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Year 6 > Haem > Flashcards

Haem Flashcards

1
Q

which HL carries the best prognosis

A

lymphocyte predominant

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2
Q

which B symptoms indicate a worse prognosis in Lymphoma

A

night sweats
fever >38
weight loss >10% over 6 months

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3
Q

which HL carries the worst prognosis

A

lymphocyte depleted

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4
Q

what is a cause of post radiotherapy pancytopenia

A

myelodysplastic syndrome

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5
Q

what leukaemia does myelodysplasia often transform into?

A

AML

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6
Q

what anticoagulant is used in cancer patients

A

DOACs

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7
Q

if a DVT is likely, what investigation should be done

A

Proximal Leg vein USS within 4 hours

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8
Q

what should be done if Proximal Leg Vein USS is negative?

A

A D-dimer should be done

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9
Q

What should be done if proximal leg vein USS is not available within 4 hours

A

interim anticoagulation before vein USS within 24 hours

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10
Q

what if the proximal leg vein USS is negative but D-dimer is positive

A

stop interim anticoagulation
offer repeat scan in 6 to 8 days

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11
Q

what should be done if Wells score is low and DVT is unlikely

A

D-dimer

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12
Q

what should be done if D-dimer is positive in a low likelihood DVT

A

proximal leg vein USS within 4 hours

if this is not done, start interim anticoagulation

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13
Q

what anticoagulant is used in the renally impaired for DVT

A

UFH or LMWH with VKA

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14
Q

what anticoagulant is used in antiphospholipid syndrome patients with DVT

A

LMWH with VKA

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15
Q

Key investigation for child suspected of leukaemia

A

Urgent FBC within 48 hours

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16
Q

pentad of TTP

A

swinging fevers
neuro signs
renal failure
thrombocytopenia
haemolytic anaemia

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17
Q

9 positive features of Well Score

A

active cancer
immobilisation
bed ridden
tenderness along vein
leg swollen
calf swollen
previous DVT
pitting oedema
superficial contralateral veins

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18
Q

reticulocytes level in aplastic anaemia

A

LOW

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19
Q

reticulocytes level in acute sequestration

A

HIGH

also seen in haemolysis

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20
Q

how is a definitive diagnosis of sickle cell made

A

Hb electrophoresis

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21
Q

main imaging in multiple myeloma

A

whole body MRI

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22
Q

characteristic findings in SCD blood smear

A

Howell Jolly Bodies

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23
Q

Waldenstroms features

A

hyperviscosity
monoclonal IgM paraprotein
cryoglobulinaemia
hepatosplenomelagy
systemic upset

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24
Q

3 drugs that causes agranulocytosis

A

carbimazole
carbamezapine
clozapine

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25
Q

which amyloidosis is associated with chronic inflammation such as rheumatoid arthritis

what do they tend to present with

A

AA

renal disease e.g. nephrotic syndrome, proteinuria, renal failure
heptosplenomegaly

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26
Q

which amyloidosis is associated with multiple myeloma

A

AL

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27
Q

indirect marker of lymphoma proliferation

A

raised LDH

poor prognosis

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28
Q

what sort of lymphoma is associated with H.pylori

A

gastric MALT

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29
Q

what sort of lymphoma is associated with EBV

A

Burkitt’s

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30
Q

what sort of lymphoma is associated with HIV

A

CNS lymphoma

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31
Q

what sort of lymphomas is associated with Hep C

A

diffuse large B-cell lymphoma and splenic marginal zone lymphoma.

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32
Q

what sort of lymphoma is associated with HTLV-1

A

T-cell lymphoma.

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33
Q

which conditions are associated with lymphoma [4]

A

coeliac disease
Sjogrens
post-transplant
AIDS

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34
Q

sickle cell crisis vs aplastic anaemia

A

aplastic: low reticulocytes, pancytopenia

crisis–> haemolysis: high reticulocytes to compensate

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35
Q

pathology behind sub acute combined degeneration of spinal cord

A

vitamin B12 deficiency caused by degeneration both the dorsal columns and corticospinal tracts (pain and temperature sensation are typically preserved)

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36
Q

Causes of basophilic stippling [6]

A

megablastic anaemia
myelodysplasia
thalassaemia alpha
sideroblastic anaemia
alcohol abuse
lead poisoning

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37
Q

causes of Howell Jolly Bodies

A

Hyposplenism

38
Q

causes of schistocytes

A

MAHA: HUS, TTP, DIC

39
Q

what does left shift mean

A

presence of immature cells

(including so-called band cells - neutrophils with an unlobed, band-shaped nucleus)

40
Q

what is the significance of the number of lobes in the neutrophil nucleus

A

index of maturity

41
Q

causes of left shift in neutrophils [4]

A

acute infection
myeloproliferative: CML, myelofibrosis, acute leukaemia

42
Q

what does right shift mean

A

signifies the prevalence of hypermature neutrophils with greater than five nuclear lobes

In some cases, right shift may involve the presence of band cells, which are immature neutrophils with an unlobed, band-shaped nucleus

43
Q

causes of right shift in neutrophils [3]

A

chronic infections
G-CSF
megaloblastic anaemic

44
Q

what does the presence of reticulocytes indicate

A

high turnover of red cells matched by increased marrow production and release

45
Q

causes of reticulocytosis [2]

A

acute bleeding
haemolysis

46
Q

causes of target cells [3]

A

obstructive liver disease
haemoglobinopathies (thalassaemia and sickle cell disease)
post-splenectomy

47
Q

causes of roleaux formation [3]

A

multiple myeloma
Waldenstrom’s macroglobulinemia
inflammatory disorders and malignancies.

48
Q

what is meant by a leukoerythroblastosis

A

A leukoerythroblastic film described to combined presence of immature (including nucleated) red blood cells and left shift (immature white cells)

49
Q

causes of leukoerythroblastosis

A

marrow fibrosis or invasion, such as: primary myelofibrosis, metastatic cancer, TB and Gaucher’s disease.

50
Q

most common cause of anisocytosis

A

iron deficiency

51
Q

causes of acanthocytes/spur cells

A

liver disease and neuroacanthocytosis (including abetalipoproteinemia and homozygous familial hypobetalipoproteinemia)

52
Q

causes of Echinocytes or burr cells

A

liver disease, vitamin E deficiency, end-stage renal disease, and the haemolytic enzyme disorder pyruvate kinase deficiency.

53
Q

difference between acanthocytes and echinocytes

A

Acanthocytes or spur cells are red blood cells that appear irregularly spiked on a blood film.

They are distinct from echinocytes (or burr cells) which are also spiked but with smaller projections in a more regular distribution than those seen on acanthocytes

Echinocytes or burr cells are red blood cells with small, regularly distributed projections across the cell surface. They are distinct from acanthocytes (or spur cells) which appear irregularly spiked or thorny.

54
Q

how do you prevent painful episodes/crises in sickle cell disease

A

hydroxyurea

increases HbF

55
Q

investigations for multiple myeloma

A

1) Bloods
full blood count: anaemia
peripheral blood film: rouleaux formation
urea and electrolytes: renal failure
bone profile: hypercalcaemia

2) Protein electrophoresis
raised concentrations of monoclonal IgA/IgG proteins will be present in the serum
in the urine, they are known as Bence Jones proteins

3) Bone marrow aspiration
confirms the diagnosis if the number of plasma cells is significantly raised

4) Imaging
historically a skeletal survey has been done to look for bone lesions
however, whole-body MRI is increasingly used and is now recommended in the 2016 NICE guidelines
X-rays: ‘rain-drop skull’ (likened to the pattern rain forms after hitting a surface and splashing, where it leaves a random pattern of dark spots). Note that a very similar, but subtly different finding is found in primary hyperparathyroidism - ‘pepperpot skull’

56
Q

which blood film abnormalities may be seen in coeliac disease [2]

A

Howell Jolly and target cells

57
Q

how should children with new onset purpura be managed

A

admitted immediately for investigations as it may be a sign of meningococcal septicaemia or acute lymphoblastic leukaemia

58
Q

how should children with new bruising be treated

A

urgent FBC

59
Q

features of acute chest syndrome [4]

A

dyspnoea
chest pain
pulmonary infiltrates on chest x-ray
low pO2

60
Q

platelet transfusion threshold for clinically significant bleeding (World Health organisation bleeding grade 2- e.g. haematemesis, melaena, prolonged epistaxis)

A

< 30 x10^9

61
Q

platelet transfusion threshold for patients with severe bleeding (World Health organisation bleeding grades 3&4), or bleeding at critical sites, such as the CNS.

A

< 100 x10^9

62
Q

when should a platelet transfusion not be done [4]

A

Chronic bone marrow failure
Autoimmune thrombocytopenia
Heparin-induced thrombocytopenia, or
Thrombotic thrombocytopenic purpura.

63
Q

Platelet level aim for most patients before/after surgery

A

> 50 ×10^9/L for most patients

64
Q

Platelet level aim for patients with high risk of bleeding before/after surgery

A

50-75 x 10^9

65
Q

Platelet level aim for patients having surgery at critical sites before/after surgery

A

> 100 x10^9

66
Q

causes of spherocytes [2]

A

Hereditary spherocytosis
Autoimmune hemolytic anaemia

67
Q

causes of Heinz Bodies [2]

A

G6PD deficiency
Alpha-thalassaemia

68
Q

cause of tear drop cells

A

myelofibrosis

69
Q

test for hereditary spherocytosis

A

EMA binding test

70
Q

how is tranexamic acid given in major haemorrhage

A

IV bolus followed by slow infusion

71
Q

medication to reduce risk of tumour lysis syndrome

A

allopurinol or rasburicase

72
Q

how does MCV compare to Hb in thalassaemia

A

disproportionately low in comparison

73
Q

most common inherited bleeding disorder

A

von Willibrand

raised aPTT and prolonged bleeding time

74
Q

blood film features in hyposplenism (post splenectomy, coeliac)

A

target cells
Howell-Jolly bodies
Pappenheimer bodies
siderotic granules
acanthocytes

75
Q

rheum conditions that cause neutropenia

A

SLE and RA

76
Q

what can polycythaemia rubra vera progress to [2]

A

AML or myelofibrosis

77
Q

treatment of polycythaemia vera [3]

A

aspirin
reduces the risk of thrombotic events
venesection
first-line treatment to keep the haemoglobin in the normal range
chemotherapy
hydroxyurea - slight increased risk of secondary leukaemia
phosphorus-32 therapy

78
Q

Sickle cell patients should be started on long term ___________ to reduce the incidence of complications and acute crises

A

Sickle cell patients should be started on long term hydroxycarbamide to reduce the incidence of complications and acute crises

79
Q

features of acute intermittent porphyria

management?

A

abdominal: abdominal pain, vomiting
neurological: motor neuropathy
psychiatric: e.g. depression
hypertension and tachycardia common

avoiding triggers
acute attacks
IV haematin/haem arginate
IV glucose should be used if haematin/haem arginate is not immediately available

80
Q

transfusion threshold in someone with ACS

without ACS?

A

<80 (target 80-100)

<70 (target 70-90)

81
Q

Ann-Arbor staging

A

I: single lymph node
II: 2 or more lymph nodes/regions on the same side of the diaphragm
III: nodes on both sides of the diaphragm
IV: spread beyond lymph nodes

82
Q

cause of thrombocytopenia

A

Causes of severe thrombocytopenia
ITP
DIC
TTP
haematological malignancy

Causes of moderate thrombocytopenia
heparin induced thrombocytopenia (HIT)
drug-induced (e.g. quinine, diuretics, sulphonamides, aspirin, thiazides)
alcohol
liver disease
hypersplenism
viral infection (EBV, HIV, hepatitis)
pregnancy
SLE/antiphospholipid syndrome
vitamin B12 deficiency

83
Q

purpose of irradiated blood

A

depleted of T-lymphocytes and used to avoid transfusion-associated graft versus host disease (TA-GVHD) caused by engraftment of viable donor T lymphocytes.

84
Q

features of TACO

A

Hypertension, raised jugular venous pulse, afebrile, S3 present

85
Q

features of TRALI

A

Hypotension, pyrexia, normal/unchanged JVP

86
Q

what does cryoprecipitate contain

A

contains factor VIII, fibrinogen, von Willebrand factor and factor XIII

87
Q

which leukaemia undergoes Richters transformation

what is the result of a richter’s transformation

A

CLL

becomes a NHL

88
Q

in a non-urgent scenario, a unit of RBC is usually transfused over _____

A

in a non-urgent scenario, a unit of RBC is usually transfused over 90-120 minutes

89
Q

is CLL associated with warm or cold autoimmune haemolytic anaemia

A

warm

90
Q

The universal donor of fresh frozen plasma is ___ RhD ______ blood

A

The universal donor of fresh frozen plasma is AB RhD negative blood

Year 6 (19 decks)

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