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Year 4 > haematology > Flashcards

haematology Flashcards

1
Q

What is anaemia

A

low haemoglobin due to decreased red cell mass

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2
Q

what are the three types of anaemia

A

microcytic
normocytic
macrocytic

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3
Q

What are symptoms of anaemia

A
  • tiredness
  • dyspnoea
  • pallor
  • palpitations
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4
Q

What are signs of anaemia

A
  • pallor (conjunctival)
  • tachycardia
  • heart failure
  • retinal haemorrhages
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5
Q

When should you suspect haemolytic anaemia

A

reticulocytosis and elevated bilirubin

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6
Q

What are types of microcytic anaemia

A
  • IDA
  • thalassaemias
  • sideroblastic anaemia
  • anaemia of chronic disease
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7
Q

What is the most common type of anaemia

A

iron deficiency anaemia

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8
Q

What are possible causes of IDA

A

poor intake eg vegetarian

malabsorption eg IBD

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9
Q

What is treatment for IDA

A

iron supplements

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10
Q

What is treatment for thalassaemia

A

Nothing or transfusions with iron chelating agents

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11
Q

What are causes of normocytic anaemia?

A
  • acute blood loss
  • bone marrow failure
  • renal failure
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12
Q

normocytic anaemia with low WCC and low platelets should make you suspect ___?

A

bone marrow failure

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13
Q

What treatment can be given for anaemia caused by renal failure

A

EPO

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14
Q

What are causes of macrocytic anaemia

A
  • myelodysplastic anaemia
  • haemolytic anaemia
  • B12/folate deficiency
  • liver disease
  • alcohol excess
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15
Q

How would you treat B12 deficiency macrocytic anaemia

A

oral B12 or IM B12 if malabsorptive

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16
Q

Why would B12/folate deficiency cause macrocytic anaemia?

A

impaired DNA synthesis of RBCs

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17
Q

what type of patient is particularly susceptible to folate deficiency?

A

pregnant women

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18
Q

What can severe anaemia cause

A

tachycardia and heart failure

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19
Q

what are the two types of causes of haemolytic anaemia

A

acquired and hereditary

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20
Q

What are some acquired causes of haemolytic anaemia

A
  • malaria
  • hepatitis
  • autoimmune haemolytic anaemia
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21
Q

reticulocytosis, normo/microcytic anaemia, and elevated bilirubin should make you suspect ____

A

haemolytic anaemia

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22
Q

What are some causes of hereditary anaemia

A
  • sickle cell disease
  • G6PD deficiency
  • hereditary spherocytosis
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23
Q

What is pancytopenia

A

decrease in all major blood cell types

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24
Q

What is treatment for bone marrow failure

A

bone marrow transplant

transfusion regimen

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25
Q

what are the types of causes of pancytopenia

A
  • bone marrow failure
  • bone marrow infiltration
  • ineffective haematopoiesis
  • peripheral pooling/destruction
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26
Q

What are causes of bone marrow failure

A
  • viral
  • drugs
  • aplastic anaemia
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27
Q

What are causes of bone marrow infiltration

A
  • acute leukaemia
  • myeloma
  • lymphoma
  • myelodysplastic syndromes
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28
Q

What causes ineffective haematopoiesis

A

megaloblastic anaemia

AIDS

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29
Q

What are causes of peripheral destruction causing pancytopenia

A
  • hypersplenism

* SLE

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30
Q

What are the classifications of bleeding disorders

A
  • vascular causes
  • platelet disorders
  • coagulation disorders
  • mixed
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31
Q

What are the vascular causes of bleeding disorders

A
  • connective tissue disorders eg Ehlers Danlos

* osler-weber-rendu (arteriovenus malformations)

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32
Q

What are platelet causes of bleeding disorders

A

PLATELET DESTRUCTION

  • immune thrombocytopenic purpura
  • other immune conditions, eg SLE
  • sequestration
  • DIC

REDUCED PRODUCTION

  • bone marrow failure/infiltration
  • aplastic/megaloblastic anaemia

MALFORMATION
* eg myelodysplastic syndromes

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33
Q

How are platelet disorders treated

A

transfusions or treat cause

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34
Q

What are coagulopathy causes of bleeding disorders

A

INHERITED

  • haemophilia A
  • haemophilia B
  • von willebrand disease

ACQUIRED

  • antiplatelet drugs (eg heparin)
  • liver disease
  • vitamin K deficiency
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35
Q

What are the mixed bleeding disorders

A
  • DIC

* von willebrand disease

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36
Q

What is DIC

A

disseminated intravascular coagulation is increased clot formation causing organ ischaemia but also loss of clotting factors and platelets causing bleeding

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37
Q

What is purpura and easy bruising with epistaxis consistent with?

A

vascular and platelet disorders

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38
Q

What is haemarthrosis consistent with

A

coagulopathies

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39
Q

What blood results would indicate DIC

A
  • long PT and PTT
  • thrombocytopenia
  • elevated d-dimer
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40
Q

What are some causes of DIC

A

sepsis, malignancy

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41
Q

What clotting factor is affected in haemophilia A

A

factor VIII (8)

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42
Q

What clotting factor is affected in haemophilia B

A

Factor IX (9)

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43
Q

What is given in haemophilia A

A

desmopressin + factor VIII

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44
Q

What is myeloma

A

abnormal proliferation of B-lymphocytes (plasma cells)

45
Q

What are paraproteins

A

the light chains produced by abnormal plasma cells in myeloma

46
Q

What are symptoms of myeloma

A
  • symptoms of hypercalcaemia
  • bone pain
  • pathological fractures
  • AKI
  • symptoms of hyperviscosity (eg confusion, visual disturbances)
  • fatigue due to anaemia
  • infections
47
Q

What investigations do you do for myeloma? what results would you expect

A
  • Bence-Jones positive in urine and serum electrophoresis
  • anaemia on FBC
  • raised ESR
  • raised urea and creatinine
  • lytic lesions on x ray
  • hypercalcaemia
48
Q

What is treatment for myeloma

A
  • chemo
  • analgesia for bone pain
  • transufion + EPO for anaemia/pancytopenia
  • IV fluid for hypercalcaemia and AKI
  • bisphosphonates
49
Q

What is thrombophilia?

A

Increased predisposition to clotting

50
Q

When should you screen for thrombophilia?

A
  • more than 1 episode of DVT
  • DVT at a young age
  • DVT in unusual location
  • recurrent miscarriages
51
Q

What are the types of inherited thrombophilia

A
  • factor V Leiden
  • protein C + S deficiency
  • prothrombin gene mutation
  • antithrombin deficienct
52
Q

What is the most common acquired thrombophilia

A

antiphospholipid antibody syndrome

53
Q

What condition is associated with antiphospholipid antibody syndrome

A

SLE

54
Q

What is the most common inherited thrombophilia

A

Factor V Leiden

55
Q

What is factor V Leiden

A

factor V is resistant to the antithrombin action of protein C, causing increased clot formation

56
Q

What causes warfarin induced skin necrosis

A

protein C + S have a shorter half life than the clotting factors so they are depleted first when starting warfarin, so there is a short window of hypercoagulability after starting warfarin regimen

57
Q

What are myelodysplastic syndromes

A

a group of clonal disorders of the bone marrow

58
Q

30% of myelodysplastic disorders transform into ___

A

acute leukaemia

59
Q

How do myelodysplastic syndromes present

A

with bone marrow failure, infection and bleeding

60
Q

What is treatment for myelodysplastic syndromes?

A
  • blood transfusions
  • platelets
  • iron chelation possibly
61
Q

What are the myeloproliferative disorders

A
  • polycythaemia rubra vera
  • essential thrombocythaemia
  • myelofibrosis
62
Q

What is polycythaemia rubra vera

A

malignant proliferatino of a clone derived from one pluripotent marrow stem cell
there is excess proliferation of RBCs, WBCs and platelets, leading to hyperviscosity and thrombosis

63
Q

What are the symptoms of polycythaemia rubra vera

A

hyperviscosity signs

  • tinnitus
  • visual disturbances
  • headaches
  • confusion

venous or arterial thrombosis

splenomegaly common

gout may occur due to increased RBC turnover (and therefore increased urate)

64
Q

What might polycythaemia rubra vera transform into

A

myelofibrosis

65
Q

What is essential thrombocythaemia

A

clonal proliferation of megakaryocytes that leads to persistently raised platelets with abnormal function

66
Q

How does essential thrombocythaemia present

A

with bleeding or arterial/venous thrombosis or microvascular occlusion (headache, light headedness, atypical chest pain)

67
Q

How is essential thrombocythaemia treated

A

low dose aspirin

68
Q

What is myelofibrosis

A

hyperplasia of megakaryocytes which produce platelet-derived growth factor, leading to intense marrow fibrosis and myeloid metaplasia (haemopoiesis in the spleen and liver)

69
Q

What does myelofibrosis present with

A

hypermetabolic symptoms:
* night sweats, fever, weight loss

hepatosplenomegaly (and therefor possible abdo discomfort)

may present with bone marrow failure

70
Q

What is the treatment for myelofibrosis

A

bone marrow support

or stem cell transplant in young people

71
Q

What is leukaemia

A

a type of cancer caused by unregulated proliferation of a clone of immature blood cells derived from mutant haematopoietic stem cells

72
Q

broadly, what is the difference between leukaemia and lymphoma?

A

leukaemia cells accumulate in the blood and bone marrow, whereas in lymphoma they form solid tumour masses in the lymphatics and spleen

73
Q

What are the four types of leukaemia

A

ALL, AML, CML, CLL

74
Q

What are the main dangers to consider as a junior doctor with leukaemia

A
  • tumour lysis syndrome
  • DIC
  • preventing sepsis
75
Q

What blood results indicate tumour lysis syndrome?

A
  • hyperkalaemia
  • high urate levels
  • AKI
76
Q

How is tumour lysis syndrome prevented

A

fluids and allopurinol

77
Q

What is the broad difference between cells found in acute leukaemia and chronic?

A

In acute, the cells are less mature blast cells, and in chronic, the cells are immature but resemble mature cells while not retaining their function

78
Q

what is ALL?

A

Acute lymphoblastic leukaemia is a malignancy of lymphoid cells; B or T lymphocytes

79
Q

Which genetic syndrome is an important association for leukaemia

A

Down’s syndrome

80
Q

What are the main symptoms of acute lymphocytic leukaemia

A

Symptoms due to marrow failure:

  • anaemia
  • bleeding
  • infection

Symptoms due to infiltration:

  • hepatosplenomegaly
  • lymphadenopathy
  • CNS involvement
81
Q

ALL is typically seen in which age group?

A

children

82
Q

Mediastinal lymph node mass is typical of which leukaemia?

A

T-cell ALL

83
Q

What investigations should you order in suspicion of ALL?

A
  • FBC
  • blood film
  • coag
  • bone marrow biopsy
  • CXR (look for mediastinal and abdominal lymphadenopathy)
84
Q

What % of blast cells indicates leukaemia in the bone marrow biopsy

A

> 20%

85
Q

What is acute myeloid leukaemia

A

proliferation of blast cells derived from marrow myeloid elements

86
Q

What condition can become AML

A

myelodysplastic syndromes

87
Q

What treatment might AML be a long-term complication of

A

chemotherapy

88
Q

What are symptoms of AML

A

symptoms of bone marrow failure

symptoms of infiltration

  • hepatosplenomegaly
  • gum hypertrophy
  • skin involvement
89
Q

What is treatment for ALL

A
  • chemotherapy
  • bone marrow support
  • infection control
  • bone marrow transplant
90
Q

What is treatment for AML

A
  • chemotherapy
  • bone marrow support
  • infection control
  • bone marrow transplant
91
Q

What is CML

A

uncontrolled proliferation of myeloid cells

It is a myeloproliferative disorder

92
Q

What age do patients typically present with CML

A

40-60

93
Q

What mutation is commonly seen in CML

A

Philadelphia chromosome (chr22) BCR-ABL

94
Q

What are symptoms of CML

A
  • abdominal discomfort due to splenomegaly
  • bleeding
  • weight loss, tiredness, fatigue, fever, sweats
95
Q

How is chronic myeloid leukaemia treated

A

with imatinib if philadelphia chromosome positive

96
Q

What is CLL

A

accumulation of mature B cells

97
Q

What is the common presentation of CLL

A

often an incidental finding

may be anaemic or infection-prone, or have weight loss and sweats

98
Q

What are signs of CLL

A
  • enlarged, rubbery, non-tender nodes
  • splenomegaly
  • hepatomegaly
99
Q

What are complications of chronic lymphocytic leukaemia

A

antibodies produced by the B-cells may cause immune thrombocytosis or autoimmune haemolytic anaemia

may also cause infection and bone marrow failure

100
Q

What leukaemia are ‘auer rods’ typical of

A

AML

101
Q

Which cells are classic in Hodgkin’s lymphoma

A

Reed-Sternberg cells

102
Q

What is the most common cell lineage in Non-Hodgkin Lymphoma

A

B-cell lymphoma

103
Q

What is the most common type of NHL

A

large b-cell lymphoma

104
Q

enlarged cervical lymph nodes are typical of (HL/NHL)

A

hodgkins’ lymphoma

105
Q

What are symptoms of HL

A
  • enlarged, rubbery, non-tender lymph nodes
  • constitutional symptoms: sweats, fever, weight loss
  • sometimes splenomegaly
106
Q

How do patients with non-hodgkin lymphoma present

A

consitutional symptoms + pancytopenia + symptoms specific to organ involvement

eg T-cell lymphomas may specifically affect the skin

107
Q

What % of patients present with NHL with nodal disease

A

75%

108
Q

What are the two peaks of incidence in hodgkin lymphoma

A

young adults and the elderly

109
Q

What is the difference between hodgkin lymphoma and NHL

A
  • Reed-Sternberg cells not present in NHL

* NHL can spread to extra-nodal sites like the skin, GI tract, bones, lung and brain

Year 4 (13 decks)

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