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Haematology Flashcards

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1
Q

Sx of anaemia?

A

fatigue, dyspnoea, faintness

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2
Q

Severe anaemia bloods?

Signs?

A

< 8g/dL

Tachycardia, cardiac enlargement, increased CO

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3
Q

Transports iron?

A

Transferrin

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4
Q

Stores iron?

A

Ferritin, haemosiderin

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5
Q

Pres of iron-def anaemia?

Signs?

A

Fatigues, faintness, dyspnoa

+/- :
Pallor
Nail changes [koilonychia (spoon), brittle]
Hair loss
Mouth [angular stomatitis, atrophic glossitis]

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6
Q

Cause of iron-def ?

A 
Inadequate intake (h.pylori)
Poor absorption (coeliac)
Excess loss (GI bleed)
Excess iron requirement
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7
Q

Ix in iron-def anaemia?

A

Hb <13g/dL (men), <12g/dL (women)
MCV = microcytic
Blood smear
Iron studies

Coeliac autoantibodies
Endoscopy

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8
Q

Why may ferritin be high in iron-def?

A

Acute phase protein so increases in inflam

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9
Q

DDx for iron-def anaemia?

A

Chronic disease

Sideroblastic anaemia

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10
Q

Mx of iron-def?

A

Ferrous sulphate

+/- transfusion

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11
Q

SE of ferrous sulphate

A

Constipation
Black stools
Vomit

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12
Q

When would you suspect sideroblastic anaemia

A

Microcytic hypochromic anaemia

NOT responding to iron

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13
Q

Cause of sideroblastic anaemia?

A

Ineffective erythropoesis [cant incorporate iron into Hb]

Congenital - X-linked

Acquired - MDS, myeloma

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14
Q

Ix in sideroblastic anaemia

A

Hb
MCV
Iron studies

MARROW ASPIRATE

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15
Q

Mx of sideroblastic

A

Iron chelation

Desferrioxamine

Avoid alcohol / Vit C

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16
Q

B thalassmia?

A

Inherited microcytic anaemia

Mutation to beta-globin gene

Ineffective erythropeiss

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17
Q

Sx of b thalassemia

A

Bony changes - skull bossing

Hepatosplenomegaly

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18
Q

ix in b thalassemia

A 
FBC
Blood smear
Hb analysis
LFT
Skull xray
Abdo USS
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19
Q

Mx of b thalassemia

A

Genetic counselling
Transfusion
Iron chelation

Splenectomy
BMT

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20
Q

comps of thalassemia

A

Thrombotic
Iron overload
Transfusion reactions

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21
Q

Causes of haemolysis

A

Liver macrophages

Spleen

Red cell destruction by immune system

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22
Q

Hereditary causes of haemolytic anaemia?

A

G6PDD

Hereditary spherocytosis

SC, thalassemia

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23
Q

Test for immune mediated haemolytic anaemia?

A

Direct antiglobulin +ve (Coombs)

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24
Q

Causes of non-immune mediated haemolytic anaemia?

A

Infection (malaria) , trauma

DIC, TTP, HUS, HELLP

Paroxysmal nocturnal haemoglobinuria

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25
Dx of paroxysmal nocturnal haemoglobinuria?
Urinary haemosiderin
26
Ix in haemolytic anaemia?
``` FBC MCV is increased! (reticulocytes) Unconj bilirubin Urinalysis Blood film Coombs test ```
27
Mx of haemolytic anaemia?
Folic acid supplement
28
Pres of G6PDD?
Prolonged neonatal jaundice
29
Mx of G6PDD?
Fluids Folic acid Transfusion
30
Anaemia of chronic disease?
Decreased RBC production and survival Normocytic normochromic Low reticulocytes, low iron, elevated ferritin
31
Pres of ickle cell disease?
Cresentic shaped Hb --> disrupt blood flow and break --> painful crisis, organ damage, increased infections
32
Triggers of sickle cell crisis
``` CHIDS Cold Hypoxia Infection Dehydration Stress ```
33
Areas affected by sickle cell crisis?
Chest - pain, fever, dyspnoea, tachypnoea Bone infarction - avasc necrosis of femoral head Acute abdo - mesenteric ischaemia
34
Dx of sickle cell?
Newborn screening
35
Mx of sickle cell crisis
``` Corss match Analgesia O2 IV fluids Abx +/- blood transfusion ```
36
Cause of megaloblastic anaemia?
B12/folate deficiency Defective DNA synthesis --> leukopenia and thrombocytopenia
37
Dietary sources of folate?
Green veg Nuts Liver
38
Causes of folate deficiency?
Poor diet Increased demand (pregnancy, renal disease) Malabsorp (coeliac) Drugs, alcohol, MTX
39
Signs of folate def
Headache Anaemia Wt loss Glossitis, dermatitis
40
Mx of folate def
Folic acid oral
41
Pres of B12 def?
Macrocytic anaemia with peripheral neuropathy and neuropsych complaints
42
Dietary sources of V12
Meat Fish Dairy
43
Which cell is needed for b12 absorption?
Parietal cells produce Intrinsic Factor
44
Mouth signs of b12 deficiency
Glossitis (painful!), | Angular chelitis
45
Neuro sx of b12 def
Subacute degen of spinal cord + peripheral neuorpath + dementia + ataxia + paraesthesia
46
Mx of b12 def
IM hydroxycobalamin Oral folic acid +/- blood transfusion
47
Pernicious anaemia?
Autoimmune atrophic gastritis + autoantibodies to IF
48
Leukaemia?
Excess of abnormal white cells in peripheral blood | Can be myeloid of lymphoid
49
Pres of acute leukaemia?
Bone pain, fever, lethargy, night sweats, wt loss Anaemia, thrombocytopenia, neutropenia Headache, lymphadenopathy, hepatosplenomegaly
50
Dx of AML
Tends to be >75yo | Bone marrow blasts > 20%
51
Ix in AML
FBC Blood film - blasts + auer rods Bone marrow biopsy - blasts > 20% Coag
52
Tumour lysis syndrome?
Electrolyte + metabolic disturbance due to breakdown of large number cancer cells (common in leukaemia) Hyperuricaemia, hyperphosphataemia, hyperkalaemia, hypocalcaemia, +/- renal impairment)
53
Mx of tumour lysis syndrome?
IV fluids Allopurinol in chemo reigime +/- Haemodialysis
54
Chromosomal assos with ALL
Philadelphia - t(9,22)
55
Pres of ALL
Most common tumour of childhood <5yo. / > 45yo Assos with Down's syndrome Bruising, pancytopaenia
56
Ix of ALL
``` FBC Blood film - blasts Coag Bone marrow biopsy CXR ```
57
seen on CXR of ALL
mediastinal widening
58
Comps of ALL
Tumour lysis syndrome Neutropenic sepsis Pancytopenia Chemo SEs
59
Mx of ALL
Hydration, allopurinol, prophylactic abx/anti-virals/antifungals Transfusions Chemo + imatinib
60
Mx of CML
Imatinib Chemo Stem cell transplant
61
What happens in CLL?
B lymphocytes avoid apoptosis --> invade liver, spleen and bone marrow >55yo
62
Sx of CLL?
>55yo Haemolytic anaemia Can transfrom into lymphoma [Infiltration, B sx] = Richters transformation
63
Ix in CLL?
FBC Blood film - smudge cells CT
64
Mx of CLL
Chemo +/- stem cell transplant
65
Lymphoma vs leukaemia?
``` Lymphoma = solid Leukaemia = circulating ``` "lemon vs lemonade"
66
Most common type of NHL?
Diffuse B-Cell lymphoma | can produce Ig
67
Pres of NHL?
Lymphadenopathy, dry cough, bone marrow, spleonmegaly B sx
68
Ix in NHL?
FBC LN biopsy CT/MRI
69
HL from what cells?
Mature B cells
70
Pres of HL?
Cervical/supraclav lymphadenopathy (painless) B sx in 30%
71
Which cells seen in HL?
Reed-Sternberg look like an owl
72
Aetiology of HL?
immunodef EBV AI - SLE
73
Mediastinal adenopathy is common in HL --> how would this present?
Dry cough, dyspnoea, chest pain | SVCO
74
Multiple myeloma?
Clonal proliferation of plasma cells in bone marrow --> overprod of Ig
75
Dx of MM?
Serum + urine protein electrophoresis
76
Pres of MM?
Bone pain Anaemia Fatigue, infections, hypercalcamiea, RENAL IMPAIRMENT
77
Features of MM?
``` OLD CRAB Old age Calcium raised Renal insufficiency Anaemia Bone disease ```
78
What causes renal impairment in MM?
Deposition of Tamm-Horsfall protein in LoH
79
Mx of MM?
Bisphosphonates Blood transfusion/EPO Hydration
80
Polycythaemia?
Increased proportion of Hb in blood
81
Pres of PRV?
Hyperviscosity | Pruritis
82
Ix in PRV?
FBC | JAK2 mutation
83
Mx of PRV?
Hydroxycarbamide (decreases bone marrow production) + aspirin Manage CV RFs
84
What regulates platelet production?
Thrombopoeitin (from the liver)
85
When does ITP occur?
Children post viral illness
86
Ix in ITP
FBC LFTs peripheral smear BM biopsy
87
Mx of ITP
Acute --> IVIg, pred, pt transfusion Chronic --> rituximab + splenectomy
88
Pres of TTP?
EMERGENCY! ``` Fever Renal failure Haemolytic anaemia Thrombocytopenia Neurological change ```
89
Cause of TTP?
Absence of VWF cleaving protein --> platelet aggregation in microvasculature + haemolysis
90
Seen on blood smear in TTP?
Microangiopathic blood film with SCHISTOCYTES
91
Mx of TTP?
Urgent plasma exchange + prednisolone + aspirin DO NOT GIVE PLATELETS
92
Drug to target antibody production?
Rituximab
93
Pres of DIC?
Systemic collapse --> tachycardia, hypotension, oliguria Bleeding --> bruising, purpura
94
Mx of DIC?
Platelet transfusion | FFP
95
Haemophillia inheritance?
X-linked recessive
96
Pres of haemophillia?
Boys - toddlers | Bleeding into muscles + joints
97
Pres of VWD?
Teens | Bleeding into mucus membranes and skin
98
Haemophillia A & B factors?
``` A = 8 deficient B = 9 deficient ```
99
Avoid in haemophillia?
IM injections Aspirin NSAIDs
100
Cause of VWD?
AD chromosome 12
101
Mx of VWD?
IV desmopressin
102
Vit K for which factors?
1972
103
What is prolonged in liver disease?
PT
104
Staging for lymphoma?
Ann-Arbor
105
HL vs NHL age?
HL = younger 20-34
106
Stages of CML
Chronic (asympto - 5y) Accelerated (anaemia, thrombocytopaenia) - more blast cells in blood Blast (pancytopaenia - can be fatal) >30% blasts PHILADELPHIA CHROMOSOME

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