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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
Malaria signs and symptoms
Acute severe headache Fever Malaise Diarrhoea Myalgia Recent travel
26
Malaria investigations
FBC: low Hb, platelets, high BR U&E Venous lactate Blood culture HIV Thick and thin blood film for malaria parasite
27
Malaria management
Complicated: IV Artesunate Uncomplicated: artemether + lumefantrine 3/7 Primaquine to prevent relapse
28
Thalassaemia management
Blood transfusion, iron chelation to prevent overload Bone marrow transplant Hydroxyurea
29
Aplastic anaemia
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
Sideroblastic anaemia
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
Autoimmune haemolytic anaemia
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
ACD
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
Disseminated intravascular coagulation
Causes: Malignancy Sepsis Diagnosis: Low platelet, fibrinogen High PT, APTT High D dimer Management: Treat underlying Ventilation FFP, cryoprecipitate, platelets
34
Chronic leukaemia
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
Acute leukaemia
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
Non-Hodgkin lymphoma symptoms and subtypes
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
Lymphoma investigations
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
Polycythaemia signs and symptoms
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
Polycythaemia investigations
High haematocrit or Hb High WCC High platelets Bon marrow biopsy: fibrosis
40
Polycythaemia management
Phlebotomy for autologous donation in spent phase Myelosuppressive: hydroxyurea, ruxolitinib (JAK2i) Antihistamines Aspirin
41
Leukaemia investigations
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
Causes of high or low reticulocyte count in anaemia
High: Haemolytic crisis Haemorrhage Low: Parvovirus B19 Aplastic crisis (sickle cell) Blood transfusion

Y3 (9 decks)

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