Haem Flashcards
Acute Myeloblastic Leukaemia (AML)…
Diagnostic blood film has?
Treatment?
Auer Rods
Presents as pale child who is lethargic with a history of recurrent infections and a new onset bruise across trunk.
Numerous blasts in bone marrow are seen on blood film
Diagnosis?
Management?
Diagnosis - Acute lymphoblastic leukaemia (ALL)
Management - Pegaspargase
70 year old male presents with tiredness, weight loss and night sweats. His bloods reveal a very high neutropenia and genetic testing reveals a Philadelphia chromosome.
Diagnosis?
Management?
Diagnosis - Chronic Myeloid Leukaemia (CML)
Management -
56 year old female presents comes in for routine bloods which finds lymphocytosis. No PMH, and feels okay in herself.
Diagnosis?
What cells would be seen on blood film?
Management?
Chronic Lymphoblastic leukaemia (CLL)
Smudge cells seen on blood film
Management -
Associated immune thrombocytopenia Purpura (ITP)
Which is the most common leukaemia in children?
ALL
35 year old male presents with rapidly enlarging lump on neck, fever, drenching night sweats and weight loss. His PMH includes HIV and T1DM.
Diagnosis?
Management?
Burkitts lymphoma
Management -
35 year old Afro-caribbean male presents with fever, drenching night sweats, weight loss and back pain. His PMH asthma which is well controlled.
Diagnosis?
What markers would be found in further investigations?
Management?
Diagnosis - Multiple myeloma
Marker - Bence jones proteins
Management -
ITP
How does it present?
Diagnosis?
Management?
Antibodies are created against platelets
Presents as:
- Nose and gum bleeds
- Isolated low platelets (thrombocytopenia)
- purpuric rash
Diagnosed - urgent FBC to find isolated thrombocytopenia
Mx Usually will resolve itself if mild/no symptoms If platelets < 10 or severe symptomatic - Prenisolone - IV immunoglobulins - Rituximab - Splenectomy
TTP
How does it present?
Management?
- Tiny blood clots throughout small vessels
- Deficiency in ADAMTS13 protein
- Presents after a viral infection
Presents as haemolytic anaemia
Mx
- Steroids
- Plasma exchange
- Rituximab
Monitoring
Warfarin
Heparin
PT
APTT
DIC
How do you managed DIC?
Low platelets Low fibrinogen APTT is up PT is up D dimer is up
Mx - Treat underlying cause
- Cross match - if sepsis/infection - Do Sepsis 6
What factors does warfarin act on?
2, 7, 9, 10
TACO
What complication from transfusion?
Transfusion associated circulatory overload
Due to excessive rate of infusion
Stop transfusion
Give furosemide if overloaded
Antiphospholipid syndrome
Presentation
Management
Recurrent miscarriages
Hypercoaguable state
Warfarin then enoxaparin if preggers
How low do platelets need to be for transfusion?
Under 30
Unless bleeding from CSF site (then under 100)
Macrocytic anaemia
Megaloblastic
Non-megaloblastic
Megaloblastic - Vit B12 & Folate deficiency
Pernicious anaemia - loss of the intrinsic factors - unable to absorb Vit B12
Linked to damage small bowel (autoimmune)
Mx - hydroquthalamine
Normocytic anaemia causes
Alcohol Hyperthyoridism Liver disease Drugs Anaemia of Chronic Disease
Types of Haemolytic anaemias
Hereditary Spherocytosis
Thalasaemia
Sick cell anaemia
G6PD deficiency
Hereditary Spherocytosis
Presents as…
Diagnosis?
Management?
Autosomal dominant
Causes sphere shaped RBC that are easily broken down when passing through spleen
Presents as:
- Aplastic crisis in Parvovirus
- Jaundice, gallstones, splenomegaly
Dx - spherocytes on blood film
- high reticulocyte count - raised unconjugated bilirubin
Mx - folate supplements & splenectomy
Thalassemia
Presents as…
Diagnosis?
Management?
Autosomal recessive
Genetic defect in protein chains that make Hb
Alpha Thal - Chromosome 16, Beta thal - Chromosome 11
Fatigue, Pallor, Jaundice, Splenomegaly, Poor growth
Pronounced forehead & molar eminences
Dx - FBC - microcytic anaemia
Hb electrophoresis
DNA testing
Mx - Regular iron transfusions, iron chelation & splenectomy
Sickle cell anaemia
Autosomal recessive genetic condition causes RBC to be present shaped
Dx
- newborn screening heel prick
- schisotocytes on blood film
Mx - Antibiotic prophylaxis
- Hydroxycarbamide
- blood transfusion
- DEFINITIVE: bone marrow transplant
G6PD deficiency
X -linked recessive condition where the enzyme G6PD is deficient
More common in Med or African patients
Presents as jaundice (in neonatal period), gallstones, anaemia, splenomegaly and HEINZ bodies on blood film
Dx - G6PD enzyme assay
Mx - Remove the trigger
Exam style question: patient who turns jaundice and anaemia after eating broad beans/developing infection/being treated with antimalarials
