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Long Case > Haematology > Flashcards

Haematology Flashcards

(44 cards)

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1
Q

What are your differentials for a platelet disorder?

A 
Viral infection
Drugs
ITP
DIC
TTP
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2
Q

What are your differentials for coagulation disorders?

A 
Haemophilia Type A=factor 8 Type B=factor 9
Von willebrands
Warfarin
Vitamin K deficiency
Liver disease
DIC
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3
Q

Which factors does APTT assess?

A

Intrinsic and common pathways

All factors apart from 7 but especially Factors 8, 9, 11 and 12

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4
Q

Which factors does Prothrombin ratio assess?

A

Extrinsic and common pathways

Factors 2, 5, 7 , 10, fibrinogen and prothrombin

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5
Q

How does chronic immune thrombocytopenic purpura present?

A

Bleeding, purpura, epistaxis, menorrhagia without splenomegaly

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6
Q

Management of ITP

A 
If mild, just supportive
Prednisolone
Splenectomy cures 80% of relapses
IV IG
TPO-RAs
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7
Q

What is ALL associated with?

A

Children between 2 and 10.

Associated with Down’s Syndrome

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8
Q

Presentation of ALL

A

Marrow failure, bleeding, infection, lymphadenopathy, hepatosplenomegaly

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9
Q

Management of ALL

A 
Blood/platelet transfusion
Allopurinol (prevents tumour lysis syndrome)
IV antibiotics if febrile neutropenia
Chemotherapy
Bone marrow transplant
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10
Q

Prognosis of ALL

A

90% cure rate in children

40% in adults

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11
Q

What is AML associated with?

A

Complication of radiotherapy/chemo

Commonest acute leukaemia in adults

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12
Q

What is CML associated with?

A

Philadelphia chromosome in 80% of cases-better prognosis

Splenomegaly

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13
Q

Investigations for CML

A

FBC
Bone marrow aspirate
Check for Philadelphia chromosome

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14
Q

Management of CML

A

Chemotherapy: imatinib

Stem cell transplant

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15
Q

How does CLL present?

A

Most common leukaemia
Often incidental finding on bloods
Painless lymphadenopathy

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16
Q

Investigations for CLL

A

FBC
Blood film
Bone marrow aspirate
Direct coomb’s test

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17
Q

Management of CLL

A 
Watchful waiting if mild
Steroids
IVIG
Transfusions
Allogenic stem cell transplantation
Fludarabine, cyclophosphamide and rituximab
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18
Q

Complications of CLL

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A

Autoimmune haemolysis
Infections
Marrow failure

19
Q

Key features of Hodgkin’s lymphoma

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A

Reed-sternberg cells
FhX, EBV, sle
Young adults and elderly

20
Q

Symptoms of lymphoma

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A 
Rubbery painless nodes
fever, weight loss, fatigue
Mediastinal involvement
Extranodal disease
Infection
21
Q

Investigations for lymphoma

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A

Lymph node biopsy
Bone marrow aspirate
CXR/CT/MRI
Bloods

22
Q

Differentials for cervical lymph node enlargement

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A

Infection: CMV,TB, EBV, HIV
Autoimmune: rheumatoid arthritis
Malignancy: Lymphoma, CLL, ALL, melanoma, thyroid cancer, stomach cancer, breast cancer

23
Q

What is the staging for lymphoma?

Study These Flashcards
A

Ann Arbor Staging System
I-confined to single lymph node
II-> 2 nodal areas, same side of the diaphragm
III-> 2 nodal areas, both sides of diaphragm
IV- spread beyond lymph nodes

24
Q

Management for hodgkins lymphoma

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A

80% 5 year survival
Radiotherapy and chemotherapy
ABVD chemo (adriamycin, bleomycin, vinblastine, decarbazine)

25
Management for non-hodgkin's lymphoma
40% 5 year survival Low grade-just radiotherapy High grade- RCHOP: rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, prednisolone
26
What is the pathogenesis of multiple myeloma?
The malignant proliferation of plasma cells producing identical immunoglobulins
27
Presentation of multiple myeloma
``` CRAB hyperCalcemia Renal involvement Anemia Bone lesions/Back pain Plus increased infections ```
28
How to diagnose multiple myeloma
Monoclonal protein band on serum electrophoresis Increased plasma cells on bone marrow biopsy Evidence of end organ damage Bence jones protein in urine
29
Investigations for multiple myeloma
Bloods: anemia, hypercalcemia, rouleaux formation Electrophoresis Skeletal survey Bone marrow
30
Management of multiple myeloma
``` Analgesia Bisphosphonates Transfusions and erythropoietin IV immunoglobulin Chemotherapy 3-4 year survival ```
31
What is virchow's triad
Hypercoagulability Stasis of blood flow Changes to blood flow wall
32
Pathogenesis of Factor V Leiden
Protein C cleaves Factor V molecule | Factor V Leiden is resistant to cleavage and so protein C cannot act as an anticoagulant
33
Causes of microcytic anaemia
Iron deficiency Thalassemia Sideroblastic anaemia Iron deficiency: Serum ferritin is low, TIBC is up and iron is low
34
Causes of normocytic anaemia
``` Acute blood loss Anaemia of chronic disease Renal failure Pregnancy Bone marrow failure Hypothyroidism ```
35
Causes of macrocytic anaemia
B12/folate deficiency Liver failure Alcohol Cytotoxic drugs
36
Lab results in anaemia of chronic disease
Serum ferritin: high TIBC: low Iron: low
37
What are the four myeloproliferative disorders?
Polycythaemia (RBC increased) Chronic myeloid leukaemia (WBC increased) Essential thrombocythaemia (platelets increased) Myelofibrosis (fibroblasts increased)
38
Presentation of polycythemia rubra vera
``` Itch after bath/shower Facial redness Headaches DVT PVD JAK2 positive Massive splenomegaly ```
39
Management of polycythemia rubra vera
Venesection Hydroxyurea/interferon Low dose aspirin
40
Presentation of essential thrombocythaemia
Abnormal bleeding Thromboembolism Headaches JAK2 -50%
41
Management of thrombocythaemia
Don't treat if asymptomatic Transexamic acid Aspirin Hydroxyurea/interferon
42
Presentation of myelofibrosis
Lethargy, weakness, weight loss, fever, easy bleeding
43
Investigations for myelofibrosis
Tear drop cells on blood film Nucleated RBCs Fibrosis on bone marrow trephine
44
Management of myelofibrosis
Bone marrow support-RBC and platelet transfusion

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