DAT haem Flashcards
what is hematopoiesis
formation of blood cellular componenets - occurs through yolk sac and then the liver - bone marrow taken over by birth
multipotential haemoatopoietic stem cell differentiates into
common myeloid and common lymphoid
common myeloid gives rise too
megakaryocyts , erythrocytes , mast cells and myelobasts
myeloid side - RBC and wbc in innate immune system
myeloblasts diff into
granulocytes - baso , neutrophil, eosinophils and monocytes ( macrophages)
common lymphoid progenitors give rise to
natural killer cells( innate) T and B lymphoctes ( adpative)
difference between innate and adaptive immunity
Innate immunity is the body’s first line of defence against pathogens. It is general and non-specific, which means it does not differentiate between types of pathogens. Adaptive immunity is a type of immunity that is built up as we are exposed to diseases or get vaccinated
blast vs cyte
blasts are immautre and tend to be much larger than when they are mature - cytes
sx in blood cancer
B symptoms (or “constitutional symptoms”) - immune stimulation,
occurs more commonly in the lymphoid types
* Fever
* Weight loss >10% in 6 months
* Night sweats (drenching)
* Itching
* Bone marrow infiltration / crowding
* Bruising and bleeding (thrombocytopenia)
* Pallor, shortness of breath, fatigue (anaemia)
* Infections (leukopenia)
* Infiltration / tumour effect
* Lymphadenopathy
* Hepatosplenomegaly
* **blood - precursors, red cells, white cells, platelets, immunoglobulins
CML - t(9:22) phildeelpha BCR-ABL fusion gene - produces tyrosine kianse driving abnormal prolif and affects myeloid cells
3 phases what are they
chronic - raised WCC
agrresive - systemic sx
blast phase - over 20% of blast cells in blood
ix show
FBC hb normal or low, raised WBC , platelets normla low or high
blood film neutropenia
bone marrow aspiration shows increased cellulairty
AML - 1
children - acute proliferation of a single type of lymphocyte - usually B - excessive accumualtion of these cell in bone marrow causes infiltration and leads to
pancytopenia
CLL - 3
slow proliferation of a single type of well differentiated lymphocyte - usually B
adults over 60
presents how
frequent infections, anaemia, bleeding adn WL
painless cervical, axillary or groin lymphadenopathy and hepatosplenomegaly
IX in CLL show what
raised WCC , Hb normal or low , plateletes will be normal or low
immunoglobulins could be low
blood film - shows high percentage of lymphocytes, smear or smudge cells as WBC are fragile so rupture
bone marrow - heavily infiltrated with lymphocytes
rare sign in boys with AML
testicular enlargement
IX all show what
low Hb
raised WCC
low platelets
large blast cells on blood film
reducede erythropoeisis and reduced margakayroctes
CXR - t lymphoblastic leukaemia there may be mediastinal widening
AML - present any age usualyl later
can result from transformation of a meyloproliferative disorder
clonal expansion of immature blast cells
rare to have lymphadenopathy
ix
low HB
raised WBC but low neutorphils
lo platelets
auer rods
myeloma why do you get hper ca , renal impaire, anemai and bone lesion
primarily due to increased bone resorption
light chain depositon in renal tubules
bone marrow crowding
bone marrow infiltration creates lytic bone lesions
mx of myeloma
chemotherapy + VTE prophylaxis
stem cell treatment
A 26 year old female comes into clinic. For the last few weeks she has
been experiencing fevers, night sweats and feels she is losing weight.
When you examine her she has enlarged, rubbery cervical lymph nodes.
What investigations should you do?
What are your differential diagnoses?
suspecting lymphoma
hodgkin features
20s or 70s
monucelosis infection
enalrgeed rubbery LN
enalrgeed spleen and liver
b sx
puritis fatigeu, anoeeia alcohol induced
bloods in hodgkins show what
normocystic anaemia
lymphocytopenia
esoinophilia
raised ESR
GGT adn ALP and LDH raise
need biopsy for deifntiive
CT involvemnt
ann arbour
non hodgkins is what
55-75 associated with EBV
Malignant tumours of the lymphoid tissue, that do not contain Reed-Sternberg cells.
70% B cell origin, 30% T cell origin
NHL refers to a wide range of conditions including MALT and Burkitt lymphoma.
sx non hodgkins
painless superficial lymphadenopathy
b sx
pancytopenai infections and brusiing
comrpession sx
ix do all for HL plus
bone marro aspiration adn trephine
immunophenotyping differntiate btween B and t tumours
measure uric acid - high lead to renal failure
immunoglobulin test
HIV test
A 77-year-old man is being followed up in the haematology clinic after being
diagnosed with non-Hodgkin’s lymphoma. He initially presented to his general
practitioner with a painless, rapidly enlarging cervical mass. An excisional node biopsy
revealed a ‘starry sky’ pattern. He has commenced chemotherapy with
cyclophosphamide, doxorubicin, vincristine, and prednisolone. The specialist wants to
co-prescribe a medication that has been demonstrated to improve outcomes in
patients with this diagnosis.
What should be prescribed?
Bezlotoxumab
B. Denosumab
C. Infliximab
D. Interferon-alpha
E. Rituximab
E - Rituximab should be prescribed alongside CHOP chemotherapy
regimen
- A 10-year-old boy is brought to the general practitioner by his mother. She is
concerned that he is not quite himself at the moment. She thinks he is looking paler
than usual and over the last few weeks, he has been much more tired than usual
despite no change in his daily routine. She says that he has also had several coughs
and colds in the last month which is unusual for him. His vital signs are all normal and
on examination, you note some pallor but no other abnormalities. What should be the
next step to investigate this patient?
A. Routine FBCs within 2 weeks
B. FBC to be performed within 48 hours
C. Bone marrow biopsy to be performed within 48 hours
D. Lymph node biopsy within 2 weeks
E. Bone marrow biopsy within 2 weeks
B - This child should be offered a FBC within 48 hours to assess for
leukaemia
A 75-year-old lady presents with worsening fatigue, weight loss, and night
sweats over the past two months. She has also noticed some lumps in her right
groin, which seem to be enlarging and spreading although they do not hurt.
A lymph node biopsy shows large multinucleate cells with prominent eosinophilic
nucleoli.
What is the most likely diagnosis?
A. Burkitt lymphoma
B. Sarcoidosis
C. Chronic lymphocytic lymphoma
D. Hodgkin’s lymphoma
E. Tuberculosis
D - Hodgkin lymphoma, the findings of large multinucleate cells with
prominent eosinophilic nucleoli are Reed-Sternberg cells
A 68-year-old male presents to his GP having noticed enlarge lymph nodes in
neck, axillae and groin. Blood tests show:
A blood film shows that 60% of the white cells are small mature lymphocytes.
What is the most likely diagnosis?
A. Acute lymphoblastic leukaemia
B. Hodgkin’s lymphoma
C. Chronic lymphocytic leukaemia
D. Non-Hodgkin’s lymphoma
E. Chronic myeloid leukaemia
C - these findings are consistent with chronic lymphocytic leukaemia
A 65-year-old woman presents to her GP complaining of a constant sense of
fullness. She is currently eating a third of her normal portion before having to stop
due to the feeling.
On examination, the patient looks alert and comfortable. The heart sounds are
normal and vesicular sounds are heard over the lung fields. There is increased
dullness in the left hypochondrium extending to the umbilicus. Her blood tests
show the following:
Hb
98 g/L
(115 - 160)
Platelets
456 * 10 9/L
(150 - 400)
WBC
30.3 * 10 9/L
(4.0 - 11.0)
Neuts
26.1 * 10 9/L
(2.0 - 7.0)
Lymphs
3.0 * 10 9/L
(1.0 - 3.5)
Mono
0.8 * 10 9/L
(0.2 - 0.8)
Eosin
0.4 * 10 9/L
(0.0 - 0.4)
What is the most likely diagnosis?
A. Acute lymphocytic leukaemia
B. Acute myeloid leukaemia
C. Chronic lymphocytic leukaemia
D. Chronic myeloid leukaemia
E. Leukemoid reaction
D - these blood results - anaemia, thrombocytosis, raised WCC and
raised neutrophils point towards chronic myeloid leukaemia
how can COPD lead to polycythaemia
It is important to remember that most abnormal blood results are reactive. It is first essential to differentiate between a true and relative polycythaemia. A true polycythaemia can be primary (e.g. myeloproliferative disorder) or secondary (reactive). Dehydration and diuretics can cause a relative polycythaemia (pseudopolycythaemia) where there is relatively low plasma volume to red cell mass ratio. Red cell mass and plasma volume studies are helpful to demonstrate a relative polycythaemia.
The patient in this example has risk factors for secondary polycythaemia including COPD and smoking. Impaired oxygen exchange in the lungs can result in a low PaO2 which results in stimulation of EPO release from the kidneys. EPO stimulates erythropoiesis and increases red cell mass, thereby resulting in polycythaemia. The low SpO2 is highly suggestive of a hypoxic driven polycythaemia. Therefore the most likely answer is COPD.
A sudden anemia and a low reticulocute count indicates in sickle cell ….
parovirus
Acute sequestration and haemolysis causes a high reticulocyte count.
