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Phase 2a > Haematology conditions > Flashcards

Haematology conditions Flashcards

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1
Q

What does a FBC test for? (5)

A
  • RBC volume
  • WBC volume
  • Platelet volume
  • Haemoglobin concentration
  • Mean Corpuscular Volume
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2
Q

What does a reticulocyte count show?

A
  • Shows how quickly the bone marrow is producing new RBCs
  • Reticulocytes are immature RBCs
  • Low = something preventing RBCs being produced
  • High = RBCs are being lost or destroyed (bleeding), RBCs are being produced to compensate
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3
Q

What does a serum ferritin test show?

A
  • Ferritin is iron storage protein
  • Measures iron levels
  • Can be falsely raised in inflammation and malignancy
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4
Q

What does a blood film show?

A
  • Smears put on slides and looked at under microscope
  • Thick = observes potential parasites
  • Thin = observes RBC morphology and parasites
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5
Q

Anaemia: Classification results

A
  • MCV <80 = Microcytic
  • MCV 80-100 = Normocytic
  • MCV >100 = Macrocytic
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6
Q

Anaemia: Symptoms (5)

A
  • Pale skin
  • Tachycardia
  • Fatigue
  • Headache
  • Palpitations
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7
Q

Iron Deficiency Anaemia: Pathology and type

A
  • Type of microcytic anaemia
  • Low iron → decreased haem synthesis → less haemoglobin → lack of effective RBCs → anaemia
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8
Q

Iron Deficiency Anaemia: Causes (4)

A
  • Low iron diet
  • Blood loss
  • Malabsorption
  • Pregnancy
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9
Q

Iron Deficiency Anaemia: Symptoms (4)

A
  • Brittle hair and nails
  • Atrophic glossitis (smooth and inflamed tongue)
  • Koilonychia (spoon shaped nails)
  • Angular Stomatitis (inflammation of corners of mouth)
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10
Q

Iron Deficiency Anaemia: Differential Diagnosis

A

Thalassaemia

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11
Q

Iron Deficiency Anaemia: Investigations (4)

A
  • FBC and blood film
  • Serum Ferritin - will be low
  • Reticulocyte count - reduced
  • Endoscopy and colonoscopy to look for bleeds
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12
Q

Iron Deficiency Anaemia: Treatement

A

Ferrous Sulphate (oral iron)

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13
Q

Pernicious Anaemia: Pathology

A
  • Autoimmune
  • Type of macrocytic anaemia
  • Intrinsic factor deficiency → reduced absorption of B12 in the terminal ilium
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14
Q

Pernicious Anaemia: Causes of B12 Deficiency (4)

A
  • Diet (vegan)
  • Gastrectomy
  • Crohn’s disease
  • Coeliac disease
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15
Q

Pernicious Anaemia: Symptoms (3)

A
  • General anaemia symptoms
  • Jaundice
  • Polyneuropathy
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16
Q

Pernicious Anaemia: Investigations (4)

A
  • FBC
  • Blood film - would show macrocytic RBCs
  • Autoantibody screen
  • Serum B12 - low
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17
Q

Pernicious Anaemia: Treatment

A

Vitamin B12 tablets (hydroxocobalamin)

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18
Q

Folate Deficiency Anaemia: Causes (4)

A
  • Diet (alcoholics, elderly)
  • Malabsorption (Crohn’s or Coeliac)
  • Pregnancy
  • Drugs
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19
Q

Folate Deficiency Anaemia: Symptoms

A
  • Anaemia symtpoms
  • No neuropathy (distinguishes between B12 and folate deficiency)
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20
Q

Folate Deficiency Anaemia: Investigations (3)

A
  • FBC
  • Blood film - macrocytic anaemia
  • Serum and erythrocyte folate levels
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21
Q

Folate Deficiency Anaemia: Treatment

A
  • Treat underlying cause
  • Folic acid supplementation (in pregnancy)
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22
Q

Haemolytic Anaemia: Pathology

A
  • RBCs are destroyed before their normal 120 day lifespan
  • Breakdown produces excess bilirubin
  • Can be intravascular (in blood vessels) or extravascular (most commonly in reticuloendothelial system)
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23
Q

Haemolytic Anaemia: Causes (6)

A
  • Sickle cell anaemia
  • Thalassaemia
  • Membranopathies
  • Glucose-6-phosphate deficiency
  • Autoimmune
  • Infections (malaria)
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24
Q

Haemolytic Anaemia: Symptoms (4)

A
  • Gallstones (excess bilirubin)
  • Jaundice (excess bilirubin)
  • Leg ulcers
  • Enlarged spleen
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25
Haemolytic Anaemia: Investigations (5)
- FBC - reduced haemoglobin - Blood film - schistocytes (RBC fragments) - High serum unconjugated bilirubin - High urinary urobilinogen - High faecal stercobilinogen
26
Haemolytic Anaemia: Treatment (3)
- Folate and iron supplements - Immunosuppressives - Splenectomy
27
Aplastic Anaemia: Description
Reduction in number of pluripotent stem cells → lack of haemopoiesis (RBC and platelet production)
28
Aplastic Anaemia: Causes (5)
- Congenital - Acquired - Chemotherapy - Infection - Pregnancy
29
Aplastic Anaemia: Symptoms (4)
- Anaemia symptoms - Increased susceptibility to infection - Increased bruising - Increased bleeding
30
Aplastic Anaemia: Investigations (3)
- FBC - pancytopenia (low levels of all blood cells) - Reticulocyte count - low or absent - Bone marrow biopsy - hypocellular with fat spaces
31
Aplastic Anaemia: Treatments (4)
- Treat cause - Blood/platelet transfusion - BM transplant - Immunosuppressants (anti-thymocyte globulin and ciclosporin)
32
Sickle Cell Anaemia: Description
Autosomal recessive condition, more common in afro-caribbean. Protects from malaria
33
Sickle Cell Anaemia: Pathology
- Mutation of B globin gene results in HbS variant - Under stress RBCs become deoxygenated and HbS polymerises causing cells to sickle - Sickling can cause destruction of RBCs and obstruction
34
Sickle Cell Anaemia: Symptoms (4)
- Acute pain in hands and feet - Jaundice (Hb breakdown) - Anaemia symptoms (rare due to compensatory Hb production) - Acute chest pain (pulmonary vasculature obstruction)
35
Sickle Cell Anaemia: Investigations (3)
- Blood/heel prick test (neonates) - FBC (low Hb, high reticulocyte) - Blood film (sickled erythrocytes)
36
Sickle Cell Anaemia: Treatment (5)
- Folic acid - Opiates - Hydroxycarbamide (increases HbF conc) - Stem cell transplant - Antibiotics
37
Sickle Cell Anaemia: Complications
- Acute - pain, mesenteric ischaemia - Chronic - renal impairment, pulmonary hypertension, joint damage
38
Thalassaemia: Description
- Autosomal recessive - Decreased rate of production of one or more globin chains in red cell precursors causes reduced production and premature destruction of RBCs
39
Thalassaemia: α Thalassaemia description
- Gene deletions in the 4 genes that control production of alpha globin chains - 2 deletions = mild microcytic anaemia - 3 = severe - 4 = stillborn
40
Thalassaemia: ß Thalassaemia pathology
Reduced beta chain production → excess alpha chain production → alpha chains bind with delta chains (HbA2) or gamma chains (HbF)
41
Thalassaemia: Investigations (2)
- FBC and blood film - show mmicrocytic anaemia, irregular and pale RBCs, increased reticulocytes - Hb electrophoresis - shows increased HbF and low HbA (diagnostic)
42
Thalassaemia: Treatment (2)
- Blood transfusion - Long term folic acid supplements
43
Glucose-6-Phosphate Dehydrogenase Deficiency: Description
- G6PD maintains glutathione in reduce state - Glutathione protects RBCs from oxidative crisis
44
Glucose-6-Phosphate Dehydrogenase Deficiency: Epidemiology
- X-linked recessive (males) - Protects from malaria
45
Glucose-6-Phosphate Dehydrogenase Deficiency: Symptoms (6)
- Asymptomatic until exposed to oxidative stressor - Neonatal jaundice - Chronic haemolytic anaemia - Acute haemolysis - Back pain - Dark urine
46
DVT: Definition
Occlusion in normal vessels (usually in leg)
47
DVT: Causes (6)
- Surgery - Immobility - Leg fracture - Oral contraceptive pill - Flights - Pregnancy
48
DVT: Risk Factors (3)
- Age - Obesity - Varicose veins
49
DVT: Symptoms (5)
- Calf pain and swelling - Calf warmth - Calf redness - Ankle oedema - Pitting oedema
50
DVT: Investigations (3)
- D dimer - coagulation screen (not diagnostic) - FBC - Angiography - Doppler/Compression ultrasound - if popliteal vein can’t be squashed = diagnostic
51
DVT: Differential Diagnosis
Cellulitis
52
DVT: Treatment (3)
- LMW heparin - inactivates factor Xa - Warfarin - Direct acting Oral Anti-Coagulants (DOACs) e.g. apixaban
53
ALL: Epidemiology
Most common malignancy of childhood, good survival
54
ALL: Pathology
Mutation → clonal proliferation of lymphoblasts → divide uncontrollably → other blood cells in BM are crowded out → cytopenia (anaemia, thrombocytopenia and leukopenia)
55
ALL: Symptoms (7)
- Weight loss - Appetite loss - Fatigue (anaemia) - Bleeding and bruising (thrombocytopenia) - Infection (leukopenia) - Painful lymph nodes - Bone pain (BM expansion)
56
ALL: Investigations (3)
- FBC - anaemia and throbocytopenia - Blood film - shows excess lymphoblasts - BM biopsy - increased cellularity, increased lymphoblasts
57
ALL: Treatment (4)
- Chemo - BM transplant - Treat anaemia/thromboytopenia - IV antibiotics if infections
58
AML: Epidemiology
Usually in older people, better survival if younger
59
AML: Pathology
Mutation → clonal proliferation of myeloblasts → divide uncontrollably → other blood cells in BM are crowded out → cytopenia (anaemia, thrombocytopenia and leukopenia)
60
AML: Symptoms (7)
- Weight loss - Appetite loss - Fatigue (anaemia) - Bleeding and bruising (thrombocytopenia) - Infection (leukopenia) - Gum swelling (IMPORTANT differentiates ALL) - Bone pain (BM expansion)
61
AML: Investigations (3)
- FBC - anaemia and throbocytopenia - Blood film - shows excess myeloblasts - BM biopsy - increased cellularity, increased myeloblasts
62
AML: Treatment (4)
- Chemo - BM transplant - Treat anaemia/thromboytopenia - IV antibiotics if infections
63
CLL: Epidemiology
- Most common form - Incurable - Affects more older people - More white people
64
CLL: Pathology
Uncontrolled proliferation and accumulation of mature B lymphocytes that didn’t apoptose → crowd out other cells in BM → cytopenia (anaemia, thrombocytopenia, leukopenia)
65
CLL: Symptoms (4)
- Early stages asymptomatic - Fatigue (anaemia) - Bleeding and bruising (thrombocytopenia) - Infections (leukopenia)
66
CLL: Investigations (3)
- FBC - Lots of lymphocytes, Hypogammaglobulinemia (as no plasma cells), anaemia, thrombocytopenia - Blood film - small mature lymphocytes with smear or smudge cells - Immunophenotyping - excludes reactive lymphocytosis
67
CLL: Treatment (5)
- Wait in early stage - Chemo in advanced stage - Radiotherapy - Splenectomy - BM transplant
68
CML: Epidemiology
- Middle aged people - Exposure to ionising radiation
69
CML: Symptoms (5)
- Asymptomatic - Fever - Weight loss - Sweating - Anaemia
70
CML: Investigations (3)
- FBC - leucocytosis (increased WBC), anaemia, normal/high platelets, Hb low - BM biopsy - hypercellular marrow, increased myeloid progenitors (take from iliac crest) - Genetic testing - for Philadelphia chromosome. Chromosome 9 and 22 are translocated to form this abnormality, causing an over-activation of tyrosine kinase
71
CML: Treatment (5)
- Imatinib - if Philadelphia chromosome positive - Wait - Chemo - Stem cell transplant - BM transplant
72
Hodgkin's Lymphoma: Description
Malignant proliferation of lymphocytes which accumulate in lymph nodes causing lymphadenopathy (swelling) Has Reed-Sternberg cells!
73
Hodgkin's Lymphoma: Epidemiology
- Young adults - Increased risk with history of Epstein-Barr Virus
74
Hodgkin's Lymphoma: Symptoms (2)
- Painless lymphadenopathy - B symptoms - night sweats, weight loss, loss of appetite, fever
75
Hodgkin's Lymphoma: Investigations (3)
- CT/MRI of chest, abdomen and pelvis (staging) - Lymph node biopsy - reed-sternberg cells - FBC - may be normal or show normochromic, normocytic anaemia
76
Hodgkin's Lymphoma: Staging
- Ann Arbor system - Stage 1 - lymph nodes in one region - Stage 2 - 2 or more lymph node regions on the same side of the diaphragm - Stage 3 - lymph node regions on both sides of the diaphragm - Stage 4 - widespread outside of lymph nodes - Prefixed with A (no B symptoms) or B (with B symptoms)
77
Hodgkin's Lymphoma: Treatment
- ABVD - Adriagmycin, Bleomycin, Vinblastine, Dacarbazine - Stage 1-2a - short course ABVD then radiotherapy - Stage 2b-4 - longer course ABVD
78
Non-Hodgkin's Lymphoma: Pathology
Malignant clonal expansion of lymphocytes occurs at different stages of lymphocyte development. Majority B cell. No reed-sternberg cells
79
Non-Hodgkin's Lymphoma: Symptoms (3)
- Painless lymphadenopathy - B symptoms (night sweats, weight loss, loss of appetite, fever) - Extranodal involvement symptoms (more common in Hodgkin’s)
80
Non-Hodgkin's Lymphoma: Investigations (3)
- CT - staging - Lymph node biopsy - FBC - anaemia, raised ESR (erythrocyte sedimention rate), elevated WBC or thrombocytopenia suggests B involvement
81
Non-Hodgkin's Lymphoma: Classification
Low grade: - Slow growing - Usually advanced presentation - Incurable - 9-11 years survival High grade: - More severe but 30% cure rate
82
Non-Hodgkin's Lymphoma: Treatment (3)
- R-CHOP - Rituximab, Cyclophosphamide, Hydroxy-daunorubicin, O-Vincristine, Prednisolone - Low grade - watch and wait, combination chemo, radiotherapy, BM transplant - High grade - early (sort course R-CHOP with radiotherapy), advanced (R-CHOP and monoclonal antobodies)
83
Myeloma: Description
Cancer of plasma cells which usually produce antibodies
84
Myeloma: Epidemiology
- More men than women - Mostly present around 60 - More common in Afro-Caribbeans
85
Myeloma: Pathology
Clonal proliferation of plasma cells → produce excess of one immunoglobulin (usually IgG or IgA)
86
Myeloma: Symptoms (4)
CRAB - Calcium raised, cancer symptoms, confusion - Renal failure - Anaemia (infections and bleeding) - Bone pain (increased osteoclast activity)
87
Myeloma: Investigations (4)
- Serum and urine electrophoresis - B2 microglobulin - Blood film - Rouleaux formation (aggregates of RBCs) - Urine - Bence Jones protein - X-ray - pepperpot skull
88
Myeloma: Treatment (4)
- Chemo - BM transplant - Bisphosphonates - Treat anaemia (RBC and erythropoietin transfusions)
89
Malaria: Causes
Protozoa infection transmitted by female mosquitos
90
Malaria: Stages
- Exo-erythrocytic stage - Endo-erythrocytic stage - Hypnozoite stage
91
Malaria: Pathology
- Infection travels to liver → multiply in hepatocytes → rupture releasing merozoites into blood → taken up into erythrocytes → develop further → rupture causing anaemia and fever - Infected RBCs adhere to endothelium of small vessels → vascular occlusion → organ damage
92
Malaria: Symptoms (6)
- Fever - Chills and sweats - Jaundice - Anaemia - Fatigue - Black urine
93
Malaria: Investigations (4)
- Thick blood film - detects parasite - Thin blood film - identifies what parasite - Rapid Diagnostic Test - detects plasmodium antigens in blood - Fever + exotic travel = malaria until proven otherwise
94
Malaria: Treatment (2)
- Quinine (antimalarial) - Doxycycline (antibiotic)
95
Polycythaemia: Pathology
- Absolute - increased RBC mass - Secondary - hypoxia and high erythropoietin secretion
96
Polycythaemia: Symptoms (6)
- Headache - Itching - Fatigue - Tinnitus - Hypertension - Angina
97
Polycythaemia: Investigations (3)
- FBC - raised WBC count, platelets, haemoglobin - Genetic screening - JAK2 mutation (in 95%) - BM biopsy - proliferation of granulocytes and megakaryocytes
98
Polycythaemia: Treatment (3)
- No cure - Venesection (reduce RBCs) - Low dose aspirin
99
Haemophilia: Types
- A - factor 8 deficiency - B - factor 9 deficiency
100
Haemophilia: Epidemiology
- X-linked recessive disorder - men - A is more common
101
Haemophilia: Symptoms (6)
- Easy bruising - Haematomas - Excess bleeding - Plasma levels of factor 8/9 <1 - severe, bleeding into muscles and joints - Levels 1-5 - severe bleeding after injury - Levels >5 - mild, bleeding only with trauma or surgery
102
Haemophilia: Investigation
Prolonged Activated Partial Thromboplastin Time (APTT) - factor 8/9 in intrinsic pathway. Shows longer time
103
Haemophilia: Treatment (2)
- IV recombinant factor 8/9 - Synthetic vasopressin
104
Over-anticoagulation: RFs, Symptoms, Investigations
- Risk Factors - Vitamin K antagonists, DOACs - Symptoms - Bruising, bleeding, haematemesis (vomiting blood), haemoptysis (coughing blood) - Investigations - APTT and PTT
105
Disseminated Intravascular Crisis: Description, causes, symptoms
- Wide spread clotting and bleeding - Occurs when balance between forming new clots and breaking down clots goes to making clots → depleted clotting factors → bleeding - Causes - malignancy, septicaemia, trauma, infections - Symptoms - bleeding from IV sites, nose and mouth, bruising , haemoptysis
106
Disseminated Intravascular Crisis: Investigations, treatment
- Investigations - PTT and APTT, blood film shows fragmented RBCs - Treatment - treat underlying cause, transfusions, activated C protein
107
Thrombocytopenia: Description
- Platelet deficiency - Either Immune thrombocytopenic purpura (ITP) or Thrombotic thrombocytopenic purpura (TTP) - ITP more common

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