Haem Flashcards
1
Q
what is polycythaemia vera
A
myeoloproliferative disorder causing excessive cell production
2
Q
what gene mutation is associated with polycythaemia vera
A
JAK2 mutation
3
Q
3 features of polycythaemia vera
A
- pruritus after hot bath
- splenomegaly
- hyperviscosity
4
Q
bloods for polycythaemia vera
A
- FBC (high haematocrit)
- ESR
- U&Es & LFTs
- JAK2 mutation
5
Q
how do you investigate polycythaemia if JAK2 negative
A
red cell mass
serum erythropoietin
6
Q
how do you manage polycythaemia vera
A
venesection + aspirin
7
Q
what are the three types of anaemia and how are they classified
A
- microcytic (low MCV)
- normocytic (normal MCV)
- macrocytic (high MCV)
based on MCV
8
Q
list two causes of microcytic anaemia
A
- iron deficiency (most common)
- thalassaemia
9
Q
what are features of a mixed anaemia
A
- iron deficiency features (low ferritin, high TIBC)
- normocytic MCV
10
Q
list four causes of normocytic anaemia
A
- anaemia of chronic disease (hospital)
- aplastic anaemia
- haemolytic anaemia
- CKD (low erythropoietin)
11
Q
what do you see in FBC in aplastic anaemia and what virus is associated with it
A
- pancytopenia
- low reticulocytes
- parvovirus
12
Q
list two causes of megaloblastic anaemia
A
B12 and folate deficiency
13
Q
what are the causes of non-megaloblastic macrocytic anaemia
A
AMHLF (alcoholics may have liver failure)
- alcohol
- myelodysplasia
- hypothyroidism
- liver disease
- folate/B12
14
Q
what are the symptoms of anaemia (Asya’s acronym)
A
PALE
- pallor
- absent minded
- lethargy (tired)
- exertional dyspnoea
15
Q
two signs of severe anaemia
A
tachycardia and tachypnoea
16
Q
what are the three causes of iron deficiency anaemia
A
- reduced uptake
- malnutrition, vegetarian
- coeliac, IBD
- increased loss
- bleed (colon cancer, ulcer NSAIDs)
- menstruation
- increased requirements
- pregnancy
17
Q
3 signs of iron deficiency anaemia
A
- conjuctival pallor
- angular stomatitis
- koilonychia
18
Q
what do you see in the blood film in iron deficiency anaemia
A
- hypochromic cells
- anisopoikilocytosis
- pencil cells
19
Q
what do you see in the bloods in iron deficiency anaemia
A
- low ferritin
- high TIBC
20
Q
what do you want to do for males and post-menopausal females with unexplained iron deficiency anaemia
A
- endoscopy to investigate GI bleed
- 2ww referral to gastroenterologist
21
Q
3 ways to manage iron deficiency anaemia
A
- treat the cause
- oral ferrous sulphate for 3 months
- iron rich diet (dark leafy veg, meat)
22
Q
what causes anaemia of chronic disease
A
- autoimmune, infection
- chronic inflammation decreases ferroportin so less iron uptake and more iron storage
23
Q
what do you see in the bloods in anaemia of chronic disease
A
- high/normal ferritin
- low TIBC
- MCV can be low or normal
24
Q
what is the pathophysiology of haemolytic anaemia
A
- increased red cell breakdown
- increased red cell production
25
how do you classify haemolytic anaemia
based on the site of haemolysis
- intra-vascular (transfusion, G6PD, microangiopathic)
- extra-vascular (haemoglobinopathies, sickle cell)
26
three causes of hereditary haemolytic anaemia
1. enzyme defects (G6PD deficiency)
2. membrane defects (hereditary spherocytosis)
3. haemoglobin issues (sickle cell, thalassaemia)
27
what do you see on the blood film of G6PD deficiency
Heinz bodies
28
what is the pathophysiology and associations of G6PD deficiency
- oxidant damage caused by Fava beans (Heinz beans)
- males only
29
what do you see on the blood film for hereditary spherocytosis
spherocytes
30
what is the pathophysiology of hereditary spherocytosis
round cells get trapped in the spleen
31
what are acquired causes of haemolytic anaemia
- Coombs positive:
- autoimmune
- transfusion reaction
- Coombs negative
- microangiopathic (HUS, DIC, TTP)
32
antibodies associated with warm and cold autoimmune haemolytic anaemia
- warm: IgM
- cold: IgG
33
what are four features of HUS
- thrombocytopenia
- AKI
- haemolysis
- abdominal pain
34
what is the epidemiology and cause of HUS
- children
- E Coli
35
what are the three features of TTP
- HUS
- fever
- CNS issues
36
two specific signs of haemolytic anaemia
- jaundice (dark urine, yellow sclera)
- splenomegaly
37
what are three signs of haemolysis seen in bloods
- high reticulocytes
- high LDH
- high bilirubin
38
what is a sign of intravascular haemolysis seen in bloods
low haptoglobin
39
pathophysiology behind B12 and folate deficiency anaemia
- B12 and folate needed for DNA synthesis
- delayed nuclear maturation compared to the cytoplasm so megaloblastic cells
40
where is folate found and how long does it last in the blood
- green leafy vegetables
- lasts for 4 months
41
4 causes of folate deficiency
- increased requirement (pregnancy)
- malabsorption (coeliac, IBD)
- drugs (methotrexate)
- alcohol
42
where is B12 found and how long does it last in the blood
- meat
- lasts for 4 years
43
2 causes of B12 deficiency
- pernicious anaemia
- vegan
44
what is pernicious anaemia and what is its epidemiology
- autoimmune atrophic gastritis
- most common B12 deficiency
- young females
45
what is a characteristic sign of pernicious anaemia
Lemon tinge skin
46
what are 2 symptoms of B12 deficiency
- glove and stocking paraesthesia
- hyporeflexia
47
what do you see on the blood film of megaloblastic anaemia
hypersegmented neutrophils
48
antibodies for pernicious anaemia
- intrinsic factor (most specific)
- anti-parietal cell
49
how to manage folate and B12 deficiency
- hydroxocobalamin (B12) + folic acid tablets
- prophylactic folate in pregnancy
- always remember to treat B12 before folate
50
what is the treatment for pernicious anaemia
- IM B12 injections
- 3 per week for 2 weeks then every 3 months
51
complication of pernicious anaemia
gastric cancer
52
what is the epidemiology of Hodgkin's lymphoma
bimodal (30 and over 70 yrs)
53
what are 2 associations with Hodgkin's lymphoma
- HIV
- EBV
54
what are the symptoms of Hodgkin's lymphoma
- supraclavicular painless neck lump that's painful after alcohol
- B symptoms: fever, weight loss, night sweats
55
what is the significance of B symptoms in Hodgkin's lymphoma
- they appear later so indicate poor prognosis
56
what are two features seen in the bloods in Hodgkin's lymphoma
- eosinophilia
- high LDH
57
what is the diagnostic investigation and finding for Hodgkin's lymphoma
- lymph node biopsy
- Reed-Stenberg cells (mirror nuclei)
58
what is the management for Hodgkin's lymphoma
chemotherapy
59
what is tumour lysis syndrome and how do you prevent it
- complication of chemotherapy for lymphoma
- high potassium, low calcium
- allopurinol prophylaxis
60
what is the epidemiology for non-Hodgkin's lymphoma
old and white
61
what are 3 associations with non-Hodgkin's lymphoma
- HIV
- EBV
- Sjogren's
62
what are 2 features of non-hodgkin's lymphoma
- painless lump in the neck, axilla
- organ involvement (hepatomegaly)
63
what is seen in the bloods for non-Hodgkin's lymphoma
neutropenia
64
what is a characteristic feature of Burkitt lymphoma
lump in the jaw
65
what is seen in the lymph node biopsy for Burkitt lymphoma
starry sky appearance
66
what is sickle cell disease and what is its epidemiology
- abnormal haemoglobin HbS is fragile so it breaks and gets stuck, blocking vessels
- African, chromosome 11
67
how does sickle cell disease present
- usually asymptomatic
- acute painful crises such as dactylitis from the cold
- sequestration crisis causing splenomegaly
- gallstones due to high bilirubin
68
what do you see in the FBC and blood film for sickle cell disease
- FBC: high reticulocytes
- blood film: Howell Jolly bodies
69
how do you investigate an acute crisis of sickle cell
clinical no investigation needed
70
what is the diagnostic investigation for sickle cell disease
haemoglobin electrophoresis
71
how do you manage an acute painful crisis of sickle cell
- sats: oxygen
- antibiotics
- pain: analgesia
- cannula: fluids
72
what is a long term way to prevent recurrent sickle cell crises
hydroxycarbamide
