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Haematology Flashcards

(110 cards)

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1
Q

How long does it take to produce a neutrophil?

A

7-10 days

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2
Q

What is the quickest response for releasing neutrophils?

A

Demargination

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3
Q

Give some causes of neutrophilia

A 
Infection/inflammation
Steroids, adrenaline, GCSE
Cold/heat/surgery 
Myeloprofilerative disorder 
Malignancy
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4
Q

What is the lifespan of a neutrophil?

A

12-18 hours

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5
Q

What is GCSF used for?

A

It stops the WCC dropping too low during chemotherapy

Therefore can be a cause of neutrophilia

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6
Q

Give some causes of neutropenia

A 
Chemotherapy agents
Anticonvulsants, carbimazole, IBD meds
Viral infection 
BM failure 
Immune mediated - SLE
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7
Q

Give some causes of lymphocytosis

A 
Viral infections: EBV, CMV, influenza
Leukaemia, lymphoma
MI
Sickle cell crisis
Trauma
RA
Splenectomy
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8
Q

What is the commonest cause of a >6 week lymphocytosis?

A

Chronic lymphocytic leukaemia

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9
Q

Give some causes of a lymphopenia

A 
Malignancy - Hodgkin’s or NHL
RA, SLE
Chemotherapy
Burns
Anorexia nervosa
Renal or liver failure
Sarcoidosis 
Aplastic anaemia
Myelodysplatic syndromes
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10
Q

Give some causes of eosinophilia

A

Allergic conditions:asthma, eczema, hayfever
Allergic reaction to medication
Parasites; tapeworm, hookworm, schistosomiasis
Hodgkin’s lymphoma
Sarcoidosis
Irradiation

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11
Q

What is aquagenic pruritus?

A

Itching when exposed to hot water

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12
Q

What is polycythaemia Vera?

A

All blood cell types are produced excessively
Particular increase in the RBCs
This is a myeloproliferative neoplasm
Linked with JAK2 mutation

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13
Q

What do smear cells indicate?

A

Chronic lymphocytic leukaemia

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14
Q

Define leukaemia

A

A group of disorders that are characterised by the accumulation of malignant white cells in the bone marrow (primarily) and peripheral blood

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15
Q

How can we tell if BM failure is acute or chronic?

A

Mature cells present if chronic

Immature cells present if acute

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16
Q

Is CLL curable?

A

No

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17
Q

CLL is a disorder of which cells?

A

B cells

B1

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18
Q

How might CLL present?

A 
Insidious onset
Recurrent infections 
Enlarged LNs
Mucocutaneous bleeding 
Tiredness and fatigue
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19
Q

Are B symptoms common in CLL?

A

No

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20
Q

What are the B symptoms?

A

Fever
Weight loss
Night sweats

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21
Q

What degree of weight loss is considered worrying?

A

> 10% in the last 6 months

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22
Q

Give a differential diagnosis for low Hb, low WCC and low platelets

A

Acute leukaemia until proven otherwise : ALL/AML
Aplastic anaemia
B12 deficiency

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23
Q

What is the purpose of flow cytometry?

A

To see if the lineage is lymphoid or myeloid

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24
Q

What blood tests need doing if you suspect DIC?

A

PT
APTT
Fibrinogen

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25
How many days from diagnosis do you have to treat a haematological malignancy?
7 days
26
What are the signs of leukostasis?
Respiratory distress Decreased mental status Priapism
27
What gene diagnoses CML and how do we detect it?
BCR-ABL | FISH
28
What disease is the Philadelphia chromosome linked to?
Chronic myeloid leukaemia
29
What is the management of CML?
Tyrosine kinase inhibitor | BM transplant
30
What age groups get Hodgkin’s lymphoma?
15-30 years | >60 years
31
What proportion of patients have B symptoms in Hodgkin’s lymphoma?
Third
32
What other disease is Hodgkin’s linked to?
EBV exposure
33
What is the prognosis for Hodgkin’s lymphoma?
Good | 80% cure
34
What is the management of Hodgkin’s?
Radiotherapy | Chemotherapy ABVD combo
35
What medicines are in the ABVD combo?
Adriamycin (doxorubicin) Bleomycin Vinblastine Dacarbazine
36
Describe the Ann Arbor Staging
``` I = 1 LN region II = 2 + LN regions III = 2+ LN regions on different sides of diaphragm IV = extralymphatic spread ```
37
What are the classic 3 signs of myeloma?
Anaemia Back pain High ESR
38
Myeloma makes what type of bone lesions?
Lytic
39
How do we diagnose myeloma?
Histology >10% plasma cells in BM Paraprotein or excess light chains Myeloma related organ dysfunction
40
What is the management of myeloma?
Steroids - dexamethasone Chemo - cyclophosphamide Thalidomide Proteasome inhibitors
41
What is the CRAB mnemonic for myeloma?
C - calcium increase R - renal insufficiency A - anaemia B - bone lesions
42
Why can tinnitus occur in severe anaemia?
Hyperdynamic circulation
43
Name some causes of microcytic anaemia
``` Iron deficiency Anaemia of chronic disease Thalassaemia Hereditary spherocytosis Sideroblastic anaaemia Hodgkin’s disease ```
44
What is dysfunctional in haemochromatosis?
DMT 1 transporters are overzealous in the duodenum
45
What is ferroportin?
A protein which dictates how much iron is brought into the circulation
46
What cells recycle iron from RBCs?
Macrophages
47
How is iron stored?
2/3 in RBCs Intracellular ferritin in Spleen, liver and bone marrow Myoglobin Iron containing enzymes
48
What is the natural iron turnover in a day?
1 mg
49
What is the maximum iron that can absorbed from a diet?
20-25 mg/ day
50
What will a blood film show in iron deficiency anaemia?
Variable RBC size and shape Microcytes Hypochromia Target cells
51
Why might ferritin be increased in an iron deficiency anaemia?
Ferritin is an acute phase reactant and therefore can by raised with acute inflammation
52
What are the non-megaloblastic causes of macrocytosis?
``` Chronic alcohol excess Liver disease Haemolysis Hypothyroidism Pregnancy ```
53
What are the megaloblastic causes of macrocytosis?
B12 or folate deficiency Primary bone marrow disorders eg. Myelodysplasia Drugs interfering with DNA synthesis eg. Azathioprine
54
What does megaloblastic mean?
The nucleus is more immature than the cytoplasm
55
If B12 is low, what other test needs ordering?
Anti- IF | Intrinsic factor antibodies
56
Give some causes of B12 deficiency
Pernicious anaemia Post total gastrectomy Vegan Terminal ileum disease eg. Crohn’s, worms, diverticula
57
How long do the body stores of B12 last?
2-3 years
58
What are the causes of folate deficiency?
Poor diet Increased requirement: pregnancy, haemolysis, haemodialysis Malabsorption Drugs eg. Trimethoprim
59
How long do body stores of folate last?
3 months
60
What are the serious complications of B12 deficiency?
Peripheral neuropathy | Subacute combined degeneration of cord
61
What are the causes of normocytic anaemia?
``` Acute blood loss Anaemia of chronic disease Renal failure Marrow failure Hypothyroidism Pregnancy Haemolysis ```
62
Name some hereditary causes of haemolysis
Sickle cell anaemia, thalassaemia G6PD deficiency Hereditary spherocytosis, elliptocytosis
63
Name some acquired causes of haemolysis
Infections via complement activation Physical damage eg. DIC Drug induced Autoimmune
64
What is included in a haemolysis screen?
``` FBC, reticulocyte count, blood film Direct Coombs test Bilirubin (unconjugated) LDH Haptoglobin ```
65
What is the role of haptoglobin?
To mop up free Hb
66
Beta 2 microglobulin is a tumour marker for ...
Myeloma CLL some lymphomas
67
What gene do we look for in CML?
BCR - ABL
68
What is the tumour marker for non Hodgkin lymphoma?
CD20
69
What are the haem red flags?
``` Anaemia Persistent or recurrent infections Fever Night sweats Neck lumps Unexplained bleeding or bruising Bone pain Pruritus ```
70
Describe Ann Arbor staging
I : 1 LN group involved II: 2 LN groups on same side of diaphragm III: >2 LN groups on both sides of diaphragm IV: extralymphatic organ involvement
71
Name some causes of mild splenomegaly
Acute splenitis Acute congestion Infectious mononucleosis Acute febrile disorders
72
Name some causes of moderate splenomegaly
``` Chronic congestion Acute leukaemia Hereditary spherocytosis Thalassaemia major AI haemolytic anaemia Amyloidosis ```
73
Name some causes of massive splenomegaly
``` Chronic myeloproliferative disorders CLL Hair cell laeukaemia Lymphomas Malaria Primary splenic neoplasms ```
74
What can MGUS turn into?
Myeloma
75
What is DIC?
Clotting system becomes overactive and clots form in the small vessels. This uses up all the clotting factors so it can lead to excessive bleeding
76
Name some causes of DIC
Infections (sepsis) Cancer Trauma/major surgery Pregnancy and childbirth
77
What percentage of ALL occurs in children?
60%
78
What percentage of AML occurs in children?
20%
79
What percentage of CML associated with BCR ABL?
> 90%
80
Name some risk factors for AML development
Prolonged exposure to benzene and petroleum Prior chemotherapy with alkylating agents Down syndrome Bloom syndrome Fanconi anaemia
81
How does leukaemia present?
Fatigue Bruising or bleeding esp mucosal surfaces Fever Infections
82
What complications can hyperviscosity lead to?
Priapism Tinnitus Retinal haemorrhage CVA
83
What is the treatment for acute leukaemia?
Combination chemotherapy to achieve remission | Supportive therapies eg. Abx, RBCs, platelets
84
Broadly, how is CLL treated?
Only treat if Sx arise Chemotherapy Steroids Rituximab
85
What percentage of patients with Hodgkin’s have a normal lifespan?
80
86
When are the peaks for Hodgkin’s?
20s and 60s
87
What is the most common subtype of Hodgkin’s?
Nodular sclerosing
88
What investigations would you order for suspected Hodgkin’s?
FBC, ESR, U+E, LFT, ALP,LDH Biopsy of involved LN CXR and CT CAP Consider BM biopsy
89
What is the treatment of Hodgkin’s?
Stage 1-2a radiotherapy | Stage 2b + chemotherapy
90
What is the combination chemo given for Hodgkin’s?
ABVD | Adriamycin, bleomycin, vinblastine, dacarbazine
91
What factors would indicate a poor prognosis in Hodgkin’s?
``` B symptoms >45 years old Bulky mediastinal disease Extranodal involvement Decreased haematocrit or increased ESR Increased CD30 and IL2 ```
92
What percentage of patients with Hodgkin’s have a normal lifespan?
80
93
When are the peaks for Hodgkin’s?
20s and 60s
94
What is the most common subtype of Hodgkin’s?
Nodular sclerosing
95
What investigations would you order for suspected Hodgkin’s?
FBC, ESR, U+E, LFT, ALP,LDH Biopsy of involved LN CXR and CT CAP Consider BM biopsy
96
What is the treatment of Hodgkin’s?
Stage 1-2a radiotherapy | Stage 2b + chemotherapy
97
What is the combination chemo given for Hodgkin’s?
ABVD | Adriamycin, bleomycin, vinblastine, dacarbazine
98
What factors would indicate a poor prognosis in Hodgkin’s?
``` B symptoms >45 years old Bulky mediastinal disease Extranodal involvement Decreased haematocrit or increased ESR Increased CD30 and IL2 ```
99
What is the median age of presentation of NHL?
50+
100
What investigations would you do for suspected NHL?
``` Excisional biopsy FBC, U+E, LDH, Beta 2 microglobulin BM aspirate/trephine CXR CT CAO ```
101
What is the management of low grade NHL?
Radiotherapy Chemotherapy - cyclophosphamide, vinocristine Prednisolone Rituximab
102
What is the management for intermediate or high grade NHL?
Radiotherapy and combination chemo | CHOP
103
What is myeloma?
A clonal proliferation of mature plasma cells that secrete Ig leading to an overproduction of a single Ig class (paraprotein)
104
What is the management of myeloma?
``` Correct any deficits Allopurinol Opiates and RT for bone pain Chemo: cyclophosphamide, thalidomide and dexamethasone Stem cell transplant ```
105
What is the 5 year survival of myeloma?
35%
106
What is Waldenstroms macroglobulinaemia?
Rare type of slow growing NHL Lymphoplasmacytic cells become abnormal and can build up in LNs, BM or Spleen Makes large amounts of IgM
107
Was is included in RCHOP therapy?
``` Rituximab Cyclophosphamide Doxorubicin (hydroxy..) Vincristine (oncovin) Prednisolone ```
108
What is RCHOP chemo used for?
Non-Hodgkins lymphoma
109
What is included in ABVD chemo?
Doxorubicin (adriamycin) Bleomycin Vinblastine Dacarbazine
110
What is ABVD chemo used for?
Hodgkin lymphoma

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