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Year 3 > Haematology - Anaemia and the Leukaemias > Flashcards

Haematology - Anaemia and the Leukaemias Flashcards

1
Q

anaemia

A

decreased o2 delivery to metabolising tissues

leads to tiredness, sob and palpitations etc

Normal Hb levels 130g/l male, 120g/l female

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2
Q

which of these are the primary red cell indices

a.Hb, HCt, RBC
b.MCV,MCH.MCHC

A

a.Hb, HCt, RBC

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3
Q

which of these are the secondary red cell indices

a.Hb, HCt, RBC
b.MCV,MCH.MCHC

A

b.MCV,MCH.MCHC

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4
Q

what type of anaemia does thalassaemia cause

a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic

A

a.microcytic hypochromic

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5
Q

what type of anaemia does early iron deficiency cause

a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic

A

c.normocytic, normochromic

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6
Q

what type of anaemia does acute/subacute bleeding cause

a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic

A

c.normocytic, normochromic

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7
Q

what type of anaemia does renal failure cause

a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic

A

c.normocytic, normochromic

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8
Q

what type of anaemia does anaemia of chronic disease cause

a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic

A

c.normocytic, normochromic

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9
Q

what type of anaemia does lead poisoning cause

a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic

A

c.normocytic, normochromic

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10
Q

what type of anaemia do primary bone marrow disorders and leukaemias cause

a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic

A

c.normocytic, normochromic

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11
Q

what type of anaemia do b12 and folate deficiency cause

a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic

A

b.macrocytic

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12
Q

what type of anaemia does alcohol deficiency cause

a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic

A

b.macrocytic

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13
Q

what type of anaemia does red cell aplasia cause

a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic

A

c.normocytic, normochromic

with reduced reticulocytes

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14
Q

2 main causes of anaemia

A

REDUCED RBC PRODUCTION

I) DEFICIENCY
B12,folate,Fe deficiency
decreased erythropoietin 2 to ckd

II) BONE MARROW SURPRESSION
drug induced
infiltrate (malignancy)
thalassameia
aplasia

INCREASED RBC DESTRUCTION

I)BLOOD LOSS

II)REDUCED RBC SURVIVAL
haemolytic anaemias (increase LDH, decreased haptoglobin) eg….
autoimmune
hereditary spherocytosis
G6PD deficiency
sickle cell disease
unstable haemoglobin

hypersplenism (increased reticulocytes)

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15
Q

symptoms of haematological malignancy

A

non specific

tiredness
weight loss
recent night sweats and bone pain
bleeding and bruising
petechiae
lymph node swelling

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16
Q

petechiae are ..

a.blanching
b.non blanching

A

b.non blanching

trauma to vessel - leakage of blood into skin from vessels , cannot go back in so doesn’t blanch

appear around weight bearing parts eg ankles
appear under areas of tight clothing

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17
Q

what is the first investigation for suspected haematological cancer

a.fbc
b.blood film
c.bone marrow aspirate and trophine
d.flow cytometry
e.cytogenetics

A

b.blood film

presence of abnormal cells
increased BLAST cells (early white cell precursors, not normally present in peripheral blood should be present in bone marrow only

18
Q

what is trephine

A

biopsy of bone marrow tissue examined for pathology

19
Q

cwhat is first in the pathway of diagnosis of haematological malignancy

a.morphological exam of aspirate
b.immunophenotyping with flow cytometry
c.cytogenetics
d.molecular diagnosis

A

a.morphological exam of aspirate

20
Q

what is second in the pathway of diagnosis of haematological malignancy

a.morphological exam of aspirate
b.immunophenotyping with flow cytometry
c.cytogenetics
d.molecular diagnosis

A

b.immunophenotyping with flow cytometry

21
Q

what is third in the pathway of diagnosis of haematological malignancy

a.morphological exam of aspirate
b.immunophenotyping with flow cytometry
c.cytogenetics
d.molecular diagnosis

A

c.cytogenetics

22
Q

what is fourth in the pathway of diagnosis of haematological malignancy

a.morphological exam of aspirate
b.immunophenotyping with flow cytometry
c.cytogenetics
d.molecular diagnosis

A

d.molecular diagnosis

23
Q

in which part of haematological cancer diagnosis are a mix of antibodies used to identify antigens on pt cells in order to deduce the cells present in the aspirate

a.morphological exam
b.flow cytometry
c.cytogenetics
d.molecular diagnosis

A

b.flow cytometry

can tell if myeloid or lymphoid

24
Q

in which part of haematological cancer diagnosis are bone marrow cells grown in culture to analyse the chromosomal arrangement in cells

a.morphological exam
b.flow cytometry
c.cytogenetics
d.molecular diagnosis

A

c.cytogenetics

in leukaemia cells there is an acquired abnormality with chromosomal rearrangement in all cells

PML/RARA fuse due to rearrangement of chromosomes 15 and 17

fusion protein drives disease and continued production of leukaemia cells

leads to acute myelocytic leukaemia

25
Q

in which part of haematological cancer diagnosis is per used to assess size of genes present in the cells

a.morphological exam
b.flow cytometry
c.cytogenetics
d.molecular diagnosis

A

d.molecular diagnosis

fusion genes different size

26
Q

blast cells are usually found in ……….. numbers in the bone marrow

a.small
b.large

A

a.small

27
Q

blast cells are found in large numbers in the bone marrow when there is a malignant change in which cell type

a.pluripotent stem cell
b.haematopoetic stem cell
c.common myeloid progenitor
d.common lymphoid progenitor

A

b.haematopoetic stem cell

blast cells that form from this are abnormal so don’t differentiate into abc and remain in large numbers in bone marrow

28
Q

leukaemia

A

acquired series of events leading to expansion of abnormal clone of cells that accumulate in the bone marrow and blood leading to blood cancer

29
Q

4 types of leukaemia

A

ACUTE - lymphoid and myeloid (usually aggressive)

CHRONIC- lymphoid and myeloid (more mature and aggressive)

30
Q

first line treatment for either acute leukaemia

a.supportive treatment , anti emetic, antibiotics allopurinol and fluids to prevent tumour lysis

b.chemotherapy

c.CNS directed therapy

d.stem cell transplant

A

a.supportive treatment , anti emetic, antibiotics allopurinol and fluids to prevent tumour lysis

then chemo

then transplant

cons directed therapy needed in lymphoblastic

31
Q

what match is required with a donor for stem cells

a.HLA
b.HRE
c.Philadelphia gene

A

a.HLA

32
Q

main side effect of stem cell transplant

a.graft vs host disease
b.infection
c.rejection
d.post transplant lymphoproliferative disorder

A

a.graft vs host disease

33
Q

if Philadelphia positive ALL then transplant should ..

a.be done
b.not be done

A

a.be done

higher chance of relapse

34
Q

stem cell transplants are directed at those in…

a.first remission
b.second remission

A

a.first remission

35
Q

patient with symptoms of leukaemia, bloods show increased WCC, increased neutrophils, basophils and eosinophils which most likely

a.ALL
b.AML
c.CLL
d.CML

A

d.CML

chronic myeloid

chronic as cells that are present are further along in development pathway

neut, baso.eosin all come from the myeloid progenitor so myeloid

36
Q

the bone marrow in chronic myeloid leukaemia is

a.hypocellular
b.hypercellular

A

b.hypercellular
large number of myeloid precursors

all have Philadelphia chromosome (small chromosome 22)

leads to BCR-ABL fusion gene driving disease

37
Q

management for chronic myeloid leukaemia

a.tyrosine kinase inhibitors (-inib)

b.supportive therapy

c.stem cell transplant

d.chemotherapy and steroids

A

a.tyrosine kinase inhibitors (-inib)

BCR-ABL makes a tyrosine kinase protein long term inhibitor given with monitoring of bar all levels

38
Q

slow growing cancer of the immune cells (b lymphocytes) arising as an immune response to infection that does not switch off and eventually becomes malignant

a.ALL
b.AML
c.CLL
d.CML

A

c.CLL

39
Q

suspected chronic leukaemia blood shows increased lymphocytes , anaemia and thrombocytopenia what is most likely

a.ALL
b.AML
c.CLL
d.CML

A

c.CLL

40
Q

treatment for cll

A

depends on stage and aggression

some never need treatment

young with aggressively progressive disease - stem cell transplant - curative

Year 3 (25 decks)

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