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Phase 4 > Haematology final one plz > Flashcards

Haematology final one plz Flashcards

(45 cards)

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1
Q

Contrast HUS and TTP:

A

HUS:

  • bloody diarrhoea
  • Microangiopathic haemolytic anaemia
  • thrombocytopenia
  • kidney failure

TTP:

  • no diarrhoea
  • Microangiopathic haemolytic anaemia
  • Thrombocytopenia
  • Kidney failure
  • CNS involvement
  • Fever
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2
Q

How does an amniotic embolism cause DIC?

A

Releases tissue factor which triggers the extrinsic pathway

Tissue factor is the triggering factor

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3
Q

What are some of the causes of DIC?

A

Sepsis

Obstetric complications
- especially amniotic embolisms

Acute pancreatitis

Haematological malignancy
- AML -M3

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4
Q

What is found in cryoprecipitate?

A

Von- Williebrand
Factor VIII
Fibrinogen

Useful for:

  • Haemophilia A
  • DIC
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5
Q

How is DIC management:

A
  • *treat the underlying cause
  • *contact haematology
  • FFP
  • platelets
  • Cryoprecipitate (fibrinogen, von-Williebrand, VIII)
    +/-
  • Heparin if coagulating
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6
Q

Which drug can cause haemolytic anaemia which is associated with coeliac disease?

A

Dapsone

- used for dermatitis herpatoformis

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7
Q

What is the diagnostic criteria for tumour lysis syndrome and how is it managed?

A

Clinical:

  • AKI
  • Cardiac arrhythmias
  • Confusion/ weakness - hypocalcaemia
  • Muscle cramps

Bloods;

  • Hypocalcaemia
  • Hyperuricemia
  • Hyperphosphatemia
  • Hyperkalaemia
Treatment: 
- IV fluids 
- Frusemide
- Calcium gluconate (both replenish Ca2+ and protects for K+) 
- Phosphate binders 
- Rasburicase (anti- uricaemic) 
\+/- 
- Haemodialysis
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8
Q

In heparin induced thrombocytopenia - what would you expect the bleeding to be like?

A

There is a paradoxical increased risk of thrombosis

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9
Q

If requesting blood for a pregnant female - what do you ask for?

A

CMV - negative RBCs

*this is also required if neonate transfusion

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10
Q

What is the test to diagnose hereditary spherocytosis?

A

EMA binding test

Autosomal dominant

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11
Q

How is tranexamic acid delivered during an emergency?

A

IV bolus
followed by
IV infusion

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12
Q

Outline the major causes of Polycythaemia:

A

Polycythaemia Ruba Vera
- haematological malignancy

Relative polycythaemia

Secondary to COPD, high altitude

EPO producing tumour
- renal cell carcinoma

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13
Q

What are some of the signs of polycythaemia Ruba vera and list some complications:

A

Facial plethora
Itching
Headaches
Itchiness

Complications:

  • Budd Chiari
  • Stroke
  • Cavernous sinus thrombosis
  • Malignant transformation into AML
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14
Q

How would you manage a patient bleeding who has haemophilia A and those with haemophilia B?

A

Haemophilia A:

  • Desmopressin
  • Recombinant Factor VIII (can cause antibodies to them)
  • Cryoprecipitate (contains VIII)

Haemophilia B:

  • Recombinant IX
  • FFP
  • Prothrombin Complex Concentrate
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15
Q

In the setting of acute haemolytic reaction what two major bloods do you want? what else should should be done?

A

Two Major bloods:
Cross match
- repeat

Direct Coombs test

Other bloods:

  • coagulation
  • U&Es

Keep unit of blood and sent to haematology
Check all details

IV fluids and flush

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16
Q

If someone has Raised MCV anaemia with hypothyroidism - what may be causing the raised MCV?

A

Pernicious anaemia

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17
Q

What is the kidney disorder that can occur in sickle cell disease leading to AKI?

A

Renal Papillary necrosis
- due to ischemia

Avascular necrosis can also occur in the bone

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18
Q

Who get Hodgkin’s lymphoma? and What are the diagnostic investigations and what is the treatment?

A

Young people
Elderly
- bimodal disruption

Investigations: 
Bloods: 
- FBC 
- Blood film 
- LDH *prognosticator 
- HIV serology

CXR
ST for staging (Ann Arborr)

Lymph node biopsy *Reid Steinberg cells seen
Bone marrow aspiration with trephine

Treatment:

  • radiotherapy
  • Chemotherapy (ABVD)
  • Autologous Stem cell transplant
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19
Q

What is the most common type of Hodgkin’s lymphoma? and what are some risk factors?

Study These Flashcards
A

Nodular Sclerosing

Risk factors:

  • EBV
  • HIV
  • Sarcoidosis
  • Family history
20
Q

What is the common translocation in CML? and what other leukaemia can this be present in and what does it suggest?

Study These Flashcards
A

Philadelphia chromosome
- 9:22

It can also be associated with ALL which is a poor prognostic factor

21
Q

What are the stages of CML?

Study These Flashcards
A

Chronic phase

Accelerated phase

Blast phase

22
Q

What would you expect to see on the blood film of CLL?

23
Q

What are the three phases of chemotherapy?

Study These Flashcards
A

Remission induction
Remission consolidation
Remission Maintenance

24
Q

How are leukaemia’s classified?

Study These Flashcards
A

Morphology

Immunological

Cytogenetics

25
What are the poor prognostic factors for ALL?
``` Age <2 years, >10 years 9:22 translocation High B and T cell count Male sex >20 WCC ```
26
Name the notable causes for a massive splenomegaly:
Malaria Myelofibrosis CML
27
What is the immunological agent that can cure CML and how does it work?
Imatinib BCR- ABL Tyrosine kinase inhibitor
28
What cells may you see on a blood film of someone with iron deficiency anaemia?
Anisocytosis - changes in cell sizes and shapes Piokilocytosis - irregular shaped
29
What are the clinical features of iron deficiency anaemia?
Symptoms: - dizziness - Palpitation - Dyspnoea - Reduced energy - Headaches - restless leg Signs: - Angulitis stomatitis - atrophic glossitis - Koilonychia - Pale - Oesophageal webs
30
What are the iron supplements that can be given? When giving IV Iron supplementation what is an important aspect to be aware of?
Ferrous Fumarate Ferrous gluconate IV Iron will not cause a haematological response any quicker than PO, but does replenish iron stores slightly quicker.
31
If there is folate deficiency - what must you check before treating?
Must check B12 levels | - can worsen sub-acute combined spinal cord degeneration if not
32
What type of haemolysis is Hereditary spherocytosis and how is it managed long term?
Autosomal dominant. Extravascular. Diagnosed: - EMA binding Management: - folate replacement - Splenectomy **can be a cause of haemolytic jaundice and splenomegaly
33
What are the general causes of aplastic anaemia?
Primary: - idiopathic/ genetic related Secondary: - Virus induced - parvovirus B19 Iatrogenic: (including radiation) Management: - Blood transfusions - Neutropenic sepsis management <40 years: - allogenic stem cell transplant >40 years: - Anti-thymocyte drugs
34
What is the intervention done which removes plasma from the blood?
Plasmapheresis *look at spelling!!
35
What tests should you order in multiple myeloma to establish an increase in paraprotein, and what test to distinguish exactly what it is?
Electrophoresis of the plasma: - establishes high M protein * is quantitative Immunofixation of plasma: - establish the type (IgG, IgM, Kappa, lamda) * is Qualitative
36
What do bands on a blood film suggest?
The suggest granulocytes at different stages of maturation. | Very suggestive of CML as multiple neutrophils etc will be at different stages.
37
What is a D-Dimer?
Fibrin Degradation products
38
High light all the clinical signs/ symptoms you may see with someone who has myeloma:
Amaurosis Fagux - high ESR Bruising/ easy bleeding Pathological fractures Confusion Constipation Carpal tunnel - secondary amyloidosis Nephritis - Amyloidosis - tubular acidosis - Direct toxicity of paraproteins - NSAID use Infections
39
What test is needed for the confirmation of myeloma?
Bone marrow aspiration | >10% blast cells
40
What is needed for a diagnosis of myeloma?
Blast cells >10% in bone marrow Evidence of paraproteins - in urine or - Blood Evidence of CRAB
41
What is the treatment for myeloma?
Cancer: - chemotherapy - autologous stem cell transplant Anaemia: - Blood transfusions - EPO Infections: - Prophylactic antibiotics - Immunoglobulin transfusions Bones: - Bisphosphonates - Analgesia - Radiotherapy - Vertebroplasty/ Kyphoplasty Anti-thrombotic prevention - risk of DVTs is high Prognosis: - smouldering disease - 5 years - 50%
42
How should warfarin overdose be managed?
INR 5-8: with hold and start again when <5 INR >8: Withhold. IV vitamin K. Contact haematology Any major bleed/ Intracranial bleed: Stop warfarin, IV vitamin K, Prothrombin complex concentrate *prothrombin complex concentrate contains factors: - II, V, IX, X all which warfarin inhibits
43
What are you differentials for myeloma?
Monoclonal gammopathy of undetermined significance Waldenstrom's macroglobinaemia Amyloidosis Hodgkin's
44
What clinical test can be done to help establish a DVT?
Dorsiflexion of the affected limp will often produce significant pain
45
Where does a P.E typically originate from?
Iliofemoral

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