GM: Haematology Flashcards by cole roberts

What causes a normocytic anaemia?

Anaemia without altered RBC structure

Anaemia of chronic disease

Acute blood loss

Aplastic anaemia

Haemolytic anaemia

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What are the causes of microcytic anaemia

Thalassaemia: AR defects of haem chains

Anaemic of chronic disease

Iron deficency:can also be normocytic

Lead poisoning: blocks heme synthesising enzymes

Sideroblastic: Iron wont fit into RBCs

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How do you investigate iron deficiency anaemia?

FBCs showing low Hb, can confirm if low ferritin

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What is the initial management of iron deficiency anaemia?

oral iron

+ IV iron or blood transfusion

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For anaemia, when do you refer to…

Haematology

Supplementation fails to increase by 20g/L over 2-4 weeks and no GI or Gynae criteria

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Paraesthesia, changes to mood and vision+/- mild jaundice suggests which anaemia?

B12 deficiency

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What investigations suggest B12 deficiency

Macrocytic anaemia

Hypersegmented polymorphs

Low cobalamin is B12, low folate is folate

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How do you treat B12 deficiency?

No neuro: IM hydroxycobalamin 3x day 2 weeks; 1 per 3 months afterwards

Neuro: IM 1mg every other day until improves

TREAT B12 BEFORE FOLATE

give folic acid 5mg day 4 months

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When do you refer a vit B12 deficiency to…

Haem

Gastro

Haem: Uncertain, malignancy, resistant to treatment

Gastro: IBD, malabsorption, GI malignancy

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How doe sickle cell present on…

FBC

Blood film

Microcytic anaemia

Sickle cells, howell-Jolly bodies

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Outline the inheritance of sickle cell anaemia

AR inheritance of HbS instead of A.

One gene casues trait

Two causes disease

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Compare vaso-occlusive, splenic sequestration, aplastic crisis and acute chest syndrome in terms of…

Pain

Associated symptoms

Lab findings

VOC // SS // AC // ACS

Localised pain // abdo pain // painless // painless

Fever, priapism // HSM, hypotension // infective Hx // Resp symptoms

Raised Hc // Severe anaemia // severe anaemia // Infiltrates on X-ray

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How do you treat sickle cell crises?

Admit

Treat infection

IV fluids

Keep warm

Analgesia

Aspirate if priapism

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What prophylaxis is given to sickle cell patients

Penicillin 3m-5yrs

PPV23 every 5 years

MenB + ACWY then another MenB 4 weeks later

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What patient features might point towards thalassaemia?

Pronounced forehead and jaw

Jaundice, gallstone, splenomegaly

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How do you diagnose thalassaemia?

Haem electrophoresis

DNA testing

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How do you treat thalassaemia that is

alpha

Beta…

minor

intermedia

major

Alpha: monitor. Transfusions and bone marrow transplant potentially.

Bm: Conservative

BI: monitor + transfuse

BM: regular transfusion, chelation and splenectomy. Bone transplant can be curative

Anaemia + gallstones + large spleen

Blood film…

Diagnose and treat

Hereditary spherocytosis

Folate supplementation + splenectomy

Patient with PMHx of infections + jaundice after eating beans

G6PD deficiency

Heinz enzyme assay to confirm

Avoid triggers

What are the features of leukaemia?

Abnormal bruising

Splenomegaly, lymphadenopathy

Palness, fever, fatigue

Where suspected, what are the 1st line and GS test in leukaemia?

1st: <48hr FBC

GS: Bone marrow biopsy

+ blood film biopsy

How are the leukaemias distributed by age?

ALL CLLmates have CMMon AMbitions

ALL: <5s, >45s

CLL: Over 55

CML: Over 65

AML: Over 75

How can ALL, CLL, AML and CML be differentiate based on

Clinical history

Blood results

ALL: Children, Down’s syndrome, Blast cells (left)

CLL: Most common in adults, Smudge cells (right

AML: Myeloproliferative, Auer rods (middle)

CML: Raised WCC/low Hb, plts, pancyto

How do you treat leukaemia?

Chemo and steroids

What are the general features of a lymphoma?

Painless, assymetrical lymphadenopathy + systemic B symptoms

How do NHL and HL differ on... Age Symptoms Cells Associations

NHL // HL \>75s // 20s, 70s Early B symptoms, extra-nodal disease // painful nodes on alcohol Depends on subtype // Reed sternberg cells

How is Lymphoma confirmed?

Lymph node biopsy +CT/MRI/PET

What is myeloma and its subgroups

Plasma cell malignancy resulting in excess antibody production MGUS: Raised antibodies without specific infection Multiple myeloma: affected multiple sites Smouldering: MGUS progression with higher Ig levels; waldenstrom's if specifically IgM raised

\>60s presents with bone pain. Bloods show rasied calcium, total protein and renal impairment What is the diagnosis

myeloma

What investigations are performed in suspected myeloma?

Monoclonal IgM or IgA in serum and urine (BJ proteins) Increased plasma cells on bone marrow biopsy Whole body MRI for bone lesions + 'tear-drop skull' on X-ray

B symptoms + splenomegaly + the following bloods indicate what? Raised Hb Raised platelets Low Hb, abnormal platelets + WCC, teardrop RBCs

Myeloproliferative disorders Polycythaemia vera Essential thrombocytopaenia Myelofibrosis

How do you treat... Polycythaemia vera Essential thrombocytopaenia MF

PC: Venesection, chemo ET: chemo MF: Chemo + stem cell transplant

How do you stage Hodgkin's lymphoma?

Ann-Arbor staging I: Single lymph node II: 2 or more nodes/regions on same diaphragm side III: Nodes on both sides of diaphragm IV: Spread beyond lymph nodes + A: Pruritis only B: \>10% weight loss, fever \>38 degrees, night sweats

What are the diagnostic criteria for myeloma

_Factor: Major // minor_ Imaging: Plasmacytoma // osteolytic lesions Plasma cells: 30% // 10-30% M protein: Elevated // minor elevations + low antibody levels for minor **NEED 1 MAJOR + 1 MINOR / 3 MINOR**

What are the subtypes of non-hodgkin's lymphoma and their associations?

Burkitt's: EBV, tumour lysis, 'starry sky' histology MALT: H. pylori, perigastric tissue Diffuse B cell: rapidly growing painless mass in \>65yrs

Muscle cramps in a NHL patient just starting chemo suggests what and how is it prevented?

Tumour lysis syndrome in burkitt's lymphoma Give rasburicase to prevent uric acid --\> allantoin Allopurinol is alternative

Infant experiencing painful swelling in hands and feet in absence of other pathology suggests what?

Thrombotic crises

How can you distinguish ITP, TTP and DIC in terms of... Symptoms Labs Cells

ITP // TTP // DIC Bleeding // 'The Terrible Pentad'\* // Bleeding, sepsis high bleed time // high bleed, low platelets // high bleed, low platelets + D-dimer none // schistocytes // schistocytes

Polycythaemia rubra vera is most likely to convert into which cancer?

AML or myelofibrosis

What test confirms the diagnosis if spherocytes are found on blood film?

DIRECT coomb's test confirms diagnosis of haemolytic anaemia