Haem Flashcards
1
Q
Microcytic anaemia causes
A
- <80 MCV
- Iron deficiency
- Thalassemia
- Sideroblastic
- Chronic disease
2
Q
Transferrin
A
Transports iron in blood = rises when iron stored low
3
Q
Ferritin
A
Stores iron intracellularly
Reflects serum iron level
4
Q
S+S IDA
A
- fatigue
pallor
dyspnoea
atrophic glossitis
angular stomatitis
5
Q
IDA blood smear
A
- microcytic
hypochromic RBCs
6
Q
Iron studies in IDA
A
- Fe and ferritin low
- TIBC high
7
Q
Iron studies in chronic disease
A
- Fe and TIBC low
Ferritin high
8
Q
Macrocytic anaemia
A
> 100
- Megaloblastic = B12 and folate
- Non megaloblastic
9
Q
B12 def
A
- Macrocytic
- pernicious anaemia
- Glove and stocking
- Hypersegmented neutrophils
- B12 low, folate normal
10
Q
B12 tx
A
Hydroxocobalamin
11
Q
folate deficiency
A
- diet, abx, pregnancy
- Glossitis, no neuro
- Hypersegmented neutrophils
- 5mg folic acid daily
12
Q
Normocytic anaemia
A
80-100
- Haemolytic = G6PD, SCD, spherocytosis
- Non-haemolytic = CKD, blood loss, aplastic
13
Q
Normocytic and reticulocytes
A
- <2% = CKS or aplastic anaemia
- > 2% = haemolytic anaemia or blood loss
14
Q
What are pluripotent haematopoietic stem cells
A
- Undifferentiated cells
They become - Myeloid stem cells
- Lymphoid stem cells
- Dendritic cells
15
Q
What are reticulocytes
A
- Immature RBCs
- originate from myeloid stem cells
16
Q
Lifespan f platelets
A
10 days
17
Q
What to B cells differentiate into
A
- Plasma cells
- Memory B cells
18
Q
What do T lymphocytes develop into
A
- CD4 cells (t helpers)
- CD8 cells (cytotoxic T cells)
- Natural killer cells
19
Q
When are target cells seen
A
- iron def anaemia
- Post splenectoym
20
Q
when are heinz bodies seen
A
- G6PD deficiency
- Alpha thal
21
Q
when are schistocytes seen
A
- HUS
- DIC
- TTP
22
Q
3 A’s and 2 H’s for normocytic anaemia
A
- Acute blood loss
- Anaemia chronic disease
- Aplastic anaemia
- Haemolytic anaemia
- Hypothyroid
23
Q
Where is iron mainly absorbed
A
duodenum and jejunum
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
25
Pathophysiology of pernicious
- Parietal cells produce intrinsic factor
- IF = absorbs B12 is distal ileum
- Autoantibodies target PC or IF therefore lack B12 absorption
26
B12 def S+S
- Peripheral neuropathy
- Loss vibration sense
- Loss proprioception
- Visual changes
- Mood and cognition changes
27
pernicious anaemia Mx
- IM hydroxocobalamin
- 3X weekly for 2 weeks if no neuro sx
- neuro sx = alternate days until no further improvement
28
B12 and folate def together
- Treat B12 before folate otherwise = subacute combined degeneration of the cord
29
S+S haemolytic anaemia
- Anaemia
- Splenomegaly
- Jaundice
30
Ix haemolytic anaemia
- FBC = normocytic anaemia
- Blood film schistocytes
- Direct coombs test +ve
31
Most common inherited haemolytic anaemia
Hereditary spherocytosis
- fragile sphere RBCs break down passing through spleen
32
Genetic inheritance of hereditary spherocytosis
- Autosomal dominant
33
presentation of HS and mx
- Anaemia, gallstones and jaundice
- aplastic crisis in presence of parvovirus
- folate, blood transfuse, splenectomy
34
Genetic inheritance of G6PD
X linked recessive
35
Key triggers G6PD
- Fava beans
- Ciprofloxacin
- Sulfonylureas
- Sulfasalazine
36
Mx autoimmune haemolytic anaemia
- Transfuse
- Pred
- Rittuximab
- splenectomy
37
conditions causing microangiopathic haemolytic anaemia
- HUS
- DIC
- TTP
- SLE
- cancer
38
DIC patho and blood results
- coagulation and fibrinolysis dysregulated = widespread clotting and bleeding
- Low Plt
- Low fibrinogen
- Increased PT and APTT
39
Causes DIC
- sepsis
- trauma
- pregnancy = HELLP
- malignancy
40
inheritance of thalassaemia
autosomal recessive
Alpha = Csome 16
Beta = Csome 11
41
Ix thalassaemia
- Microcytic
- Raised ferritin (iron overload)
- Electrophoresis
- DNA testing
42
alpha thal mx
- monitoring
- transfusions
- splenectomy
- BM transplant
43
B thal minor
- trait
- one abnormal and one normal
- mild sx = monitoring
44
B thal intermidia
- 2 defective genes
- blood transfusion only if needed. Usually become severely anaemic at times severe stress
- chelation
45
B thal major S+S
- homozygous for deletion genes
- severe anaemia and failure to throve
- frontal bossing
- Enlarged maxilla
- Flat nose
- Protruding teeth
46
B thal major mx
- regular transfusion
- Iron monitoring and chelation
- Consider splenectomy
47
Pathophysiology SCD
- autosomal recessive
- Affects B globin gene on csome 11
- 1 abnormal = SC trait
48
Sickle cell crisis mx
- Treat infection
- Warmth
- IV fluids
- Analgesia (no nsaids)
49
vaso-occlusive crisis S+S and Mx
- capillaries clogged = distal ischaemia
- pain and swelling in hands and feet
- fever
- priapism
- Analgesia, supportive care, hydrate
50
splenic sequestration crisis
- enlarged and painful spleen
- hypovolaemia shock
- transfusions, fluids
51
what triggers aplastic crisis
- parvovirus B19
52
prophylaxis in SCD
- penicillin V = phenomymethylpenicillin
due to hyposplenism to prevent from encapsulated bacteria
53
Ix SCD
- Newborn blood spot screen
- DNA assays
54
Most common leukaemia in children
- ALL
- ALL = acute proliferation of single type of lymphocyte
55
general s+s anaemia
- fatigue
- pallor
- fever
- petechiae
- bleeding
- lymphadenopahty and hepatosplenomegaly
56
CLL blood film
- Smear/smudge cells
57
3 phases of CML
- chronic = asymptomatic
- accelerated = anaemia, thrombocytopenia, immunodef
- blast = pancytopenia
Bloods = increased granulocytes at different maturation
58
Mx CML
- Imatinib (TK inhibitor)
59
chromosome associated with CML
- philadelphia csome = abnormal csome 22
60
blood film in AML
- Blast cells and auer rods
61
what does tumour lysis syndrome result in
- high uric acid
- hyperkalaemia
- high phosphate
- low calcium
give allopurinol to prevent
62
FBC in leukaemia
- anaemia
- thrombocytopenia
- neutropenia
63
Hodgkins lymphoma RF
- HIV
- EBV
- Autoimmune
- FHx
Bimodal age distribution
64
NH lymphoma common types
- Diffuse large B cell = rapid growing painless
- Burkitt = EBV and HIV
- MALT
65
RF NHL
- HIV and EBV
- H pylori
- Hep B or C
- Pesticides
66
HL S+S
- Lymphadenopathy
- Non tender, firm, rubbery
- LN pain after alcohol
- B symptoms
67
NHL S+S
same but no alcohol related sx
68
HL biopsy findings
Reed-sternberg cells (mirror image)
69
Lugano classification
- 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
HL mx
- Chemotherapy
- Radiotherapy
71
NHL Mx
- waiting
- chemo
- monoclonal abs = rituximab
- radio
- stem cell
72
what cells does myeloma affect
- plasma cells in bone marrow
73
4 features of myeloma
Calcium elevated
Renal failure
Anaemia
Bone lesions and pain
74
what type of anaemia in myeloma
- Normocytic and normochromic anaemia
75
Common sites of myeloma bone disease
- skull
- spine
- long bones
- ribs
more bone reabsorbed than constructed = osteolytic regions
76
Ix for myeloma
- FBC, calcium, ESR, U+E
- plasma viscocity
- serum protein electrophoresis
- serum free light chain assay
- urein protein eletrophoresis = bence jones
77
order of rpeference for myeloma imaging
- whole body MRI
- whole body low dose CT
- skeletal survey
78
XR findings myeloma
- punched out lytic lesions
- Osteopenia
- Abnormal fractires
- pepper pot skill
79
Polycythaemia Vera cell and blood finding
- Erythroid cells proliferating
- High Hb
80
Primary myelofibrosis cell and bloods
- Haematopoietic stem cells proliferating
- Low H
- Extreme WCC
- extreme platelets
81
essential thrombocytopenia cell type and bloods
- Megakaryocyte proliferation
- High platelets
82
blood film myelofibrosis
- Teardrop RBCs
- Anisocytosis = varying size RBCs
- Blasts
83
clinical signs of polycythaemia
- Red face
- Conjunctival plethora
- Splenomegaly
- HTN
84
Mx polycythaemia vera
- Venesection
- Aspirin
- Chemo
85
Mx primary myelofibrosis
- Supportive
- Chemo
- Target therapy = JAK2 inhibs
- Allogenic stem cell transplant
86
Mx essential thrombcythaemia
- aspirin
- chemo
- anagrelide
87
triad in myelodysplastic syndrome
- Anaemia
- Neutropenia
- Thrombocytopenia
88
thrombocytopenia means
- low platelet count
- due to issed with production or destruction of platelets
89
S+S thrombocytopenia
- bruising
- Prolonged bleeds
- Nosebleeds, gums, heavy periods
- Haematuria and rectal bleeds
90
ITP patho
- antibodies created against platelets
- Immune response = destruction = low platelet count
91
S+S ITP
- purpura
92
Mx ITP
- prednisolone
- IvIg
- thrombopoietin receptor agonists
- Rituximab
- splenectomy
93
TTP patho
- Tiny thrombi develop throughout small vessels using up platelets
94
TTP can cause
- thrombocytopenia
- purpura
- tissue ischaemia and end organ damage
95
heparin induced thrombocytopenia
- 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
sextet seen in TTP
- Fever
- Fluctuating CNS signs
- MAHA
- Decreased platelets
- Renal failure
- Proteinuria/haematuria
97
TTP blood film
schistocytes
98
TTP Mx
- plasma exchange
- steroids
- rituximab
99
3 types of VWD
- 1 = partial VWF def
- 2 = reduced function of VWF
- 3 = comeplete def VWF
100
S+S VWD
- bleeding gums
- nosebleeds
- easy bruising
- menorrhagia
- bleeding operations
101
blood results in VWD
- Prolonged bleeding time
- APTT prolonged
- Normal platelets
102
Mx VWD
- desmopressin = stimulates VWF release
- TXA
- VWF infusion
- Factor VII plus VWF infusion
103
inheritance of haemophilia
- autosomal recessive
104
Cause of Haemophilia A
- deficiency of factor VIII
105
Cause haemophillia B
deficiency in factor IX
106
neonatal haemophilia px
- intracranial haemorrhage
- haematoma
- cord bleeding
107
Mx haemophillia
- affected clotting factors given
108
B cells ...
- Produce antibodies
- Present antigens to T cells
- Mature to plasma cells or memory B
109
plasma cells ...
- produce antibodies
110
T cells ...
- adaptive immune system
111
main action neutrophils
- against bacterial and fungal
112
main action eosinophils
against parasitic
113
main action basophils
against allergens
114
main action monocytes
bacterial infections
115
Febrile allergic hypotensive transfusion reaction S+S
- increase temp 1-2 degrees or >38 in isolation
- hypotension
- Isolated rash, angioedema, dyspnoea
116
acute heamolytic transfusion reaction s+s
- rise in temp
- pain at site
- anxiety
117
TACO
- resp compromise
- pilmonary oedema
- cardio changes
- LAH signs
118
med given in mild and severe allergic reaction tranfusion
chlorphenamine first
119
3 myeloproliferative disorders
- Primary myelofibrosis
- PCV
- Essential thrombocytopenia
JAK2
Proliferation of single cell line leads to BM fibrosis
120
Wells PE score >4 mx
- Immediate CTPA or interim coag
121
wells PE <4
- DD result in 4hrs or interim acute in unsure
- DD -ve = stop and dd
122
dvt wells >2
- leg uss 4hrs or anticoagulate interim
- Scan -ve = do dd
123
Haemochromotosis
- AR
- Iron overload = iron storage disorder
- lethargy, joint pain, bronzed, erectile dysfunction
- ferritin high
- mx = venesection
124
bone marrow failure on fbc
- anaemia
- thrombocytopenia
- neutropenia
125
tumour lysis syndrome leads to
- high K
- high P
- low ca
126
vaso occlusive crisis
- painful = clogging capillaries
- pain and swelling
- priaprism
127
splenic sequestration crisis
- rbc block flow from spleen
- enlarged spleen
- anaemia and shock
- transfusion
128
aplastic crisis
- parvovirus b19
- anaemia
