Haematology Flashcards
(127 cards)
1
Q
Name 2 causes of microcytic anaemia
A
iron deficiency, chronic disease
2
Q
Name 2 causes of normocytic anaemia
A
Blood loss, combined haematinic deficiency
3
Q
Name 3 causes of macrocytic anaemia
A
B12 deficiency, alcohol excess, hypothyroidism
4
Q
What is the treatment for iron deficiency anaemia?
A
Oral ferrous sulphate
5
Q
Where is intrinsic factor produced?
A
Parietal cells in the stomach
6
Q
What does intrinsic factor bind?
A
Vitamin B12
7
Q
Where is B12 absorbed?
A
terminal ileum
8
Q
What is perinicious anaemia?
A
Autoimmune disease against the parietal cells
9
Q
Glossitis, jaundice and peripheral nerve damage are signs of what kind of anaemia?
A
B12 deficiency
10
Q
Acute pain in the hands and feet of an African child may indicate?
A
Painful crisis, sickle cell anaemia
11
Q
Where would an adult most likely get pain in a sickle cell crisis?
A
Long bones, ribs, spine and pelvis
12
Q
Which gene is responsible for sickle cell?
A
HbS
13
Q
What would you find on FBC in sickle cell anaemia?
A
High reticulocytes
14
Q
What drug is used as prophylaxis of painful crises in sickle cell anaemia?
A
Hydroxycarbamide
15
Q
How are patients with sickle cell anaemia managed?
A
Folic acid, flu and pneumococcal vaccinations and daily penicillin
16
Q
“Disproportionate microcytic anaemia” is found in…
A
beta thalassaemia trait
17
Q
How is beta-thalassaemia major managed?
A
repeat transfusions and desferrioxamine
18
Q
How does alpha thalassaemia, 2 chains affected?
A
hypochromic and microcytic, normal Hb
19
Q
How does alpha thalassaemia, 3 chains affected?
A
hypochromic microcytic anaemia with splenomegaly
20
Q
How does alpha thalassaemia, all 4 chains affected?
A
Hydrops fetalis, miscarriage
21
Q
What happens if you eat fava beans and you have G6PD deficiency?
A
Haemolysis
22
Q
Name 3 drugs which can cause haemolysis in those with G6PD deficiency
A
sulphonamides, quinolones, nitrofurantoin
23
Q
Briefly describe the meaning of polycythaemia
A
too many red blood cells/increased Hb concentration in the blood
24
Q
Gout, ruddy face, thrombosis and splenomegaly may be due to…
A
Polycythaemia
25
What happens if someone with polycythaemia has a hot bath?
They get itchy
26
What would you see in the blood of someone with polycythaemia?
Increased haematocrit, neutrophils and basophils, decreased erythropoietin.
27
What mutation causes primary polycythaemia/polycythaemia rubra vera?
JAK-2 Kinase
28
Name some causes of secondary polycythaemia?
COPD, altitute, sleep apnoea
29
What initiates DIC?
Release of tissue factor
30
Name 3 causes of DIC
sepsis, surgery, amniotic fluid embolism
31
Briefly describe ITP?
Idiopathic/Immune thrombocytopenic purpura: immune-mediated reduction in platelet count
32
What may cause ITP?
Infection or vaccination
33
What is the treatment for ITP?
None, usually self limiting
34
What is seen on FBCs in ITP?
Low platelets, everything else is normal
35
What is the classic pentad of Thrombotic Thrombocytopenic Purpura?
1. Fever
2. Altered Mental status
3. Haemolytic anaemia
4. Kidney damage
5. Thrombocytoopenia
36
What is thromboctopenia?
Low platelets
37
How is TTP managed?
1. Plasma exchange
2. Prednisolone
3. Aspirin
38
What type of leukaemia are people with Downs Syndrome predisposed to?
ALL
39
What chromosome is linked to CML?
Philadelphia chromosome
40
What causes the philadelphia chromosome?
t(9:22)
41
What is the normal % of blast cells in bone marrow?
1-2%
42
What % of blast cells are seen in acut leukaemia?
>20%
43
What acute leukaemia is more common in adults?
Acute Myeloid Leukaemia, AML
44
Which chromosome deletions are poor prognositc factors in AML?
Chromosome 5 and 7
45
What is seen on blood film in AML?
Auer rods
46
Which chromosome translation is associated with AML?
t(15:17)
47
What is the diagnostic enzyme in AML?
Myeloperoxidase
48
What does an increase in granulocytes at different stages of maturation indicate?
CML - chronic myeloid leukaemia
49
What is the first line treatment of CML?
Imatinib
50
What is the most common malignancy affecting children?
ALL
51
What indicates a positive diagnosis of ALL?
Positive TdT
52
Which translocation is seen in childhood ALL?
t(12:21)
53
What would you be worried about in a patient with CLL who suddenly becomes unwell?
Richter's transformation to high-grade lymphoma
54
What would you see on blood flim in CLL?
Smudge/smear cells (weak B cells that burst on the blood film)
55
Rubbery, painless enlarged cervical lymph nodes is indicative of?
Hodgkin's Lymphoma
56
Name 4 features of Hodgkin's lymphoma:
1. Fever
2. Night sweats
3. Hepatosplenomegaly
4. >10% weightloss
57
Describe the 4 stages of Hodgkin's lymphoma:
1. single lymph node
2. 2 or more lymph nodes on the same side of the diaphragm
3. lymph nodes involved on both sides of the diapragm
4. Involvement of extra nodal sites
58
What would you see on histology in hodgkin's lymphoma?
Reed-Sternberg cells
59
How is Hodgkin's lymphoma diagnosed?
Lymph node removed and histology
60
What age group(s) most likely to get Hodgkin's lymphma?
20s and 60s
61
Which virus predisposes non-Hodgkin lymphoma?
Epstein Barr virus
62
What characteristic of an enlarged lymph node would point to Hodgkin's lymphoma (over non-hodgkin's lymphoma)
Pain on drinking alcohol = Hodgkin
63
How is non Hodgkin Lymphoma staged?
Ann-Arbor system
64
Extra nodal disease would point towards...?
Non-Hodgkin's lymphoma
65
What do the abnormal plasma cells in someone with myeloma secrete?
PARA PROTEINS
66
What are the 4 symptoms/signs of myeloma?
1. HyperCalcaemia
2. Renal impairment
3. Anaemia
4. Lytic bone lesions
67
What would you see in the urine of someone with myeloma?
Bence-Jones proteins
68
What would you see on bone marrow biopsy in myeloma?
>10% plasma cells
69
Name 2 drugs used in the treatment of myeloma
Thalidomide, dexamethasone
70
What may myelodysplasia progress into?
AML
71
What is given as prophylaxis for tumour lysis syndrome?
IV allopurinol
72
In a patient who has just started chemotherapy, you notice the potassium and phosphate is HIGH and the calcium is LOW, what has happened?
Tumour Lysis Syndrome
73
Give the blood features of tumour lysis syndrome
1. High potassium and phosphate
2. Low calcium
Raised creatinine
74
In DIC what is raised in the blood?
Fibrin degradation products or D-Dimerq
75
What is the typical blood picture in DIC?
Low platelets, prolonged bleeding, prothrombin and APTT, D-Dimer, schistocytes
76
What is the typical blood picture in warfarin?
Prolonged prothrombin
77
What is the typical blood picture in aspirin?
Prolonged bleeding
78
What is the typical blood picture in Heparin?
Prolonged APTT
79
What does raised HbA2 alongside anaemia indicate?
Beta thalassaemia trait
80
Which non-Hodgkin's lymphoma has the worst prognosis?
Lymphocyte depleted
81
What 3 things would you see on a blood film in hyposplenism (e.g. post splenectomy?)
Howell-Jolly bodes
Target cells
Pappenheimer bodies
82
What would you see on a blood film in iron-deficiency anaemia
Target cells
| Pencil poikiloytes
83
What would you see on a blood film in myelofibrosis?.
Tear drop poikiloctyes
84
What would you see on a blood film in intravascular haemolysis?
Schistocytes
85
Hypersegemnted neutrophils would be seen on a blood film in which condition?
megaloblastic anaemia/folate deficiency anaemia
86
What does factor V leiden predispose you to?
DVT, VTE
87
What is the 1st line treatment of DVT in pregnant women?
LMWH subcut
88
What is the DVT scoring system?
Well's score
89
If the Well's score is>2 what does this mean?
DVT LIKELY
| > doppler ultrasound and D-Dimer
90
What should you do if DVT is likely but you cannot ultrasound?
Do a D-Dimer within 4 hours and give LMWH
91
What to do if a DVT is unlikely (Well's <1)?
D-Dimer before ultrasound (if d-dimer is positive)
92
What is the treatment regimen for a "provoked" DVT diagnosis?
1. LMWH
| 2. Warfarin for 3 months
93
Why would you treat a DVT with warfarin for 6 months?
If the DVT is unprovoked (e.g. no surgery or significant immobility)
94
What investigations are needed in a patient with unprovoked DVT?
CXR
Blood tests
Urinalysis
95
What additional investigations are advised in patients >40 with unprovoked DVT?
abdo-pelvis CT
| Mammogram
96
Splenomegaly and raised platelets are seen in?
Chronic myeloid leukaemia
97
What blood test should you order to screen for coeliac disease?
Anti-TTG
98
What does the Total Iron Binding Capacity (TIBC) look like in iron deficiency anaemia?
High
99
What is the most common inherited bleeding disorder?.
Von Willebrand's disease
100
What is the inheritance pattern of Von Willebrand?
Autosomal dominant
101
Name 3 causes of secondary polycythaemie
COPD
Altitude
Obstructive sleep apnoea
102
How does rivaroxiban work?
direct factor Xa inhibitor
103
What is the most common type of hodkin's lymphoma?
Nodular sclerosing
104
When would you consider a platelet transfusion?
when platelets are <30
105
When would you do a red blood cell transfusion in someone with acute coronary syndrome?
when Hb is <70
106
When would you do a red blood cell transfusion in someone without acute coronary syndrome?
Hb <80
107
What are thrombotic crises also known as?
Painful cirses, in sickle cell anaemia
108
What may be affected in a sequestration crisis?
spleen and lungs
109
A patient with sickle cell presents with SOB, chest pain, pulmonary infiltrates and low pO2, what is happening?
Acute chest syndrome
110
What may cause a sudden drop in haemaglobin of someone with sickle cell or spherocytosis?
Parvovirus infection
111
What may parvovirus cause in patients with sickle cell?
Aplastic crises
112
When would you give cryoprecipitate?
Massive haemorhage or uncontrolled bleeding due to haemophilia
113
What does cryoprecipitate contain?
Factor VIII, fibrinogen, vWf, factor XIII
114
How is autoimmune haemolytic anaemia diagnosed?
Antiglobulin test, Coomb's Test
115
What is seen on lymph node biopsy in Burkitt's lymphoma?
Starry-sky appearance
116
What illness is associated with Burkitt's lymphoma?
EBV, epstein barr virus
117
What would you see on the blood film in megaloblastic anaemia?
Hypersegmented neutrophils
118
Name 2 causes of megaloblastic anaemia
B12 and folate deficiency
119
What would a Heinz body on blood film indicate?
G6PD deficiency
120
Name 3 drugs that cause haemolysis in G6PD deficiency:
primaquine
ciprofloxacin
sulph- drugs
121
What would you see on the blood film in G6PD deficiency?
bite cless, blister cells and Heinz bodies
122
Itching after being in the bath is a classic symptom of...
Polycythaemia rubra vera
123
Which clotting factor is deficient in haemophilia A?
Factor VIII
124
What is Richter's transformation?
Chronic lymphocytic leukaemia becomes non-hodgkin's lymphoma
125
What condition may you develop if you have CLL?
HIgh grade/Non-Hodgkin's lymphoma
126
Smear/smudge cells are found in...
CLL (crushed little lymphocytes)
127
Name 2 drugs which are prophylactic against tumour lysis syndrome
Allopurinol and rasburicase
