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Y3 > Haem > Flashcards

Haem Flashcards

1
Q

Microcytic anaemia causes

A

Iron deficiency: blood loss(GI, menstrual), diet, pregnancy

ACD: TB/HIV, malignancy, RA or other AI disorders

Thalassaemia: beta if H2A2 raised

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2
Q

Microcytic anaemia investigations

A

Ferritin: low in IDA, high in ACD
Transferrin: high in IDA, low in ACD
ESR: high in ACD

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3
Q

Iron deficiency anaemia management

A

Oral ferrous sulfate

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4
Q

Macrocytic anaemia causes

A

Alcohol

Myelodysplasia

Hypothyroidism

Liver disease

Folate deficiency: diet, coeliac, pregnancy
B12 deficiency: veganism, gastrectomy, Crohn’s, pernicious anaemia

Haemolytic anaemia: autoimmune, SCA, G6PD deficiency

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5
Q

Folate and B12 deficiency management

A

Treat B12 first or at the same time as folate

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6
Q

Haemophilia signs and symptoms

A

Haemarthrosis
Superficial cuts do not bleed
Bleeding into deep tissue, muscle, joints

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7
Q

Haemophilia investigations

A

PT: high if factor VII
APTT: high if factors VIII, IX, XI, XII
Both raised: liver disease, anticoagulants, DIC, dilution after transfusion

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8
Q

Haemophilia management

A

Factor concentrates
FFP: all factors
Cryoprecipitate: fibrinogen

Bispecific antibodies for haemophilia A
Desmopressin increases VWF and factor VIII

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9
Q

Thrombocytopenia signs and symptoms

A

Prolonged bleeding from cuts
Easy bruising
Petechiae (blanches): thrombocytopenia
Purpura (no blanch): platelet/vascular disorder

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10
Q

Thrombocytopenia investigations

A

Platelet count
PT
APTT

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11
Q

Thrombocytopenia management

A

Splenectomy if ITP
Stop antiplatelets
Immuno suppression if autoimmune
Replace platelet

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12
Q

Choice of anticoagulant

A

Mechanical heart valve: warfarin

Pregnancy: LMWH

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13
Q

Sickle cell crisis signs and symptoms

A

Chest pain
Pyrexia

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14
Q

Sickle cell crisis investigations

A

FBC
Blood cultures

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15
Q

Sickle cell crisis management

A

Opiate analgesia
Paracetamol/NSAID
Fluids (oral if possible)
Hydroxyurea (reduces frequency of crises)

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16
Q

AML investigations

A

Bone marrow aspirate
Bone profile (Ca, PO4)
ECG (hyperK+)
Urate (tumour lysis syndrome)

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17
Q

Tumour lysis syndrome management

A

Allopurinol OR rasburicase
IV fluid
Monitor renal function, Ca, PO4

18
Q

CLL signs and symptoms

A

Elderly
Lymphadenopathy
Lymphocytosis
Hepatosplenomegaly

19
Q

CLL management

A

Bone marrow transplant if young
Vaccination
Prophylactic antibiotics
Splenectomy

20
Q

Myeloma signs and symptoms

A

CRAB:
Hypercalcaemia (stones, abdo discomfort)
Renal failure
Anaemia (tiredness)
Bone disease (?back pain)

21
Q

Myeloma investigations

A

Ca > 2.7mmol/L
Bence-Jones proteins > 6mg/dL
FBC: pancytopenia
Protein electrophoresis: monoclonal IgG band
Serum free light chain
Bone marrow aspirate: >30% plasma cells
LFT: normal ALP
Whole body MRI

22
Q

Myeloma management

A

Treat hypercalcaemia:
Hydration (oral/IV)
Bisphosphonate
Stop thiazide diuretics and calcium/vit D drugs
Steroids
Consider calcitonin and haemodialysis

Myeloma:
Chemo (not curative)
Radiotherapy if plasmacytoma causing spinal cord compression
Mel phalanx to kill myeloma cells
Bone marrow transplant

23
Q

Hodgkin lymphoma symptoms and subtypes

A

Causes:
HIV
EBV

Features:
Spreads contiguosly
Rarely extranodal
Reed-sternberg cells - multinucleated
Hodgkin cells - large, mononuclear

Classical HL:
1. Nodular sclerosis(commonest) - lacunar cells and neoplasticism cells surrounded by collagen
2. Mixed cellularity
3. Lymphocyte rich (best prognosis)
4. Lymphocyte depleted (rare)
Symptoms - painless cervical lymphadenopathy, mediastinal(nodular sclerosis), fever+night sweats+weight loss

Nodular lymphocyte predominant HL:
More common in men
Express CD20 and CD45
No CD15 and CD30
Popcorn cells
Symptoms - only a few cervical lymph nodes

24
Q

Lymphoma management

A

Chemo
Radio
Rituximab if CD20/nodular lymphocyte predominant HL

Acyclovir (HSV)
Co-trimoxazole (PSP)
Allopurinol (TLS)

25
Q

Malaria signs and symptoms

A

Acute severe headache
Fever
Malaise
Diarrhoea
Myalgia
Recent travel

26
Q

Malaria investigations

A

FBC: low Hb, platelets, high BR
U&E
Venous lactate
Blood culture
HIV
Thick and thin blood film for malaria parasite

27
Q

Malaria management

A

Complicated: IV Artesunate
Uncomplicated: artemether + lumefantrine 3/7

Primaquine to prevent relapse

28
Q

Thalassaemia management

A

Blood transfusion, iron chelation to prevent overload
Bone marrow transplant
Hydroxyurea

29
Q

Aplastic anaemia

A

Pancytopenia:
Anaemia->chest pain, SOB
Thrombocytopenia->bruising, bleeding
Leukocytopenia->infections

Causes:
Chemo, toxins
drugs->sulphonamides, PTU
Infection->EBV
Fanconi’s anaemia

Treatment:
<50 - stem cell transplant
>50 - immunosuppression w/ ciclosporin/steroids, transfusion

30
Q

Sideroblastic anaemia

A

Causes:
Congenital -> X linked (mainly males affected)
Excess alcohol
Vit B6/iron/folate deficiency
Lead poisoning

Signs&Symptoms:
Fatigue
Heart/liver damage
Splenomegaly
Kidney failure
Diarrhoea

Blood smear findings:
Basophilic stippling
Pappenheimer bodies

Bloods:
MCV -> normal/low congenital, normal/high acquired
Iron high
Ferritin high
Total iron binding capacity low

Management:
toxin removal
Thiamine/folate/pyridoxine
Iron chelation (deferoxamine)
Severe->bone marrow/liver transplant

31
Q

Autoimmune haemolytic anaemia

A

Normocytic
High LDH
Intravascular:
Dark urine
Gallstones
Jaundice
Haemoglobinuria

Warm:
More common
>37 degrees
IgG
Caused by idiopathic, beta lactams, viral infection, lymphoma, leukaemia

Cold:
Rare
<10 degrees
IgM
Happens in liver -> extravascular
Chronic caused by lymphoma/leukaemia
Acute(children) caused by viral pneumonia, mycoplasma, infectious mononucleosis

Diagnosis:
Direct Coomb’s test

Treatment:
Transfusion if Hb<7
Warm -> steroids, splenectomy, immunosuppression
Cold -> no treatment
Severe -> plasmapheresis to remove antibodies

32
Q

ACD

A

Causes:
Infections
Diabetes
Malignancy
Autoimmune

TNFa and IFNg reduce EPO production
IL-6 causes liver to produce more hepcidin

Diagnosis:
Low Hb, MCV, transferrin
High ferritin, hepcidin

Management:
Treat underlying

33
Q

Disseminated intravascular coagulation

A

Causes:
Malignancy
Sepsis

Diagnosis:
Low platelet, fibrinogen
High PT, APTT
High D dimer

Management:
Treat underlying
Ventilation
FFP, cryoprecipitate, platelets

34
Q

Chronic leukaemia

A

Presentation:
Anaemia
Thrombocytopenia
Leukocytopenia

CML:
Granulocytes divide too quickly
Philadelphia chromosome (9 & 22)
Hepatosplenomegaly
Division -> mutation -> blast crisis

CLL:
B cells don’t die
Lymphadenopathy
Can result in autoimmune haemolytic anaemia

Management:
Chemo
Stem cell transplant
Bone marrow transplant
Imatinib (CML)

35
Q

Acute leukaemia

A

AML:
Commoner in elderly
Can be caused by myelodysplastic syndrome, Down syndrome, radiation
Can cause DIC
Gum swelling

ALL:
Commoner in children
Translocation 12&22 or Philadelphia chromosome, Down syndrome, radiation
Can be T cell or B cell
Hepatosplenomegaly and lymphadenopathy
Thymus enlargement

Management:
Chemo
Biological therapy
Stem cell transplant
Bone marrow transplant
ATRA for acute promyelocytic leukaemia

36
Q

Non-Hodgkin lymphoma symptoms and subtypes

A

B cell lymphomas:
1. Diffuse large B cell lymphoma
Most common
Aggressive
2. Follicular lymphoma
Indolent
Translocation 14 & 18
3. Burkitt lymphoma
Highly aggressive
Translocation 8 & 14
Extranodal abdo involvement
Associated with EBV in Africa
Starry sky sign on blood film
4. Mantle cell lymphoma

T cell lymphomas:
1. Adult T cell lymphoma (leukemia)
HTLV infection
2. Mycosis fungoides
Affects skin
Cerebriform nucleus on blood film
Sezary syndrome - red rash/itchy skin

Symptoms:
Painless lymphadenopathy
Fever, night sweats, weight loss
Extranodal involvement - GI tract (bowel obstruction), bone marrow (pancytopenia), spinal cord (sensory loss)

37
Q

Lymphoma investigations

A

CT scan for staging
Lymph node biopsy

Starry sky sign - Burkitt lymphoma
Reed sternberg cells - HL
Lacunar cells surrounded by collagen - nodular sclerosis classical HL
Popcorn cells - nodular lymphocyte predominant HL

38
Q

Polycythaemia signs and symptoms

A

Increased sweating
Redness in face
Itchiness after a hot shower (histamine release)
Splenomegaly
Gout/kidney stones (urate)
More prone to blood clots: stroke, MI, DVT, Budd-Chiari syndrome

39
Q

Polycythaemia investigations

A

High haematocrit or Hb
High WCC
High platelets
Bon marrow biopsy: fibrosis

40
Q

Polycythaemia management

A

Phlebotomy for autologous donation in spent phase
Myelosuppressive: hydroxyurea, ruxolitinib (JAK2i)
Antihistamines
Aspirin

41
Q

Leukaemia investigations

A

Blood film:
AML - blast cells + auer rods
ALL - blast cells
CML - raised granulocytes & monocytes
CLL - smudge cells

Immunophenotyping (acute)

Bone marrow biopsy: >20% blast cells (acute)

42
Q

Causes of high or low reticulocyte count in anaemia

A

High:
Haemolytic crisis
Haemorrhage

Low:
Parvovirus B19
Aplastic crisis (sickle cell)
Blood transfusion

Y3 (9 decks)

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