

anaemia: lethargy
weight loss
splenomegaly/hepatomegaly
night sweats

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21
Q

What investigations need to be done in CML

A

FBC LDH
Blood film
bone marrow aspirate and trephine
cytogenetics - philadelphia chromosome

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22
Q

What is the difference between a group and save and a cross match?

A

group and save - gives blood group and screens for abnormal antibodies. no blood is issued

cross match - patient and donor blood mixed. blood issued if no immune reaction

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23
Q

How are blood samples like group and save and cross match meant to be taken

A

two separate samples
three points of ID
informed consent from patient for blood transfusion
label bottles by bedside by hand
complete request form by patient’s bedside

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24
Q

What is the threshold for red cell transfusion

Study These Flashcards
A

Hb <70g/L

Hb <80g/L if acute coronary syndrome

25
What does FFP contain
clotting factors, albumin, immunoglobulin
26
What are the indications for giving FFP
(i) Disseminated Intravascular Coagulation (DIC); (ii) Any haemorrhage secondary to liver disease; (iii) All massive haemorrhages (commonly given after the 2nd unit of packed red cells)
27
What are the indications for giving platelets
(i) Haemorrhagic shock in a trauma patient; (ii) Profound thrombocytopenia <20 x 109/L (iii) Bleeding with thrombocytopenia - if < 100 x 10 9 for patients with severe bleeding, or bleeding at critical sites, such as the CNS (iv) Pre-operative platelet level <50 x 109/L
28
What does cryoprecipitate contain
fibrinogen von willebrand factor factor VII fibronectin
29
What are the indications for giving cryoprecipitate
(i) DIC with fibrinogen <1g/L; (ii) von Willebrands Disease; or (iii) Massive haemorrhage
30
When is CMV -ve blood inidcated
if risk of congenital CMV infection - causes cerebral palsy or sensorineural deafness pregnancy intrauterine transfusion neonates <28 days
31
When is irradiated blood indicated
if increased risk of graft versus host disease eg: Those receiving blood from first or second-degree family members Patients with Hodgkin’s Lymphoma Recent haematpoietic stem cell (HSC) transplants After Anti-Thymocyte Globulin (ATG) or Alemtuzumab therapy Those receiving purine analogues (e.g. fludarabine) as chemotherapy Intra-uterine transfusions congenital cellular immune deficiency
32
What onservations should be carried out when giving a blood transdusion
obs including temperature ``` before, after 1 min, after 15 mins, after 1 hour, at completion ```
33
What size cannula should blood be given through? Why?
green - 18G grey - 16G prevents shearing of the red blood cells as they through a too narrow tube
34
What are some acute complications of a blood transfusion
``` acute haemolyic non-haemolytic febrile allergic infective TRALI fluid overload hyperkalaemia ```
35
What causes an acute haemolytic reaction to a blood transfusion
Incompatible transfused red cells react with the patient's own anti-A or anti-B antibodies or other alloantibodies (eg, anti-rhesus (Rh) D, RhE, Rhc and Kell) Complement can be activated and may lead to disseminated intravascular coagulation (DIC).
36
What are the features of acute haemolytic reaction to a blood transfusion
within a few minutes of start of transfusion: fever abdominal and chest pain agitation hypotension
37
How should an acute haemolytic reaction to a blood transfusion be managed
stop the transfusion immediately!!! Keep the intravenous (IV) line open with saline. Give oxygen and fluid support. Monitor urine output, usually following catheterisation. Maintain urine output at more than 100 ml/hour, giving furosemide if this falls. Consider inotrope support if hypotension is prolonged. Treat DIC appropriately - seek expert advice early and transfuse platelets/fresh frozen plasma (FFP) guided by the coagulation screen and bleeding status. Inform the hospital transfusion department immediately.
38
What causes a non-haemolytic febrile reaction to a blood transfusion
patient antibodies to transfused white cells.
39
What are features of a non-haemolytic febrile reaction to a blood transfusion
occurs near end of or after transfusion fever >1 degrees from baseline rigors
40
How should a non-haemolytic febrile reaction to a blood transfusion be managed?
lowing or stopping the transfusion | giving paracetamol.
41
What causes an allergic response to a blood transfusion
antibodies that react with proteins in transfused blood components. IgE or IgG mediated
42
What are the features of an allergic response to a blood transfusion
Urticaria and itching are common within minutes of starting a transfusion. anaphylaxis: acutely dyspnoeic due to bronchospasm and laryngeal oedema and may complain of chest pain, abdominal pain and nausea.
43
How is an allergic response to a blood transfusion managed?
slowing the transfusion giving antihistamine transfusion may be continued if there is no progression at 30 minutes. anaphylaxis: IM adrenaline, steroids, bronchodilators
44
What is TRALI and what causes it?
Transfusion-related acute lung injury donor plasma contains antibodies against the patient's leukocytes. leads to acute respiratory distress
45
What are the features of TRALI
within 6 hours of transfusion ``` dyspnoea non-productive dry cough hypoxia frothy sputum fever rigors ```
46
What are the features of TRALI on CXR
multiple perihilar nodules | infiltration of the lower lung fields
47
How is TRALI managed
Give high-concentration oxygen, IV fluids and inotropes (as for acute respiratory distress syndrome). SENIOR HELP Monitor blood gases, serial CXR and CVP/pulmonary capillary pressure. Ventilation may be urgently required - discuss with ICU.
48
What are some long term complications of blood transfusion
``` infection iron overload Graft versus host disease post transfusion purpura delayed haemolysis of red cells ```
49
What causes graft versus host disease
T lymphocytes
50
What are the features of GvHD
occurs between day 4 and day 30 following transfusion high fever diffuse erythematous skin rash progressing to erythroderma, diarrhoea and abnormal liver function. Patients deteriorate with bone marrow failure and death occurs through overwhelming infection.
51
What causes post transfusion purpura
platelet-specific alloantibodies,
52
What are the features of post transfusion purpura
occurs 5-9 days following transfusion. Bleeding associated with a very low platelet count develops
53
Which patients are at increased risk of allergic reaction to a blood transfusion
those with severe IgA deficiency they may develop antibody to IgA
54
How is a microcytic or normocytic anaemia managed in pregnancy
oral iron should be considered as the first step, further investigations only required if no rise in haemaglobin after 2 weeks.
55
Which blood product carries the highest risk of bacterial infection with transfusion? Why?
platelets stored at room temperature
56
How should a patient on warfarin with a major bleed be managed
STOP warfarin 5mg Vit K IV FFP
57
How should a patient on warfarin with a minor bleed and INR >5 be managed
STOP warfarin 1-3mg Vit K IV - repeat if INR still >5 at 24 hours restart warfarin when INR <5.0
58
How should a patient on warfarin with no bleed and INR >8 be managed
STOP warfarin 1-5mg Vit K PO - repeat if INR still >5 at 24 hours restart warfarin when INR <5.0
59
How should a patient on warfarin with no bleed and INR 5-8 be managed
withhold 1-2 doses of warfarin | reduce the maintenance dose

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