Haemotology Conditions A Flashcards Preview

Phase 2 - Haemotology > Haemotology Conditions A > Flashcards

Flashcards in Haemotology Conditions A Deck (106):
1

Deep Vein Thrombosis - Description

blood clot in deep veins (esp. legs)

2

Deep Vein Thrombosis - Risk Factors (Change in Blood Flow) (4)

circulatory stasis
1) surgery
2) leg fracture —> plaster of Paris
3) long haul flight
4) obesity

3

Deep Vein Thrombosis - Risk Factors (Change in Blood Vessel) (2)

endothelial damage
1) smoking
2) hypertension

4

Deep Vein Thrombosis - Risk Factors (Change in Blood Constituents) (6)

1) pregnancy
2) oral contraceptive
3) hormone replacement therapy
4) dehydration
5) polycythaemia
6) inherited thrombophilia

5

Deep Vein Thrombosis - Signs (6)

1) calf warmth (calor)
2) calf tenderness (dolor)
3) calf erythema (rubor)
4) calf swelling (tumor)
5) fever (mild)
6) pitting oedema

6

Deep Vein Thrombosis - Complications (1)

1) pulmonary embolism

8

Deep Vein Thrombosis - Diagnosis (Well’s Score) (9)

≥2 DVT likely —> imaging, <2 DVT unlikely —> D-dimer
1) active cancer
2) differential calf swelling (>3cm)
3) swelling of entire leg
4) pitting oedema
5) prominent superficial veins
6) localised deep venous system pain
7) paralysis, paresis, recent cast immobility
8) recent bed rest >3 days or major surgery with 12 weeks
9) previous DVT

9

Deep Vein Thrombosis - Management (2/3/0)

conservative
1) compression stockings
2) physical activity
medical
1) treat underlying cause
2) LMW heparin
3) warfarin

10

Malaria - Description

infection by Plasmodium genus

11

Malaria - Causes (5)

1) Plasmodium falciparum
2) Plasmodium ovale
3) Plasmodium vivas
4) Plasmodium malariae
5) Plasmodium knowlesi

12

Malaria - Symptoms (7)

1) fever (inc. rigor)*
2) headache
3) myalgia
4) fatigue
5) abdominal pain
6) vomiting
7) diarrhoea

13

Malaria - Signs (4)

1) hepatomegaly
2) splenomegaly
3) jaundice
4) dark urine (black water fever)

14

Malaria - Complications (Severe Falciparum) (5)

1) sepsis
2) anaemia
3) cerebral pathology
4) acute respiratory distress syndrome
5) acute kidney injury

15

Malaria - Investigations (2/0)

initial
1) blood smear microscopy (Giemsa stain)
2) parasite antigen rapid diagnostic test

16

Malaria - Management (3/2/0)

conservative
1) insect repellent
2) bed nets
3) long-sleeved clothes
medical
1) chloroquine
2) artesunate (severe falciparum)

17

Anaemia - General Description

decreased blood haemoglobin concentration

18

Anaemia - Causes (Microcytic) (2)

1) iron deficiency (most common)
2) thalassaemia

19

Anaemia - Causes (Normocytic) (6)

1) chronic disease (2nd most common)
2) combined haemanitic deficiency (Fe + B9)
3) pregnancy
4) blood loss
5) kidney disease
6) sickle cell disease

20

Anaemia - Causes (Macrocytic) (6)

1) B9 deficiency
2) B12 deficiency (inc. pernicious)
3) liver disease (inc. alcohol)
4) hypothyroidism
5) bone marrow failure
6) chemotherapy

21

Anaemia - General Symptoms (7)

1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication

22

Anaemia - General Signs (3)

may be absent even if severe
1) pallor
2) tachycardia
3) functional systolic ejection murmur

23

Anaemia - General Investigations (8)

1) FBC
2) B9
3) B12
4) ferritin
5) U&E
6) LFT
7) TSH
8) blood film

24

Anaemia - General Complications (2)

1) heart failure
2) infection risk

25

Anaemia - General Management (0/1/0)

medical
1) treat underlying cause

26

Iron Deficiency Anaemia - Description

decreased blood haemoglobin concentration due to iron deficiency

27

Iron Deficiency Anaemia - Causes (6)

1) poor dietary intake
2) malabsorption (e.g. Coeliac disease, Crohn’s disease)
3) GI bleed
4) menorrhagia
5) pregnancy
6) hookworm (most common WW)

28

Iron Deficiency Anaemia - Symptoms (7)

1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication

29

Iron Deficiency Anaemia - Signs (8)

may be absent even if severe
1) pallor
2) tachycardia
3) functional systolic ejection murmur
4) brittle hair
5) brittle nails
6) koilonychia (spoon shaped nails)
7) atrophic glossitis (tongue papillae atrophy, i.e. smooth tongue)
8) angular cheilitis (mouth corner ulcers)

30

Iron Deficiency Anaemia - Complications (3)

1) heart failure
2) infection risk
3) pregnancy problems

31

Iron Deficiency Anaemia - Investigations (2/0)

initial
1) FBC (microcytic anaemia)
2) iron studies (low iron, low ferritin)

32

Iron Deficiency Anaemia - Management (1/3/1)

conservative
1) high dietary iron (e.g. red meat, spinach)
medical
1) treat underlying cause
2) ferrous sulphate (PO —> IV)
3) ascorbic acid (increases absorption)
surgery
1) red cell transfusion (2nd line)

33

Folate Deficiency Anaemia - Description

decreased blood haemoglobin concentration due to folate deficiency

34

Folate Deficiency Anaemia - Causes (5)

1) poor dietary intake (poverty, alcohol, elderly)
2) malabsorption (e.g. Coeliac disease, Crohn’s disease)
3) pregnancy
4) increased cell turnover (e.g. malignancy, inflammatory disease, haemolysis, dialysis)
5) antifolate drugs (e.g. methotrexate, trimethoprim)

35

Folate Deficiency Anaemia - Risk Factors (5)

1) poverty
2) Coeliac disease, Crohn’s disease
3) alcohol
4) pregnancy
5) elderly

36

Folate Deficiency Anaemia - Symptoms (7)

1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication

37

Folate Deficiency Anaemia - Signs (4)

may be absent even if severe
1) pallor
2) tachycardia
3) functional systolic ejection murmur
4) atrophic glossitis (tongue papillae atrophy, i.e. smooth tongue)

38

Folate Deficiency Anaemia - Complications (3)

1) heart failure
2) infection risk
3) pregnancy problems (spina bifida)

39

Folate Deficiency Anaemia - Investigations (2/3)

initial
1) FBC (macrocytic anaemia)
2) blood film (hypersegemented neutrophils)
consider
1) serum folate (low)
2) erythrocyte folate (low)
3) bone marrow biopsy (megaloblastic marrow)

40

Folate Deficiency Anaemia - Management (0/3/0)

medical
1) treat underlying cause
2) folic acid + B12 supplement (4 months)
3) prophylactic folic acid (pregnancy)

41

Haemolytic Anaemia - Description

decreased blood haemoglobin concentration due to erythrocyte haemolysis

42

Haemolytic Anaemia - Causes (6)

1) hereditary spherocytosis (most common in Northern Europeans)
2) glucose-6-phosphate dehydrogenase deficiency
3) α thalassaemia
4) β thalassaemia
5) sickle cell disease
6) autoimmune haemolytic anaemia

43

Haemolytic Anaemia - Pathophysiology (5)

1) premature breakdown of erythrocytes
2) increased erythropoesis by bone marrow to compensate (up to 6-8 times)
3) premature reticulocytes are released by bone marrow
4) premature breakdown of erythrocytes exceed compensation
5) anaemia

44

Haemolytic Anaemia - Symptoms (7)

1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication

45

Haemolytic Anaemia - Signs (3)

may be absent even if severe
1) pallor
2) tachycardia
3) functional systolic ejection murmur

46

Haemolytic Anaemia - Complications (4)

1) heart failure
2) infection risk
3) cholelithiasis
4) jaundice

47

Haemolytic Anaemia - Investigations (5/0)

initial
1) FBC (macrocytic anaemia, reticulocytosis)
2) blood film
3) LFT (high unconjugated bilirubin)
4) urine urobilinogen (high)
5) stool stercobilinogen (high)

48

Haemolytic Anaemia - Management (0/1/0)

medical
1) treat underlying cause

49

Acute Lymphoblastic Leukaemia - Description

malignant proliferation of lymphoblasts

50

Acute Lymphoblastic Leukaemia - Risk Factors (5)

1) <6 years old
2) radiation exposure (inc. radiotherapy)
3) chemotherapy
4) Down’s syndrome
5) Klinefelter’s syndrome

51

Acute Lymphoblastic Leukaemia - Pathophysiology (4)

1) malignant proliferation of lymphoblasts
2) decreased space and energy for proliferation of other cells in bone marrow (bone marrow failure)
3) decreased functional blood cells in blood
4) increased non-functional blast cells in blood

52

Acute Lymphoblastic Leukaemia - Symptoms (7)

1) fatigue
2) fever
3) headache
4) palpitations
5) dyspnoea
6) epistaxis
7) menorrhagia

53

Acute Lymphoblastic Leukaemia - Signs (6)

1) lymphadenopathy
2) hepatomegaly
3) splenomegaly
4) pallor
5) petechiae/purpura/ecchymoses
6) mouth ulcers

54

Acute Lymphoblastic Leukaemia - Complications (2)

1) pancytopenia
2) cranial nerve palsy

55

Acute Lymphoblastic Leukaemia - Investigations (2/1)

initial
1) FBC (anaemia, leucocytosis, neutropenia, thrombocytopenia)
2) blood film (lymphoblasts)
consider
1) bone marrow biopsy* (>20% lymphoblasts)

56

Acute Lymphoblastic Leukaemia - Management (1/3/3)

conservative
1) Hickman line (permanent cannula in main vessel to easily take blood and administer drugs and fluids)
medical
1) prophylactic antibiotics, antivirals, antifungals
2) chemotherapy
3) allopurinol (prevent tumour lysis syndrome)
surgery
1) red cell transfusion
2) platelet transfusion
3) bone marrow stem cell transplant (after 1st remission)

57

Chronic Lymphocytic Leukaemia - Description

malignant proliferation of B lymphocytes

58

Chronic Lymphocytic Leukaemia - Risk Factors (3)

1) >60 years old
2) radiation exposure (inc. radiotherapy)
3) male

59

Chronic Lymphocytic Leukaemia - Pathophysiology (4)

1) malignant proliferation of B lymphocytes
2) decreased space and energy for proliferation of other cells in bone marrow (bone marrow failure)
3) decreased functional blood cells in blood
4) increased non-functional blast cells in blood

60

Chronic Lymphocytic Leukaemia - Symptoms (6)

1) asymptomatic (often incidental FBC finding)
severe
2) fatigue*
3) dyspnoea*
4) fatigue (inc. rigor, sweats)
5) anorexia
6) weight loss

61

Chronic Lymphocytic Leukaemia - Signs (3)

1) lymphadenopathy
2) hepatomegaly
3) splenomegaly

62

Chronic Lymphocytic Leukaemia - Complications (3)

1) pancytopenia
2) hypogammaglobulinaemia —> infection risk
3) autoimmune haemolytic anaemia

63

Chronic Lymphocytic Leukaemia - Investigations (2/0)

initial
1) FBC (anaemia, leucocytosis, lymphocytosis, neutropenia, thrombocytopenia)
2) blood film (smudge cells)

64

Chronic Lymphocytic Leukaemia - Management (0/2/2)

medical
1) IV IgG
2) chemotherapy/radiotherapy
surgery
1) blood transfusion
2) bone marrow stem cell transplant

65

Acute Myeloid Leukaemia - Description

malignant proliferation of common myeloid progenitors/myeloblasts

66

Acute Myeloid Leukaemia - Risk Factors (5)

1) >65 years old
2) radiation exposure (inc. radiotherapy)
3) chemotherapy
4) Down’s syndrome
5) Klinefelter’s syndrome

67

Acute Myeloid Leukaemia - Pathophysiology (4)

1) malignant proliferation of common myeloid progenitors/myeloblasts
2) decreased space and energy for proliferation of other cells in bone marrow (bone marrow failure)
3) decreased functional blood cells in blood
4) increased non-functional blast cells in blood

68

Acute Myeloid Leukaemia - Symptoms (7)

1) fatigue
2) fever
3) headache
4) palpitations
5) dyspnoea
6) epistaxis
7) menorrhagia

69

Acute Myeloid Leukaemia - Signs (6)

1) lymphadenopathy
2) hepatomegaly
3) splenomegaly
4) pallor
5) petechiae/purpura/ecchymoses
6) mouth ulcers

70

Acute Myeloid Leukaemia - Complications (3)

1) pancytopenia
2) infection risk
3) disseminated intravascular coagulation

71

Acute Myeloid Leukaemia - Investigations (2/1)

initial
1) FBC (anaemia, leucocytosis, neutropenia)
2) blood film (Aurer rod blast cells)
consider
1) bone marrow biopsy* (>20% blast cell infiltration)

72

Acute Myeloid Leukaemia - Management (1/3/3)

conservative
1) Hickman line (permanent catheter in main vessel to easily take bloods and administer drugs and fluids)
medical
1) prophylactic antibiotics, antivirals, antifungals
2) chemotherapy
3) allopurinol (prevent tumour lysis syndrome)
surgery
1) red cell transfusion
2) platelet transfusion
3) bone marrow stem cell biopsy

73

Chronic Myeloid Leukaemia - Description

malignant proliferation of basophils/eosinophils/neutrophils

74

Chronic Myeloid Leukaemia - Risk Factors (3)

1) 65-74 years old
2) radiation exposure (inc. radiotherapy)
3) male

75

Chronic Myeloid Leukaemia - Pathophysiology (4)

1) malignant proliferation of basophils/eosinophils/neutrophils
2) decreased space and energy for proliferation of other cells in bone marrow (bone marrow failure
3) decreased functional blood cells in blood
4) increased non-functional blast cells in blood

76

Chronic Myeloid Leukaemia - Symptoms (3)

1) fatigue
2) fever (inc. rigor, sweats)
3) weight loss

77

Chronic Myeloid Leukaemia - Signs (1)

1) splenomegaly

78

Chronic Myeloid Leukaemia - Complications (1)

1) pancytopenia

79

Chronic Myeloid Leukaemia - Investigations (2/1)

initial
1) FBC (anaemia, leucocytosis, thrombocytosis/penia)
2) blood film (almost all maturing/mature myeloid cells)
consider
1) bone marrow biopsy* (granulocytic hyperplasia)

80

Chronic Myeloid Leukaemia - Management (0/1/1)

medical
1) chemotherapy (PO imatinib)
surgery
1) bone marrow stem cell transplant

81

Hodgkin’s Lymphoma - Description

malignant proliferation of lymphocytes

82

Hodgkin’s Lymphoma - Types (2)

1) classical Hodgkin’s lymphoma (95%, Reed-Sternberg cells)
2) nodular lymphocyte predominant Hodgkin’s lymphoma (5%, popcorn cells)

83

Deep Vein Thrombosis - Investigations (2/1)

initial
1) LFTs (normal)
2) D-dimer (Wells’<2, negative excludes)
consider
1) proximal duplex ultrasound* (Wells’≥2 or positive D-dimer)

84

Hodgkin’s Lymphoma - Risk Factors (7)

1) 13-19 years old
2) >65 years old
3) male
4) family history (esp. siblings)
5) Epstein-Barr virus
6) autoimmune (e.g. SLE)
7) immunocompromised

85

Hodgkin’s Lymphoma - Symptoms (2)

1) weight loss
2) fever (inc. night sweats)

86

Hodgkin’s Lymphoma - Signs (3)

1) lymphadenopathy
2) hepatomegaly
3) splenomegaly

87

Hodgkin’s Lymphoma - Complications (4)

chemotherapy/radiotherapy complications
1) secondary malignancy
2) thyroid pathology (e.g. hypothyroidism)
3) heart pathology (e.g. ischaemic heart disease)
4) lung pathology (e.g. lung fibrosis)

88

Hodgkin’s Lymphoma - Investigations (1/5)

initial
1) lymph node biopsy* (Reed-Sternberg/popcorn cells)
consider
1) bone marrow biopsy (Reed-Sternberg/popcorn cells)
2) FBC (anaemia, worse prognosis)
3) serum lactate dehydrogenase (high)
4) high CRP + ESR
5) chest, abdomen, pelvis CT (Ann Arbor classification)

89

Hodgkin’s Lymphoma - Classification (Ann Arbor) (6)

I) one lymph node group
II) multiple lymph node groups same side of diaphragm
III) multiple lymph node groups either side of diaphragm
IV) spread beyond lymph nodes (e.g. liver, bone marrow)
A) no B symptoms (except pruritus)
B) B symptoms (e.g. weight loss, fever, night sweats)

90

Hodgkin’s Lymphoma - Management (0/5/0)

medical
medical
1) radiotherapy
chemotherapy (ABVD)
2) adriamycin
3) bleomycin
4) vinblastine
5) dacarbazine

91

Non-Hodgkin’s Lymphoma - Description

malignant proliferation of lymphocytes

92

Non-Hodgkin’s Lymphoma - Risk Factors (7)

1) >50 years old
2) male
3) family history
4) Epstein-Barr virus
5) hepatitis C
6) Helicobacter pylori
7) immunocompromised

93

Non-Hodgkin’s Lymphoma - Symptoms (2)

1) weight loss
2) fever (inc. night sweats)

94

Non-Hodgkin’s Lymphoma - Signs (3)

1) lymphadenopathy
2) hepatomegaly
3) splenomegaly

95

Non-Hodgkin’s Lymphoma - Complications (2)

1) chemotherapy/radiotherapy complications (e.g. secondary malignancy)
2) tumour lysis syndrome (Burkitt’s lymphoma)

96

Non-Hodgkin’s Lymphoma - Investigations (1/5)

initial
1) lymph node biopsy* (non-Reed-Sternberg cells)
consider
1) bone marrow biopsy (non-Reed-Sternberg cells)
2) FBC (anaemia, worse prognosis)
3) serum lactate dehydrogenase (high)
4) high CRP + ESR
5) chest, abdomen, thorax CT (Ann Arbor classification)

97

Non-Hodgkin’s Lymphoma - Classification (Ann Arbor) (6)

I) one lymph node group
II) multiple lymph node groups same side of diaphragm
III) multiple lymph node groups either side of diaphragm
IV) spread beyond lymph node groups (e.g. liver, bone marrow)
A) no B symptoms (except pruritus)
B) B symptoms (e.g. weight loss, fever, night sweats)

98

Non-Hodgkin’s Lymphoma - Management (0/6/0)

medical
1) radiotherapy
chemotherapy (R-CHOP)
2) rituximab
3) cyclophosphamide
4) hydroxy-daunorubicin
5) oncovin
6) prednisolone

99

Non-Hodgkin’s Lymphoma - Management (Course) (6)

low grade
1) none may be needed
2) radiotherapy
high grade (early)
3) chemotherapy (3 months R-CHOP)
4) radiotherapy
high grade (late)
5) chemotherapy (6 months R-CHOP)
6) radiotherapy

100

Myeloma - Description

malignant proliferation of plasma cells

101

Myeloma - Risk Factors (3)

1) old (peak 70 years old)
2) Afro-Caribbean
3) family history

102

Myeloma - Symptoms (3)

1) fatigue
2) weight loss
3) bone pain

103

Myeloma - Complications (7)

1) pancytopenia
2) anaemia (normocytic)
3) chronic kidney disease
4) hypercalcaemia
5) osteopenia
6) fractures
7) spinal cord compression

104

Myeloma - Investigations (4/5)

initial
1) serum/urine electrophoresis*
2) FBC (anaemia)
3) U&E (high urea, high creatinine)
4) serum Ca2+ (high)
consider
1) bone marrow biopsy* (plasma cell infiltration)
2) blood film (Rouleux formation)
3) β2-microglobulin (high, worse prognosis)
4) x-ray (‘punched-out’ lytic lesions)
5) Bence-Jones proteins

105

Myeloma - Management (1/4/1)

conservative
1) high fluid intake (3L/day)
medical
1) analgesia (bone pain, avoid NSAIDs (CKD))
2) bisphosphonates (bone pain, reduce fractures)
3) prophylactic antibiotics
4) chemotherapy
surgery
1) haemodialysis (CKD)

106

Myeloma - Management (Chemotherapy) (6)

fit - VAD 6 cycles
1) vanblastine
2) adriamycin
3) dexamethasone
unfit - CTD 8 cycles
4) cyclophosphamide
5) thalidomide
6) dexamethasone

107

Hodgkin’s Lymphoma - Management (Course) (2)

1) I-A to II-A —> short course
2) II-B to IV-B —> long course