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finals > haem > Flashcards

haem Flashcards

1
Q

what is in serum

A

glucose
electrolytes
protein

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2
Q

where is bone marrow

A

pelvis
vertebrae
ribs
sternum

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3
Q

where do blood cells develop

A

bone marrow

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4
Q

what does the pluripotent haematopoietic stem cell form

A

myeloid stem cell
lymphoid stem cell

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5
Q

what do megakaryocytes form

A

platelets

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6
Q

what does the myeloid stem cell form

A

->reticulocytes->RBC
->promyelocytes->monocytes->macrophages, neutrophils, eosinophils, mast cells, basophils

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7
Q

what do lymphoid stem cells form

A

-> B cell (plasma or memory)
-> T cell (CD4, CD8, NK)

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8
Q

lifespan RBC

A

3m

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9
Q

anisocytosis

A

variation size RBC
myelodysplasic syndrome

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10
Q

what are target cells found in

A

iron deficiency anaemia
post splenectomy

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11
Q

when are heinz bodies found

A

G6PD deficiency
alpha thalassaemia

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12
Q

heinz bodies

A

blob in RBC

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13
Q

howell jolly bodies

A

blobs DNA in RBC

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14
Q

when are howell jolly bodies found

A

post splenectomy
severe anaemia

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15
Q

reticulocytes

A

larger than RBC
mesh like

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16
Q

when are reticulocytes found

A

haemolytic anaemia

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17
Q

schistocytes

A

RBC fragments

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18
Q

when are schistocytes found

A

HUS
DIC
thrombotic thrombocytopenic purpura

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19
Q

sideroblasts

A

blobs iron in immature RBC

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20
Q

when are sideroblasts found

A

myelodysplasic syndrome

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21
Q

smudge clls

A

ruptured WBC (fragile)

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22
Q

when are smudge cells found

A

CLL

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23
Q

spherocytes

A

spherical RBC

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24
Q

when are spherocytes found

A

AI haemolytic anaemia
hereditary spherocytosis

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25
Q

normal Hb

A

F: 120-165
M: 130-180

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26
Q

normal MCV

A

80-100

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27
Q

causes microcytic anaemia

A

thalassaemia
chronic disease
iron deficiency
lead poisoning
sideroblastic

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28
Q

causes normocytic anaemia

A

acute blood loss
chronic disease
aplastic
haemolytic
hypothyroid

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29
Q

causes macrocytic anaemia

A

megaloblastic: B12/folate deficeincy
normoblastic: alcohol, reticulocytosis, hypothyroid, liver disease, azathoprine

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30
Q

sx anaemia

A

tired
SOB
headache
dizzy
palpitations
pallor
increased HR and RR

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31
Q

features iron deficiency anaemia

A

picca
hair loss
koilonychia
angular chelitis
atrophic glossitis
brittle hair and nails

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32
Q

features haemolytic anaemia

A

jaundice

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33
Q

ix anaemia

A

Hb
MCV
B12
Folate
ferritin
blood film
OGD
colonoscopy
BM biopsy

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34
Q

where is iron absorbed

A

duodenum and jejunum

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35
Q

transferrin saturation

A

= serum iron / total iron binding capacity

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36
Q

mx iron deficiency anaemua

A

if no cause: OGD and colonoscopy
oral ferrous suphate, iron infusion, blood transfusion

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37
Q

SE oral ferrous sulphate

A

constipation
black stool

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38
Q

cause pernicious anaemia

A

AI
Ab against parietal cells/intrinsic factor therefore B12 not absorbed

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39
Q

sx pernicious anaemia

A

peripheral neuropathy - numbness, paraesthesia
loss vibration sense
visual change
mood change

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40
Q

ix pernicious anaema

A

auto ab- intrinsic factor ab, gastric parietal cell ab

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41
Q

mx pernicious anaemia

A

1g IM hydroxycobalamin 3/wk for 2wk then every 3m

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42
Q

inherited causes haemolytic anaemia

A

hereditary spherocytosis
hereditary elliptocytosis
thalassaemia
SC anaemia
G6PD deficiency

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43
Q

acquired causes haemolytic anaemia

A

AI
alloimmune
paroxysmal nocturnal haemoglobinuria
microangiopathic
prosthetic valve related

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44
Q

features hereditary spherocytosis

A

AD
jaundice
gallstones
splenomegaly and aplastic crisis with parvovirus
increased MCHC and reticulocytes

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45
Q

mx hereditary spherocytosis

A

folate
splenectomy

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46
Q

features hereditary elliptocytosis

A

AD
jaundice
gallstones
splenomegaly and aplastic crisis with parvovirus
increased MCHC and reticulocytes

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47
Q

mx hereditary elliptocytosis

A

folate
splenectomy

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48
Q

inheritance G6PD deficiency

A

X linked recessive
mediteranean/african

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49
Q

triggers of crises in G6PD defeicny

A

infection
meds: primaquine, ciprofloxacin, sulfonylureas, sulfasalazine
broad beans

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50
Q

sx G6PD deficiency

A

jaundice
gallstones
anaemia
splenomegaly

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51
Q

types AI haemolytic anaemia

A

warm: at normal/above temp = idopathic
cold (<10 degrees): agglutination = secondary to lymphoma, leukaemia, SLE, EBV, CMV, HIV

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52
Q

mx AI haemolytic anaemia

A

blood transfusion
pred
rituximab
splenectomy

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53
Q

cause alloimmune haemolytic anaemia

A

transfusion rxn
haemolytic disease newborb

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54
Q

cause paroxysmal nocturnal haemoglobinuria

A

gene mutation in life results in activation complement cascade

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55
Q

features paroxysmal nocturnal haemoglobinuria

A

red urine in morning
risk VTE
smooth muscle dystoniam

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56
Q

mx paoxysmal nocturnal haemoglobinuria

A

eculizimab
BM transplant

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57
Q

cause microangiopathic haemolytic anaemia

A

vessel abnormality damages RBC
secondary to HUS, DIC, TTP, SLE, cancer

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58
Q

cause prosthetic valve haemolysis

A

valve churns up RBC

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59
Q

mx prosthetic valve haemolyssi

A

oral iron
transfusion
revision surgery

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60
Q

inheritance thalassaemia

A

AR

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61
Q

features thalassaemia

A

microcytic anaemia
fatigue
pallor
jaundice
gallstones
splenomegaly
poor growth
pronounced forehead and malar eminences

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62
Q

ix thalassaemia

A

FBC
Hb electrophoresis
DNA

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63
Q

why is there iron overload in thalassaemia

A

faulty RBC
transfusions

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64
Q

features iron overload

A

fatigue
liver cirrhosus
impotence
HF
arrhythmia
DM
osteoporosis

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65
Q

mx iron overload

A

iron chelation

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66
Q

alpha thalassaemia mutation

A

chrom 16

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67
Q

mx alpha thalssaemia

A

transfusion
splenectomy
BM transplant

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68
Q

beta thalassaemia mutation

A

chrom 11

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69
Q

types beta thalassaemia

A

minor: 1 normal and 1 abnormal gene
intermedia: 2 abnormal beta globin
major: homozygous for deletion

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70
Q

mx intermediate beta thalassaemia

A

transfusion

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71
Q

mx major beta thalassaemia

A

regular transfusion
BM transplant
splenecomy

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72
Q

what is HbF replaced by

A

HbA at 6w

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73
Q

inheritance SC anaemia

A

AR
abnormal gene for beta globin on chrom 11

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74
Q

SC trait genes

A

1 copy faultygene

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75
Q

complications SC disease

A

anaemia
increased risk infection
stroke
avsascular necrosis
pulmonary HTN
priapism
CKD
SC crisis
vaso-occlusive/painful crisis
splenic sequestration crisis
aplastic crisis
acute chest syndrome

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76
Q

triggers SC crisis

A

infection
dehydration
cold

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77
Q

cause vaso-occlusive crisis SC

A

sickle cells block capillaries

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78
Q

features splenic sequestration crisis SC

A

severe anaemia
hypovolaemic shock

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79
Q

mx splenic sequestration crisis SC

A

blood transfusion
fluid

80
Q

what happens in aplastic crisis SC

A

triggered by parvovirus B19
no new RBC made ->anaemia

81
Q

causes acute chest syndrome SC

A

infective or non infective (vaso-occlusive, fat emboli)

82
Q

features acute chest syndrome SC

A

fever
resp sx
new infiltrates on CXR

83
Q

mx SC disease

A

avoid dehydration
vaccinations
abx prophylaxis - penicillin V
hydroxycarbamide - increaes HbF
blood transfusion
BM transplant

84
Q

what is leukaemia

A

cancer BM
mutation results in overproliferation of 1 cell type

85
Q

sx leukaemia

A

fatigue
fever
FTT
pallor
petechiae/bruising
abnormal bleeding
lymphadenopathy
hepatosplenomegaly

86
Q

ix leukaemia

A

FBC
blood film
increased LDH
BM biopsy
CT/MRI/CXR

87
Q

associattions ALL

A

<5 or >45
down syndrome
philadelphia chromosome

88
Q

most common leukaemia adults

A

CLL

89
Q

features CLL

A

warm haemolytic anaemia
richters transformation to lymphoma
smudge/smear cells

90
Q

phases CML

A

chronic: asx - 5y
accelerated
blast

91
Q

chromosome CML

A

philadelphia

92
Q

what can cause AML

A

transformation from myeloproloiferative disorder

93
Q

Blood film AML

A

auer rods

94
Q

mx leukaemia

A

chemo
steroids
BM transplant

95
Q

SE chemo

A

reduced growth
infection
neurotoxicity
inferitlity
seconadry maligancy
cardiotoxixity
tumour lysis syndrome (release uric acid ->AKI)

96
Q

lymphoma

A

cancers of lymphocytes

97
Q

RF hodgkins lymphoma

A

20y or 75y
HIV
EBV
RA
fhx

98
Q

features hodgkins lymphoma

A

lymphadenopathy: rubbery, pain with alcohol
B sx: fever, wt loss, night sweats

99
Q

ix findings hodgkins lymphoma

A

increased LDH
lymph node biopsy=reed sternburg ells

100
Q

mx hodgkins lymphoma

A

chemo and radio

101
Q

staging for lymphomas

A

ANN ARBOR
1. 1 region of lymph nodes
2. >/= 1 region same side of diaphragm
3. lymph nodes above and below diaphragm
4. non lymph organs e.g. lungs

102
Q

e.g. non hodgkins lymphoma

A

burkitt
MALT - mucosa associated lymphoid tissue
diffuse large B cell

103
Q

RF burkitt lymphoma

A

EBV
malaria
HIV

104
Q

RF MALT lymphoma

A

H.pylori

105
Q

features diffuse large B cell lymphoma

A

> 65y
painless

106
Q

myeloma

A

cancer of plasma cells

107
Q

sx myeloma

A

CRAB
increased calcium
renal failure
anaemia
bone lesions and pain

108
Q

RF myeloma

A

age
M
african
Fhx

109
Q

ix myeloma

A

bloods: reduced WCC, increased Ca, increased ESR
increased plasma viscocity
urine elctrophoresis
serum free light chain assay
serum Ig
serum protein electrophoresis
BM biopsy
XR
CT/MRI/bone scan

110
Q

finding urine electrophoresis myeloma

A

bence jones protein

111
Q

XR findings myeloma

A

punched out lytic lesions
pepperpot skull

112
Q

mx myeloma

A

chemo
stem cell transplant
VTE mx
bisphosphonates

113
Q

what are myeloproliferative disorders

A

proliferation 1 stem cell

114
Q

genes associated with myeloproliferative disorders

A

JAK2
MPL
CACR

115
Q

features myeloproliferative disorders

A

systemic sx
anaemia
splenomegaly
portal HTN

116
Q

ix myeloproliferative disorders

A

FBC
blood film
BM biopsy

117
Q

what can myeloproliferative disorders lead to

A

myelofibrosis - therefore haematopoesis in liver and spleen istead

118
Q

types myeloproliferative disorders

A

primary myelofibrosis
polycythaemia rubra vera
essential thromocytopenia

119
Q

features primary myelofibrosis

A

haematopoetic stem cell
anaemia
teardrop RBC
anisocytosis
blasts

120
Q

mx primary myelofibrosis

A

chemo
allogenic stem cell transplant

121
Q

Ix findings polycytheamiea rubra vera

A

erythroid cells
increased Hb

122
Q

mx polycythaemia rubra vera

A

venesection
aspirin
chemo

123
Q

features essential thrombocytopenia

A

megakaryocyte
increased plateleyts

124
Q

mx essential thrombocytopenia

A

aspirin
chemo

125
Q

myelodysplastic syndrome

A

myeloid BM cells dont mature properly -> anaemia, neutropenia, thrombocytopenia

126
Q

RF myelodysplastic syndrome

A

> 60
prev chemo/radio

127
Q

thrombocytopenia

A

low platelets

128
Q

causes thrombocytopenia

A

production: sepsis, reduced B12/folate, liver failure, leukaemia, myelodysplastic syndrome

destruction: meds (valproate, methotrexate, isotretinoin, antihistamines, PPI), alcohol, ITP, thrombottic thrombocytopenic purpura, herparin induced thrombocytopenia, HUS

129
Q

what is ITP

A

Ab against platelets

130
Q

mx ITP

A

pred
IVIg
rituximab
splenectomy

131
Q

what is thrombotic thrombocytopenix purpura

A

clots in small vessels

132
Q

mx thrombotic thrombocytopenic purpura

A

plasma exchange
steroids
rituximab

133
Q

features heparin induced thrombocytopenia

A

HIT Ab

134
Q

how does thrombocytopenia present

A

bleeding
bruising

135
Q

cause von wilebrand diseae

A

AD inheritance
defective VWF

136
Q

types von willebrand disease

A

1-3
3 most sev

137
Q

sx von willebrand disease

A

bleeding gums
epistaxis
menorrhagia
fhx

138
Q

mx von willebrand disease

A

desmopressin (stimulates VWF)
factor VII/VWF infusion

usually dont need daily mx, only whe surgery

139
Q

inheritance haemophilia

A

X-linked recessive
so males

140
Q

types haemophilia

A

A: reduced VIII
B: reduced: IX

141
Q

sx haemophilia

A

bleeding-major haemorhage (intracranial, joints, muscles)

142
Q

mx haemophilia

A

IV infusion factor VIII/IX
desmopressin
tranexamic acid

143
Q

what do thrombophilias predispose patient to

A

blood clots

144
Q

e.g. thrombophilias

A

antiphospholipid syndrome
antithrombus deficiency
protein C or S deficiency
factor V leiden
hyperhomocysteinaemia
prothrombin gene variant

145
Q

RF VTE

A

immobile
surgery
long haul flights
pregnancy
oestrogen HRT/COCP
malignancy
polycythaemia
SLE
thrombophilia

146
Q

DVT sx

A

unilateral leg swelling (>3cm compared to the other side 10cm below tibial tuberisty)
dilated superficial veins
tender

147
Q

VTE ix

A

wells score
d-dimer
doppler
CTPA

148
Q

mx VTE

A

LMWH (dalteparin)
then warfarin or NOAC (apixaban, rivaroxaban)

149
Q

ix unprovoked DVT

A

CXR
FBC
Ca
LFTs
urine dip
CT abdo pelvis
mammogram
antiphospholipd Ab

150
Q

budd chiari syndrome

A

clot in hepatic vein -> hepatitis

151
Q

sx budd chiari syndrome

A

abdo pain
hepatomegaly
ascites

152
Q

mx budd chiari syndrome

A

heparin/warfarin

153
Q

pancytopenia

A

anaemia, thrombocytopenia, and leukopenia

154
Q

agranulocytosis FBC

A

depleted levels of basophils and eosinophils

155
Q

universal donors

A

In adults, group O red cells can be universally donated (due to lack of A or B antigens on their surface) and group AB plasma can be universally donated (due to lack of anti-A or anti-B antibodies)

156
Q

vit k deficiency/warfarin use coag screen

A

PT/INR: increased
APTT: increased
bleeding time: norm
platelet count: norm

157
Q

haemophilia coag screen

A

PT/INR: norm
APTT: increased
bleeding time: norm
platelet count:norm

158
Q

von willebrands coag screen

A

PT/INR: norm
APTT: norm/increased
bleeding time: increased
platelet count: norm

159
Q

DIC coag screen

A

PT/INR: norm
APTT: norm
bleeding time: increased
platelet count: decreased

160
Q

ITP coag screen

A

PT/INR: norm
APTT: norm
bleeding time: increased
platelet count: decreased

161
Q

TTP coag screen

A

PT/INR: norm
APTT: norm
bleeding time: increased
platelet count: decreased

162
Q

HUS coag screen

A

PT/INR: norm
APTT: norm
bleeding time: increased
platelet count: decreased

163
Q

how do ITP, HUS and TTP differentiate on coag screen

A

THEY DONT
PT/INR: norm
APTT: norm
bleeding time: increased
platelet count: decreased

164
Q

Common causes of acute leukocytosis

A

Reactive: infection, inflammation, post-surgery
Steroids: stress response (i.e. endogenous steroids) or medication (i.e. exogenous steroids)
Haematological: acute leukaemias

165
Q

Common causes of chronic leukocytosis:

A

Reactive: chronic infection, smoking
Haematological: leukaemia, certain subtypes of lymphoma
Hyposplenism: typically mild
Pregnancy

166
Q

Common causes of leukopenia

A

Infection: can be seen as a transient phenomenon in viral illness or as a result of consumption in sepsis
Medications: antibiotics, immunosuppressants, anti-epileptics, cytotoxic agents (e.g. chemotherapy)
B12/folate deficiency
Autoimmune disease
Iron deficiency
HIV (any cytopenia could be due to HIV)
Racial variation: middle eastern and black patients can have lower baseline neutrophil counts which are not pathological
Bone marrow failure: often this will be seen alongside low platelets and low haemoglobin

167
Q

Causes of lymphocytosis include:

A

Viral infection
Smoking
Hyposplenism/post-splenectomy
Malignancy: leukaemia and certain types of lymphoma
Pertussis: rates are increasing in the U.K. with decreased vaccination rates

168
Q

Causes of lymphopenia

A

infection
Infection
Older age (rarely clinically significant in this context)
Alcohol excess
HIV
Autoimmune disease
Bone marrow disease
Medications: cytotoxic agents, immunosuppressants
Renal failure
Congenital immunodeficiency disorders (e.g. Wiskott-Aldrich syndrome)

169
Q

Common causes of monocytosis

A

Bacterial infection
Autoimmune disease
Steroids

170
Q

Causes of a very low monocyte count

A

Acute infection
Steroids
Bone marrow failure
Cytotoxic agents (e.g. chemotherapy)
Hairy cell leukaemia

171
Q

Causes of eosinophilia

A

Allergies/atopy
Parasitic infection
Autoimmune disease (e.g. vasculitis)
Medications (e.g. antibiotics, anti-epileptics, allopurinol)
Gastrointestinal disease (e.g. eosinophilic oesophagitis)
Respiratory disease (e.g. asthma)
Malignancy (any solid organ or haematological)

172
Q

Causes of basophilia

A

Allergic reactions/atopy
Iron deficiency
Chronic inflammation
Hypothyroidism
Infection
Haematological malignancies (myeloproliferative disorders)

173
Q

Causes of an elevated blast count

A

Acute leukaemia
Myeloproliferative disorders
Reactive (severe infection or treatment with G-CSF)
Cytotoxic agents (chemotherapy)

174
Q

Causes of acute thrombocytopenia

A

Consumption (e.g. infection, bleeding)
Acute viral infection
Medications (e.g. antibiotics, anti-epileptics, cytotoxic agents)
Disseminated intravascular coagulation/microangiopathic haemolytic anaemia (e.g. TTP, HUS)
Heparin-induced thrombocytopenia (HIT)
Immune thrombocytopenic purpura (ITP)
Pregnancy: pre-eclampsia/HELLP syndrome

175
Q

Causes of chronic thrombocytopenia:

A

Hypersplenism
Cirrhosis
Alcohol excess
Medications (e.g. anti-epileptics, cytotoxic agents)
ITP
Autoimmune disease
B12/folate deficiency
Iron deficiency
HIV
Hepatitis B/C
Haematological disease
Bone marrow failure

176
Q

Causes of thrombocytosis

A

Reactive: inflammation/infection
Myeloproliferative disorders: typically essential thrombocythaemia although any myeloproliferative disorder can elevate platelet counts
Iron deficiency
Hypospenlism/post-splenectomy
Underlying malignancy: likely secondary to underlying inflammatory processes

177
Q

indications poor prognosis in hodkins lymphoma

A

lymphopenia
leukpcytosis
rasied ESR
raised LDH
low alubmin

== aggressive cancer

178
Q

sx non haemolytic febrile transfusion rxn

A

shivering
fever
headache
nausea
flushing
tachycardia
30-60m after start
PATIENT IS HOT BUT WELL
MOST COMMON RXN

179
Q

cause non-haemolytic febrile transfusion rxn

A

alluimunised recipitant produces cytokines due to donor lukocytes/HCA antigens

180
Q

mx non-haemolytic febrile transfusion rxn

A

slow transfusion
monitor regularly
paracetamol

181
Q

what is acute haemolytic transfusion rxn also known as

A

ABO incompatability

182
Q

cause acute haemolytic transfusion rxn

A

IgM mediated

183
Q

sx acute haemolytic transfusion rxn

A

PATIENT IS SICK
fever
hypotension
agitation
flushing
chest/abdo pain
bleeding/DIC
AKI
within mins of starting

184
Q

mx acute haemolytic transfusion rxn

A

STOP TRANSFUSION
A-E
supportive

185
Q

features bacterial contaamination blood transfusion

A

fever
hypotension
rigors=septic shcok

186
Q

features delayed haemolytic transfusion rxn

A

anaemia
jaundice
haemoglobinuria
usually 4-8d after but up to 4w

187
Q

mx bacterial contamination blood products

A

stop transfusion
broad spectrum abx
sepsis 6

188
Q

mx delayed haemolytic transfusion rxn

A

ix
monitor renal funt

189
Q

features transfusion related acute lung injury

A

acute resp distress syndrome
dyspnoea
cough
CXR=white out
occurs <6h - usually 2h after start

190
Q

mx transfusion related acute lung injury

A

stop transfusion
oxygen
supportive care - may need ICU

191
Q

features transfusion associated circulatory overload

A

dyspnoea
hypoxaemia
tachycardia
increased JVP
basal creps

192
Q

mx transfusion associated circulatory overload

A

stop transfusion
treat as acute LVF: furosemide, oxygen

193
Q

cause non anaphylactic allergic transfusion rxn

A

plasma protein incompatability

194
Q

sx non anaphylactic allergic transfusion rxn

A

urticaria and itch

195
Q

mx non anaphylactic allergic transfusion rxn

A

stop or slow transfusion depending on severity
chlorpheniramine

196
Q

sx anaphylactic transfusion rxn

A

bronchospasm
cyanosis
hypotension
soft tissue swelling

finals (31 decks)

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