Haem Flashcards
Microcytic anaemia causes
Iron deficiency: blood loss(GI, menstrual), diet, pregnancy
ACD: TB/HIV, malignancy, RA or other AI disorders
Thalassaemia: beta if H2A2 raised
Microcytic anaemia investigations
Ferritin: low in IDA, high in ACD
Transferrin: high in IDA, low in ACD
ESR: high in ACD
Iron deficiency anaemia management
Oral ferrous sulfate
Macrocytic anaemia causes
Alcohol
Myelodysplasia
Hypothyroidism
Liver disease
Folate deficiency: diet, coeliac, pregnancy
B12 deficiency: veganism, gastrectomy, Crohn’s, pernicious anaemia
Haemolytic anaemia: autoimmune, SCA, G6PD deficiency
Folate and B12 deficiency management
Treat B12 first or at the same time as folate
Haemophilia signs and symptoms
Haemarthrosis
Superficial cuts do not bleed
Bleeding into deep tissue, muscle, joints
Haemophilia investigations
PT: high if factor VII
APTT: high if factors VIII, IX, XI, XII
Both raised: liver disease, anticoagulants, DIC, dilution after transfusion
Haemophilia management
Factor concentrates
FFP: all factors
Cryoprecipitate: fibrinogen
Bispecific antibodies for haemophilia A
Desmopressin increases VWF and factor VIII
Thrombocytopenia signs and symptoms
Prolonged bleeding from cuts
Easy bruising
Petechiae (blanches): thrombocytopenia
Purpura (no blanch): platelet/vascular disorder
Thrombocytopenia investigations
Platelet count
PT
APTT
Thrombocytopenia management
Splenectomy if ITP
Stop antiplatelets
Immuno suppression if autoimmune
Replace platelet
Choice of anticoagulant
Mechanical heart valve: warfarin
Pregnancy: LMWH
Sickle cell crisis signs and symptoms
Chest pain
Pyrexia
Sickle cell crisis investigations
FBC
Blood cultures
Sickle cell crisis management
Opiate analgesia
Paracetamol/NSAID
Fluids (oral if possible)
Hydroxyurea (reduces frequency of crises)
AML investigations
Bone marrow aspirate
Bone profile (Ca, PO4)
ECG (hyperK+)
Urate (tumour lysis syndrome)
Tumour lysis syndrome management
Allopurinol OR rasburicase
IV fluid
Monitor renal function, Ca, PO4
CLL signs and symptoms
Elderly
Lymphadenopathy
Lymphocytosis
Hepatosplenomegaly
CLL management
Bone marrow transplant if young
Vaccination
Prophylactic antibiotics
Splenectomy
Myeloma signs and symptoms
CRAB:
Hypercalcaemia (stones, abdo discomfort)
Renal failure
Anaemia (tiredness)
Bone disease (?back pain)
Myeloma investigations
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
Myeloma management
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
Hodgkin lymphoma symptoms and subtypes
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
Lymphoma management
Chemo
Radio
Rituximab if CD20/nodular lymphocyte predominant HL
Acyclovir (HSV)
Co-trimoxazole (PSP)
Allopurinol (TLS)
Malaria signs and symptoms
Acute severe headache
Fever
Malaise
Diarrhoea
Myalgia
Recent travel
Malaria investigations
FBC: low Hb, platelets, high BR
U&E
Venous lactate
Blood culture
HIV
Thick and thin blood film for malaria parasite
Malaria management
Complicated: IV Artesunate
Uncomplicated: artemether + lumefantrine 3/7
Primaquine to prevent relapse
Thalassaemia management
Blood transfusion, iron chelation to prevent overload
Bone marrow transplant
Hydroxyurea
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
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
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
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
Disseminated intravascular coagulation
Causes:
Malignancy
Sepsis
Diagnosis:
Low platelet, fibrinogen
High PT, APTT
High D dimer
Management:
Treat underlying
Ventilation
FFP, cryoprecipitate, platelets
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)
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
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)
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
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
Polycythaemia investigations
High haematocrit or Hb
High WCC
High platelets
Bon marrow biopsy: fibrosis
Polycythaemia management
Phlebotomy for autologous donation in spent phase
Myelosuppressive: hydroxyurea, ruxolitinib (JAK2i)
Antihistamines
Aspirin
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)
Causes of high or low reticulocyte count in anaemia
High:
Haemolytic crisis
Haemorrhage
Low:
Parvovirus B19
Aplastic crisis (sickle cell)
Blood transfusion
