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Haematology Flashcards

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1
Q

What is lymphoma?

A

Malignant proliferation of lymphocytes
Lymph nodes, liver, spleen
Rubbery enlarged glands

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2
Q

What tests should be done for lymphoma?

A
  1. Viral screen
  2. Excision/CT guided biopsy
  3. Contrast CT neck, thorax, abdo, pelvis
  4. FBC, LDH
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3
Q

What are the symptoms of lymphoma?

A

Painless lymphadenopathy

Fever, weight loss, night sweats, lethargy

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4
Q

How is lymphoma staged?

A
  1. Single lymph node
  2. 2 lymph nodes same side of the diaphragm
  3. Regions on both sides of the diaphragm
  4. Extra-nodal site - BM, liver, spleen

A - absence of constitutional symptoms
B - symptoms
X - bulky disease
E - single extra-nodal site

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5
Q

What are some features of Hodgkin’s lymphoma?

A 
Commonest type = nodular sclerosing 
2 peaks: young adults and elderly 
Linked to EBV 
Reed-Sternberg cells 
Radiotherapy and chemotherapy
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6
Q

What are some features of Non-Hodgkin’s lymphoma?

A

Most are B cell
Gut extra-nodal disease common
Split into indolent and aggressive
Associated with immunodeficiency - HIV, EBV, H pylori

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7
Q

What is myeloma?

A

Clonal B cell malignancy with proliferation of plasma cells
Accumulate in bone marrow and secrete m-protein
Other Ig levels are low

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8
Q

What are some clinical features of myeloma?

A 
Osteolytic lesions - backache, wedge #
Hypercalcaemia
Anaemia, neutropenia, thrombocytopenia
Recurrent bacterial infections
Renal impairment - light chain deposition
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9
Q

What investigations should be done for suspected myeloma?

A 
FBC - normocytic anaemia
ESR
UEs - raised urea, creatinine and calcium
X-rays
Bone marrow biopsy
Serum and/or urine electrophoresis
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10
Q

What are the diagnostic criteria for myeloma?

A
  1. Monoclonal protein band in serum electrophoresis
  2. Plasma cells on BM biopsy
  3. Evidence of end organ damage - hypercalcaemia, anaemia, renal insufficiency
  4. Bone lesions
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11
Q

What is the management of myeloma?

A 
Analgesia (not NSAIDs)
Bisphosphonates 
Anaemia - transfuse
Hydration
Treat infections 
Chemo
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12
Q

What are some complications of myeloma?

A

Hypercalcaemia
Spinal cord compression
Hyperviscosity
Acute renal injury

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13
Q

What is leukaemia and what are the four types?

A 
Malignant neoplastic process involving one of the white cell lines 
Acute lymphoblastic 
Acute myeloid
Chronic lymphocytic 
Chronic myeloid
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14
Q

What are the features of ALL?

A

B or T cell lineages
Arrests maturation and promotes uncontrolled proliferation of immature blast cells
Marrow failure
Infiltration - hepatosplenomegaly, lymphadenopathy

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15
Q

What tests should be done for ALL?

A

Blood film and BM biopsy
CXR and CT
LP (CNS involvement)

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16
Q

What is the treatment of ALL?

A 
Blood/platelet transfusion 
IV fluids
Allopurinol 
Hickman line 
Treat infections aggressively
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17
Q

What are some features of acute myeloid leukaemia?

A

Progresses rapidly
Can be a long term complication of chemotherapy
Auer rods
Intensive chemo and BM transplant

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18
Q

What are some features of chronic myeloid leukaemia?

A

Uncontrolled proliferation of myeloid cells - increased WCC
Philadelphia chromosome
Massive splenomegaly, hepatomegaly, anaemia, bruising

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19
Q

What is chronic lymphocytic leukaemia?

A

Accumulation of functionally incompetent B cells

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20
Q

What 3 things halt bleeding?

A
  1. Vasoconstriction
  2. Gap plugging by platelets
  3. Coagulation cascade
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21
Q

What can cause issues with vasoconstriction?

Study These Flashcards
A 
CTD
Senile purpura 
Infection - meningococcal, measles 
Steroids
Henoch-Scholein purpura
22
Q

What can cause issues with platelet?

Study These Flashcards
A 
Aplastic and megaloblastic anaemia 
Myeloma, leukaemia
Cytotoxic drugs, radiotherapy
ITP 
SLE
DIC, TTP
23
Q

What does the APTT monitor?

Study These Flashcards
A

Intrinsic pathway

Factors XII, XI, IX, VIII, VII

24
Q

What does PT monitor?

Study These Flashcards
A

Extrinsic pathway
Factors X, VII, V, II
Prothrombin and fibrinogen

25
What are some causes of an increased PT?
Warfarin Factor VII deficiency Factors II, V, X deficiency
26
What are some causes of an increased APTT?
Heparin VII-XII deficiency Von-Willebrands
27
What are some causes of an increased PT and APTT?
Vitamin K deficiency DIC Heparin toxicity
28
What are the three types of von-Willebrands?
1. Reduced amount of vW protein 2. Abnormal vW protein 3. Little or no vW protein
29
What are some features of haemophilia?
X-linked recessive A = factor VIII deficiency B - factor IX deficiency Avoid NSAIDs and IM injections
30
What are some causes of normocytic anaemia?
Acute blood loss Anaemia of chronic disease Haemolytic anaemia
31
What are some causes of microcytic anaemia?
Iron deficiency Thalassaemia Sideroblastic
32
What are some causes of macrocytic anaemia?
B12 or folate deficiency Alcohol excess Reticulocytosis Marrow infiltration
33
What investigations should be done for IDA?
Coeliac serology | If not menstruating - urgent gastroscopy and colonoscopy
34
What are some causes of anaemia of chronic disease?
``` Chronic infection Vasculitis RA Malignancy CKD ```
35
What is sideroblastic anaemia?
Ineffective erythropoiesis leads to increased iron absorption Post chemo, radio, anti-TB drugs Suspect if refractory microcytic anaemia
36
What investigations should be done for macrocytic anaemia?
LFTs, TFTs, serum B12 and folate
37
What is pernicious anaemia?
Parietal cell antibodies leads to lack of intrinsic factor | IF binds to B12 in stomach - without it cannot be absorbed in terminal ileum
38
What are the signs and symptoms of B12 deficiency?
Pallor, mild jaundice, glossitis Irritability, depression, psychosis, dementia Subacute degeneration of spinal cord
39
What is haemolytic anaemia?
Premature breakdown of RBCs before their normal lifespan In circulation = intravascular Macrophages of liver/spleen/BM = extravascular
40
What tests should be done for haemolytic anaemia?
FBC, LDH Urinary urobilinogen Thick and thin films for malaria Reticulocytes, bilirubin, haptoglobin
41
What are the types of Coomb's positive anaemia?
1. Drug induced 2. Autoimmune haemolytic anaemia - Warm = IgG mediated, extravascular - steroids - Cold = IgM mediated, intravascular
42
What are some causes of Coomb's negative anaemia?
Autoimmune hepatitis Hepatitis B and C Post vaccination Piperacillin, rituximab
43
What are some hereditary causes of haemolytic anaemia?
G6PD deficiency Pyruvate kinase deficiency Hereditary spherocytosis Sickle cell anaemia
44
What are some features of G6PD deficiency?
X-linkd Episodic intravascular haemolysis Bite and blister cells
45
What are some features of pyruvate kinase deficiency?
Autosomal recessive Decreased ATP production, decreased RBC survival Haemolysis + splenomegaly + jaundice Sputnik cells
46
What are some features of hereditary spherocytosis?
Autosomal dominant Spherical RBCs get trapped in spleen Cause of neonatal jaundice
47
What is sickle cell anaemia?
Production of abnormal Hb results in vaso-occlusive crises Autosomal recessive Hb electrophoresis confirms diagnosis
48
What are some features of sickle cell crises?
Triggers: cold, infection, hypoxia, dehydration Small blood vessels are occluded - infarction Severe pain due to bony infarction IV opioids, fluids and antibiotics
49
What is acute chest in SCA?
Pulmonary infiltrates involving complete lung segments | Pain, fever, tachypnoea, wheeze, cough
50
What are some complications of SCA?
``` Splenic infarction Poor growth Chronic renal failure Gallstones Iron overload Lung damage ```
51
What is thalassaemia?
Genetic disease of unbalanced Hb synthesis | Decreased or no production of one global chain

FINALS (19 decks)

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