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4th year passmed > Haem > Flashcards

Haem Flashcards

1
Q

What are the diagnostic criteria for multiple myeloma?

A

1 major and 1 minor OR
3 minor

Major
Plasmacytoma
30% plasma cells in BM
Raised M proteins in blood or urine

Minor
10-30% plasma cells in BM
Minor elevation of M proteins
Osteolytic lesions
Low antibody levels
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2
Q

What might a raised LDH indicate in the context of anaemia?

A

It suggests cell lysis, so indicates haemolytic anaemia

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3
Q

Which of NSAIDs and hydroxychloroquine cause haemolytic anaemia?

A

NSAIDs

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4
Q

How would you subcategorise causes of acquired haemolytic anaemia?

A

Immune
Autoimmune (e.g. SLE)
Alloimmune - transfusion reaction
Drugs - methyldoxpa

Non-immune
MAHA, TTP, HUS, DIC
Prosthetic valves
PNH
Malaria
Dapsone
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5
Q

What are the stages of Hodgkin’s lymphoma?

A

1 - single lymph node region
2 - Two or more on same side of diaphragm
3 - LNs on both sides of the diaphragm
4 - Extranodal involvement

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6
Q

What is the hallmark histological feature of Hodgkin’s lymphoma?

A

Reed-Sternberg cells

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7
Q

What type of cancer does H pylori cause?

A

Gastric lymphoma (MALT)

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8
Q

What cancer does HTLV1 cause?

A

Adult T cell leukaemia

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9
Q

What cancers does EBV cause?

A

Nasopharyngeal

Hodgkin’s lymphoma

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10
Q

How long should warfarin be given for VTE?

A

Provoked - 3 months

Unprovoked - 6 months

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11
Q

What is the management of a DVT?

A

Staart LMWH or fondaparinux immediately
Vit K within 24 hours
Continue LMWH/fondaparinux until INR reaches 2.0 and bridge with warfarin
Continue warfarin for 3/6 months depending on cause

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12
Q

What is typically seen on blood film of hyposplenism?

A

Howell Jolly bodies

Siderocytes

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13
Q

What does basophilic stippling on a blood film indicate?

A

Lead poisoning

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14
Q

What does roleaux formation on film indicate?

A

Chronic inflammation

Myeloma

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15
Q

What are schistocystes a feature of

A

Haemolytic anaemia

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16
Q

What is the commonest type of Hodgkin’s lymphoma and what is its prognosis (broadly)?

A

Nodular sclerosing

Good prognosis

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17
Q

What is the universal donor of fresh frozen plasma?

A

AB RhD neg - doesn’t have any antiA or antiB

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18
Q

What mutation is associated with polycythaemia rubria vera?

A

JAK2

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19
Q

What blood picture is seen in DIC?

A

Low platelets
Prolonged APTT, PT and bleeding time
FDPs raised
Schistocytes due to MAHA

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20
Q

Which of the following cause an isolated raise in PT?

Warfarin
Aspirin
Heparin

A

Warfarin

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21
Q

Which of the following cause an isolated raise in APTT?

Warfarin
Aspirin
Heparin

A

Heparin

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22
Q

Which of the following cause an isolated raise in bleeding time?

Warfarin
Aspirin
Heparin

A

Aspirin

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23
Q

What should be done if a patient’s Well’s score for DVT is 2 or more?

A

Proximal Doppler USS within 4 hours. If not possible in this time, give LMWH for cover

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24
Q

What is the likely cause of a macrocytic anaemia with hypersegmented neutrophil polymorphs on blood film?

A

Megaloblastic anaemia (so B12 or folate def)

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25
Q

What is the empirical antibiotic management of neutropenic sepsis?

A

Tazocin STAT

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26
Q

What is the pathophysiology of Factor V Leiden?

A

Resistance to activated Protein C -> thrombophilia

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27
Q

What are the blood findings in CML?

A

Raised white cells specifically granulocytes which are present and raised at different stages of maturation
Thrombocytosis

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28
Q

What is the management of CML?

A

Imatinib 1st line
Hydroxyurea
Interferon-alpha

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29
Q

What are the contents of cryoprecipitate and when is it used?

A

Factor 8, fibrinogen, vWf, factor 13

Used for massive haemorrhage and uncontrolled bleeding due to haemophilia, determined by a low fibrinogen level

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30
Q

Haemophilia A causes:

Prolonged PT
Prolonged APTT
Prolonged both?

A

Prolonged APTT

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31
Q

What should be given to patients pre op who have IDA and can’t/won’t tolerate oral iron?

A

IV iron 1g repeated after 1 week

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32
Q

When would you see a decrease in haptoglobin levels?

A

Intravascular haemolysis

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33
Q

What is the most common inherited bleeding disorder?

A

Von Willebrand’s disease

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34
Q

A 15-year-old girl presents with abdominal pain. She is normally fit and well and currently takes a combined oral contraceptive pill. The patient is accompanied by her mother, who is known to have hereditary spherocytosis. The pain is located in the upper abdomen and is episodic in nature, but has become severe today. There has been no change to her bowel habit and no nausea or vomiting. What is the most likely diagnosis?

A

Biliary colic - Hereditary spherocytosis causes chronic haemolysis and subsequent gallstone formation

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35
Q

What are the features of Acute Sickle Chest Syndrome?

A

Dyspnoea, chest pain, pulmonary infiltrates, low Po2

36
Q

Which inherited coagulopathy causes only a mildly elevated APTT?

A

Von Willebrand disease

37
Q

Does tamoxifen have an effect on VTE risk?

A

Yes - increases risk of recurrent VTE

38
Q

What type of anaemia is seen in beta dhal trait?

A

Mildly hypo chromic microcytic anaemia

39
Q

Which type of Hodgkin’s lymphoma has the worst prognosis?

A

Lymphocyte depleted

40
Q

What are each of the following in SCD?

Hb
MCV
Reticulocytes

A

Hb - low
MCV - normal (IV haemolytic)
Reticulocytes - raised

41
Q

Which bleeding disorder commonly causes intra-articular haemarthosis?

A

Haemophilia

42
Q

How does Dabigatran work, and what is its reversal agent?

A

Direct thrombin inhibition

Idracizumab

43
Q

What is the reversal agent for heparin?

A

Protamine

44
Q

What are the features of a non-haemolytic, febrile transfusion reaction - and how is it managed?

A

Patients experience a mild increase in temperate with otherwise no signs.

Manage by slowing the rate of transfusion and with IV paracetamol

45
Q

Disproportionate microcytic anaemia? Think…

A

Beta thalassaemia trait (will have raised HbA2)

46
Q

Which blood product poses the highest risk of an iatrogenic gram +ve septicaemia and why?

A

Platelets - as they are stored at room temperature which ideal for culturing gram positives

47
Q

Which blood product poses the highest risk of an iatrogenic gram neginfection?

A

Packed red cells as they are stored at 4 degrees

48
Q

What haematological complication can phenytoin cause?

A

Aplastic anaemia, often presenting with bleeding gums

49
Q

What is a G-CSF and when is it used?

A

Granulocyte colony stimulating factors such as Filagrastim are used to treat neutropenia particularly in chemo patients

50
Q

What should be given in the event of an anaphylactic reaction to blood transfusion?

A 
Terminate transfusion
IM adrenaline
Antihistamines
Corticoesteroids
Bronchodilators
Supportive care
51
Q

What is the management of post thrombotic syndrome?

A

Graduated compression stockings

52
Q

What should all patients with IDA be screened for and how?

A

Coeliac disease

with an anti-TTG test

53
Q

When should you not prescribe chloramphenicol eye drops?

A

In patients with concurrent BM suppression esp methotrexate

54
Q

How does ITP present?

A

Isolated thrombocytopenia

55
Q

Which NOAC is preferred for patients with renal impairment?

A

Apixaban

56
Q

How often should the PCV vaccine be given to sickle cell patients?

A

Every 5 years

57
Q

Which cell type is a hallmark of CLL?

A

Smear/smudge cells

58
Q

What electrolyte abnormalities are seen in TLS?

A

Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia

59
Q

What is the phosphate in myeloma>

A

Normal/high

60
Q

What should be done for a man with a Hb of 104?

A

Urgent 2WW referral for top and tail (any man with Hb<110)

61
Q

What are the blood findings of Hodgkin’s lymphoma?

A

Normocytic anaemia with eosinophilia

62
Q

What is the transfusion threshold for patients with and without ACS?

A

With - <80

Without - <70

63
Q

What is the mechanism of Dabigatran?

A

Direct thrombin inhibitor

64
Q

What is the mechanism of Rivaroxaban?

A

Direct Xa inhibirore

65
Q

What is the mechanism of Apixaban?

A

Direct Xa inhibitor

66
Q

Where would you see Heinz bodies with schistocytes?

A

G6PD deficiency

67
Q

What are the features lead poisoning?

A 
Abdo pain
Peripheral neuropathy
Fatigue
Constipation
Blue lines on gum margin
68
Q

What test is used to diagnose hereditary spherocytosis?

A

EMA binding test

69
Q

What else should be done for a patient with an unprovoked DVT?

A

Investigate for underlying malignancy and check fo anti-phospholipid antibodies

70
Q

What is seen on blood film in myelofibrosis?

A

Tear drop poikilocytes

71
Q

What translocation is seen in Burrito’s lymphoma?

A

C-myc

72
Q

Normocytic anaemia with low serum iron and low TIBC but raised ferritin indicates/

A

AoCD

73
Q

What haematological malignancy presents with pain on alcohol consumption?

A

Hodgkin’s lymphoma

74
Q

What does irradiating blood products achieve?

A

Depletes T cells to reduce risk of GvHD

75
Q

What is Richter’s transformation?

A

When CLL transforms to a high grade lymphoma such as DLBCNHL making patients acutely unwell

76
Q

What electrolyte abnormality is associated with red cell transfusion?

A

Hyperkalaemia

77
Q

How do you treat an acute haemolytic transfusion reaction?

A

Terminate transfusion
Lots of fluids
Inform lab

78
Q

What effect does Desmopressin have on bleeding times?

A

Reduces it by stimulating release of VWf

79
Q

What is the management of an urticarial transfusion reaction?

A

Temporary cessation of transfusion

Antihistamine

80
Q

What are ‘B’ symptoms and what do they indicate?

A

Weight loss >10% in 6 months
Fever > 38
Night sweats

Indicates poor prognosis

81
Q

What is the commonest form of lymphoma in the UK?

A

DLBCL

82
Q

EPO is normal in polycythaemia RV or 2ary?

A

RV

83
Q

What type of cancer can myelosysplasia progress to?

A

AML

84
Q

When would you see Bite Cells?

A

G6PD def

85
Q

What must you be aware of in patients with both B12 and folate deficiency?

A

Replace B12 first so as to avoid SACDC

86
Q

What condition is associated with thymomas?

A

Myasthenia graves

4th year passmed (28 decks)

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