haem Flashcards
key aspects of acute lymphoblastic leukaemia?
most common in children 2-4 yrs or 45+ associated with down’s syndrome blood film = blast cells bruising philadelphiachromosome
key aspects of chronic lymphocytic leukaemia?
older adults
associated with warm haemolytic anaemia - autoimmune disorder characterized by the premature destruction of healthy rbc (haemolysis)
richter transformation into high grade lymphoma
blood film = smear or smudge
key aspects of chronic myeloid leukaemia?
3 phases: 5 year asymptomatic chronic phase, immunocompromised accelerated phase, blast phase (severe symptoms and pancytopenia)
associated with philadelphia chromosome
key aspects of acute myeloid leukaemia?
most common ACUTE leukaemia in adults
result of transformation from a myeloproliferative disorders (stem cell disorder)
blood film = raised blast cells (rods inside cytoplasm called auer rods)
what are the age ranges for different types of leukaemia?
ALL CeLLmates have CoMmon AMbitions
ALL = 2-4 or 45+ CLL = 55+ CM = 65+ AM = 75+
symptoms of leukaemia?
fatigue, fever, failure to thrive pallor, petechia abnormal bleeding, abnormal bruising hepatosplenomegaly (liver and spleen go massive) lymphadenopathy (swollen nodes)
investigations for leukaemia?
FBC, blood film, LDH (may be raised), bone marrow biopsy (definitive diagnosis), chest x-ray (infection or swollen nodes), lymph node biopsy, CT (look at tumours)
what is pancytopenia?
combo of anaemia, leukopenia and thrombocytopenia (reduced rbc, wbc, platelets)
wtf is leukaemia ?
genetic mutation in precursor cell of bone marrow = excessive production of 1 type of abnormal wbc = suppression of other cells = pancytopenia
bone marrow biopsy? plus bone marrow aspiration vs bone marrow trephine?
biopsy = taken from iliac crest using specialist needle, local anaesthetic
aspiration = taking liquid sample of cells from bone marrow (faster) trephine = taking solid core of bone marrow (better assessment of cells/structure but longer wait time)
management of leukaemia?
primary = chemotherapy and steroids other = radiotherapy, bone marrow transplant, surgery
complications of chemo?
failure, stunted growth/development in children, infections due to immunodeficiency, neurotoxicity, infertility, secondary malignancy, cardio toxicity, tumour lysis syndrome
what is tumour lysis syndrome? how is it treated?
release of uric acid from cells being destroyed by chemo = uric acid forms crystals in interstitial tissue and tubules of kidneys = causes acute kidney injury
allopurinol or rasburicase = reduce uric acid
potassium and phosphate released so must be monitored (plus calcium)
wtf is micocytic anaemia ?
small RBC, usually hypochromic (less colour) due to lack of pigment which carries oxygen
wtf is normocytic anaemia ?
normal sized rbc but low in number (if anaemia and MCV normal = normocytic)
wtf is macrocytic anaemia ?
large rbc = low haemoglobin
causes of microcytic anaemia (mnemonic)?
T thalassaemia (inherited condition little/no haemoglobin)
A anaemia of chronic disease
I iron deficiency
L lead poisoning
S sliderblastic anaemia (enough iron but can’t put into haemoglobin)
also hookworm (low/middle income countries)
causes of normocytic anaemia (mnemonic)?
A anaemia of chronic disease
A aplastic anaemia (body no longer producing enough new blood cells)
A acute blood loss
H haemolytic anaemia (autoimmune = rbc in blood destroyed so number reduced)
H hypothyroidism
causes of macrocytic anaemia (2 types)?
megablastic: impaired dna synthesis = prevents cells from dividing normally = instead grows abnormally large
caused by: b12 & folate deficiency
normoblastic caused by: toxins eg. chemo and alcohol, hypothyroidism, liver disease, drugs, reticulocytosis (increase in baby rbc)
symptoms of anaemia?
fatigue, shortness of breath, headaches, dizziness, heart palpitations
iron deficiency specific = pica, hair loss
signs of anaemia (plus specific types)?
pale, tachycardia, increase resp rate, conjunctival pallor
iron deficiency = koilonychia (spoon shaped nails), angular chelitis (sore corners of mouth), strophic glossitis (smooth tongue due to atrophy of papillae), brittle hair and nails
haemolytic = jaundice
thalassaemia = bone deformities
initial and further investigations for anaemia?
initial: haemoglobin, MCV, B12, Folate, Ferritin, blood film
further: oesophago-gastroduodenoscopy (OGD), colonoscopy (to investigate gastrointestinal cause aka cancer if unexplained iron deficiency)
bone marrow biopsy if cause unclear
examples for causes of iron deficiency?
insufficient dietary iron (common in growing children)
iron requirements increase eg. pregnancy
iron is being lost eg. slow bleeding from oesophagitis, gastritis, GI tract cancer, menstruation (menorrhagia - heavy periods)
inadequate iron absorption eg. conditions resulting in inflammation of duodenum or jejunum (coeliac, crohns), medication which reduces stomach acid such as PPI
stomach acid is required to keep iron in soluble ferrous Fe2+ form
how do we calculate transferrin saturations and how is it useful?
iron travels in blood as ferric ions Fe3+ bound to carrier proteins called transferrin
total iron binding capacity is the total space on transferrin for molecules to bind
TIBC can be used as a marker for how much transferrin is in the blood (easier than measuring it directly)
transferrin saturation = serum iron / total iron binding capacity
TS - indicator of total iron in body
transferrin levels increase in iron deficiency and decrease in iron overload
can temporarily increase after eating a meal rich in iron
normal serum iron = 12-30 umol/L
normal TIBC = 45-80 umol/L
normal saturation = 15-50%
indication of high/low/normal ferritin levels?
ferritin = form that iron takes when deposited/stored in cells
high levels: extra is released during inflammation eg. infection or cancer
low levels: indicate iron deficiency
normal: can still be deficient (could be raised due to infection, supplements or acute liver damage)
normal = 41-400 ug/L
treatment for iron deficient anaemia?
- blood transfusion - immediate correction of anaemia but not of iron deficiency cause (has risks)
- iron infusion eg. cosmoFer - small risk of anaphylaxis but corrects iron def quickly, avoid during sepsis as feeds bacteria
- oral iron eg. ferrous sulphate - slow correction of iron def, causes constip & black stools (doesn’t work for malabsorption)
wtf is pernicious anaemia?
parietal cells of stomach produce intrinsic factor protein (essential for absorption of vit B12 in ileum)
PA is an auto immune conditions where antibodies form against the parietal cells or intrinsic factor = this prevents B12 absorption and leaves patient B12 deficient
neurological symptoms of pernicious anaemia?
peripheral neuropathy (nerves in body’s extremities are damaged) with numbness or paraesthesia (pins and needles) loss of vibration sense or proprioception mood or cognitive changes visual changes
how to diagnose pernicious anaemia?
test for intrinsic factor antibody (first line)
test off gastric parietal cell antibody (less helpful)
wtf are lymphomas ?
group of cancers which affect lymphocytes inside the lymphatic system, cancerous cells proliferate (increase rapidly) within lymph nodes causing lymphadenopathy (nodes become abnormally large)
2 main categories: hodgkin’s (specific disease) and non-hodgkin’s (encompasses all other lymphomas)
wtf is hodgkin’s lymphoma? + RF & presentation
1/5 lymphomas are hodgkin’s caused by proliferation of lymphocytes
bimodal age distribution - peaks at 20 and 75 yrs
RF: HIV, Epstein-Barr virus, family history, autoimmune conditions eg. rheumatoid arthritis and sarcoidosis (inflam in lungs and lymph nodes)
presentation: lymphadenopathy key presenting symptom (could be in neck, axilla - armpit, inguinal area - groin)
nodes are non-tender and rubbery, some feel pain when consuming alcohol
B symptoms are systemic symptoms: fever, weight loss, night sweats
others: fatigue, itching, cough, shortness of breath, abdominal pain, recurrent infections
investigate and manage hodgkin’s lymphoma?
investigate:
lactate dehydrogenase (LDH) blood test is often raised but not specific to lymphoma (can be raised in other cancers)
lymph node biopsy is key diagnostic test
reed-sternberg cell = key finding from biopsy, abnormally large B cells that have multiple nuclei with nucleoli inside them (appear like face of an owl)
CT, MRI, PET scans
manage: chemo and radiotherapy (aim to cure condition, is usually successful but risk of relapse, side effects and haematological cancers)
chemo - risk of leukaemia and infertility
radio - risk of cancer, tissue damage, hypothyroidism
what is ann arbor staging ? (lymphoma)
used for both hodgkins and non-hodgkins lymphoma - are affected nodes above or below the diaphragm ?
stage 1: confined to one region of lymph nodes
stage 2: in more than one region but on same side of diaphragm
stage 3: affects nodes above and below diaphragm
stage 4: widespread involvement including non-lymphatic organs eg. lungs, liver
wtf is non-hodgkins lymphoma ? + types & RF
group of lymphomas (almost endless types) including:
burkitt lymphoma - associated with epstein barr virus , malaria, HIV
MALT lymphoma - affects mucosa-associated lymphoid tissue (around stomach), associated with H.pylori
diffuse large B cell lymphoma - rapidly growing painless mass in patients over 65
RF: HIV, Epstein-Barr virus, H.pylori, hep B or C, exposure to pesticides or specific chemical trichloethylene (used in industrial processes), family history
non-hodgkins lymphoma presentation and management ?
similar presentation to hodgkins (often only differentiated when lymph node is biopsied)
manage: watchful waiting, chemo, radiotherapy, stem cell transplantation, monoclonal antibodies eg. rituximab
