Haematology Flashcards
(75 cards)
1
Q
Haematocrit
A
Volume of RBC’s: Total blood volume
2
Q
Transferrin
A
Iron transport in plasma
3
Q
Ferritin
A
Iron storage
4
Q
Iron deficiency anemia
- Type
- Diagnostics
- Clinical signs
A
- Microcytic
- Low Fe, Low Ferritin, High Total Fe Binding
- Post cricoid webs, angular stomatitis, koilinychia, atrophic glossitis
5
Q
Sideroblastic anemia
- Type
- Causes
- Histology sign
A
- Microcytic
- Congenital & Acquired (alcohol, mylodysplasia, cancer, anti-TB regimes)
- Sideroblasts in bone marrow (erythrocytes with iron deposits)
6
Q
Beta-Thalassemia
A
Dysfunction of Hb chains causing a microcytic anemia
7
Q
Anemia of chronic disease
- Cause and type
- Diagnostics
- Treatment options for a patient in renal failure
A
- A combination of decreased Iron release, EPO release and RBC survival. Normocytic anemia
- Low Fe, Fe binding capacity, normal ferritin
- Recombinant EPO
8
Q
Aplastic anemia
- Type and etiology
- Causes
- Diagnostics - histology features
A
- Normocytic (sometimes microcytic). caused by hypocellular marrow and blood cell complete deficiency
- Congenital, ideopathic, benzenes, chemo, HIV/Hep
- Pancytopenia, hypocellular marrow (increased fat spaces)
9
Q
Name 4 causes of normocytic haemolytic anemia
A
- Spherocytosis
- Thalessemia
- Sickle cell
- G6PD deficiency
10
Q
Name 5 causes of acquired haemolytic anemia
A
- Autoimmune
- Transfusion reactions
- Haemolytic disease of the newborn
- Prosthetic valves
- Drugs: eg dapsone (blister RBC’s) and penicillin
11
Q
Name two subtypes of macrocytic anemia
A
- Megaloblastic bone marrow
- Normoblastic bone marrow
12
Q
Causes of megalobastic anemia and histological signs
A
- B12 and folate deficiency
- Hypersegmented neutrophils
13
Q
Causes of Normoblastic anemia
A
- alcohol
- liver disease
- hypothyroidism
- pregnancy
- drugs
14
Q
Name the autoimmune type of macrocytic anemia
A
Pernicious anemia
15
Q
- Aetiology of pernicious anemia
- Associated conditions
- Risk
- Diagnostics
- Treatment
A
- Autoimmune atrophy of gastric mucosa due to deficiency of intrinsic factor. Decreased B12 and folate
- Blood group A, Thyroid disease, Addisons, Rheumatoid
- Predisposes gastric carcinoma
- Hypersegmented neutrophils, low WCC, low B12 and folate, autoAb’s parietal cells and I factor
- IM “balamin” B12 + folate injection
16
Q
Polycythaemia Vera
- Diagnostic picture
- Aetiology
A
- High RBC. Hb, haematocrit, WCC/Plt
- Secondary to hypoxia or abnormal EPO secretion - cancer and myloproliferative diseases
17
Q
Thrombotic sickle cell crisis
A
- Painful and vaso-occlusive
- Precipitated by infection/dehdration
- Can cause necrosis and infarct
18
Q
Sequestration sickle cell crisis
A
-Sickling within organs (spleen and lungs) causing pooling of blood
19
Q
Acute sickle cell chest syndrome
A
-SOB, chest pain and hypoxia, pulmonary infiltrates
20
Q
Sickle cell aplastic crisis
A
- Associated with Parvovirus
- Suddenfall in Hb and reticulocytes
21
Q
Haemolytic sickle cell crisis
A
-Rare and sudden fall in Hb due to increased haemolysis
22
Q
Features of Hodgkins lymhoma, hallmark cell found on node biopsy and associated viruses
A
- More common in men
- Reed-Sternberg cells “Owl” (from B cells)
- Associated with CMV and EBV
23
Q
What subtype of Hodgkins lymphoma is associated with fibrotic bands/ lacuner cells and is the most common form
A
Nodular Sclerosing Lymphoma
24
Q
What subtype of hodgkins lymphoma is more common in men and has the best prognosis
A
Lymphocyte rich lymphoma
25
Which subtype of Hodgkins lymphoma is linked to EBV and is not associated with fibrotic bands
Mixed cellularity lymphoma
26
What subtype of Hodgkins of lymphoma has the poorest prognosis and is associated with immunosupression (HIV).
Lymphocyte depleted lymphoma
27
What diagnostic test is indicative of poor prognosis of Hodgkins lymphoma
Serum lactate dehydrogenase LDH
28
What is the staging for Hodgkins Lymphoma
Ann Arbour
29
Gold standard treatment regime for Hodgkins Lymphoma
ABVD+ Radio
- Adriamycin
- Bleomycin
- Vinblastine
- Dacarbazine
30
How to differentiate between Hodgkins and non Hodgkins lymphoma
- No Reed-Sternberg cells (owl cells)
| - more common in older generations
31
Low grade lymphoma
- Prognostic course
- 3 types (MFL)
- Relapse and remit, although less aggressive are less curable
- MALT, Follicular, Lymphocytic
32
High grade lymphoma
- Prognostic course
- 4 types
- More aggressive but more likely to be cured
| - Burkitt, Lymphoblastic, Diffuse, Large B cell
33
What Virus is associated with Burkitts lymphoma and why is this.
What is the microscopic sign associated with Burkitts
- Malaria lowers resistance to EBV
| - Starry Sky microscopic sign
34
Chemo regime for High grade lymphoma
```
R-CHOP
R = Rituximab
C = Cyclophosphamide
H = Hydroxydaunorubicin
O = Oncovin
P = Prednisolone
```
35
Associated diagnostic features of Myloma
- Rogue Ig formation
- IgG/IgA (Bence Jones Proteins) G most common
- M-bands
- Light chains
- Rouleax Formation on blood film
36
Haematological side effect of Myloma
Hyper-viscosity syndrome = Increased blood cells
37
Symptoms of Myloma (Hyper-CRAB)
- Hyperviscosity
- Calcium
- Renal failure
- Anemia
- Bone lesions
38
AML
- Population most effected
- Histological sign
- Genetics
- Staging
- Older adults (80% adult leukemia)
- Auer rods and blast cells
- PML-RAR genes 15:17
- French-American -British (FAB)
39
ALL
- Population most effected
- Histological sign
- Staging
- Most common childhood type - associated with Downs!
- Always blast cells
- French-American-British
40
CML
- Population most effected
- Most common symptoms
- Genetics
- Complications
- Treatment
- Almost exclusively adults
- Slow progression, asymptomatic or hepatosplenomegaly
- Philadelphia chromosome t(9:22) translocation + BCR-abl
- Blast crisis = final stage, behaves like acute. May become AML
- Tyrosine Kinase inhibitors
41
CLL
- Population most effected
- Symptoms
- Histological sign (HINT: crushed little lads)
- Staging
- 2 complications
- Most commonly older adults (commonest in western world 55+)
- Pancytopenia
- Smudge/Smear cells
- Rai Staging
- Warm haemolytic anemia and hypogammaglobulinemia
42
Richter syndrome and diagnostic feature
CLL transforms into aggressive non-hodgkins lymphoma
| -Lactate dehydrogenase
43
Common complication of lytic metastasis and diagnostic feature
- Hypercalcemia
| - High ALP
44
Treat bony metastasis (2 drugs)
- Biphosphanates
| - Denosumab
45
What Leukemia is most likely to be precursor by mylodysplastic syndrome
AML
46
Acute Haemolytic transfusion reaction
- Aetiology
- Symptoms
- Treatment
- Due to mismatch ABO group
- Fever or hemolysis within 24hrs
- Halt transfusion/replace fluid and dialayse if necessary
47
Delayed Haemolytic transfusion reaction
- Aetiology
- Symptoms
- Treatment
- Undetectable Ab levels or new Ags formed against new blood
- Less severe form of acute
- Supportive often no treatment needed
48
Febrile non-haemolytic transfusion reaction
- Aetiology
- Symptoms
- Treatment
- Release of inflammatory signals from donor blood WBC
- Fever
- Halt transfusion and give antipyretic
49
Allergy or anaphylactic transfusion reaction
| -Treatment
-Halt transfusion and give antihistamine or adrenaline
50
Purpura transfusion reaction
- Aetiology
- Symptoms
- Treatment
- Rare thrombocytopenia due to anibodies against platelets
- Purple skin
- IV immunoglobulins
51
TACO & TRALI Treatment
-Supportive care
52
Graft vs Host Reaction
- Timeline
- Patient group at risk
- Treatment
- 1 wk post transfusion
- High mortality, immunosupressed patient
- Immunosupression
53
VW Disease
- Genetics
- Symptoms
- Diagnostics
-Autosomal dominant
-Mucosal/Gi bleeding, bruising and menorrhagia
+APTT, +Bleeding time
54
Hemophilia A
- Genetics
- Factor affected
- Symptoms
- Diagnostics
-X-Linked recessive
-Factor VIII
-Joint bleeds, haematuria, IC hemorrhage
+APTT, Normal Bleed time, +Prothrombin time
55
Hemophilia B (Christmas disease)
- Genetics
- Factor affected
- Symptoms
- Diagnostics
- X-Linked recessive - less common
-Factor IX
-Joint bleeds, haematuria, IC hemorrhage, nosebleeds
+APTT, Normal Bleed time, Normal Prothrombin time`
56
Drug contraindication with bleeding disorders
NSAID's
57
Fresh Frozen plasma
- Content
- Indication
- Whole blood without RBC + clotting factors
| - Used for those with significant clotting problems
58
Cryoprecipitate
- Content
- Indication
- Factor 8, 13, VWF, Fibronectin. Produced from FFP
| - Used to replace fibrinogen, often given to hemophiliacs and VW disease. No cross match needed
59
Prothrombin complex
- Content
- Indication
- Factors 2, 9 and 10
| - Reversal of anticoagulant with hemorrhage (warfarin)
60
Platelets
- Indication
- Risk
- Treat bleeding patients with low platelet count eg cancer/chemo
- Bacterial cross contamination due to warmer storage
61
Sepsis 6
| HINT: OBALFU
- O2 titrate to 94%
- Blood cultures
- Antibiotics IV
- Lactate serial measurements
- Fluid replacement
- Urine output
62
MOA Riveroxaban
Direct Factor Xa Inhibitor
63
MOA Dabigatran
Direct Thrombin Inhibitor
64
Neoadjuvant and Adjuvant chemo
| HINT: A=After
```
Neoadjuvant = Before surgery
Adjuvant = mop up after surgery
```
65
Thrombophilia - other name and mechanism
Hypercoagulablity - excess clotting capacity = DVT risk
66
thrombocytopenic purpura - symptoms
Decreased platelets - can be autoimmune or thrombotic
| Bruising and petechiea
67
What histological sybtype are most Head and Neck cancers
Squamus cell carcinoma
68
Oropharyngeal cancer
- R:factors
- Patient profile
- HPV biggest risk factor
| - younger, non smokers, richer
69
Nasopharyngeal cancer
- R:factors
- Patient profile
- EPB virus associated
| - Common in south China and Taiwain by a lot
70
Treatment head and neck cancers
Surgery and radio
| *surgery especially used in oral cancers
71
3 Types of antiemetics
- Dopamine antagonists
- Antihistamine
- 5-hydroxytryptamine (5-Ht3 antagonist)
72
Dopamine antagonists
- examples
- sites action
- SE
- Domperidome + Metocloperamide
- Antagonise D2 receptors in CRTZ also on GIT = accelerate GI emptying
- extrapyramidal, tardive dyskinesia, hyperprolactineamia
73
Anti-emetic antihistamine
- example
- sites action
- SE
- Cyclizine
- Antagonise H1 receptors CRTZ and reduce transmission from vestibular apparatus to CRTZ
- Drowsiness, anti-muscarining, contraindicated BPH
74
5-hydroxytryptamine (5-Ht3 antagonist)
- example
- clinical indication
- sites action
- SE
- Ondansetron
- 5-HT3 receptors in CRTZ + GIT
- Often post op and chemo
- ↑QT, constipation, ↓BP/HR
75
Absolute contraindications for anti-emesis
GI obstruction or haemmorhage
