Haematology Flashcards
(94 cards)
1
Q
Microcytic anaemia causes (5)
A
- Iron deficiency
- Thalassaemia
- Lead poisoning
- Anaemia of chronic disease (more commonly normocytic, normochromic picture)
- Congenital sideroblastic anaemia
TAILS
2
Q
most common cause in pre-menopausal women
most common cause in men
A
Menorrhagia GI bleed (think colon cancer)
3
Q
Ix iron deficiency anaemia
Findings on bloods:
TIBC low or high
Blood film - name two types
A
TIBC = high
Blood film = target cells, ‘pencil’ poikilocytes
4
Q
Causes of normocytic anaemia
A
- Anaemia of chronic disease
- CKD
- Aplastic anaemia
- Acute blood loss
- Haemolytic anaemia
AAACH
5
Q
Causes of macrocytic anaemia
Megaloblastic (2)
Normocytic (6)
A
Megalo 1. B12 deficiency 2. Folate deficiency Normo 3. Alcohol 4. Liver disease 5. Hypothyroid 6. Pregnancy 7. Reticulocytosis 8. Myleodysplasia
6
Q
abdominal pain peripheral neuropathy (mainly motor) fatigue constipation blue lines on gum margin =
A
Lead poisoning
7
Q
Lead poisoning
Mx (2)
A
- dimercaptosuccinic acid (DMSA)
2. D-penicillamine
8
Q
Raised
- delta aminolaevulinic acid
- urinary coproporphyrin
=
A
Lead poisoning
9
Q
target cells Howell-Jolly bodies Pappenheimer bodies siderotic granules acanthocytes
A
Hyposplenism e.g. post-splenectomy, coeliac disease
10
Q
‘tear-drop’ poikilocytes
A
Myelofibrosis
11
Q
schistocytes
A
Intravascular haemolysis
12
Q
hypersegmented neutrophils
A
Megaloblastic anaemia
13
Q
Blood film
anisopoikilocytosis (red blood cells of different sizes and shapes)
target cells
‘pencil’ poikilocytes
A
iron deficiency anaemia
14
Q
Blood film:
basophilic stippling and clover-leaf morphology
A
lead poisoning
15
Q
Blood film findings:
Myelofibrosis
A
‘tear-drop’ poikilocytes
16
Q
Blood film findings:
Megaloblastic anaemia
A
hypersegmented neutrophils
17
Q
Blood film findings:
Haemolysis
A
schistocytes
18
Q
Blood film findings:
Hyposplenism (5)
A
target cells Howell-Jolly bodies Pappenheimer bodies siderotic granules acanthocytes
TAPSH
19
Q
Spherocytes on blood film
Name two conditions
A
Hereditary spherocytosis
Autoimmune hemolytic anaemia
20
Q
Basophilic stapling
Name four conditions
A
Lead poisoning
Thalassaemia
Sideroblastic anaemia
Myelodysplasia
21
Q
Heinz bodies
Name two conditions
A
G6PD deficiency
Alpha-thalassaemia
22
Q
Schistocytes
Name three conditions
A
Haemolysis
Mechanical heart valve
Disseminated intravascular coagulation
23
Q
Target cells
Name four conditions
A
Sickle-cell/thalassaemia
Iron-deficiency anaemia
Hyposplenism
Liver disease
24
Q
positive direct antiglobulin test (Coombs’ test) =
A
Automimmune haemolytic anaemia
25
Warm autoimmune haemolytic anaemia
What causes haemolysis
Where does haemolysis tend to occur?
Mx
IgG
haemolysis tends to occur in extravascular sites, for example the spleen
steroids, immunosuppression and splenectomy
26
```
Cold autoimmune haemolytic anaemia
What causes haemolysis
Where does haemolysis tend to occur?
Features (2)
Mx
```
IgM
Haemolysis is mediated by complement and is more commonly intravascular.
Features may include symptoms of Raynaud's and acrocynaosis. Patients respond less well to steroids
27
Hereditary spherocytosis
AD/AR
Features (4)
AD
1. failure to thrive
2. jaundice, gallstones
3. splenomegaly
4. aplastic crisis precipitated by parvovirus infection
28
Hereditary spherocytosis
AD/AR
Features (5)
AD
1. failure to thrive
2. jaundice, gallstones
3. splenomegaly
4. aplastic crisis precipitated by parvovirus infection
5. MCHC elevated
29
Hereditary spherocytosis
| Dx
Clinical - if equivocal
cryohaemolysis test and EMA binding test
for atypical presentations for electrophoresis
30
Spherocytosis
| Mx
```
acute haemolytic crisis:
1. supportive
2. transfusion if necessary
longer term treatment:
1. folate replacement
2. splenectomy
```
31
Difference between G6PD deficiency and spherocytosis
Country
Blood film
Genetics
Haemoylsis location
G6PD African + Mediterranean, Heinz bodies, X linked, intravascular heamolysis
Spherocytosis Northern european, AD, extravascular haemolysis
32
Drugs that can cause haemolysis (3)
1. anti-malarials: primaquine
2. ciprofloxacin
3. sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas
33
Medications that increase VTE risk (4)
1. Antipsychotics
2. COCP
3. HRT
4. Tamoxifen
34
Direct thrombin inhibitor medication (1) --> reversal (1)
| Direct factor Xa inhibitor (2) --> reversal (1)
Dabigatran --> Idarucizumab
| Apixaban + rivaroxaban --> adnexanet
35
```
Examples of myeloproliferative disorders
RBC
WBC
Platelets
Fibroblasts
```
Polycythaemia rubra vera (PRV)
CML
Essential thrombocythaemia
Myelofibrosis
36
Auer rods
| DIC or thrombocytopenia often at presentation
ApML
37
Philadelphia chromosome =
Due to a translocation between the long arm of chromosome 9 and 22
Mx (4)
CML
1. imatinib is now considered first-line treatment
2. hydroxyurea
3. interferon-alpha
4. allogenic bone marrow transplant
38
blood film: smudge cells (also known as smear cells) =
CLL
39
CLL
| Ix:
immunophenotyping
40
CLL
| Complications (4)
anaemia
hypogammaglobulinaemia leading to recurrent infections (low IgG)
warm autoimmune haemolytic anaemia in 10-15% of patients
transformation to high-grade lymphoma (Richter's transformation)
41
What is Richter's transformation?
leukaemia cells enter the lymph node and change into a high-grade, fast-growing non-Hodgkin's lymphoma
42
Features of Richter's transformation?
```
lymph node swelling
fever without infection
weight loss
night sweats
nausea
abdominal pain
```
43
Massive splenomegaly causes (5)
1. myelofibrosis
2. leukaemia
3. leishmaniasis
4. malaria
5. Gaucher's syndrome
44
leukaemia cells enter the lymph node and change into a high-grade, fast-growing non-Hodgkin's lymphoma occurs in which leukemia
CLL
45
What is ITP?
an immune-mediated reduction in the platelet count. Antibodies are directed against the glycoprotein IIb/IIIa or Ib-V-IX complex.
46
ITP Mx
Management
1. oral prednisolone
2. pooled normal human immunoglobulin (IVIG)
47
What is thrombocytosis?
| Mx (3)
High platelets
1. hydroxyurea
2. interferon-α
3. low-dose aspirin to reduce the thrombotic risk
48
Essential thrombocytosis
| Features (4)
1. platelet count > 600
2. both thrombosis and haemorrhage can be seen
3. burning sensation in the hands
4. JAK2 mutation is found in around 50% of patients =
49
Well score interpretation
=>2 --> DVT likely
If likely then for USS within 4 hours if +ve for rx
If negative then for d-dimer, if negative scan and negative d dimer --> unlikely, and consider alt dx
If scan cannot be done within 4 hours, then for d dimer and interim anticoag with DOAC, USS to be done within 24 hours
If scan negative but d-dimer +ve, stop DOAC and repeat scan in 1 week
If DVT unlikely 1 or less, for d-dimer within 4 hours, if not for interim DOAC. If +ve dimer then for USS within 4 hours. If unable to do within 24 hours then for interim DOAC
50
When to not use DOAC
CKD eGFR<15
Antiphospholipid syndrome
TO use LMWH or unfractionated heparin
51
platelet count > 600 * 109/l
both thrombosis and haemorrhage can be seen
burning sensation in the hands
JAK2 mutation is found in around 50% of patients =
Essential thrombocytosis
52
Types of Burkitt's lymphoma and locations
| Which virus is associated with the first type?
1. Endemic --> maxilla + mandible --> assoc with EBV
| 2. Sporadic form --> abdominal (e.g. ileo-caecal) tumours, common in pt's with HIV
53
Burkitt's lymphoma miscroscopy findings?
Mx
Name of medication given before mx to prevent which condition?
'starry sky' appearance
Chemo
Rasburicase given prior to chemo to prevent tumour lysis syndrome
54
Which condition?
bone disease: bone pain, osteoporosis + pathological fractures, osteolytic lesions
lethargy
infection
hypercalcaemia
renal failure
other features: amyloidosis e.g. Macroglossia, carpal tunnel syndrome; neuropathy; hyperviscosity
Multiple myeloma
55
What is multiple myeloma?
Neoplasm of increased plasma cells
56
Multiple myeloma Ix
Bloods (2)
Scan (1)
Xray finding?
1. monoclonal proteins (usually IgG or IgA) in the serum and urine (Bence Jones proteins)
2. Whole body MRI
3. 'rain-drop skull'
57
Diagnostic criteria for multiple myeloma
one major and one minor criteria OR
three minor criteria
Major criteria
Plasmacytoma (as demonstrated on evaluation of biopsy specimen)
30% plasma cells in a bone marrow sample
Elevated levels of M protein in the blood or urine
Minor criteria
10% to 30% plasma cells in a bone marrow sample.
Minor elevations in the level of M protein in the blood or urine.
Osteolytic lesions (as demonstrated on imaging studies).
Low levels of antibodies (not produced by the cancer cells) in the blood.
58
What is Factor V Leiden?
Most common thrombophillia secondary to activated protein C resistance
Increased risk of VTE
59
What is Von Willebrand's disease?
AD/AR?
Sx
Most common inherited bleeding disorder
AD
epistaxis and menorrhagia
60
Von Willebrand
| Ix (4)
prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin
61
Von Willebrand
| Mx
tranexamic acid for mild bleeding
desmopressin (DDAVP): raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells
factor VIII concentrate
62
HbA2 raised (> 3.5%) =
Beta thalassemia
63
Hepatitis C is associated with?
cryoglobulinaemia
64
Type 1 cryoglobulinaemia examples
monoclonal - IgG or IgM
| multiple myeloma, Waldenstrom macroglobulinaemia
65
Type 2 cryoglobulinaemia examples
mixed monoclonal and polyclonal: usually with rheumatoid factor
hepatitis C, rheumatoid arthritis, Sjogren's, lymphoma
66
Raynaud's only seen in which type of cryoglobulinaemia?
Type 1
67
Haemophilia genetics
| Haemophilia A and B which factors?
X linked recessive disorder of coagulation
| VIII and IX
68
prolonged APTT only =
Haemophillia
69
usually asymptomatic
| lower level of paraproteinaemia than myeloma
Monoclonal gammopathy of undetermined significance
70
C1 1NH deficiency =
Hereditory angioedema
71
attacks may be proceeded by painful macular rash
painless, non-pruritic swelling of subcutaneous/submucosal tissues
may affect upper airways, skin or abdominal organs (can occasionally present as abdominal pain due to visceral oedema)
urticaria is not usually a feature
=
Hereditory angioedema
72
What is Waldenstrom macroglobulinemia?
type of non-Hodgkin lymphoma
73
What is Paroxysmal nocturnal haemoglobinuria
acquired disorder leading to haemolysis caused by a lack of glycoprotein glycosyl-phosphatidylinositol (GPI)
Increased risk of VTE
74
Dark-coloured urine, haemolytic anaemia, thrombosis =
Paroxysmal nocturnal haemoglobinuria
75
Paroxysmal nocturnal haemoglobinuria
Ix
Mx (2)
flow cytometry of blood to detect low levels of CD59 and CD55
blood product replacement
anticoagulation
76
Secondary causes of polycythaemia (4)
COPD
altitude
obstructive sleep apnoea
excessive EPO: cerebellar haemangioma, hypernephroma, hepatoma, uterine fibroids*
77
```
JAK2 mutation
hyperviscosity
pruritus, typically after a hot bath
splenomegaly
haemorrhage (secondary to abnormal platelet function)
plethoric appearance
hypertension in a third of patients
low ESR =
```
polycythaemia
78
low ESR and a raised leukocyte alkaline phosphatase =
polycythaemia
79
Polycythaemia
| Mx (3)
aspirin
venesection - first line treatment
hydroxyurea -slight increased risk of secondary leukaemia
80
definitive Ix of sickle cell disease =
haemoglobin electrophoresis
81
Name the crises sickle cell
| sickling within organs such as the spleen or lungs causes pooling of blood with worsening of the anaemia
Sequestration
82
Name the crises sickle cell
dyspnoea, chest pain, pulmonary infiltrates, low pO2
the most common cause of death after childhood
Acute chest syndrome
83
Name the crises sickle cell
caused by infection with parvovirus
sudden fall in haemoglobin
Aplastic
84
Name the crises sickle cell
| fall in haemoglobin due an increased rate of haemolysis
Haemolytic
85
Name the crises sickle cell
also known as painful crises or vaso-occlusive crises
precipitated by infection, dehydration, deoxygenation
Thrombotic
86
Most common cause of thrombophillia =
| Second most common cause
factor V Leiden
| prothrombin gene mutation
87
vit B12 deficiency is most commonly caused by?
pernicious anaemia
88
Causes of vit b12 deficiency (5)
```
pernicious anaemia
post gastrectomy
vegan/ poor diet
disorders/surgery of terminal ileum (site of absorption)
e.g Crohn's
metformin (rare)
```
89
What does B12 use to be absorbed?
Where is this secreted from?
Where is it absorbed?
intrinsic factor (secreted from parietal cells in the stomach) and is actively absorbed in the terminal ileum.
90
Mx B12
if no neuro 1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then every 3 months
if also deficient in folic acid then to treat B12 deficiency first to avoid precipitating subacute combined degeneration of the cord
91
Sx B12 deficiency (4)
| type of anaemia
1. macrocytic anaemia
2. sore tongue and mouth
3. neurological symptoms
the dorsal column is usually affected first (joint position, vibration) prior to distal paraesthesia
4. neuropsychiatric symptoms: e.g. mood disturbances
92
Which haemophillia accounts for 90% of cases?
A
93
What is the antidote for heparin
protamine sulfate
94
HbA2 raised (> 3.5%) =
beta thalassemia trait
