haem Flashcards
1
Q
presentations of Hodgkin’s lymphoma?
A
- bimodal
- painless asymmetrical
- pain when drinking alcohol
2
Q
presentations of multiple myeloma?
A
- 70+,
- anaemia,
- bone pain
- neutropenia
- thrombocytopenia (due to bone marrow infiltration), recurrent infections due to monoclonal Igs, renal impairment due to free light chains, pathological fractures and vertebral collapse due to bone lesions
3
Q
what is polycythaemia rubra vera?
A
blood hyper viscosity due to increase in cellular content, causing thrombosis and poor O2 delivery
4
Q
presentations of polycythaemia rubra vera?
A
- thrombosis and poor O2 delivery
- headaches, dizziness, visual disturbances, vertigo, tinnitus, intermittent claudication
5
Q
why is stomach cancer sometimes a differential for lymphomas?
A
can present with Virchow’s node - supraclavicular
6
Q
where are Auer rod’s found?
A
acute myeloid leukaemia
7
Q
where are Reed-Steinburg cells found?
A
Hodgkin’s lymphoma
8
Q
are basophils increased or decreased in chronic myeloid leukaemia?
A
increased
9
Q
describe haemoglobin and platelet count in chronic myeloid leukaemia
A
decreased due to replacement of normal bone marrow cells with cancerous
10
Q
describe Ann Arbor classification for Hodgkin’s and non lymphoma
A
- Single LN region
- > /= 2 nodal area on the same side of the diaphragm
- Nodes on both sides of the diaphragm
- Disseminate e.g. metastasised to the liver
11
Q
where would you find monoclonal antibodies and Bence-Jones proteins?
A
multiple myeloma
12
Q
what would the FBC show for chronic myeloid leukaemia?
A
high WCC; haemoglobin and platelets can be higher or lower
13
Q
list the risk factors of DVT
A
- immobility (e.g. hospital bed, long haul flight)
- dehydration
- oestrogen increase (e.g. pregnancy, OCP)
- obesity (atherosclerosis)
- age
- varicose veins
- surgery
- previous DVT
- trauma
- infection
- malignancy
14
Q
what is the gold standard investigation for DVT?
A
Doppler US
15
Q
when do you use the D-dimer test?
A
suspected DVT - high sensitivity and low specificity; negative - rules out DVT, positive - does not confirm
16
Q
which type of anaemia is reduced reflexes a symptom of?
A
macrocytic anaemia caused by hypothyroidism and vitB12 deficiency
17
Q
which type of anaemia can a vegan diet cause?
A
vit B12 deficiency - macrocytic megaloblastic anaemia
18
Q
how do you differentiate between vit B12 and folate deficiency which both lead to macrocytic, megaloblastic anaemia?
A
vit B12 deficiency may present with neurological symptoms e.g. peripheral neuropathy
19
Q
A patient recently started ceftriaxone for meningitis which has caused haemolysis, what would you expect to see on assessment of the patient?
A
darker urine (haematuria), acute anaemia, jaundice, dyspnoea, fatigue, tachycardia
20
Q
list some causes of iron deficiency anaemia
A
CKD, GI bleed, NSAIDs, pregnancy, colorectal cancer, low dietary intake
21
Q
3 signs and symptoms of immune thrombocytopenia purpura
A
easy bruising, epistaxis, gum bleeding
22
Q
what is immune thrombocytopenia purpura?
A
A condition causing platelets to be destroyed by immune system
23
Q
Name 4 signs you might see on examination of a patients’ face, skin, and nails that are associated with iron deficiency anaemia.
A
angular stomatitis, brittle skin, nails and hair, koilonychia, Atrophic glossitis
24
Q
what signs would you expect to see in a patient when diagnosing malaria?
A
fever, chills/sweats, headache, myalgia, fatigue, diarrhoea, nausea, vomiting, abdominal discomfort, anaemia, jaundice etc
25
what species of protozoa can cause relapses of malaria?
plasmodium ovale and plasmodium vivax - can form hypnozoites in the liver which can lie dormant for years and cause relapses
26
What are the criteria needed to characterise multiple myeloma?
- monoclonal protein in serum or urine
- lytic bone lesions / CRAB end organ damage
- excess plasma cells in bone marrow
27
Which chromosomal abnormalities are associated with multiple myeloma?
t(11;14)
28
What would you expect to see on a bone marrow biopsy for acute myeloid leukaemia?
Auer rods
29
what 2 things are associated with acute myeloid leukaemia?
down's syndrome, radiation
30
5 potential treatments of acute myeloid leukaemia?
blood transfusion, IV antibiotics, chemotherapy, steroids, bone marrow transplant
31
expected age range for chronic lymphoblastic leukaemia?
70+
32
examination findings of chronic lymphoblastic leukaemia?
commonly asymptomatic, enlarged, rubbery, non-tender lymph nodes, sweating, anorexia
33
blood film of chronic lymphoblastic leukaemia?
smudge cells
34
treatment for chronic lymphoblastic leukaemia?
chemotherapy, monoclonal antibodies (rituximab), bruton kinase inhibitors (ibrutinib)
35
main complication of chronic lymphoblastic leukaemia?
Richter's syndrome - transformation of CLL to an aggressive lymphoma
36
what investigations would you do for suspected lymphoma?
FBC, CXR, blood film
37
what would a FBC show for someone with Hodgkin's lymphoma?
anaemia, high ESR
38
what would a CXR show for someone with Hodgkin's lymphoma?
wide mediastinum
39
what would a blood film show for someone with Hodgkin's lymphoma?
Reed-Sternberg cells
40
treatment for Hodgkin's lymphoma?
chemotherapy ABVD treatment, marrow transplant
41
what is the function of G6PD?
protects the RBCs against oxidative damage
42
4 common presentations of G6PD deficiency?
fatigue, palpitations, SOB, pallor
43
What would you see on a blood film for G6PD deficiency?
bite cells, reticulocytes
44
which antibiotic is contraindicated for UTIs with a G6PD deficiency?
nitrofurantoin
45
6 symptoms for acute limb ischaemia?
Pulselessness, Perishingly cold, Pain, Pallor, Paraesthesia, Paralysis
46
complications of DVT?
PE, post-thrombotic syndrome, chronic venous insufficiency
47
first line investigation of DVT?
D-dimer test
48
name of scoring system used in making a diagnosis of DVT?
Well's score
49
list 5 factors in the Well's scoring system for DVT
- clinical S/S of DVT
- HR > 11bpm
- previous DVT or PE
- hemoptysis
- immobilization >/ days or surgery in the previous 4 weeks
50
what is the platelet count for someone with disseminated intravascular coagulation?
low
51
how would prothrombin times change in disseminated intravascular coagulation?
- PTT - elevated
- APTT - elevated
52
how would the bleeding time change in disseminated intravascular coagulation?
elevated
53
what would the levels of fibrin degradation products and fibrinogen levels look like in disseminated intravascular coagulation?
high fibrin degradation products, low fibrinogen
54
what would D-dimer levels look like in disseminated intravascular coagulation?
elevated
55
what would coagulation factor show in disseminated intravascular coagulation?
low
56
explain the pathophysiology of disseminated intravascular coagulation
- Cytokine release in response to a systemic inflammatory response syndrome
- This causes fibrin to be deposited and the initiation of the coagulation pathway
- This causes platelets and coagulation factors to be used up leading to EITHER microvascular thrombosis and organ failure OR bleeding
57
what are the sepsis 6?
BUFALO:
- Blood cultures
- Urine sample
- Fluids
- Antibiotics
- Lactate
- Oxygen
58
Which antibiotic is to be prescribed for the complicated UTI caused by E. coli?
nitrofurantoin or trimethoprim
59
differentials of polycythaemia rubra vera?
acute dehydration, chronic obesity, HTN, alcohol excess
60
typical presentations of polycythaemia rubra vera?
- blurred vision, headaches, SOB, fatigue, weight loss, history of TIA/stroke/angina
- LUQ tenderness, gum bleeding, splenomegaly
61
what would the blood test results show for polycythaemia rubra vera?
- RBC: elevated
- haematocrit: elevated
- haemoglobin count: elevated
- EPO levels: low - normal
62
what mutation may suggest polycythaemia rubra vera?
JAK-2
63
mode of inheritance for haemophilia A?
x linked recessive
64
mode of inheritance for haemophilia B?
x linked recessive
65
mode of inheritance for haemophilia C?
autosomal recessive
66
haemophilia A is a deficiency of what?
factor VIII
67
haemophilia B is a deficiency of what?
factor IX
68
haemophilia C is a deficiency of what?
factor XI
69
define platelet count
level of platelets per microlitre of blood
70
define bleeding time
- lab test to assess platelet function and the body’s ability to form a clot.
- puncture wound is made and time taken for bleeding to stop is monitored
71
define prothrombin time
measures the extrinsic pathway of clotting cascade - the time in seconds required for fibrin clot formation in a blood sample
72
define activated partial prothrombin time
a measure of the functionality of the intrinsic and common pathways of the coagulation cascade.
73
define thrombin time
a screening coagulation test designed to assess fibrin formation from fibrinogen in plasma
74
define fibrin degradation products
a measure of the substances left behind when clots dissolve in the blood
75
define d-dimer
degradation product of crosslinked (by factor XIII) fibrin, reflects ongoing activation of the hemostatic system
76
activated partial thromboplastin time in haemophilia?
increased
77
thrombin time in haemophilia?
normal or increased
78
state 5 presentations of haemophilia
- deep bruising
- pain/swelling of joints
- epistaxis
- bleeds into heads causing headaches/double vision/weakness/vomiting
79
treatment for haemophilia?
replace the missing factor with plasma
80
which clotting factors does disseminated intravascular coagulation affect?
V and VIII
81
what is hereditary spherocytosis?
- defect in RBC membrane causing loss of membrane as they pass through the spleen
- this causes increased Na+ permeability, requiring increased active transport out
- SA:V decreases and cells become spherocytic
82
define spherocytic
rigid and less deformable (than a normal RBC)
83
What is the management for hereditary spherocytosis?
splenectomy
84
describe the appearance of a blood film of a patient with beta thalassaemia major?
Large and small irregular hypochromic RBCs
85
what differentiates to multiple myeloma in a question?
monoclonal antibodies, rouleaux formation and Bence-Jones proteins
86
The most severe form of malaria with the highest rate of mortality in humans is caused by which species of mosquito?
Plasmodium falciparum
87
what is the difference between complicated and uncomplicated malaria?
complicated - characterised by vascular occlusion (e.g. drowsiness, increased ICP -> seizures, coma)
88
paediatric cancer?
acute lymphoblastic leukaemia (ALL)
89
imatinib?
tyrosine kinase inhibitor, given in CML alongside chemo
90
ibrutinib?
bruton kinase inhibitor, given in CLL
91
rituximab?
monoclonal antibody, given in CLL
92
describe Virchow's triad
stasis of blood flow, hypercoagulability, endothelial injury
93
what is the first line treatment for iron deficiency anaemia?
ferrous sulphate
94
what drug is contraindicated in G6PD deficiency?
nitrofurantoin - can cause drug induced oxidative crisis; presents with symptoms associated with anaemia
95
name 4 things that can cause thrombocytopenia
- viral infections such as HIV / TB
- toxins e.g. alcohol can reduce platelet production
- myeloma and other cancers that can reduce platelet production
- heparin can increase destruction of platelets (drug induced)
96
what test is diagnostic for sickle cell anaemia?
Hb electrophoresis
97
what drug is first line treatment for CML and what is its mechanism?
imatinib - tyrosine kinase inhibitor
98
describe stage 1a of the Ann Arbor classification system
1 nodal area with no systemic symptoms (e.g. weight loss, fever, night sweats)
99
describe stage 2a of the Ann Arbor classification system
2 or more nodal areas on the same side of the diaphragm with no systemic symptoms
100
describe stage 2b of the Ann Arbor classification system
2 or more nodal areas on the same side of the diaphragm with systemic symptoms
101
describe stage 3a of the Ann Arbor classification system
Involvement of nodal areas on both sides of the
diaphragm, with no systemic symptoms
102
describe stage 3b of the Ann Arbor classification system
Involvement of nodal areas on both sides of the
diaphragm, with systemic symptoms
103
describe the pathophysiology of hereditary spherocytosis
Spherocytosis is caused by a defect in the red cell membrane, which causes them to lose part of their membrane as they pass through the spleen. This abnormality is then associated with an increased permeability to sodium ions
104
which stage of development of malaria is infective?
sporozoites
105
what is the duration of apixiban treatment in provoked DVT?
3 months
106
what is the duration of apixiban treatment in unprovoked DVT?
6 months
107
what would the MVC be in a chronic alcoholic?
macrocytic anaemia
108
what factor indicates a poor prognosis if found at time of diagnosis in ALL?
WCC > 20
109
state 4 side effects of ABVD
infertility, cardiomyopathy, lung damage, peripheral neuropathy
110
which gene is associated with multiple myeloma?
MGUS
111
bimodal age incidence is characteristic of which leukaemia?
acute lymphoblastic
112
decreased HbA, increased HbA2 and present HbF on Haemoglobin electrophoresis would confirm your diagnosis of what?
beta thalassaemia major
113
state some presentations of beta thalassaemia major
jaundice, slow growth, chipmunk faces, swollen abdomen, fatigue/weakness
114
what is the haemoglobin and reticulocyte count for sickle cell anaemia?
low haem, high reticulocyte
115
previous infection with what is thought to have an association with developing non and Hodgkin's lymphoma?
epstein-barr virus
116
define pancytopenia
deficiency of all blood types - RBCs, WBCs, platelets
117
what is the proper term for "spoon nails"?
koilonychia
118
Give three possible causes of iron deficiency
low dietary intake, menorrhagia, pregnancy, GI malignancy
119
In iron deficiency anaemia what three changes will be seen in plasma iron studies other than decreased MCV?
decreased ferritin levels, low iron levels, increased total binding capacity
120
What plasma protein transports iron in the blood to the bone marrow?
transferrin
121
Give 2 features of Microcytic Anaemia that would be seen on a blood film
- small red blood cells
- Pale red blood cells (hypochromic)
- Variation in red blood cell shape (poikilocytosis)
- Variation in red blood cell size (anisocytosis)
122
Name 2 blood tests that would be carried out to diagnose Microcytic Anaemia
- Serum ferritin
- Serum iron
- Serum soluble transferrin receptors
- Reticulocyte count
123
give 2 side effects of iron supplements
nausea, abdo discomfort, black stools, diarrhoea/constipation
124
define monoclonal paraprotein
One immunoglobulin which is excessively produced (in myeloma)
125
Which electrolyte is raised in patients with myeloma?
calcium
126
Which type of anaemia is commonly observed in patients with myeloma?
normocytic normochromic anaemia
127
Why do you give bisphosphonates to patients with myeloma?
to reduce fracture rates and bone pains
128
How much fluid should myeloma patients drink daily?
3L
129
What is the urgent gold standard treatment for someone with thrombotic thrombocytopenic purpura?
plasma exchange
130
A 65-year-old man is on the ward recovering from a recent total hip replacement following a neck of femur fracture. What is an appropriate thromboprophylaxis regimen?
Dalteparin acutely and then maintenance treatment with apixaban
131
What is the protein target of Rituximab?
CD20 protein on surface of B cells
132
What is the ideal first line treatment for severe/complicated malaria?
IV artesunate
133
define anaemia
low Hb conc due to reduced cell mass or increased plasma volume
134
give 4 causes of macrocytic anaemia
alcohol excess, hypothyroidism, B12/folate deficiency, reticulocytosis
135
what is the cause of chronic myeloid leukaemia?
translocation of a gene between chromosome 9 and 22 leading to the Philadelphia chromosome
136
how do you treat tumour lysis syndrome?
IV fluids, meds to decrease uric acid, electrolyte replacement
137
What are the 2 features required for a diagnosis of febrile neutropenia?
- temp > 30 degrees
- absolute neutrophil count < 1
138
Why do patients with myeloma experience bone loss?
Myeloma leads to cytokines stimulating osteoclasts and inhibiting osteoblasts
139
which kind of anaemia is typically seen in sickle cell disease?
haemolytic
140
treatment for reversal of warfarin?
IV prothrombin complex concentrate and IV vit K
141
how is iron transported in blood and stored?
transported as transferrin and stored as ferritin in tissues
142
what is the most common subtype of Hodgkin's?
nodular sclerosing
143
which subtype of Hodgkin's has the worst prognosis?
lymphocyte depleted
144
what does ABVD stand for?
Adriamycin, Bleomycin, Vinblastine, Decarbazine
145
give 3 signs of Hodgkin's lymphoma
hepatosplenomegaly, anaemia, lymphadenopathy
146
define carcinoma
malignant tumour of epithelial cells
147
name 4 causes of neutrophilia?
appendicitis, CML, MI, strep pyogenes
148
what is the most common cause of secondary polycythaemia?
chronic hypoxia e.g. lung disease smoking or low FiO2
149
what can precipitate a sickle cell crisis?
parvovirus B19
150
which main cells are involved in CLL?
B cells
151
give 2 FBC findings and 1 blood smear with CLL
anaemia, lymphocytosis, smudge cells
152
what test can be done to confirm a diagnosis of CLL?
immunophenotyping
153
What is the most common cause of microcytic anaemia worldwide?
iron deficiency
154
what is the treatment for haemochromatosis?
therapeutic phlebotomy
155
what can be given as prophylaxis of tumour lysis syndrome in leukaemia?
allopurinol - reduces the conversion of nucleic acid byproducts to uric acid in order to prevent nephropathy and subsequent renal failure
156
what is prophylaxis for sickle cell crisis?
hydroxycarbamide - increases HbF conc. -> reducing proportion of RBCs with haem S
157
give 4 symptoms of chronic limb ischaemia
- Hair loss,
- atrophic skin
- brittle / slow-growing nails
- ulcers
- numbness in feet
- absent distal pulses,
- intermittent claudication
158
what causes renal failure in myeloma?
light chain deposition in kidney
159
what is absolute polycythaemia?
an increase in red blood cell mass
160
why does dehydration cause APPARENT polycythaemia?
decreased plasma volume in dehydration. Although the patient’s RBC mass is normal, in proportion to the plasma it will look higher
