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Yr 5 - Haematology > Corrections > Flashcards

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1
Q

Is eosinophilia more commonly associated with non-HL or HL?

A

HL

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2
Q

What happens in myelofibrosis?

A

Bone marrow gets replaced with connective tissue (fibrosis).

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3
Q

What is the JAK2 mutation associated with?

A

Myeloproliferative disorders, such as:

1) polycythemia vera

2) essential thrombocythemia

3) primary myelofibrosis

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4
Q

What is the most suitable mx option for epistaxis where the bleed site is difficult to localise?

A

Anterior packing (followed by referral to ENT for posterior packing)

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5
Q

Cause of a severe drop in Hb and reticulocyte suppression in sickle cell?

A

Parvovirus infection —> causes aplastic crisis (temporary arrest of red cell production in bone marrow, hence low reticulocytes)

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6
Q

What is a typical cause of thrombocytopenia after surgery?

A

Heparin induced thrombocytopaenia

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7
Q

Post-splenectomy patients are often given prophylactic penicillin V.

What organism does this protect them against?

What organism does it not protect them against?

A

Protects them against Strep. pneumoniae

Does not protect them against Hib (due to the production of beta-lactamases by the organism)

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8
Q

Well’s score results for PE vs DVT?

A

PE: ≥4.5 (likely)

DVT: ≥2 (likely)

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9
Q

As a first line investigation, what should all people with iron deficiency anaemia be screened for?

A

Coeliac disease

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10
Q

DVT investigation: if proximal leg US is negative but D-dimer is positive?

A

Stop anticoagulation and repeat scan in 1 week (as still as risk of developing a clot)

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11
Q

Mx of gastric MALT lymphoma?

A

H. pylori eradication

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12
Q

What is the Richter’s transformation?

A

CLL can transform to high-grade lymphoma (Richter’s transformation), making patients suddenly unwell.

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13
Q

What type of leukaemia is the Richter’s transformation seen in?

A

CLL

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14
Q

What are some contraindications for a platelet transfusion?

A

1) Chronic bone marrow failure

2) Autoimmune thrombocytopenia

3) HIT

4) TTP

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15
Q

What is used in the mx of CML?

A

Tyrosine kinase inhibitors e.g. imatinib

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16
Q

Haptoglobin levels in intravascular haemolysis?

A

Reduced

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17
Q

What is given to patients with polycythaemia vera to reduce the risk of thrombotic events?

A

Aspirin

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18
Q

What finding is most likely on a blood film in multiple myeloma?

A

Rouleaux formation (appear as stacks of RBCs)

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19
Q

What medication can be used in sickle cell to prevent further crises?

A

Hydroxyurea

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20
Q

What condition does APS most commonly occur 2ary to?

A

SLE

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21
Q

1ary vs 2ary prevention of clots in APS?

A

1ary –> low dose aspirin

2ary –> warfarin (ie. APS patients have lifelong warfarin post DVT/PE instead of DOAC)

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22
Q

What mutation is present in sickle cell?

A

Single point mutation in beta globin gene on chromosome 11.

Results in amino acid replacement from glutamic acid to valine (HbS).

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23
Q

What hypersensitivity reaction is seen in ITP?

A

Type II

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24
Q

What is free Hb in the plasma bound by?

A

Haptoglobin (hence why haptoglobin levels are low in haemolysis)

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25
Q

What is aplastic crisis in sickle cell?

A

Temporary cessation of erythropoesis, resulting in severe anaemia.

Pts may present with high output HF 2ary to anaemia.

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26
Q

What investigation is required for diagnosis of sickle cell?

A

Hb electrophoresis

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27
Q

Normally no treatment is required in ITP.

What are some cases where treatment may be required?

A

1) pt is actively bleeding

2) severe thrombocytopenia (<10)

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28
Q

What is hair on end skull a sign of?

A

Chronic haemolysis (so expansion of medullary cavities)

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29
Q

What type of gallstones are seen in sickle cell?

A

Pigmented (as a result of raised unconjugated bilirubin from RBC breakdown)

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30
Q

What may be seen on a peripheral blood smear in sickle cell?

A

Howell Jolly bodies –> basophilic nuclear remnants of RBCs

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31
Q

What shoold be monitored in HSP?

A

BP & urinalysis (for renal involvement)

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32
Q

What 4 bacteria are those with sickle cell particularly susceptible to?

A

1) Neisseria meningitidis

2) Strep. pneumoniae

3) Hib

4) Salmonella

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33
Q

What 4 bacteria are those with sickle cell particularly susceptible to?

A

Hair on end appearance

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34
Q

Where does extramedullary haematopoesis most commonly occur in sickle cell?

A

In the liver

35
Q

Mx of acute chest syndrome in sickle cell?

A

Same as vaso-occlusive crisis i.e. analgesia & O2

PLUS antibiotics & transfusion

36
Q

When is hydroxyurea given in sickle cell?

A

from 9 months of age (except in pregnancy)

37
Q

In beta-thalassaemia major, what is required alongside repeated transfusions?

A

Desferrioxamine (to prevent complications of iron overload)

38
Q

How does SLE affect neutrophils?

A

Commonly causes neutropenia

39
Q

For a patient undergoing an elective splenectomy, when is the optimal time to give the pneumococcal vaccine?

A

2 weeks before the surgery

This timing allows for optimal antibody response to develop before the patient becomes functionally asplenic.

40
Q

Does the COCP form part of the Wells score?

41
Q

What is seen on a blood film in megaloblastic anaemia (e.g. B12/folate deficiency)?

A

Hypersegmented neutrophils

42
Q

What is seen on a peripheral blood film in myeloma?

A

Rouleaux formation

43
Q

What investigation confirms the diagnosis of myeloma?

A

Bone marrow aspiration –> raised plasma cells

44
Q

What lifelong mx is indicated in beta-thalassaemia major?

A

Lifelong blood transfusions

45
Q

Mx of APS in pregnancy?

A

Aspirin + LMWH

(the addition of aspirin is recommended to reduce the risk of pre-eclampsia as APS is a high risk feature)

46
Q

Whtat class of medication can precipitate renal failure in patients with myeloma?

47
Q

What type of Hodgkin’s lymphoma carries the best prognosis?

A

Lymphocyte predominant

48
Q

Lymph node pain when drinking alcohol is very specific for what?

49
Q

Who is benign ethnic neutropaenia common in?

A

Black African and Afro-Caribbean ethnicity

50
Q

Mx of polycythaemia vera?

A

1) aspirin

2) venesection

3) chemo e.g. hydroxyurea

51
Q

What is there a risk of progression to in polycythaemia vera?

A

1) myelofibrosis (5-15%)

2) AML (5-15%) - risk increased with chemotherapy treatment e.g. hyroxyurea

52
Q

Features of lead poisoning?

A
  • abdominal pain
  • peripheral neuropathy (mainly motor)
  • neuropsychiatric features
  • fatigue
  • constipation
  • blue lines on gum margin
53
Q

What is seen on a blood film in lead poisoning?

A

Basophilic stippling

54
Q

What is irradiated blood depleted of?

A

T-lymphocytes

55
Q

Purpose of irradiated blood?

A

Used to avoid transfusion associated graft vs host disease

56
Q

Skull XR findings in myeloma?

A

‘raindrop’ skull appearance –> well defined lytic lesions (punched out lesions)

57
Q

Is SLE a cause of autoimmune haemolytic anaemia?

58
Q

Where is iron predominantly absorbed?

A

Duodenum & proximal jejunum

59
Q

Where is B12 absorbed?

A

Terminal ileum (e.g. affected by an ileocaecal resection)

60
Q

What deficiency can an ileocaecal resection result in?

A

B12 deficiency

61
Q

What age should prompt a very urgent (within 48h) FBC to investigate for leukaemia?

62
Q

What features should prompt a very urgent FBC to investigate for leukaemia in children & young people?

A
  • Pallor
  • Persistent fatigue
  • Unexplained fever
  • Unexplained persistent infections
  • Generalised lymphadenopathy
  • Persistent or unexplained bone pain
  • Unexplained bruising
  • Unexplained bleeding
63
Q

What is the most common inherited thrombophilia?

A

Factor V Leiden (activated protein C resistance)

64
Q

In a non urgent scenario, how quickly is a unit of RBC transfused?

A

90-120 mins

65
Q

In an urgent scenario, how quickly can a unit of RBC be transfused?

66
Q

What is the underlying pathophysiology in acute haemolytic transfusion?

A

RBC destruction by IgM-type antibodies

67
Q

What platelet level should you aim for before surgery or an invasive procedure (e.g. biopsy)?

A

> 50: most patients

50-75: high risk of bleeding

> 100: if surgery at critical site

68
Q

Describe Reed Sternberg cells

A

Large cells with a bilobed nucleus and prominent eosinophilic inclusion-like nucleoli.

69
Q

Blood film findings in myelofibrosis?

A

‘tear drop’ poikilocytes

70
Q

Bone marrow biopsy in myelofibrosis?

A

Unobtainable (‘dry tap’)

71
Q

When is LMWH initiated in APS in pregnancy?

A

Once foetal heartbeat is seen on US

72
Q

Blood film findings in iron deficiency anaemia?

A
  • target cells
  • ‘pencil’ poikilocytes
73
Q

Blood film findings in hyposplenism e.g. coeliac, post-splenectomy?

A
  • target cells
  • Howell-Jolly bodies
  • acanthocytes
  • siderotic granules
  • Pappenheimer bodies
74
Q

Presentation of acute intermittent porphyria?

A

1) abdominal: abdominal pain, vomiting

2) neurological: motor neuropathy

3) psychiatric: e.g. depression

4) hypertension and tachycardia common

75
Q

2 indications for tolvaptan?

A

1) ADPKD (slow kidney function decline)

2) Hyponatraemia 2ary to SIADH

76
Q

What medication is often used in the management of non-Hodgkin’s lymphoma?

77
Q

What should ALL patients be screened for before treatment with rituximab?

A

Hep B

It can cause reactivation of HBV in those with prior exposure

78
Q

Exposure to pesticides is an important risk factor for what cancer?

79
Q

What is seen on a blood film in EBV?

A

Atypical lymphocytes

80
Q

What investigation is required to confirm a diagnosis of spinal stenosis?

81
Q

What is given to patients with polycythaemia vera to reduce the risk of thrombotic events?

82
Q

Risk factors for NHL?

A
  • elderly
  • caucasians
  • viral infection (EBV)
  • FH
  • pesticides & solvents
  • chemo or radiotherapy
  • immunodeficiency e.g. HIV, diabetes, transplant
  • autoimmune e.g. SLE, coeliac

Yr 5 - Haematology (11 decks)

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