Haematology and Oncology Flashcards by Derin King

What are the history and examination findings in DIC? How do you investigate it?

Signs of circulatory collapse - oliguria, hypotension, or tachycardia

microvascular/ macrovascular thrombosis - purpura fulminans,

gangrene, acral cyanosis, delrium, coma
Petechiae, ecchymosis, hematuria, epistaxis

Diagnosis = at least 1 underlying condition causing DIC + abnormal global coagulation tests (decreased PC, increased PT and PTT, elevated FDPS, decreased fibrinogen

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What are the findings in essential thrombocytosis?

Investigation?

Management?

Erythromelalgia - burning pain and redness in different parts of body
Splenomegaly
Bleeding, arterial and venous thrombosis
Livedo reticularis

FBC & Blood smear -> thrombocytosis

Acute = plateletpheresis
Cytoreductive therapy if high risk and non-pregnant
Antiplatelet therapy if high risk and pregnat

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what are the findings, investigation and management for myelofibrosis?

leukoerythroblastosis(nucleated Rbcs and immature wbcs) + splenomegaly = hallmarks

History and Examination
Constitutional symptoms - weight loss, night sweats, low-grade fever, pruritus, etc
Splenomegaly
Extramedullary hematopoeisis - Hematuria, spinal cord compression, focal siezures

Investigation 
FBC - anemia 
Peripheral blood smear - teardrop RBCs
Bone marrow aspiration - dry tap 
Bone marrow biopsy - fibrosis

Management
Asymptomatic = folic acid and pyridoxine
Symptomatic = stem cell transplant

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What is pancytopenia?

combination of anaemia, leukopenia, and thrombocytopenia.

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What are the findings, investigation and management for polycythemia vera?

Features of thrombosis - stroke, MI, PE, DVT etc
pruritus - often aquagenic
Erythromelalgia - tender or painful burning and/or redness of fingers, palms, heels or toes
Headache, facial redness

Investigation
Hb and hematocrit - elevated
Wbc and platelets - may be elevated
JAK2 mutation screen - usually present

Management
Acute = PHLEBOTOMY + low dose aspirin
Acute High-risk thrombosis patients = cytoreductive therapy(hydroxycarbamide) + aspirin
Ongoing = busulfan

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What are the key findings in TRALI?

Dyspnea, hypoxemia, pulmonary oedema

- CXR - bilateral lung infiltrates

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Key findings in GvHD?

maculopapular rash is common

diarrhoea, abdominal pain, nausea
LFTs may be elevated

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Key findings in allergic/anaphylactic reactions?

respiratory distress, angioedema, hives and itching, hypotension

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Key findings in febrile non-hemolytic reactions?

negative DAT test.

- 1 degree rise in temp may have chills/malaise

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Key findings in acute hemolytic reactions?

fever, abdominal pain, hypotension, tachycardia

Haemoglobinaemia, hemoglobinuria, positive DAT

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Key findings in TACO?

pulmonary oedema and hypotension

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Hemophilia findings and investigations?

Heamarthrosis, bleeding into muscles, mucocutaneous bleeding

pT time - normal
ApTT time - usually prolonged
Plasma factor 8 and 9 assays - decreased or absent

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Findings, investigation and management for sickle cell disease?

persistent pain in skeleton, chest, and/or abdomen
dactylitis - swollen dorsa of hands and feet
Others: pneumonia like syndrome, visual floaters, jaundice(indicates hemolysis of rbcs), protuberant abdomen often with umbilical hernia(enlarged spleen), pallor

Hb electrophoresis
Peripheral blood smear- nucleated red blood cells, sickle-shaped cells, and Howell-Jolly bodies(seen in hyposplenia)
Fbc

Crisis = analgesia + o2 + treatment of cause

hydroxycarbamide, L-glutamine, crizanlizumab, voxeltor, blood transfusions may sometimes be used. Bone marrow transplantation in severe cases

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What are anticoagulants used for?

Give name of a drug from each group

Treat arterial and venous thrombosis

Direct thrombin inhibitors - Dabigatran, lepirudin
Indirect thrombin inhibitors - heparin
Vitamin K epoxide reductase inhibitor - warfarin
Direct Xa inhibitor - apixaban

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What are antiplatelet drugs used for? Give an example from each class

Arterial disease

Cox inhibitor - aspirin
Glycoprotein inhibitors - eptifibatide, tirofiban
ADP inhibitors - clopidogrel

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What are thrombolytics used for?

Give examples

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Arterial and venous thrombosis

Plasminogen activators - streptokinase, tenecteplase

How does alpha thalassemi present? What are the different types?
Treatment?

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Microcytic anemia

Alpha thalessemia minima - silent carrier
Minor - mild anaemia
Hemoglobin h disease - moderate to severe anaemia
Hemoglobin barts disease - incompatible with life

Acute hemolytic episodes- identification of cause + folic acid
Aplastic crisis - red blood cell transfusion

Findings, investigation and management for beta thalessemia?

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Microcytic anemia
Chipmunk facies
Hepatospleenomegaly and jaundice may occur

Diagnosis = increase in HbA2 on electrophoresis

Management - transfusions at times of symptomatic anaemia

What are the findings in hodgkins lymphoma?

Investigations?

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painless lymphadenopathy - cervical, supraclavicular, axillary, inguinofemoral

B SYMPTOMS! (fevers, night sweats, weight loss)

Dyspnea, cough, chest pain - mediastinal involvement

uncommonly but CHARACTERISTIC: pruritus, alcohol-induced pain at involved sites

PET-CT
Biopsy - Reed-Sternberg cells

Non hodgkins lymphoma?

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non-hodgkins = NO reed-sternberg cells
multiplel lymph nodes often involved
extranodal involvement unlike HL

painless lymphadenopathy
b symptoms - fevers, Night sweats, weight loss)
extranodal GI involvement - Bowel obstruction
extranodal bone marrow - fatigue, easy bruising, infections
spinal cord - weakness and loss of sensation

subdivided into b cell lymphomas (large b-cell lymphoma being the most common) and t cell lymphomas

Acute lymphocytic leukemia/ALL findings?

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> 20% blasts
Tdt +ve with immunophenotyping. T(ALL)
common in children

Peripheral blood smear = leukaemic lymphoblasts
FBC: aneamia, thrombocytopenia, ELEVATED WCC but neutropenia(=infection risk)

Definitive diagnosis = biopsy which shows >20% blasts

Chronic lymphocytic leukemia/ CLL findings?

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WBC count elevated with absolute lymphocytosis

- Blood film shows SMUDGE/SMEAR cells. CL(L) -> clean -> smudge

Acute myelogenous leukemia

Investigations?
Management?

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blast cells ≥20%
A in acronym -> Aeur Rods (cytoplasmic inclusions)
M in acronym -> MPO+ve
PML subtype associated with DIC and responds to treatment with all trans retinoic acid
common in older adults

FBC: may show pancytopenia
Peripheral blood smear: Auer rods
Definitive diagnosis = bone marrow biopsy and shows >20% blasts

What is Chronic myelogenous leukemia?

Investigations?

Management?

Complications?

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Myeloid stem cell proliferation - productions of mature and maturing granulocytes = neutrophils, metamyelocytes, myelocytes, basophils

FBC: may show aneamia and thrombocytopenia. ELEVATED WBC!!!!
Cytogenetic testing confirms diagnosis = Philadelphia chromosome t(9,22)

Tyrosine kinase inhibitor to treat

blast crisis: blast rises to >20%
low lap score differentiates from leukomoid reaction (benign neutrophilia)

Multiple myeloma findings investigation and managment

A haematological cancer characterised by clonal proliferation of plasma cells in the bone marrow, typically associated with a monoclonal immunoglobulin in the serum and/or urine. Bone pain(typically localised to the back) and anemia - most common CRAB = Hypercalcemia, renal involvement, anemia, back pain serum and urine protein electrophoresis = 1st line - paraprotein spike (IgG >35 g/L [>3.5 g/dL] or IgA >20 g/L [>2.0 g/dL] and light chain urinary excretion >1 g/day); hypogammaglobulinaemia bone marrow aspirate and biopsy - plasma cell infiltration whole-body low-dose CT - osteolytic lesions, pathological fractures Under 65: Induction therapy (thalidomide + dexamethasone) + DVT prophylaxis(aspirin) + stem cell transplant. + bisphosphonates/denosumab for bone disease Non transplant: Melphalan, prednisolon

Classic hemolysis findings?

``` Normocytic anemia (normal MCV) Increase in LDH Increase in indirect bilirubin Increase in reticulocyte count Urine hgb and hemosiderin (intravascular) decrease in haptoglobin ```

Findings and treatment for herdeitary spherocytosis?

Labs consistent with hemolytic anemia Spherocytes on blood film Splenomegaly Treatment = red blood cell transfusion for symptomatic aneamia. folic acid, splenectomy if severe

What are the findings, investigations and treatment for paroxysmal nocturnal hemoglobinuria?

Hemoglobinuria(dark brown urine, typically occurring at night), budd-chiari syndrome, thrombosis Flow cytometry for GPI anchor proteins - >1% of anchor deficient granulocytes Urine dipstick - hemoglobinuria Treatment = eculizumab

Findings investigation and management for G6PD deficiency?

Labs consistent with hemolytic anemia Blood film shows heinz bodies (precipitated oxidized hemoglobin) Ghost cells and hemighost cells from intravascular hemolysis, bite cells avoid fava beans, oxidant drugs, and naphthalene. + give folic acid

How does pyruvate kinase deficiency present?

A cause of hemolytic anemia in a newborn. Echinocytes on blood film

Differentiate between iron deficiency anemia and aneamia of chronic disease

In iron deficiency - low iron and low ferritin(store of iron). Transferrin/TIBC is HIGH (transports iron around the body). Transferrin saturation (iron/TIBC) is low In anemia of chronic disease - low iron and HIGH ferritin. Transferrin and transferrin saturation is low. Associated with Chronic infections (TB, HIV) autoimmune disorders like RA, malignancy.

How does aplastic aneamia present?

May present with neutropenia, anemia or thrombocytopenia Bone marrow biopsy - hypocellular without abnormal cells RFs - radiation and drugs, PNH Immunosuppressants + stem cell transplantation

Differentiate between the different causes of megaloblastic anemia and how they present

Vitamin B12 - neurological symptoms, increase in methylmalonic acid and homocysteine Folate deficiency - no neurological symptoms, normal methylmalonic acid. Raised homocysteine. If both B12 and folate deficiency, treat B12 first to prevent SACD Agents or mutations that impair DNA synthesis: azathioprine cytotoxic chemotherapy Folate antagonists - methotrexate Bone marrow cancers - myelodysplastic syndrome

Treatment for b12 and folate deficiency?

``` B12 = IM hydroxycobalamin Folate = oral supplements ```

key leukemia symptoms?

fatigue - anemia easy bleeding -thrombocytopenia infections - neutropenia pain and tenderness in bones due to blast production in acute leukemias hepatomegaly, spleenomegaly, lymphadenopathy variable

What is tumour lysis syndrome? | What are the features?

Complication of cancer treatment/chemo 1. Kidney Failure and Hypocalcemia - due to released phosphate that forms crystals 2. Released Uric acid -> Gout 3. Released Potassium -> Hyperkalemia and arrhythmias

What are the findings in TTP?

HUS + fever and neurological manifestations Hemolytic ureamic syndrome = triad of Hemolytic anemia(low Hb, high bilirubin), uremia(AKI- may show rise in creatinine, proteinuria, hematuria) and thrombocytopenia. Usually following Diarrhea episode!! which is usually bloody!!! and due to shiga-toxin producing e.coli.

Haematology and Oncology Flashcards

(37 cards)