Hematology Flashcards
(47 cards)
(Age)* 67y + wt loss + FAHM + night sweeting +hoarseness of voice + CXR show opacity in the rt upper mediastinum + spenomegly +hepatomegly +no hx of dysnea or smoking
Most appropriate invest ?
*dx : lymphoma Tissue diagnosis is the most definitive way So.do LN biopsy # Just for recall Mediastnium Lns ddx : * TB *Sarcoidosis *Non_Hodgkin Lymphoma *bronchogenic carcinoma
FAHM +night sweeting + diagnosed with Hodgkin lymphoma #Type of cell is associated with itb?
Reed_Sternberg cells
HIV +ve + loss of wt +night sweeting + peripheral lymphadenopathy + splenomegly
Non Hodgkin lymphoma
🇦🇱 NHL more assosiated with HIV than HL (Hodgkin lymphoma )
Hx of travel from Newyork to UK + wt loss +night sweeting + cervical lymphadenopathy
Most appropriate dx ?
Lymphoma
🇦🇱👻 u should be able to differentiate bet TB &lymphoma
TB
1_ hx of travel to south Asia or south Africa
2_ FAHM
3Hilar ,paratracheal LN ,superficial nodes involved
4Firm ,tender,discrete .
5 chronic productive cough with purulent +-blood stained sputum
6 erythema nodosum
Lymphoma 1_ hx of HIV🤔 2_ FAHM 3_LN in the lower neck &supreclavicular LN 4_ painless, rubbery 5_chest discomfort with cough &dysnea 6_ splenomegly,hepatomegly,SVC ,bone . 7_mediastnium masses are frequent
28w pregnant + HB :11 🤔
Normal physiological anemia (dilutional) Limits of anaemia in pregnancy *<11 in 1st trimester *<10.5 2nd &3rd tried *<10 postpartum period 📢📢hematological changes in pregnancy : *inc. Plasma vol. *inc. Erythropoetin * MCV/MCHC unaffected *Dec. Fe Inc. TIBc ,transferring
75y +enlarged cervical LNs + several recurrent infections +place conjunctiva (anaemia 🤔) + fatigue .
Type of cells most likely in blood smear?
- Mature lymphocytes
*dx:CLL
#Clincher:
*Old age لوكميا العواجيز طيبة الى حد وشبه الليمفوما
*cervical lymphadenopathy
*recuurent infection (WBC dysfunction)
*anaemia
#blood
*absolute lymphocytosis
*AIHA
*Dec . platelets DT BM failure
#BM immature lymphocytes >30%
50y + No past medical hx + Massive splenomegly + pale conjunctivitis
FBC show :
Anemia ,massive leucocytosis ,normal platelets .
Dx?
*CMLchronic myeloid leukaemia
🇦🇱📢if u see massive spleen :
Think of { CML &Malaria which can be excluded with hx of travel }
🎤🏥invest:
1_FBC
* massive leucocytosis
*deferential show granulocytes at all stages
*platelet show Dec. Incr. Or N
2_inc. uric acid (Gout)
3_BM biopsy: definitive {blast &promylocytes}
4_cytogenic : pH. Chromosome .
14y (child_🤔) + $of pancytopenia + blood film :blast cells
Dx?
ALL (لوكميا الاطفال ) #blast cells in peripheral blood سؤال #BM biopsy show blasts confirm the dx & exclude a plastic anemia . #ph.che. occurs in 30% &associated with poor dx .
(28 y )+sudden onset of bone pain +( bleeding from gum) + looks pale + hepatosplenomegly + leucocytosis +blasts in peripheral blood + BM biospy show incr. Blasts .
Dx?
Dx:AML (emergency case)
📢leucocytosis cause bone pain
51y + headache (HTN)+pruritis after hot bath + DVT +incr. { RBCs,WBC,platelet} +Dec. Erythropoietin + JAK mutation screen (سؤال)
Dx?
Management?
PRV (polycythemia rubra vers )
incr. RBCs plethora + { hyper viscosity :MI,stroke, DVT}
incr. WBCs { basephil:pruritis }
*incr platelets: bleeding especially git .
*++=splenomegly
#ttt:
1_ venesection(phlebotomy)
2_chemotherapy
(<40 ;interferon/>40y hydroxyuria )
3_Aspirin 75mg OD»_space;reduce thrombotic events
(63y)* + thirsty + back ache + elevated Ca
Blood film most likely finding ?
# Rouleaux formation
📢🎤Dx MM (multiple myeloma)
*Age :old man
*Bone pain {back,rib,long bone}
* pathological fr.
*fatigue ,lethargy,
* polydepsia > polyuria dt elevat. Ca
Pathophysio(malignant proliferation of plasma cells secreting monoclonal IG (functionless)
🚩Invest:
*Normocytic normochromic
*ESR>100
*Electrophoresis >> monoclonal IG
*Urine : +ve Bense jone proteins
*Plain x ray : punched out lytic lesion
*inc. Ca
*BUN,create. Elevated
BM diagnostic(definitive ) :plasma cell > 20%
Blood film:rouleaux formationXX presented with prolonged bleeding after dental extraction + her father &paternal grandma have similar pb What is the mood of inheritance?? Dx? Invest to confirm? Ttt?
*AD #dx:VWD 🚩girl to exclude hemophilia 🏁imp. Points: #cause mucosal bleeding eg; epistaxis ,menorrhagia #AD #Role of VWF @promote platetet aggregation B) carrier molecule for factor 8 🏴Invest; ⬆BT ⬆APTT Factor 8 level ⬇ 📢ttt; 1_ tranxamic acid for mild bleeding 2_desmopressin 3_factor 8concentrate.
Deep Bleeding into muscle &joints
⬆PTT
Haemphilia (8)
Bleeding everywhere
⬆PTT
⬆BT
⬆PT
DIC
(Vegan)* + peripheral parasthesia + mild dyspnea + angular stomatitis + sore red tongue
Cell type on blood film ?
*oval macrocytic red cells
🎤📢angular stomatitis can be caused by ; b12 ⬇,FE⬇.
🎤PERIPHERAL NEURITIS dt bit b 12 ⬇
5y+ falling >swelling at the knee +rashes on buttock + ⬆aptt
Dx?
Haemophilia 🚩mode of inheritance :x linked 🎤males are typically affected 🎤low level of factor 8 Invest: PT ,BT,fibrinogen level &VWF all normal aPTT ⬆ Ttt: desmopressin Recombinant factor 8 Do not give IM injection . Avoid NSAID>>give opiote
DVT after long flight + started on warfarin
Target INR ?
INR 2:3
Also this range needed for :
⬇risk of embolism for ppt with AF &valvular heart diz .
☻pt with metallic valve with lifelong anti coagulant needs INR 3:4
Mucosal bleeding +*petechial rashes + looks pale + ⬇RBCs,WBC,platelets
+ blood films show no retic.+BM aspiration show across reduction in all haemopoetic tissue {replaced by fat spaces}.
A plastic anaemia
Pancytopenia + BM hypoplasia
#causes :
Autoimmune triggered by drug {[parvovirus, hepatitis}
. or radiation .Greek man +dark red urine + after eating fava beans+ signs of shock + blood film show spherocytes &fragments RBCs.
Dx?
Mode of inheritance?
Dx: G6PD ⬇ 🚩spherocyes seen in : *hereditary spherocytosis *AIHA *can be seen in severe cases of hamolysis *can be seen in G6PD ⬇ #x_linked #mostly affect Africa, Asia & Mediterranean descent.
#Common drug induced G6PD ⬇? # invest. Of G6PD? #managements:
Primaquine
# invest:
*Heinz bodies in blood film of drug induced hemolysis. + GB stones also common
* ⬆retic, in. Bilirubin,⬇heptoglobin.
*blood film show spherocytes , RBCs fragments
📢📢🚩diagnostic :
G6PD ⬇
Ttt:
*Avoidance of precipitating drugs & broad fava bean .
*transfusion in severe cases.
*IV fluid
36y Female with petecheal rash + menorrhagia ⬇platelets .
Dx?
Thrombocytopenia . 🚩adult ITP not commonly follow infection. 🚩📢presentation: Bleeding Purpura Epistaxis Menorrhagia. 🎤clinically diagnosis by exclusion but definitive is BM biopsy.
📢🎤ttt:
- bleeding
- IV IG
- emergency platelet transfusion in case of life threatening hge.
4y boy + (in winter season)+ cough 🤔(URTI) arthritis + non blanching rash on legs +no hx if fever + abd .pain+ hematuria
Blood results all with normal range
Dx?
اه يا بطنى،اه يا مفاصلي ‘ايه ده البول الاحمر وايه اللى ع رجلى ده كمان
HSP (henoch_schonlein purpura). #mainly clinical diagnosis #⬆ESR ,IGA ⬆creat. 📢📢ttt: Self_limiting :conservative management NSAID for arthritis but not if renal impairment Corticosteroid in case of git dysfunction.
Fatigue + constipation +on inspection : dry coarse skin ,hair loss ,cold extremities + diffuse goiter&lobulated+ peripheral smear show macrocytic anemua .
🚩Pernicious anaemia .
(Macroctic + autoimmune hashimoto goiter)
👅🗿all goiters grow diffuse except hashimoto (diffuse &lobulated) while goiter (diffuse & unilobuated).
