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HYMS Y4 > KEY HAEMATOLOGY > Flashcards

KEY HAEMATOLOGY Flashcards

1
Q

State the symptoms of leukaemia that can occur due to bone marrow failure.

A

Anaemia symptoms
thrombocytopenia (bleeding + bruising)
Neutropenia (increased risk of infections)

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2
Q

State the symptoms of leukaemia that can occur due tissue infiltration.

A 
Bone pain
Gum hypertrophy
Hepatosplenomegaly
Lymphadenopathy
Cranial nerve palsies
Testicular enlargement
Mediastinal mass
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3
Q

State the symptoms of leukaemia that can occur due to substance release.

A

DIC (bleeding + bruising)

Hyperuricaemia (gout, renal stones, AKI).

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4
Q

Name the 4 groups of myeloid malignancies.

A

AML
CML
Myelodysplastic syndrome
Myeloproliferative neoplasms

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5
Q

Who is AML more common in?

A

Older adults + the elderly.

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6
Q

The presence of which cells in the blood stream is always abnormal?

**They indicate AML.

A

Blast cells.

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7
Q

What can AML occur secondary to?

A

Myelodysplastic syndromes.

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8
Q

Name the main subtype of AML.

A

Acute promyelocytic leukaemia.

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9
Q

What mutation is acute promyelocytic leukaemia due to?

A

15:17 translocation.

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10
Q

What cells are pathognomonic of AML/ acute promyelocytic leukaemia?

A

Auer rods.

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11
Q

General FBC findings in AML?

A

Pancytopenia.

Low Hb, low WCC, low plts.

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12
Q

Blood film findings in AML?

A 
Blast cells (myeloblasts)
Auer rods
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13
Q

Bone marrow aspirate findings in AML?

A

Increased cellularity

Replacement by blast cells of >20%

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14
Q

1st line treatment for acute promyelocytic leukaemia?

A

All-trans-retinoic acid + chemotherapy.

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15
Q

Acute promyelocytic leukaemia commonly presents as what?

A

DIC.

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16
Q

Blast cells will stain positive for what in AML?

A

Myeloperoxidase.

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17
Q

What causes are associated with AML?

A

Radiotherapy + alkylating agents

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18
Q

Condition associated with development of AML/ CML?

A

Down’s syndrome.

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19
Q

All leukaemia cells in CML contain what?

A

The Philadelphia chromosome.

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20
Q

What is the Philadelphia chromosome?

A

9:22 translocation forming BCR-ABL gene.

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21
Q

What can CML turn into?

A

AML.

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22
Q

Most common physical finding in CML?

A

Splenomegaly.

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23
Q

FBC findings in CML?

A

Could be normal.
If anything will cause neutrophilia.

**Classically = isolated raised eosinophils or basophils.

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24
Q

Blood film findings in CML?

A

Leukoerythroblasts.

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25
Q

Bone marrow aspirate findings in CML?

A

Increased cellularity.

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26
Q

1st line treatment for CML?

A

Imatinib.

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27
Q

General overall findings in myelodysplastic syndrome.

A

Blood cytopenias + hyper cellular bone marrow.

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28
Q

Myelodysplastic syndromes can predispose to what?

A

AML.

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29
Q

In myelodysplastic syndromes, morphological abnormalities are present in how many cell lines?

A

2 or more.

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30
Q

FBC findings in myelodysplastic syndromes.

A

Low RBCs ± low WCCs ± Low platelets.

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31
Q

How are myelodysplastic syndromes different to CML?

A

Overall neutropenia which is not seen in CML.

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32
Q

How are myelodysplastic syndromes diagnosed?

A

Bone marrow aspiration with <20% blast cells.

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33
Q

Management of myelodysplastic syndromes?

A

Mainly conservative - monitor the condition.

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34
Q

Name the 4 myeloprpliferative neoplasms.

A

Polycythaemia vera
Essential thrombocythaemia
Myelofibrosis
CML

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35
Q

Why are the myeloproliferative neoplasms grouped together?

A

They all have the ability to transition from one disease to another and can all transform into AML.

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36
Q

Mutation seen in >95% of those with polycythaemia vera.

A

JAK2.

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37
Q

Difference between polycythaemia vera and secondary polycythaemia?

A

Secondary polycythaemia has no splenomegaly.

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38
Q

Management of polycythaemia vera.

A

Venesection + chemotherapy.

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39
Q

Symptoms of polycythaemia vera.

A

Tiredness, itching, vertigo, headache, visual disturbances.

**All due to the expanded cell volume.

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40
Q

When does the itching associated with polycythaemia vera tend to be worse?

A

After a hot bath or shower.

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41
Q

Problem in polycythaemia vera?

A

Too many red blood cells.

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42
Q

Problem in essential thrombocythaemia?

A

Too many platelets.

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43
Q

Mutation present in >50% patients with essential thrombocythaemia?

A

JAK2.

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44
Q

Symptoms of essential thrombocythaemia?

A

Bruising, bleeding. cerebrovascular symptoms.

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45
Q

Management for essential thrombocythaemia?

A

Treat if symptoms present.

Hydroxyurea + aspirin used.

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46
Q

4 characteristics of myelofibrosis.

A

1) Fibrosis in bone marrow
2) Extramedullary haematopoiesis
3) Anaemia
4) Tear drop poikilocytosis in peripheral blood

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47
Q

> 50% those with myelofibrosis have what mutation?

A

JAK2.

48
Q

Main sign in those with myelofibrosis?

A

Massive splenomegaly.

49
Q

Finding on peripheral blood film in myelofibrosis?

A

Tear drop poikilocytosis.

50
Q

General underlying pathophysiology in myelofibrosis?

A

Fibrosis of the bone marrow causing extramedually haematopoiesis.

51
Q

4 main causes of massive splenomegaly?

A

CML
Myelofibrosis
Polycythaemia vera
Chronic TB

52
Q

ALL normally causes massive proliferation of what type of cell?

A

B cells.

53
Q

ALL is most common in who?

A

Young children.

54
Q

ALL is associated with which condition?

A

Down’s syndrome.

55
Q

Common symptoms and signs in ALL?

A

Mediastinal mass ± respiratory symptoms.

56
Q

ALL is more likely than other forms of leukaemia to affect which system?

A

CNS.

57
Q

FBC findings in ALL.

A

Very low myeloid cells.

High lymphocyte count.

58
Q

Blood film findings in ALL?

A

Lymphoblast cells.

59
Q

Bone marrow aspirate findings in ALL?

A

Hypercellularity with >20% blast cells.

60
Q

Investigations often needed in ALL?

A

CXR (mediastinal mass?)

LP (any abnormal cells in CNS?)

61
Q

Management of ALL?

A

Chemotherapy + intrathecal prophylactic chemotherapy.

If abnormal cells found on LP, cranial irradiation may be needed.

62
Q

What is the most common leukaemia?

A

CLL.

63
Q

What sign occurs in 80% patients with CLL?

A

Lymphadenopathy.

64
Q

What is Richter’s transformation?

A

Where CLL changes into diffuse large B cell lymphoma.

65
Q

Findings on FBC for CLL?

A

Raised WCC.

66
Q

Blood film findings in CLL?

A

Smear/ smudge cells.

67
Q

Bone marrow aspirate findings in CLL?

A

Hypercellularity with blast cells.

68
Q

Condition associated with CLL?

A

Warm autoimmune haemolytic anaemia.

69
Q

Most common cause of death in CLL?

A

Infection (naive B cells do not work).

70
Q

Myeloma is malignancy of what cells?

A

Plasma cells (causes production of large amounts of abnormal antibodies)

71
Q

Antibody normally produced in myeloma?

A

IgG.

72
Q

Prevalence of myeloma increases in proportion to what?

A

Increasing age.

73
Q

Precursor to myeloma?

A

MGUS.

74
Q

Stage between MGUS and myeloma?

A

Smouldering.

75
Q

Name the common features of myeloma.

A

1) Calcium high - bone destruction.
2) Renal impairment - commonly damaged by light chain nephropathy.
3) Anaemia - marrow infiltration + CKD.
4) Bone disease + pain - lytic lesions due to increased osteoclastic activity.
5) Spinal cord compression.

76
Q

FBC findings in myeloma.

A

Pancytopenia.

77
Q

Blood film finding in myeloma?

A

Rouleaux formation.

Plasma cells >10%.

78
Q

Special test for myeloma?

A

Urine electrophoresis + serum electrophoresis for Bence-Jones proteins

79
Q

Prognostic indicator for myeloma?

A

Beta-2 microglobulins.

80
Q

Condition similar to myeloma which causes release of IgM antibodies?

A

Waldenstrom’s macroglobulinaemia.

81
Q

Other blood findings in myeloma?

A

High calcium

High ESR

82
Q

Skull imaging finding in some patients with myeloma?

A

Raindrop/ Pepperpot skull

83
Q

2 types of lymphoma?

A

Hodgkin’s + Non-Hodgkin’s

84
Q

Most common subtype fo lymphoma?

A

Non-Hodgkin’s

85
Q

Common presentations for lymphomas.

A

Lymphadenopathy + B symptoms.

86
Q

What are B symptoms?

A

Systemic symptoms of:

  • Fever
  • Night sweats
  • Weight loss (>10% in 6/12)
87
Q

Hodgkin’s lymphoma affects what kinds of people?

A

Tends to affect younger people.

88
Q

Lymph node biopsy findings in Hodgkin’s lymphoma?

A

Reed-Sternberg cells.

89
Q

Most probable cause of Hodgkin’s lymphoma?

A

EBV.

90
Q

Staging used for Hodgkin’s lymphoma?

A

Ann-Arbor staging

91
Q

Ann Arbor stage 1?

A

Problem in 1 lymph node or group of nodes.

92
Q

Ann Arbor stage 2?

A

Problem in 2 places on same side of diaphragm.

93
Q

Ann Arbor stage 3?

A

Malignant problem on both sides of diaphragm.

94
Q

Ann Arbor stage 4?

A

Involvement of extra-nodal sites.

95
Q

What is Pel Ebstein fever?

A

Cyclical fevers occurring over a few weeks.

96
Q

Pel Ebstein fever is associated with what?

A

Hodgkin’s lymphoma.

97
Q

Which subtype of Non-Hodgkin lymphoma is associated with EBV?

A

Burkitt’s lymphoma (worst prognosis).

98
Q

Most common adult lymphoma?

A

Diffuse large B cell lymphoma.

99
Q

Lymphoma with worst prognosis?

A

Burkitt’s.

100
Q

Lymphoma affecting the stomach, associated with H. Pylori?

A

MALT.

101
Q

Blood film finding in Burkitt’s lymphoma?

A

‘Starry-sky appearance’.

102
Q

Increased itch after heat exposure in polycythaemia probably caused by what?

A

Histamine ± prostaglandin release.

103
Q

Indicators of a poor prognosis in Hodgkin’s lymphoma.

A 
Male gender
B symptoms present
Lymphocyte depleted
Fever
Age >45 at diagnosis
104
Q

What might have happened if new B symptoms are developed in a patient with CLL?

A

Richter’s transformation.

105
Q

Empirical antibiotic in neutropenic sepsis?

A

Pip-Taz.

106
Q

Polycythaemia vera has the capacity to transform into what conditions?

A

Myelofibrosis/ AML.

107
Q

Most common type of Hodgkin’s lymphoma?

A

Nodular sclerosing.

108
Q

Subtype of Hodgkin’s lymphoma with best prognosis?

A

Lymphocyte predominant Hodgkin’s lymphoma.

109
Q

Overall most common type of lymphoma?

A

Diffuse large B cell lymphoma.

110
Q

What do Howell-Jolly bodies suggest?

A

Hyposplenism (can be seen in coeliac disease).

111
Q

Blood film anomaly seen in CML?

A

Pseudo-pelger-huet anomaly.

112
Q

Haematological malignancy associated with Rouleaux formation?

A

Myeloma.

113
Q

Haematological malignancy associated with Reed-Sternberg cells?

A

Hodgkin’s lymphoma.

114
Q

Type of Hodgkin’s lymphoma with worst prognosis?

A

Lymphocyte depleted.

115
Q

Polycythaemia vera causes what FBC finding?

A

Isolate rise in RBC count.

116
Q

Thymomas are strongly associated with what condition?

A

Myasthenia Gravis.

HYMS Y4 (8 decks)

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