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Finals > Haem > Flashcards

Haem Flashcards

1
Q

ALL:

A
  • Most common in children less than 5 years old, associated with Down’s Syndrome
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2
Q

CLL:

A

Smudge cells, Warm haemolytic anaemia, Richter’s transformation(from CLL to an aggressive high grade b-lymphoma

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3
Q

AML:

A

Auer rods and high number of blast cells, transformation from a Myeloproliferative disorder(eg. polycythaemia vera)

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4
Q

CML:

A

Philadelphia Chromosome, has 3 phase: long chronic(several years), accelerated(blast cells take up proportion of blood cells), blast phase

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5
Q

Leukaemia presenting feature:

A
  • Bleeding under the skin due to thrombocytopenia causing non-blanching lesions
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6
Q

Leukaemia Investigations:

A
  • FBC within 48 hours
  • Bone marrow Biopsy= for definitive diagnosis (Gold standard)
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7
Q

Leukaemia general mx:

A
  • Chemotherapy
  • Targeted therapy(mainly used in CLL- tyrosine kinase inhibitors eg. ibrutinib and monoclonal antibodies eg. rituximab)
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8
Q

Haemophilia: (2 types, inherited X–linked recessive blood disorder therefore mainly affect Males as only have 1 chromosome

A

A- deficiency in Factor 8

B(Christmas Disease)- deficiency in Factor 9

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9
Q

Haemophilia Presentation:

A

is a severe bleeding disorder; can result in spontaneous bleeding without trauma and bleeding from eg. internal organs, into joints, intracranial haemorrhage

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10
Q

Haemophilia Inv:

A

Bleeding score, coagulation factor assays, genetic testing

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11
Q

Haemophilia Mx:

A
  • Give Clotting factors 8/9 depending on type as an IV infusion.
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12
Q

Von Willebrand disease:

A
  • Is the most common inherited cause of abnormal and prolonged bleeding
    -deficiency of Von-Willebrand factor(important in platelet adhesion and aggregation)
  • 3 types: 1(partial deficiency), 2(reduced function), 3(complete deficiency)
    Mx: Tranexamic acid for mild bleeding, Desmopressin
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13
Q

Thrombocytopenia= Low platelet count:

A

either:
- reduced platelet production
- increased platelet destruction

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14
Q

ITP(Immune Thrombocytopenia Purpura):

TTP(Thrombotic Thrombocytopenia Purpura):

A

ITP: Antibodies are created against platelets, presents with Purpura (non-blanching reasons due to bleeding under the skin). Mx: Prednisolone(steroids), IV immunoglobulin, Rituximab(monoclonal antibody that targets B cells- good for autoimmune related conditions.

TTP:
- Tiny thrombus develop through blood vessels using up platelets. Causes: Thrombocytopenia, purpura, tissue ischaemia/end organ damage
(ADAMTS13 protein),

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15
Q

Myelodysplastic syndromes:

A
  • Form of cancer caused by mutation of myeloid cells and has the potential to transform into AML.
    -Presents with: Anaemia, Neutropenia(low neutrophils), Thrombocytopenia-bleeding and purpura (low platelets)
    Inv: Bone marrow biopsy is required to confirm diagnosis
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16
Q

Myeloproliferative disorder:

A

-Uncontrolled proliferation of a single type of blood cell, could transform into AML
- JAK2 mutation
- Main ones to remember(3):
1) Primary Myelofibrosis- low Hb, Mx: JAK2 inhibitor, supportive mx, chemotherapy
2) Polycythaemia Vera- High Hb, gout and thrombosis is a complication of the condition
3) Essential thrombocythaemia High platelet

Blood film: Tear-dropped shaped RBC, Anisocytosis(varying sizes of RBCs), Blasts (immature red and white cells)

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17
Q

Polycythaemia Vera (type of myeloproliferative disorder):

A
  • Red face, conjunctival plethora(red insides of eye), splenomegaly, hypertension
  • Bone marrow biopsy to confirm diagnosis
    Mx: venesection, aspirin, chemo(hydroxycarbamide)
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18
Q

Myeloma:

A
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19
Q

Reversal agent for Dabigratran(anticoagulant):

A

-Idarucizumab

-Other reversal agent: Protamine to reverse=heparin, Vitamin K=warfarin

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20
Q

Sickle cell disease definitive diagnostic inv:

A

haemoglobin electrophoresis

21
Q

Transfusion reactions presentations:

A

Transfusion Associated Circularory Overload(TRACO): HYPERtension, raised jugular venous pulse, AFebrile, S3 present.

Transfusion Related Acute Lung Injury(TRALI): HYPOtension, pyrexia(Febrile), normal/unchanged JVP

22
Q

Tumour lysis syndrome reduce risk:

A

Allopurinol or Rasburicase= to lower uric acid in the blood.

Tumour lysis syndrome: Hyperuricaemia, Hyperkalaemia, Hyperphosphate, Hypocalcaemia

  • Burkitt’s Lymphoma(fast growing b-cell Non-Hodgkin’s Lymphoma)= common cause of Tumour Lysis syndrome
23
Q

Post-thrombotic syndrome:

A
  • slow progression of pruritus, pain and swelling are complications that can occur following a DVT.
24
Q

Why are irradiated blood products used in blood transfusions?

A
  • they are depleted in T cell lymphocytes so it reduces the risk of graft vs. host disease
25
Q

Target cells, Howell Jowell bodies seen in what condition/presentation:

A
  • coeliac disease= Hyposplenism
26
Q

Myeloma clinical presentation:

A

Hypercalcaemia, renal failure, high total protein(could be high proteinuria)

27
Q

Hodgkin’s lymphoma staging:

A

1: single lymph node is involved
2: more than 1 lymph node, same side of diaphragm
3: more than 1, both sides of diaphragm
4: spread beyond lymph nodes

28
Q

Multiple Myeloma presentation: CRAB=

A

C- HyperCalcaemia
R- Renal failure
A- Anaemia
B- Bone fractures/lytic lesions

29
Q

Sickle cell crisis: Painful (vaso occlusive: diagnostic Inv=

A
  • Clinical diagnosis and no additional testing is required.
30
Q

Non-haemolytic febrile transfusion reaction:

A

Mx: Paracetamol can be used to reduce the pyrexia(fever), also need to stop the transfusion.

31
Q

Heinz bodies are seen in what condition?

A
  • G6PD deficiency
  • Alpha Thalassaemia
32
Q

Target cells(Bull’s eye spot):

A
  • Iron deficiency anaemia
  • Post-Splenectomy
33
Q

Howell-Jolly bodies:

A
  • Non-functioning spleen
    -severe anaemia
34
Q

Smudge cells (ruptured WBC) :

A
  • Associated with CLL
35
Q

Spherocytes: (are sphere shaped RBC without bi-concave disk)

A
  • Autoimmune Haemolytic Anaemia
    or
    -Hereditary Spherocytosis
36
Q

Anaemia:

A
  • Is defined as low haemoglobin in the blood
  • MCV= means size of blood cells and is significant in relation to anaemia
37
Q

MCV levels in anaemia and type of anaemia correlation:
- Low MCV
- Normal MCV
- High MCV

A
  • Low MCV: Microcytic Anaemia
  • Normal MCV: Normocytic Anaemia
  • High MCV: Macrocytic Anaemia
38
Q

Causes of Microcytic Anaemia (TAILS mnemonic):

A
  • T (Thalassaemia)
  • A (Anaemia of Chronic disease)
  • I (Iron deficiency Anaemia)
  • L (Lead Poisoning)
  • S (Sideroblastic Anaemia- body produces enough iron but is unable to put it into haemoglobin)
39
Q

Causes of Normocytic Anaemia (3 A’s and 2 H’s):

A
  • Acute Blood loss
  • Anaemia of chronic disease (often occurs with CKD due to reduced production of erythropoietin)
  • Aplastic Anaemia
  • Haemolytic Anaemia
  • Hypothyroidism
40
Q

Causes of Megaloblastic Anaemia:

A
  • B12 Deficiency
  • Folate Deficiency
41
Q

Generic symptoms and signs of Anaemia:

A

Symptoms:
- Tiredness
- SOB
- Headaches
- Dizziness
- Palpitations
- Worsening of other conditions eg. angina/heart failure

Signs:
- Pale Skin
- Conjunctival Pallor
- Tachycardia
- Raised Respiratory Rate

42
Q

Symptoms and signs specific to Iron-deficiency anaemia:

A
  • PICA (dietary cravings for abnormal things eg. metal, dirt, soil)
  • Hair Loss

Signs:
- Koilonychia (spoon shaped nails)
- Angular Cheilitis
-Atrophic Glossitis
-Brittle hair and nails
-

43
Q

what should you do for UNEXPLAINED iron-deficiency anaemia?

A
  • OGD or Colonoscopy= to exclude GI cause of bleeding
  • Bone marrow biopsy also= to exclude unknown malignancy(leukaemia/myeloma)
44
Q

Main Haem conditions:

A

Iron deficiency (Microcytic Anaemia)

Vitamin B12 deficiency (Macrocytic Anaemia)

Folate deficiency (Macrocytic Anaemia)

Haemophilia (Bleeding Disorder)

Deep vein thrombosis

Pulmonary embolism

Complications of blood transfusion

45
Q

Myeloma:
(including causes of Myeloma- CRAB mnemonic)

A
  • Type of cancer effecting plasma cells in bone marrow, causes high amounts of M protein (M for Myeloma)
  • Presence of Bence Jones Proteins in: Urine protein electrophoresis
  • CRAB: Calcium (elevated), Renal failure, Anaemia, Bone lesions and bone pain
  • Most common complication= Anaemia
    -Other conditions that can be caused=Myeloma bone disease, Renal disease
  • Bone marrow biopsy= is required to confirm diagnosis
  • X-ray findings= Raindrop skull/pepper pot skull: refers to multiple lytic lesions seen on x-ray
  • Mx: will never be fully cured; disease is relapsing-remitting.
    Treatment: Chemotherapy/High-dose chemotherapy
46
Q

Lymphoma key symptom:

A
  • Lymphadenopathy
47
Q

Hodgkin’s Lymphoma:

A
  • May experience lymph node pain after drinking alcohol
    +
  • B symptoms= Fever, weight loss and night sweats
  • Reed-Sternberg cells= key finding in biopsy
  • Diagnostic investigation: Lymph Node Biopsy
  • Additional non-specific symptoms: Fatigue, itching, cough,SOB, Abdominal pain, Recurrent infections
    Management:
  • Hodgkin’s Lymphoma= Chemotherapy and Radiotherapy
48
Q

4 stages of Lymphoma (Lugano Classification):

A

Stage 1: Confined to ONE node/group of nodes
Stage 2: More than group, but on the SAME SIDE of the diaphragm
Stage 3: Lymph nodes ABOVE and BELOW diaphragm.
Stage 4: Widespread involvement, including non-lymphatic organs.

49
Q

Management for: TACO (Transfusion Associated Circulatory Overload)=

A
  • Should be treated with IV loop Diuretics
  • Eg. presentation= Patient had blood transfusion and then started getting SOB/reaction to the medication/blood given.
  • Is also indicated by crackles at the bilateral lung bases.

Finals (38 decks)

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