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Haem Flashcards

1
Q

Define anaemia.

A

Low haemoglobin concentration due to reduced cell mass, or increased plasma volume

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2
Q

Give 4 causes of macrocytic anaemia

A

B12/folate deficiency
Alcohol excess/ liver disease
Hypothyroidism
Reticulocytosis

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3
Q

Give 2 causes of megaloblastic macrocytic anaemia.

A

Folate deficiency

B12 deficiency

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4
Q

What mutation is the philadelphia chromosome?

A

A translocation of part of chromosome 9 to chromosome 22.

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5
Q

What distinguished Hodgkin’s Lymphoma from NHL?

A

Reed-Sternberg cells

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6
Q

What electrolyte abnormalities are seen in tumour lysis syndrome?

A

Hypocalcaemia, hyperkalaemia, hyperuricaemia, hyperphosphataemia

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7
Q

What is tumour lysis syndrome?

A

Electrolyte and metabolite abnormalities that occur after starting cancer treatment

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8
Q

Why does tumour lysis syndrome occur?

A

The rapid breakdown of large numbers of cells released electrolytes

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9
Q

What is the treatment of tumour lysis syndrome?

A

IV fluids
Allopurinol - to reduce uric acid
Phosphate binder - aluminium hydroxide
Dialysis for electrolyte rebalance

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10
Q

What would confirm acute lymphoid leukaemia on a blood film?

A

More than 20% blast cells

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11
Q

Why does febrile neutropenia occur?

A

Complication of cancer treatment

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12
Q

What is the criteria for the diagnosis of febrile neutropenia?

A

Fever >38

Absolute neutrophil count < 1

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13
Q

Why do patients with myeloma experience bone loss?

A

Myeloma leads to the release of cytokines that stimulate osteoclasts and inhibit osteoblasts

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14
Q

What is rituximab used to treat?

A

Chronic lymphocytic leukaemia, some non-Hodgkin lymphomas

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15
Q

What type of drug is rituximab?

A

Monoclonal antibody

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16
Q

What receptor does rituximab target?

A

CD20 proteins on the surface of B cells

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17
Q

What is the most common cause of B12 deficiency?

A

Pernicious anaemia

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18
Q

What tests can be done for pernicious anaemia?

A

Intrinsic factor levels and parietal cell antibodies

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19
Q

How long do stores of vitamin B12 last?

A

2-5 years

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20
Q

What is the most common cell of origin for NHL?

A

B cells

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21
Q

What symptoms are seen in hypocalcaemia?

A

Mnemonic - CATs go numb

C - convulsions
A - arrhythmias
T - tetany (muscle spasms)

Numbness
Prolonged QT

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22
Q

What signs are seen in hypocalcaemia?

A

Chovstek’s sign and Trosseau’s sign

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23
Q

What is Chovstek’s sign?

A

A twitch of the facial muscles when touching a patient’s cheek (in front of the ear)

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24
Q

What is Trosseau’s sign?

A

Flexion of the wrist when a blood pressure monitor is inflated

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25
Q

What blood results are seen in haemolytic anaemia?

A

Decreased haptoglobin
Normocytic anaemia
Increased reticulocytes

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26
Q

What kind of anaemia can G6PD deficiency cause?

A

Haemolytic anaemia - normocytic anaemia

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27
Q

Give 4 causes of polycythemia.

A

JAK2 mutation, alcohol, living at altitude, obstructive sleep apnoea

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28
Q

Which cause of polycythemia is a primary cause?

A

JAK2 mutation

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29
Q

What condition are auer rods associated with?

A

Acute myeloid leukaemia

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30
Q

What is the treatment of uncomplicated malaria?

A

Oral hydroxychloroquine + primaquine

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31
Q

What is black water fever?

A

A complication of malaria as a result of haemolysis

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32
Q

What is seen in blackwater fever?

A

Dark urine

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33
Q

What is the first line treatment for severe malaria?

A

IV artesunate

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34
Q

What changes would be seen on a blood film in iron deficiency anaemia?

A

Hypochromic red blood cells, microcytic cells

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35
Q

What type of anaemia is chronic disease associated with?

A

Microcytic or normocytic

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36
Q

What is the most common form of anaemia?

A

Iron deficiency anaemia

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37
Q

What is the first line treatment of iron deficiency anaemia?

A

Oral iron supplements

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38
Q

What is sideroblastic anaemia?

A

Anaemia where the body produces enough iron but is unable to incorporate it into haemoglobin

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39
Q

What is the first line treatment of sideroblastic anaemia?

A

Pyridoxine (vitamin B6)

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40
Q

What medication is used as prophylaxis for sickle cell crisis?

A

Hydroxycarbamide

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41
Q

What are xanthoma?

A

Fatty yellow spots under the eyes

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42
Q

What is the precursor condition to myeloma?

A

MGUS (monoclonal gammopathy of undetermined significance)

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43
Q

What blood and urine results would be seen in myeloma?

A

Blood - roleaux formation of RBCs

Urine - Bence-Jones proteins

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44
Q

What is the most common cause of polycythemia rubra vera?

A

JAK2 mutation

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45
Q

Give 4 symptoms of polycythemia rubra vera.

A

Itching
Haemorrhage
Thrombosis
Dizziness

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46
Q

What condition are Heinz bodies seen in?

A

G6PD deficiency

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47
Q

How is G6PD deficiency inheritied?

A

X-linked recessive

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48
Q

What enzyme is deficient in Gilbert’s syndrome?

A

UDP glucoronosyltransferase

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49
Q

When is jaundice typically seen in Gilbert’s syndrome?

A

Current infection, exercise or fasting

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50
Q

What is the treatment for normocytic anaemia or anaemia of chronic disease?

A

EPO injection

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51
Q

What treatment options are there for vitamin B12 deficiency?

A

Oral B12, IM hydroxocobalamine

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52
Q

What drug is contraindicated in G6PD deficiency?

A

Nitrofurantoin

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53
Q

What condition are bite cells associated with?

A

G6PD deficiency

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54
Q

Give 4 causes of thrombocytopenia.

A

Myeloma
Heparin
Toxins (including alcohol)
Viral infection (e.g HIV, TB)

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55
Q

What age is CML commonly seen?

A

40-60

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56
Q

What age group is CLL seen in?

A

Elderly

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57
Q

What age typically are myeloma patients?

A

> 70

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58
Q

What is the gold standard test for sickle cell anaemia?

A

Hb electrophoresis

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59
Q

What is the first line treatment of chronic myeloid leukaemia?

A

Tyrosine kinase inhibitor

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60
Q

Give an example of a tyrosine kinase inhibitor

A

Imatinib

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61
Q

What is the first line treatment of myeloma?

A

VAD chemotherapy

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62
Q

What makes up VAD chemotherapy?

A

Vincristine
Adriamycin
Doxorubicin

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63
Q

What is the pathophysiology of hereditary spherocytosis?

A

A defect in the red cell membrane make the cell more permeable to sodium ions

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64
Q

What is the infective stage of malaria?

A

Sporozoites

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65
Q

What happens after a person is infected with malaria?

A

The sporozoites are transported to the liver and mature into schizonts

66
Q

What happens after sporozoites have matured into schizonts?

A

The schizonts rupture and release merozoites

67
Q

What are trophozoites?

A

The form of malaria found after merozoites infect the red blood cells of its host

68
Q

What are auer rods associated with?

A

Acute myeloid leukaemia

69
Q

What are roleaux formation RBCs associated with?

A

Multiple myeloma

70
Q

What type of cells is ALL associated with?

A

Blast cells

71
Q

What are smudge cells associated with?

A

Chronic lymphocytic leukaemia

72
Q

What is the action of tyrosine kinase inhibitors?

A

Inhibits replication of eosinophils, basophils and neutrophils

73
Q

What condition are Howell-Jolly bodies seen in?

A

Hyposplenism

74
Q

How long is a course of apixaban in provoked DVT?

75
Q

How long is a course of apixaban in unprovoked DVT?

76
Q

What is a poor prognostic factor in ALL?

A

High white cell count

77
Q

What chemotherapy treatment is used in Hodgkin’s lymphoma?

A

ABVD chemotherapy

78
Q

What gene is associated with myeloma?

79
Q

In which type of lymphoma is the affected lymph node sore after drinking alcohol?

A

Hodgkin’s lymphoma

80
Q

What condition are Kayser-Fleischer rings found in?

A

Wilson’s disease

81
Q

Which clotting factor is deficient in haemophilia A?

A

Factor VIII

82
Q

What is the inheritance pattern of haemophilia A?

A

X-linked recessive

83
Q

What clotting factor is deficient in haemophilia B?

84
Q

What is deficient in beta thalassemia?

A

Beta haemoglobin

85
Q

What is HbA2?

A

Haemoglobin consisting of two alpha chains and two delta chains

86
Q

When is HbA2 increased?

A

In beta thalassemia, to compensate for the lack of HbA

87
Q

What is HbA composed of?

A

Two alpha chains and two beta chains

88
Q

What type of anaemia presents with a low haemoglobin and high reticulocyte count?

A

Sickle cell anaemia

89
Q

What virus has an association with developing Hodgkin’s lymphoma?

90
Q

What is the presentation of haemolytic uraemic syndrome?

A

Thrombocytopenia, anaemia, and kidney failure

91
Q

What can cause haemolytic uraemic syndrome?

A

Shiga toxin from E. coli

92
Q

What type of anaemia is seen in sickle cell disease?

A

Normocytic anaemia - haemolytic anaemia

93
Q

What is cyroprecipitate?

A

A portion of plasma rich in clotting factors

94
Q

What condition is roleaux formation associated with?

95
Q

In which condition are Bence-Jones proteins seen in the urine?

96
Q

What type of cells does myeloma affect?

A

Plasma cells

97
Q

What investigations might be done in myeloma patients?

A

X-ray spine
Serum immunoglobulins
Serum-free light chain assay

98
Q

Where is B12 absorbed?

A

Terminal ileum

99
Q

Where is iron absorbed?

100
Q

Where is folate absorbed?

101
Q

What type of crisis in sickle cell anaemia causes severe pain?

A

Vaso-occlusive crisis

102
Q

Which people are likely to have less severe malaria?

A

Those with sickle cell trait

103
Q

What can trigger a sickle cell crisis?

A

Stress and dehydration due to infection

104
Q

What is the management of a vaso-occlusive crisis?

A

Keep warm
IV fluids
Simple analgesia

105
Q

Name 3 other sickle cell crises (other than vaso-occlusive).

A

Acute chest syndrome
Splenic sequestration crisis
Aplastic crisis

106
Q

What factor deficiency causes haemophilia B?

107
Q

What factor deficiency causes haemophilia A?

A

Factor VIII

108
Q

What type of anaemia is seen in thalasseamia?

A

Microcytic

109
Q

What condition are auer rods associated with?

A

Acute myeloid leukaemia

110
Q

What is the most appropriate investigation for DVT?

A

Well’s score

111
Q

What is the most appropriate investigation if Well’s score is low?

112
Q

What is the most appropriate investigation if Well’s score is high?

A

Doppler ultrasound

113
Q

Give 3 causes of lymphadenopathy.

A

Malignancy
Sarcoidosis
Infection

114
Q

What cells are involved in CLL?

115
Q

What are the FBC findings in CLL?

A
  • Anaemia

- Lymphocytosis

116
Q

What is found on a blood film in CLL?

A

Smear cells/smudge cells

117
Q

What is Richter’s syndrome?

A

Transformation of CLL into Non-Hodgkin’s lymphoma

118
Q

What type of anaemia is commonly seen in colorectal cancer?

A

Iron deficiency anaemia

119
Q

Give three signs of thrombocytopenic purpura.

A

Easy bruising
Purpura
Menorrhagia
Gum bleeding

120
Q

What age group is primary thrombocytopenic purpura commonly seen in?

121
Q

What might primary thrombocytopenic purpura be preceeded by?

A

Infection (chicken pox/measles) or immunisation

122
Q

What is the classic history of secondary thrombocytopenic purpura?

A

Adults, more often seen in women, seen in autoimmune diseases such as SLE and thryoid disease, as well as CLL

123
Q

What is the first line management of thrombocytopenic purpura?

A

Corticosteroids - prednisolone

124
Q

What is the second line management of thrombocytopenic purpura?

A

Splenectomy

125
Q

What are the signs and symptoms of malaria?

A

Signs:

  • Blackwater fever
  • Anaemia
  • Hepatosplenomegaly

Symptoms:

  • Fatigue
  • Sweats/chills
  • Fever
126
Q

What types of malaria can cause relapses?

A

Plasmodium vivax

Plasmodium ovale

127
Q

What chromosomal abnormality is associated with multiple myeloma?

A

Translocation of chromosome 11 to chromosome 14

128
Q

What blood film abnormality is associated with chronic lymphocytic leukaemia?

A

Smudge cells

129
Q

What is the treatment of CLL?

A

Chemotherapy

Rituximab

130
Q

What kind of chemotherapy is used in Hodgkin’s lymphoma?

131
Q

Give 4 symptoms of G6PD.

A

Fatigue, palpitations, shortness of breath, pallor

132
Q

What are bite cells associated with?

A

G6PD deficiency

133
Q

What is the function of G6PD?

A

It protects red blood cells against oxidative damage

134
Q

What makes up the wells score?

A

Previous DVT
Immobility more than 3 days or surgery in last 4 weeks
Clinical signs or symptoms of DVT
Haemoptysis
Malignancy with active treatment in last 6 months

135
Q

Give 3 differentials of polycythemia.

A

Acute dehydration

Chronic hypertension

136
Q

What is the inheritance pattern of haemophilia C?

A

Autosomal recessive

137
Q

What factor is deficient in haemophilia C?

138
Q

What is prothrombin time?

A

A measure of the extrinsic pathway of the coagulation cascade

139
Q

Which factors make up prothrombin time?

A

2, 5, 7 and 10

140
Q

What is activated partial thromboplastin time?

A

Assesses the intrinsic pathway of the coagulation cascade

141
Q

Which factors contribute to the APTT?

A

1, 2, 5, 8, 9, 10, 11, 12

142
Q

What is bleeding time?

A

A laboratory test to assess platelet function

143
Q

What is fibrin degradation products commonly used to diagnose?

A

Disseminated intravacular coagulation

144
Q

What is D-dimer?

A

A breakdown product of crosslinked fibrin

145
Q

What is the treatment of haemophilia?

A

Replace the deficient factor by giving plasma

146
Q

What is the most common cause of microcytic anaemia worldwide?

A

Iron deficiency

147
Q

What is the initial management of haemochromatosis?

A

Therapeutic phlebotomy until ferritin levels come back to normal

148
Q

What is the maintenance management of haemochromatosis?

A

Desferrioxamine

149
Q

What is the level of serum and urine copper in wilson’s disease?

A

High urinary copper

Low serum copper

150
Q

What is ceruloplasmin?

A

The molecule that binds copper to transport it

151
Q

What is the level of ceruloplasmin in wilsons disease?

A

Low ceruloplasmin

152
Q

What condition are bite cells associated with?

A

G6PD deficiency

153
Q

What condition are smudge cells associated with?

A

Chronic lymphocytic leukaemia

154
Q

Give an example of a tyrosine kinase inhibitor.

155
Q

Which factors does the intrinsic pathway include?

A

1, 2, 9, 10, 11, 12

156
Q

Which measure of coagulation corresponds to the intrinsic pathway?

157
Q

Which measure of coagulation corresponds to the extrinsic pathway?

A

Prothrombin time

158
Q

Which factors does the extrinsic pathway include?

A

1, 2, 7, 10

159
Q

What blood investigation will be prolonged in haemophilia?

A

Activated partial prothrombin time

160
Q

What causes normocytic anaemia?

A

Anaemia of chronic disease
Haemolytic anaemia
Aplastic anaemia
Acute blood loss

Random Revision Note Questions (10 decks)

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