haem Flashcards
blood test results in VWD:
- bleeding time:
- platelet count:
- prolonged APTT:
- bleeding time: increased
- platelet count: normal
- prolonged APTT: increased
____________ 1st line imaging in suspected multiple myeloma
Whole body MRI
B thalassaemia: ____ reticulocytes and ____ bilirubin
raised, raised
bilirubin is normal in iron deficient anaemia
Bleeding on dabigatran? Can use _______ to reverse
idarucizumab
_________is used for the reversal of apixaban or rivaroxaban
Andexanet alfa
The blood tests show a __________________________, characteristic of DIC. The condition is associated with ___________ on blood film.
depletion of platelets and coagulation factors
schistocytes
weight loss, pallor, thrombocytosis, raised neutrophils, low/normal other WBCs, anaemia ‘sense of fullness’ –>
CML
splenomegaly
___________ is usually picked up as an incidental finding of lymphocytosis, as it has no symptoms
Chronic lymphocytic leukaemia (CLL)
how to diagnose a haem malognancy?
Step given by my lecturer (simple yet helpful)
1. Look at lymphocytes
2. Look at WBC
3. Others hint (blast cell/ bands)
Example
1.Low Lymphocytes -> the answer should be AML or CML
2. WBC > 100 -> Chronic causes so Consider CML (rule out AML)
3. Presence of bands cell -> confirm CML
*blast -> Acute
*bands -> Chronic
Deranged coagulation in sepsis ->
DIC
DIC bloods (coag screen)
low platelets, increased clotting time and raised fibrin degradation products (FDPs), schistocytes
Heparin-induced thrombocytopenia usually happens ________ post-heparin exposure
5-14 days
B-thalassemia major - when does it present, blood tests, Tx
when: within first year of life
blood tests: HBA2 and HbF raised, HbA absent
Mx: repeated transfusion (risk: iron overload)
Blood films: what are the conditions associated with:
1. Target cells:
2. Tear-drop cells:
3. Spherocytes:
4. Basophilic stippling:
5. Howel-Jolly bodies:
6. Heinz bodies:
7. Schistocytes (helmet cells):
8. Burr cells:
9. hypersegmented neutrophils:
- Target cells: sickle-cell, thalassaemia, iron deficiency, hyposplenism, liver disease
- Tear-drop cells: myelofibrosis
- Spherocytes: spherocytosis, AIHA
- Basophilic stippling: sideroblastic, thalassaemia, lead-poinsoning, myelodysplasia
- Howel-Jolly bodies: hyposplenism
- Heinz bodies: G6PD deficiency, A-thalassaemia
- Schistocytes (helmet cells): haemolysis, mechanical heart valve, DIC
- Burr cells: uraemia
- hypersegmented neutrophils: megaloblastic anaemia
complications of blood transfusion
- immunological - acute haemolytic, non-haemolytic febrile, allergic, anaphylaxis
- infective
- TRALI
- TACO
- HyperK
- HyperFe
- clotting
key investigation for CLL (other than bone marrow biopsy)
immunotyping
________ is marked in CML
splenomegaly
difference in inheritance between two haemolytic anaemias, G6PD and hereditary spherocytosis
G6PD: X-linked recessive
spherocytosis: AD
Haematological malignancies: infections
Hodgkin’s and Burkitt’s lymphoma, nasopharyngeal carcinoma:
High-grade B-cell lymphoma:
gastric lymphoma (MALT):
Burkitt’s lymphoma:
Hodgkin’s and Burkitt’s lymphoma, nasopharyngeal carcinoma: EBV
High-grade B-cell lymphoma: HIV
gastric lymphoma (MALT): H.Pylori
Burkitt’s lymphoma: Malaria
what is increased in haemophilia?
APTT
lacunar cells are found in
nodular sclerosing Hodgkin’s lymphoma
New system of staging Hodgkin’s Lymphoma?
Lugano classification
ITP - 1st line Tx? Ix result?
Isolated thrombocytopenia
Tx: 1st line is predinosolone
2nd line: IVIG
what is Evans syndrome
ITP in association with AIHA
AOCD vs Iron deficient anaemia - serum iron, ferritin, TIBC and transferrin results?
Fe-deficient: iron and ferritin low, transferrin low, TIBC high
AOCD: iron low, ferritin high, transferrin low, TIBC low
Drainage of the ovaries, uterus and cervix
The ovaries drain to the para-aortic lymphatics.
Uterus: iliac lymph nodes
Cervix: internal and external iliac lymph nodes
polycthaemia vera Mx
aspirin: reduce risk of thrombotic events
venesection
_________________ should be suspected in any patient presenting with an acute kidney injury in the presence of a high phosphate and high uric acid level.
tumour lysis syndrome
vWD pattern of inheritence
AD (except type 3 which is AR)
Tx for vWD
tranexamic acid, desmopressin, factor Vlll concentrate
mainstay Tx for Pts undergoing sickle cell vaso-occlusive crisis?
what do you add depending on infection/low Hb?
oxygen with IV analgesia and IV fluids.
IV abx, blood transfusion
Polycythaemia vera blood results
isolated increase in Hb
low ESR
JAK2 mutation
Hodgkin’s lymphoma - most common type =
nodular sclerosing
tricuspid regurg would cause what murmur
It would cause a pan-systolic murmur, as, during systole, the blood is ejected from the ventricles which are contracting
Poor prognostic factors of ALL
- presenting <2 years or >10 years
- having B or T cell surface markers
- having a WCC > 20 * 10^9/l at diagnosis
- male sex
Steroids tend to cause a neutrophilia
Anaphylaxis - serum tryptase levels _____following an acute episode
rise
ALL is the most common childhood leukaemia and presents with
anaemia, neutropaenia and thrombocytopaenia
Acute chest syndrome is defined as
new pulmonary infiltrates on chest x-ray along with dyspnoea, chest pain, cough or hypoxia.
Burkitt’s lymphoma - ______gene translocation
c-myc
_______________can present with bone marrow failure, due to ineffective haematopoeisis. Furthermore, bone marrow biopsy may show ring sideroblasts, as described in this patient
myelodysplasia
Failure to fully recover from abx with swinging fever
empyema
vast majority of erythema multiforme are due to?
herpes simplex virus
________________can give a falsely high HbA1c level due to the increased lifespan of RBCs
Splenectomy
Ix of choice for Non-Hodgkin’s lymphoma?
Excisional node biopsy
Platelet thresholds for transfusion________________________ for patients with severe bleeding, or bleeding at critical sites, such as the CNS
are higher (maximum < 100 x 10 9)
which drugs can trigger G6PD?
sulph- drugs: sulphonamides, sulphasalazine and sulfonylureas can trigger haemolysis, ciprofloxacin too
Platelet transfusion threshold:
30 x 109 for patients not bleeding or having an invasive procedure- except where CI or alternative treatments for their condition
Platelet transfusion threshold for Pt with severe bleeding?
<100 x 10^9
