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Flashcards in Haematology and Oncology Deck (33):
1

What characteristics do malignancies that are high risk for tumour lysis syndrome have?

1. Malignancy highly responsive to treatment
2. Large tumour burden
3. High tumour cell proliferation rate - lymphomas, leukaemia, small cell carcinomas

2

List 5 metabolic derangements seen in tumour lysis syndrome

1. Hyperuricaemia - rapid cell death leads to release and breakdown of nucleic acid breakdown

2. Hyperphosphataemia - tumour cell death release large amounts of phosphate

3. Hyperkalaemia - lysed tumour cells release K which kidneys have difficulty excreting - can cause arrhythmias

4. Hypocalcaemia - usually the result of high phosphate leading to precipitation of calcium phosphate in renal tubules

5. Uraemia

3

What type of cells are targeted in chemotherapy?

Cells that divide rapidly; chemotherapy cannot distinguish between normal cells and cancer cells

"non-targeted" cells = hair follicles, GI mucosa, germ cells, bone marrow

4

What are the three types of chemotherapy-induced N&V?

1. Anticipatory - experiencing Sx in hours before receiving chemotherapy - conditioned response to previous effects from CT and environmental stimuli

2. Acute - within 24 hours and related to chemotherapeutic agents

3. Delayed - more than 24 hours post chemotherapy - specific agents - cisplatin, cyclophosphamide, adriamycin

5

List 5 medications used in the treatment of nausea (chemotherapy).

1. Dopamine antagonist - prochlorperazine/metoclopramide/haloperidol

2. Serotonin receptor blockers - ondansetron

3. Steroids - dexamethasone

4. Benzodiazepines - lorazepam

5. NK -1 receptor inhibitor - aprepitant

6

Which condition is the characterised by the presence of Reed-Sternberg cells?

Hodgkin Lymphoma

7

What is are the components Ann Arbor staging?

Numbers
Stage 1 - a single node group

Stage 2 - nodes confined to one side of the diaphragm

Stage 3 - Nodes both sides of the diaphragm

Stage 4 - liver and/or bone marrow involved

Letters
A - no constitutional symptoms
B - fever; weight loss more than 10%; night sweats

E - extra-nodal site e.g. skin, bone, lung

S - denotes spleen

X - the largest deposit is >10 cm large ("bulky disease"), or whether the mediastinum is wider than 1/3 of the chest on a chest X-ray

8

What is superior vena cava syndrome? (2)

1. Oncological emergency - partial or complete obstruction of blood flow through SVC - may be due to compression, invasion, thrombosis, fibrosis

2. Severe reduction in venous return from head, neck and upper extremities - can induce rapid increase in intracranial pressure and can lead to brain oedema

9

What is febrile neutropaenia?

Complication of cancer chemotherapy

Oral temperature of more than 38.5C OR two consecutive readings of 38.0C

AND

absolute neutrophil count of less than 0.5

10

What is the age distribution of Hodgkin lymphoma?

Bimodal - one peak at 20s, 30s and second peak at age 50

11

Describe the clinical presentation of Hodgkin lymphoma (4)

1. Cervical/supraclavicular lymphadenopathy
2. B symptoms (fever, night sweats) over weeks to months (in widespread disease)
3. Mediastinal masses - usually discovered on routin CXR
4. Splenomegaly +/- hepatomegaly

12

What is the ABVD regimen?

Doxorubicin
Bleomycin
Vinblastine
Dacarbazine

Hodgkin lymphoma

13

How would you investigate Hodgkin lymphoma? (5)

1. FBE
2. Biochem - HIV serology, LFTs, UECs (prior to initiating chemotherapy), ALP, Ca2+ (bone involvement), ESR and LDH (monitor disease progression)

3. Imaging - CXR, CT chest/abdo/pelvis

4. Excisional lymph node biopsy CONFIRMS diagnosis

5. Bone marrow biopsy to assess marrow infiltration (only necessary if B-symptoms, stage III or IV, bulky disease)

14

What investigations would you order in suspected Haemophilia A?

APTT (prolonged)
INR (normal)
Decreased Factor VIII
FBE (normal platelets)

15

What is Haemophilia A ?

Factor VIII deficiency - BLEEDING! - X-linked recessive

16

What is Haemophilia B?

Factor IX deficiency - Christmas disease - X-linked recessive - BLEEDING

17

What investigations would you order in suspected Haemophilia B?

APTT (prolonged)
INR (normal)
Decrease Factor IX
FBE (normal platelets)

18

What is the pathology behind multiple myeloma?

Abnormal proliferation of plasma cells leading to secretion of immunoglobulins - predominantly IgG (2/3) and IgA (1/3)

19

List 4 symptoms seen in multiple myeloma.

1. Osteolytic bone lesions causing backache, pathological fractures and vertebral collapse - due to increased osteoclast activation from signalling by myeloma cells

2. Anaemia, neutropaenia or thrombocytopenia - marrow infiltration of plasma cells (causing anaemia, infections or bleeding)

3. Recurrent bacterial infections

4. Renal impairment due to light chain deposition

20

What investigations should be conducted if multiple myeloma is suspected? (5)

1. FBE - anaemia
2. ESR - increased
3. UECs - elevated urea and creatinine
4. Serum and urine electrophoresis - Bence jones proteins in urine
5. Imaging: x-rays - lytic punched out lesions

21

What are mixing studies and when are they conducted?

50:50 mix of patient and test plasma incubated together. If abnormality corrects - suggests factor deficiency. If abnormality does not correct - suggests an inhibitor

Mixing studies conducted in the presence of an abnormal aPTT or PT proceed to mixing studies

22

What is the most commonly inherited bleeding disorder?

Von Willebrand disease - a deficiency in vWF which is required in platelet adhesion

23

What 2 broad categories contribute to a reduced reticulocyte count?

1. Hypoproliferative anaemias - anaemia of chronic disease, iron deficiency, bone marrow infiltration etc.

2. Maturation abnormalities - megaloblastic and sideroblastic anaemias

24

What is myelodysplasia?

Heterogeneous group - clonal stem disorders characterised by dysplastic ineffective erythropoiesis (with mature cells functionally defective), peripheral blood cytopaenias and progression to AML

25

Who gets myelodysplasia?

Median age of 70, 10-15% therapy-related

26

List 3 factors that can induce the clinical features of G6PD deficiency

1. Drugs - antimalarials/sulphonamides
2. Broad bean - favism
3. Infections

27

What is the inheritance pattern of G6PD deficiency?

X-linked

28

What is the inheritance pattern of hereditary spherocytosis?

Autosomal dominant

29

What is the pathophysiology behind hereditary spherocytosis?

Defective membrane proteins leading to increased RBC fragility and reduced deformity - haemolysis

30

What are the three charasteristic features of haemolytic uraemic syndrome?

1. MAHA
2. Thrombocytopaenia
3. Renal failure

31

List 5 causes of microcytic anaemia

1 Iron deficiency
2. Anaemia of chronic disease
3. Thalassaemias/Haemoglobinopathies
4. Hyperthyroidism
5. Sideroblastic anaemia

32

List 4 causes of normocytic anaemia

1. Acute blood loss
2. Anaemia of chronic disease
3. Chronic renal failure
4. Endocrine causes - hypothyroidism, hypopituitarism

33

List 6 causes of macrocytic anaemia.

1. Megaloblastic: B12 and folate
2. Myelodysplaisa/bone marrow
3. Reticulocytosis - haemolytic anaemia/bleeding
4. Alcohol abuse
5. Liver disease
6. Medications