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WFH > Haematology + oncology > Flashcards

Haematology + oncology Flashcards

(44 cards)

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1
Q

causes of microcytic anaemia

A

Iron deficiency (hypochromic microcytic)
Thalassaemia
Anaemia of chronic disease (rarely)

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2
Q

causes of normocytic anaemic

A 
Acute bleeding
Haemolysis
- congenital
- acquired
Aplastic anaemia
Anaemia of chronic disease
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3
Q

causes of macrocytic anaemia

A

Vitamin B12 deficiency, folate deficiency = both may cause pancytopenia

Macrocytosis without anaemia:

  • liver disease
  • hypothyroidism
  • alcohol
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4
Q

acute leukaemia is due to…

A

failed differentiation of cells, leads to large numbers of malignant precursor cells in the bone marrow

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5
Q

chronic leukaemia is due to…

A

chronic leukaemia is the result of excessive proliferation of mature malignant cells

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6
Q

acute lymphoblastic leukaemia features

A

abnormal clinical proliferation of lymphoid progenitor cells

  • typically affects children
  • bone marrow failure: anaemia, leukopenia, thrombocytopenia
  • organ infiltration: lymphadenopathy, hepatosplenomegaly, bone pain, CNS involvement (eg. nerve palsy), testicular swelling
  • high blast cells
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7
Q

differentiating ALL from AML

A

blood film shows different precursor cells

AML cells have Auer rods on microscopy

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8
Q

features of acute myeloid leukaemia

A

abnormal clinical proliferation of myeloid progenitor cells

  • typically affects adults + elderly
  • associated with myelodysplastic syndromes
  • bone marrow failure: anaemia, leukopenia, thrombocytopenia
  • organ infiltration: hepatosplenomegaly, bone pain, gum hypertrophy
  • high blast cells
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9
Q

features of myelodysplastic syndrome

A

“Premalignant” condition of haematopoietic precursors

  • affects elderly
  • may present with anaemia, thrombocytopenia, pancytopenia, may be asymptomatic
  • may become acute myeloid leukaemia
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10
Q

features of chronic myeloid leukaemia

A
  • typically affects middle-aged patients (men more commonly)
  • usually associated with Philadelphia chromosome
  • symptomatic anaemia eg. SOB, fatigue
  • weight loss
  • massive splenomegaly
  • bleeding/bruising
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11
Q

investigations for chronic myeloid leukaemia

A
  • leukocytosis (high neutrophils/basophils/eosinophils/monocytes)
  • Philadelphia chromosome (t9:22)
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12
Q

management of chronic myeloid leukaemia

A
  • presence of Philadelphia chromosome = imitanib

- chemotherapy

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13
Q

features of chronic lymphocytic leukaemia

A

proliferation of functionally incompetent malignant B cells
- most common in male patients over the age of 60
- often asymptomatic
- may have symptoms of
> bone marrow failure eg. anaemia, infection prone, bleeding
> cancer: weight loss, night sweats
> infiltration: hepatosplenomegaly, lymophadenopathy

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14
Q

investigations for chronic lymphocytic leukaemia

A

FBC: lymphocytosis, anaemia
blood film: smudge cells
immunophenotyping

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15
Q

features of Hodgkin’s lymphoma

A
  • typically young adults
  • painless lymphadenopathy
  • B symptoms: night sweats, weight loss, fever
  • may be pain on drinking alcohol
  • peaks at 15-35yrs and >55
  • Reed-Sternberg cell diagnostic on biopsy of lymph node
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16
Q

RFs for Hodgkin’s lymphoma

A
  • Epstein-Barr Virus
  • HIV
  • immunosuppression
  • smoking
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17
Q

types of Non-Hodgkin’s lymphoma

A
  • indolent or low grade eg. follicular lymphoma
    > gradual onset, usually advanced at presentation
    > may be asymptomatic
    > incurable but treatable (use for watchful waiting), median survival 10 years
  • aggressive or high grade eg diffuse large B cell lymphoma
    > rapidly progressive
    > usually symptomatic: painless lymphadenopathy, B symptoms, extranodal (gastric, bone marrow, CNS symptoms)
    > potentially curable
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18
Q

management of lymphoma

Study These Flashcards
A

manage symptoms

  • chemotherapy
  • radiotherapy
  • stem cell transplantation
19
Q

associations with non-Hodgkin’s lymphoma

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A
  • Helicobacter pylori with gastric MALT (mucosa-associated lymphoma tissue)
  • Epstein Barr virus with Burkitt’s lymphoma and AIDS-related CNS lymphoma
  • Hepatitis C virus with diffuse large B-cell lymphoma and splenic marginal zone lymphoma
  • Human T cell lymphotropic virus type 1 with T-cell lymphoma
20
Q

poor prognostic markers of lymphoma

Study These Flashcards
A

low haemoglobin and raised LDH (high red cell turnover)

21
Q

blood markers of tumour lysis syndrome

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A
  • U&E:
    > high: potassium, phosphate, uric acid, creatinine
    > low: calcium
  • ECG may have arrhythmias related to hyperkalaemia
22
Q

prophylaxis of tumour lysis syndrome

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A
  • IV allopurinol
  • OR IV rasburicase
  • if TLS develops:
    > fluids
    > electrolyte balance
    > supportive
23
Q

features of multiple myeloma

Study These Flashcards
A 
CRABBI
Calcium (hypercalcaemia)
Renal failure (high creatinine and urea)
Anaemia
Bone lesions (lytic)
Bleeding
Infections
24
Q

markers of multiple myeloma

Study These Flashcards
A
  • Bence Jones proteins (in urine)
  • monoclonal IgA/G in serum
  • raised monoclonal plasma cells on bone marrow biopsy
  • blood film = rouleaux formation
  • whole body MRI done to check for bone lesions (pepperpot skull)
25
management of multiple myeloma
- stem cell transplant in young/few comorbidities - chemotherapy - supportive > analgesia, bisophosphonates, surgery/physiotherapy for bone disease, EPO for anaemia
26
diagnosis of amyloid
rectal tissue biopsy and apple-green birefringence when stained with Congo red and viewed under polarised light
27
normal haemostasis
- localized vasoconstriction at the site of injury - adhesion of platelets to damaged vessel wall and formation of a platelet aggregate or plug - activation of the coagulation cascade leading to fibrin formation, reinforcing the platelet plug - activation of the fibrinolytic system which digests the haemostatic plug, re-establishing vascular patency
28
management of thrombosis
Arterial thrombosis – Antiplatelet drugs | Venous thrombosis – Anticoagulant drugs
29
causes of DIC
- sepsis - obstetric - malignancy - trauma
30
management of DIC
treat underlying cause | - plasma and platelets if bleeding
31
warfarin acts on:
Vit K antagonist | - factors X IX VII II remember as 1972
32
symptoms of ITP (immune thrombocytopenia)
- petichae, purpura | - bleeding (e.g. epistaxis)
33
management of ITP (immune thrombocytopenia)
- oral prednisolone - IVIG - splenectomy in refractive
34
features of TTP (thrombotic thrombocytopenic purpura)
deficiency of ADAMTS13 leads to vWF causing clumping of platelets - fever - fluctuating neuro signs (microemboli) - microangiopathic haemolytic anaemia - thrombocytopenia - renal failure
35
mutation in polycythaemia rubra vera
JAK2
36
constituents of haemoglobin
``` HbA = 2α + 2β HbA2 = 2α + 2𝛿 HbF = 2α + 2γ ```
37
management of sickle cell crisis
- high flow oxygen - IV fluids - analgesia - top-up transfusions may be required in severe cases
38
long term sickle cell anaemia management
- hydroxycarbamide: increases the HbF levels and is used in the prophylactic management of sickle cell anaemia to prevent painful episodes - pneumococcal vaccine every 5 years
39
iron deficiency further investigations
if unexplained (eg. men and post-menopausal women), endoscopy and colonoscopy required (gastro referral within 2 weeks if Hb <100 in women or <110 in men
40
management of iron deficiency anaemia with no findings on further investigations
- PO ferrous sulfate (until normal Hb then for 3 months beyond) - iron-rich diet
41
management of von Willebrand's disease
- desmopressin (DESMOnd von Willebrand): raises levels of vWF - factor VIII concentrate - tranexamic acid for mild bleed
42
aplastic anaemia features
typically in young people ~30yrs - pancytopenia and a hypoplastic bone marrow - normochromic, normocytic anaemia - leukopenia, with lymphocytes relatively spared - thrombocytopenia
43
features of pernicious anaemia
antibodies to intrinsic factor +/- gastric parietal cells leads to B12 deficiency - anaemia: lethargy, pallor, dyspnoea - neurological: peripheral neuropathy, numbness, degeneration of the spinal cord (progressive weakness, ataxia and paresthesias that may progress to spasticity and paraplegia) - neuropsychiatric features: memory loss, poor concentration, confusion, depression - other features: mild jaundice: combined with pallor results in a 'lemon tinge', glossitis
44
management of pernicious anaemia
IM B12 supplementation

WFH (18 decks)

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