Medicine - Haematology Flashcards
(185 cards)
1
Q
define anaemia
A
low Hb
2
Q
TAILS: causes of microcytic anaemia?
A
NAME?
3
Q
3As and 2Hs: causes of normocytic anaemia?
A
NAME?
4
Q
how can macrocytic anaemia be classified?
A
- megaloblastic| - normoblastic
5
Q
causes of megaloblastic anaemia?
A
- B12 def| - folate def
6
Q
causes of normoblastic, macrocytic anaemia?
A
NAME?
7
Q
symptoms of anaemia?
A
NAME?
8
Q
which conditions may worsen with anaemia?
A
NAME?
9
Q
which 3 symptoms of anaemia are specific to iron deficiency anaemia?
A
NAME?
10
Q
signs O/E of anaemia?
A
NAME?
11
Q
which signs O/E are specific to iron deficiency anaemia?
A
NAME?
12
Q
which type of anaemia is jaundice specific to?
A
haemolytic anaemia
13
Q
which type of anaemia do bone deformities indicate?
A
thalassaemia
14
Q
findings O/E of anaemia due to CKD?
A
NAME?
15
Q
bloods done to investigate for anaemia?
A
NAME?
16
Q
non-blood test investigations done in anaemia?
A
- oesophageal-gastroduodenoscopy (OGD)| - bone marrow biopsy
17
Q
causes of iron deficiency?
A
NAME?
18
Q
where in the gut does iron get absorbed? what is the soluble form of iron?
A
- duodenum and jejunum| - ferrous (Fe 2+)
19
Q
how is iron converted from the insoluble Fe3+ to the soluble Fe2+?
A
using stomach acid
20
Q
how can PPIs cause an iron deficiency?
A
- they reduce gastric acid secretion- stops iron being converted to the soluble form of Fe 2+- therefore not absorbed
21
Q
most common cause of iron deficiency in adults not menstruating?
A
blood loss in the GI tract
22
Q
most common cause of iron deficiency in children?
A
dietary insufficiency
23
Q
how can transferrin saturation be calculated?
A
serum iron / TIBC
24
Q
what can cause a raised ferritin?
A
infection
25
how are TIBC and transferrin affected by iron deficiency?
both increase
26
how are TIBC and transferrin affected by iron overload?
both decrease
27
what could cause iron studies to give an iron overload impression?
- iron supplements| - acute liver damage
28
3 management options for iron deficiency anaemia?
1. blood transfusion2. iron infusion3. PO ferrous sulfate
29
how should Hb rise with oral iron supplements?
10g/L per week
30
what are the 2 causes of B12 deficiency?
- insufficient dietary uptake| - pernicious anaemia
31
what is needed to absorb B12? where is this secreted?
- intrinsic factor| - parietal cells of the stomach
32
where in the gut does B12 get absorbed?
terminal ileum
33
neuro signs of B12 deficiency?
#NAME?
34
pathophysiology of pernicious anaemia?
#NAME?
35
how is pernicious anaemia diagnosed?
test for the following antibodies:- intrinsic factor antibody (1st line)- gastric parietal cell antibody
36
management of insufficient dietary B12?
PO cyanocobalamin supplements
37
management of pernicious anaemia? hint: can't be oral because won't be absorbed
IM hydroxycobalamin
38
why is it important to treat a B12 def before a folate def (in pts with both)?
giving folic acid to pt with B12 def can cause subacute combined degeneration of the spinal cord
39
how can causes of haemolytic anaemia be classified?
inherited vs acquired
40
inherited forms of haemolytic anaemia?
#NAME?
41
acquired forms of haemolytic anaemia?
#NAME?
42
signs O/E of haemolytic anaemia? (hint: all due to RBC destruction)
#NAME?
43
investigations for haemolytic anaemia?
#NAME?
44
what is seen on the blood film in haemolytic anaemia?
schistocytes (fragments of RBCs)
45
when does the direct Coombs test give a positive result?
autoimmune haemolytic anaemia
46
mode of inheritance of hereditary spherocytosis?
autosomal dominant
47
presentation of hereditary spherocytosis?
#NAME?
48
which organism can bring on an aplastic crisis in hereditary spherocytosis patients?
parvovirus
49
how is hereditary spherocytosis diagnosed?
#NAME?
50
findings on blood film in hereditary spherocytosis?
spherocytes
51
finding on FBC in hereditary spherocytosis? hint: it's a rogue one
MCHC is raised
52
treatment of hereditary spherocytosis?
- folate supplements| - splenectomy
53
key difference between hereditary spherocytosis and hereditary elliptocytosis?
- in the second one, RBCs are ellipse shaped| - otherwise identical
54
mode of inheritance for G6PD deficiency?
#NAME?
55
G6PD deficiency is more common in patients of which descent?
Mediterranean / African
56
what can trigger a G6PD deficiency crisis?
#NAME?
57
drugs which cause G6PD deficiency crisis?
#NAME?
58
how is G6PD deficiency diagnosed?
G6PD enzyme assay
59
signs O/E of G6PD deficiency crisis?
#NAME?
60
what is seen on the blood film of someone in G6PD deficiency crisis?
Heinz bodies
61
how can autoimmune haemolytic anaemia (AIHA) be classified?
- warm type: haemolysis at normal or higher temperatures| - cold type: haemolysis at colder temps
62
causes of warm AIHA?
idiopathic
63
causes of cold AIHA?
#NAME?
64
management of AIHA?
#NAME?
65
what is alloimmune haemolytic anaemia? give 2 types
#NAME?
66
what are the chains making up normal adult Hb?
2 alpha + 2 beta globin chains
67
pathophysiology of thalassaemia?
#NAME?
68
potential signs and symptoms of thalassaemia?
#NAME?
69
investigations in thalassaemia?
#NAME?
70
how can thalassaemia (and treatment) result in iron overload?
- increased Fe absorption in response to anaemia| - recurrent blood transfusion therapy
71
what needs to be monitored in thalassaemia patients? why?
- serum ferritin| - to check for iron overload
72
presentation of iron overload in thalassaemia? hint: similar to haemachromatosis
#NAME?
73
where is the affected gene in alpha thalassaemia?
chromosome 16
74
where is the affected gene in beta thalassaemia?
chromosome 11
75
how is iron overload in thalassaemia managed?
- limit blood transfusions| - iron chelation
76
management of alpha thalassaemia?
#NAME?
77
what are the types of beta thalassaemia?
- thalassaemia minor - " " intermedia - " " major
78
presentation of thalassaemia minor?
- mild microcytic anaemia| - only monitoring needed, no treatment
79
presentation of thalassaemia minor? management?
- mild microcytic anaemia| - only monitoring needed, no treatment
80
presentation of thalassaemia major?
#NAME?
81
pathophysiology of sickle cell anaemia?
- abnormal beta globin chain gene on chromosome 11 - this causes HbS to form instead of HbA - HbS causes RBCs to be sickle-shaped
82
what is the relation between sickle cell trait and malaria?
having sickle cell trait reduces the severity of malaria infection
83
how is sickle cell disease tested for in newborns?
part of the day 5 heel-prick test (Guthrie)
84
complications of sickle cell anaemia?
#NAME?
85
general management principles of sickle cell anaemia?
#NAME?
86
potential triggers of a sickle cell crisis?
#NAME?
87
management of a sickle cell crisis?
all supportive:- low threshold for admission- treat underlying cause (e.g. ABx, keep warm, hydrated)- paracetamol / ibuprofen - penile aspiration if priapism
88
pathophysiology of a vaso-occlusive crisis?
- sickle-shaped RBCs clog up capillaries| - causes distal ischaemia
89
presentation of vaso-occlusive crisis?
#NAME?
90
pathophysiology of splenic sequestration crisis? how does it present?
#NAME?
91
management of splenic sequestration crisis?
#NAME?
92
what is an aplastic crisis in sickle cell disease?
temporary cessation of erythropoiesis
93
typical trigger of an aplastic crisis?
parvovirus B19 infection
94
management of aplastic crisis?
- blood transfusions if needed| - otherwise self-resolving within a week
95
how is acute chest syndrome of sickle cell disease diagnosed?
both must be present:- fever / resp symptoms - new infiltrates seen on CXR
96
infective causes of acute chest syndrome?
- bronchiolitis| - pneumonia
97
non-infective causes of acute chest syndrome?
- pulmonary vaso-occlusion| - fat emboli
98
management of acute chest syndrome?
#NAME?
99
age groups typically affected by ALL?
<5 years and >45 years
100
age group typically affected by CLL?
>55 years
101
age group typically affected by CML?
>65 years
102
age group typically affected by AML?
>75 years
103
presentation of leukaemia? hint: pancytopenia
#NAME?
104
differentials for a non-blanching rash?
- leukaemia- meningococcal septicaemia- vasculitis- HSP (lower limbs, buttocks)- ITP- NAI (children / vulnerable adults)
105
initial investigation for leukaemia?
urgent FBC (<48h) for all with suspected leukaemia
106
investigations for leukaemia?
#NAME?
107
what might the blood film show in leukaemia?
- abnormal cells| - inclusions
108
where is a bone marrow biopsy usually taken from?
iliac crest
109
which cell type over-proliferates in ALL and CLL?
usually B-lymphocytes
110
which genetic condition is ALL associated with?
downs syndrome
111
blood film findings in ALL?
blast cells
112
characteristic chromosomal change seen in CML in adults?
philadelphia chromosome
113
what type of anaemia could CLL give?
warm autoimmune haemolytic anaemia
114
which other cancer could CLL transform into?
- high-grade lymphoma| - called richter's transformation
115
blood films findings in CLL?
"smudge" / "smear" cells (WBCs which ruptured in the process of preparing the film)
116
3 phases of CML?
#NAME?
117
3 phases of CML?
- chronic phase (asymptomatic, 5 years)- accelerate phase - blast phase
118
what is seen in the blast cells on a blood film in AML?
auer rods
119
which cancer could a myeloproliferative disorder (e.g. PRV) transform into?
AML
120
management of leukaemia?
#NAME?
121
complications of chemotherapy for leukaemia?
#NAME?
122
pathophysiology of tumour lysis syndrome?
#NAME?
123
management of tumour lysis syndrome?
allopurinol and rasburicase to reduce uric acid levels
124
how can lymphoma be categorised?
- hodgkin's| - non-hodgkin's (all the other types)
125
peak ages affected by hodgkin's lymphoma? hint: bimodal
aged 20 and then aged 75
126
risk factors for hodgkin's lymphoma?
#NAME?
127
presentation of hodgkin's lymphoma?
#NAME?
128
what are B symptoms? list them
#NAME?
129
investigations in hodgkin's lymphoma
#NAME?
130
lymph node biopsy findings in hodgkin's lymphoma?
reed-sternberg cells (large B cells with multiple nuclei)
131
what is ann arbor staging used for? what does it take into account?
#NAME?
132
management of hodgkin's lymphoma?
- chemotherapy| - radiotherapy
133
prognosis of hodgkin's lymphoma?
- chemo and radiotherapy are curative- they both carry own risk of secondary malignancy- B = BAD (B-symptoms have worse prognosis)
134
types of non-hodgkin's lymphoma?
#NAME?
135
key association with MALT lymphoma?
H. pylori infection
136
which other conditions are associated with burkitt lymphoma? hint: all infections
#NAME?
137
risk factors for non-hodgkin's lymphoma?
- HIV- EBV - H. pylori (MALT)- hep B / C- exposure to pesticides- FHx
138
management of non-hodgkin's lymphoma?
#NAME?
139
pathophysiology of myeloma? what is multiple myeloma?
#NAME?
140
skin sign of pernicious anaemia?
gives "lemon tinged" skin
141
most common immunoglobulin to be raised in myeloma?
IgG
142
urinalysis finding in myeloma?
bence jones protein
143
which bones are most commonly affected in myeloma?
#NAME?
144
effects of myeloma on bone turnover? result of this?
#NAME?
145
how does myeloma cause renal impairment? hint: multifactorial
- lots of Igs block tubular flow- high Ca- dehydration - bisphosphonate therapy ... all cause impairment
146
how is plasma viscosity affected in myeloma?
- increases| - due to increased Igs
147
complications relating to increased plasma viscosity in myeloma?
#NAME?
148
what type of anaemia arises from myeloma?
normocytic, normochromic
149
how does myeloma cause anaemia?
bone marrow being resorbed
150
presentation of myeloma?
#NAME?
151
risk factors for myeloma?
#NAME?
152
what must be considered in anyone over 60 with bone pain? which investigation is key?
- myeloma| - urgent FBC required
153
findings on bloods for myeloma?
#NAME?
154
BLIPE: initial investigations for multiple myeloma?
- Bence jones protein (urine electrophoresis)rest are all in blood: - Light-chain assay - Immunoglobulins - Protein Electrophoresis
155
diagnostic investigation for multiple myeloma?
bone marrow biopsy
156
pereferred investigation to stage multiple myeloma?
whole body MRI
157
signs on X-ray in multiple myeloma?
- punched out lesions - lytic lesions - "rain-drop skull" appearance
158
management of myeloma?
#NAME?
159
management of bone disease secondary to myeloma?
#NAME?
160
complications associated with myeloma?
#NAME?
161
what are the 3 types of myeloproliferative disorder?
#NAME?
162
gene mutations associated with myeloproliferative disorders?
#NAME?
163
presentation of myeloproliferative disorders?
#NAME?
164
feautres of polycythaemia vera?
- plethoric conjunctiva and face- "ruddy" complexion- splenomegaly- pruritis, worse after hot bath - HTN
165
findings on FBC in polycythaemia vera?
isolated rise in Hb
166
findings on FBC in essential thrombocythaemia?
raised platelets
167
findings on FBC in myelofibrosis?
more variable: - anaemia (low Hb)- high OR low WCC- high OR low platelets
168
findings on blood film in myelofibrosis?
#NAME?
169
diagnostic investigation and finding for myeloproliferative disorders?
- bone marrow biopsy| - comes back "dry"
170
management of myelofibrosis?
- if mild, none needed- allogeneic stem cell transplant could be curative- chemotherapy- supportive (for anaemia / splenomegaly / portal HTN)
171
management of polycythaemia vera?
#NAME?
172
management of essential thrombocythaemia?
- aspirin| - chemotherapy
173
findings on FBC in myelodysplastic syndrome?
#NAME?
174
risk factors for myelodysplastic syndrome?
#NAME?
175
which malignancy could myelodysplastic syndrome transform into?
AML
176
presentation of myelodysplastic syndrome?
#NAME?
177
how can a diagnosis of myelodysplastic syndrome be confirmed?
on bone marrow aspiration and biopsy
178
management of myelodysplastic syndrome?
#NAME?
179
causes of thrombocytopenia relating to reduced platelet production?
#NAME?
180
causes of thrombocytopenia relating to increased platelet destruction?
#NAME?
181
drugs which can cause thrombocytopenia?
#NAME?
182
presentation of thrombocytopenia?
#NAME?
183
differentials for prolonged bleeding?
#NAME?
184
pathophysiology of ITP?
antibodies made against platelets
185
management of ITP?
#NAME?
