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FINALS > Haem > Flashcards

Haem Flashcards

1
Q

Microcytic anaemia causes

A
  • <80 MCV
  • Iron deficiency
  • Thalassemia
  • Sideroblastic
  • Chronic disease
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2
Q

Transferrin

A

Transports iron in blood = rises when iron stored low

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3
Q

Ferritin

A

Stores iron intracellularly
Reflects serum iron level

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4
Q

S+S IDA

A
  • fatigue
    pallor
    dyspnoea
    atrophic glossitis
    angular stomatitis
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5
Q

IDA blood smear

A
  • microcytic
    hypochromic RBCs
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6
Q

Iron studies in IDA

A
  • Fe and ferritin low
  • TIBC high
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7
Q

Iron studies in chronic disease

A
  • Fe and TIBC low
    Ferritin high
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8
Q

Macrocytic anaemia

A

> 100
- Megaloblastic = B12 and folate
- Non megaloblastic

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9
Q

B12 def

A
  • Macrocytic
  • pernicious anaemia
  • Glove and stocking
  • Hypersegmented neutrophils
  • B12 low, folate normal
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10
Q

B12 tx

A

Hydroxocobalamin

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11
Q

folate deficiency

A
  • diet, abx, pregnancy
  • Glossitis, no neuro
  • Hypersegmented neutrophils
  • 5mg folic acid daily
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12
Q

Normocytic anaemia

A

80-100
- Haemolytic = G6PD, SCD, spherocytosis
- Non-haemolytic = CKD, blood loss, aplastic

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13
Q

Normocytic and reticulocytes

A
  • <2% = CKS or aplastic anaemia
  • > 2% = haemolytic anaemia or blood loss
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14
Q

What are pluripotent haematopoietic stem cells

A
  • Undifferentiated cells
    They become
  • Myeloid stem cells
  • Lymphoid stem cells
  • Dendritic cells
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15
Q

What are reticulocytes

A
  • Immature RBCs
  • originate from myeloid stem cells
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16
Q

Lifespan f platelets

A

10 days

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17
Q

What to B cells differentiate into

A
  • Plasma cells
  • Memory B cells
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18
Q

What do T lymphocytes develop into

A
  • CD4 cells (t helpers)
  • CD8 cells (cytotoxic T cells)
  • Natural killer cells
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19
Q

When are target cells seen

A
  • iron def anaemia
  • Post splenectoym
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20
Q

when are heinz bodies seen

A
  • G6PD deficiency
  • Alpha thal
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21
Q

when are schistocytes seen

A
  • HUS
  • DIC
  • TTP
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22
Q

3 A’s and 2 H’s for normocytic anaemia

A
  • Acute blood loss
  • Anaemia chronic disease
  • Aplastic anaemia
  • Haemolytic anaemia
  • Hypothyroid
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23
Q

Where is iron mainly absorbed

A

duodenum and jejunum

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24
Q

Mx IDA

A
  • new iron deficiency in adult without clear cause = colonoscopy and OGD
  • Oral iron = ferrous sulfate of fumarate
  • Iron infusion
  • Transfusion
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25
Q

Pathophysiology of pernicious

A
  • Parietal cells produce intrinsic factor
  • IF = absorbs B12 is distal ileum
  • Autoantibodies target PC or IF therefore lack B12 absorption
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26
Q

B12 def S+S

A
  • Peripheral neuropathy
  • Loss vibration sense
  • Loss proprioception
  • Visual changes
  • Mood and cognition changes
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27
Q

pernicious anaemia Mx

A
  • IM hydroxocobalamin
  • 3X weekly for 2 weeks if no neuro sx
  • neuro sx = alternate days until no further improvement
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28
Q

B12 and folate def together

A
  • Treat B12 before folate otherwise = subacute combined degeneration of the cord
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29
Q

S+S haemolytic anaemia

A
  • Anaemia
  • Splenomegaly
  • Jaundice
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30
Q

Ix haemolytic anaemia

A
  • FBC = normocytic anaemia
  • Blood film schistocytes
  • Direct coombs test +ve
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31
Q

Most common inherited haemolytic anaemia

A

Hereditary spherocytosis
- fragile sphere RBCs break down passing through spleen

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32
Q

Genetic inheritance of hereditary spherocytosis

A
  • Autosomal dominant
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33
Q

presentation of HS and mx

A
  • Anaemia, gallstones and jaundice
  • aplastic crisis in presence of parvovirus
  • folate, blood transfuse, splenectomy
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34
Q

Genetic inheritance of G6PD

A

X linked recessive

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35
Q

Key triggers G6PD

A
  • Fava beans
  • Ciprofloxacin
  • Sulfonylureas
  • Sulfasalazine
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36
Q

Mx autoimmune haemolytic anaemia

A
  • Transfuse
  • Pred
  • Rittuximab
  • splenectomy
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37
Q

conditions causing microangiopathic haemolytic anaemia

A
  • HUS
  • DIC
  • TTP
  • SLE
  • cancer
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38
Q

DIC patho and blood results

A
  • coagulation and fibrinolysis dysregulated = widespread clotting and bleeding
  • Low Plt
  • Low fibrinogen
  • Increased PT and APTT
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39
Q

Causes DIC

A
  • sepsis
  • trauma
  • pregnancy = HELLP
  • malignancy
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40
Q

inheritance of thalassaemia

A

autosomal recessive
Alpha = Csome 16
Beta = Csome 11

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41
Q

Ix thalassaemia

A
  • Microcytic
  • Raised ferritin (iron overload)
  • Electrophoresis
  • DNA testing
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42
Q

alpha thal mx

A
  • monitoring
  • transfusions
  • splenectomy
  • BM transplant
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43
Q

B thal minor

A
  • trait
  • one abnormal and one normal
  • mild sx = monitoring
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44
Q

B thal intermidia

A
  • 2 defective genes
  • blood transfusion only if needed. Usually become severely anaemic at times severe stress
  • chelation
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45
Q

B thal major S+S

A
  • homozygous for deletion genes
  • severe anaemia and failure to throve
  • frontal bossing
  • Enlarged maxilla
  • Flat nose
  • Protruding teeth
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46
Q

B thal major mx

A
  • regular transfusion
  • Iron monitoring and chelation
  • Consider splenectomy
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47
Q

Pathophysiology SCD

A
  • autosomal recessive
  • Affects B globin gene on csome 11
  • 1 abnormal = SC trait
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48
Q

Sickle cell crisis mx

A
  • Treat infection
  • Warmth
  • IV fluids
  • Analgesia (no nsaids)
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49
Q

vaso-occlusive crisis S+S and Mx

A
  • capillaries clogged = distal ischaemia
  • pain and swelling in hands and feet
  • fever
  • priapism
  • Analgesia, supportive care, hydrate
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50
Q

splenic sequestration crisis

A
  • enlarged and painful spleen
  • hypovolaemia shock
  • transfusions, fluids
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51
Q

what triggers aplastic crisis

A
  • parvovirus B19
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52
Q

prophylaxis in SCD

A
  • penicillin V = phenomymethylpenicillin
    due to hyposplenism to prevent from encapsulated bacteria
53
Q

Ix SCD

A
  • Newborn blood spot screen
  • DNA assays
54
Q

Most common leukaemia in children

A
  • ALL
  • ALL = acute proliferation of single type of lymphocyte
55
Q

general s+s anaemia

A
  • fatigue
  • pallor
  • fever
  • petechiae
  • bleeding
  • lymphadenopahty and hepatosplenomegaly
56
Q

CLL blood film

A
  • Smear/smudge cells
57
Q

3 phases of CML

A
  • chronic = asymptomatic
  • accelerated = anaemia, thrombocytopenia, immunodef
  • blast = pancytopenia
    Bloods = increased granulocytes at different maturation
58
Q

Mx CML

A
  • Imatinib (TK inhibitor)
59
Q

chromosome associated with CML

A
  • philadelphia csome = abnormal csome 22
60
Q

blood film in AML

A
  • Blast cells and auer rods
61
Q

what does tumour lysis syndrome result in

A
  • high uric acid
  • hyperkalaemia
  • high phosphate
  • low calcium
    give allopurinol to prevent
62
Q

FBC in leukaemia

A
  • anaemia
  • thrombocytopenia
  • neutropenia
63
Q

Hodgkins lymphoma RF

A
  • HIV
  • EBV
  • Autoimmune
  • FHx
    Bimodal age distribution
64
Q

NH lymphoma common types

A
  • Diffuse large B cell = rapid growing painless
  • Burkitt = EBV and HIV
  • MALT
65
Q

RF NHL

A
  • HIV and EBV
  • H pylori
  • Hep B or C
  • Pesticides
66
Q

HL S+S

A
  • Lymphadenopathy
  • Non tender, firm, rubbery
  • LN pain after alcohol
  • B symptoms
67
Q

NHL S+S

A

same but no alcohol related sx

68
Q

HL biopsy findings

A

Reed-sternberg cells (mirror image)

69
Q

Lugano classification

A
  • 1 = 1 node or group
    2 = more than 1 group but same side diaphraghm
    3 = LN above and below diaphragms
    4 = widespread including non lymphatic organms
70
Q

HL mx

A
  • Chemotherapy
  • Radiotherapy
71
Q

NHL Mx

A
  • waiting
  • chemo
  • monoclonal abs = rituximab
  • radio
  • stem cell
72
Q

what cells does myeloma affect

A
  • plasma cells in bone marrow
73
Q

4 features of myeloma

A

Calcium elevated
Renal failure
Anaemia
Bone lesions and pain

74
Q

what type of anaemia in myeloma

A
  • Normocytic and normochromic anaemia
75
Q

Common sites of myeloma bone disease

A
  • skull
  • spine
  • long bones
  • ribs
    more bone reabsorbed than constructed = osteolytic regions
76
Q

Ix for myeloma

A
  • FBC, calcium, ESR, U+E
  • plasma viscocity
  • serum protein electrophoresis
  • serum free light chain assay
  • urein protein eletrophoresis = bence jones
77
Q

order of rpeference for myeloma imaging

A
  • whole body MRI
  • whole body low dose CT
  • skeletal survey
78
Q

XR findings myeloma

A
  • punched out lytic lesions
  • Osteopenia
  • Abnormal fractires
  • pepper pot skill
79
Q

Polycythaemia Vera cell and blood finding

A
  • Erythroid cells proliferating
  • High Hb
80
Q

Primary myelofibrosis cell and bloods

A
  • Haematopoietic stem cells proliferating
  • Low H
  • Extreme WCC
  • extreme platelets
81
Q

essential thrombocytopenia cell type and bloods

A
  • Megakaryocyte proliferation
  • High platelets
82
Q

blood film myelofibrosis

A
  • Teardrop RBCs
  • Anisocytosis = varying size RBCs
  • Blasts
83
Q

clinical signs of polycythaemia

A
  • Red face
  • Conjunctival plethora
  • Splenomegaly
  • HTN
84
Q

Mx polycythaemia vera

A
  • Venesection
  • Aspirin
  • Chemo
85
Q

Mx primary myelofibrosis

A
  • Supportive
  • Chemo
  • Target therapy = JAK2 inhibs
  • Allogenic stem cell transplant
86
Q

Mx essential thrombcythaemia

A
  • aspirin
  • chemo
  • anagrelide
87
Q

triad in myelodysplastic syndrome

A
  • Anaemia
  • Neutropenia
  • Thrombocytopenia
88
Q

thrombocytopenia means

A
  • low platelet count
  • due to issed with production or destruction of platelets
89
Q

S+S thrombocytopenia

A
  • bruising
  • Prolonged bleeds
  • Nosebleeds, gums, heavy periods
  • Haematuria and rectal bleeds
90
Q

ITP patho

A
  • antibodies created against platelets
  • Immune response = destruction = low platelet count
91
Q

S+S ITP

A
  • purpura
92
Q

Mx ITP

A
  • prednisolone
  • IvIg
  • thrombopoietin receptor agonists
  • Rituximab
  • splenectomy
93
Q

TTP patho

A
  • Tiny thrombi develop throughout small vessels using up platelets
94
Q

TTP can cause

A
  • thrombocytopenia
  • purpura
  • tissue ischaemia and end organ damage
95
Q

heparin induced thrombocytopenia

A
  • antibodiea against platelets in response to heparin
  • 5-10 days after starting treatment
  • HIT antibodies bind to platelets = activate clotting system = hypercoagulable state and thrombosis
96
Q

sextet seen in TTP

A
  • Fever
  • Fluctuating CNS signs
  • MAHA
  • Decreased platelets
  • Renal failure
  • Proteinuria/haematuria
97
Q

TTP blood film

A

schistocytes

98
Q

TTP Mx

A
  • plasma exchange
  • steroids
  • rituximab
99
Q

3 types of VWD

A
  • 1 = partial VWF def
  • 2 = reduced function of VWF
  • 3 = comeplete def VWF
100
Q

S+S VWD

A
  • bleeding gums
  • nosebleeds
  • easy bruising
  • menorrhagia
  • bleeding operations
101
Q

blood results in VWD

A
  • Prolonged bleeding time
  • APTT prolonged
  • Normal platelets
102
Q

Mx VWD

A
  • desmopressin = stimulates VWF release
  • TXA
  • VWF infusion
  • Factor VII plus VWF infusion
103
Q

inheritance of haemophilia

A
  • autosomal recessive
104
Q

Cause of Haemophilia A

A
  • deficiency of factor VIII
105
Q

Cause haemophillia B

A

deficiency in factor IX

106
Q

neonatal haemophilia px

A
  • intracranial haemorrhage
  • haematoma
  • cord bleeding
107
Q

Mx haemophillia

A
  • affected clotting factors given
108
Q

B cells …

A
  • Produce antibodies
  • Present antigens to T cells
  • Mature to plasma cells or memory B
109
Q

plasma cells …

A
  • produce antibodies
110
Q

T cells …

A
  • adaptive immune system
111
Q

main action neutrophils

A
  • against bacterial and fungal
112
Q

main action eosinophils

A

against parasitic

113
Q

main action basophils

A

against allergens

114
Q

main action monocytes

A

bacterial infections

115
Q

Febrile allergic hypotensive transfusion reaction S+S

A
  • increase temp 1-2 degrees or >38 in isolation
  • hypotension
  • Isolated rash, angioedema, dyspnoea
116
Q

acute heamolytic transfusion reaction s+s

A
  • rise in temp
  • pain at site
  • anxiety
117
Q

TACO

A
  • resp compromise
  • pilmonary oedema
  • cardio changes
  • LAH signs
118
Q

med given in mild and severe allergic reaction tranfusion

A

chlorphenamine first

119
Q

3 myeloproliferative disorders

A
  • Primary myelofibrosis
  • PCV
  • Essential thrombocytopenia
    JAK2
    Proliferation of single cell line leads to BM fibrosis
120
Q

Wells PE score >4 mx

A
  • Immediate CTPA or interim coag
121
Q

wells PE <4

A
  • DD result in 4hrs or interim acute in unsure
  • DD -ve = stop and dd
122
Q

dvt wells >2

A
  • leg uss 4hrs or anticoagulate interim
  • Scan -ve = do dd
123
Q

Haemochromotosis

A
  • AR
  • Iron overload = iron storage disorder
  • lethargy, joint pain, bronzed, erectile dysfunction
  • ferritin high
  • mx = venesection
124
Q

bone marrow failure on fbc

A
  • anaemia
  • thrombocytopenia
  • neutropenia
125
Q

tumour lysis syndrome leads to

A
  • high K
  • high P
  • low ca
126
Q

vaso occlusive crisis

A
  • painful = clogging capillaries
  • pain and swelling
  • priaprism
127
Q

splenic sequestration crisis

A
  • rbc block flow from spleen
  • enlarged spleen
  • anaemia and shock
  • transfusion
128
Q

aplastic crisis

A
  • parvovirus b19
  • anaemia

FINALS (31 decks)

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