HAEM Flashcards
1
Q
blood film heinz bodies
A
g6pd deficiency
2
Q
howell jolly bodies
A
post splenectomy
megaloblastic anaemia
3
Q
pelger huet cells/pseu pegler huet cells
A
congenital
myelodysplastic syndromes
4
Q
right shift of RBCs
A
megaloblastic anaemia
5
Q
rouleaux bodies
A
myeloma
6
Q
target cells
A
liver disease
hyposplenism
thalassaemia
IDA
7
Q
anaemia Hb men and women
A
men= <135
women= <115
8
Q
murmur in severe anaemia
A
ejection systolic
loudest over apex
9
Q
microcytic anaemia acronym
A
FAST
iron deficiency
anaemia of chronic disease
sideroblastic
thalassaemia
10
Q
macrocytic anaemia acronym
A
FATRBC
fetus (pregnancy)
antifolates (phenytoin)
thyroid (hypothyroid)
reticulocytosis
b12/folate deficiency
cirrhosis
11
Q
cause of IDA
A
bleeding until proven otherwise
12
Q
2WW for colorectal cancer anaemia
A
anyone over 60 with IDA
13
Q
anaemia of chronic disease moa
A
cytokine driven inhibtion of RBC synthesis
kidney failure= reduced EPO synthesis
14
Q
what type of iron is high in anaemia of chronic disease
A
ferritin- stored inside macrophages to deprive pathogens of iron
process driven by hepcidin
15
Q
what transferrin saturation indicates iron deficiency
A
<20%
16
Q
ferritin levels in inflammation
A
high
17
Q
what vitamin can be given to promote RBC production
A
B6
pyroxidine
18
Q
if there is pancytopenia with splenomegaly what is implicated
A
myelofibrosis
lymphoproliferative disorders
19
Q
malabsorption of B12 in stomach causes what anaemia
A
pernicious anaemia
lack of IF
20
Q
most common cause of macrocytic anaemia in western world
A
pernicious
21
Q
what cells produce intrinsic factor
A
gastric parietal cells
22
Q
what do you need to check before giving folate
A
B12 levels- must be normal or folate will exacerbate B12 neuropathy
23
Q
normal RBC lifesoan
A
120 days
24
Q
inherited causes of haemolytic anaemia
A
membrane= hereditary spherocytosis/elliptocytosis
enzyme= G6PD, pyruvate kinase deficiency
haemoglobinopathies= sickle cell, thalassaemia
25
acquired causes of haemolytic anaemia
immune= autoimmune warm/cold, alloimmune transfusion reactions
non immune= infections, drugs, mechanical eg valves trauma, MAHA
26
intravascular haemolytic anaemia bloods
high free plasma Hb
low haptoglobin
27
extravascular haemoytic anaemia bloods
splenomegaly
28
hereditary spherocytosis associated with what condition
parovirus b19
29
hereditary spherocytosis/elliptocytosis inheritance
autosomal dominant
30
G6PD deficiency inhertiance
x linked
31
G6PD precipitated by what molecules
oxidants
32
heinz body
gdpd deficiency
33
g6pd full form
glucose 6 phosphate dehydrogenase
34
how many genes for alpha globin
4
35
how many genes for beta globin
2
36
Hb molecule is comprised of
4 globin chains
1 heme
37
globin chains in HbA, HbA2, HbF
HbA= 2 alpha 2 beta
HbA2= 2 alpha 2 delta
HbF= 2 alpha 2 gamma
38
what haemoglobinopathies affect beta globin
sickle cell
beta thalassaemia
39
sickle cell inheritance
autosomal recessive
40
sickle cell mutation and result
codon 6 of beta chain
glu to val
41
all sickle cell patients should be taking
penicillin v
folic acid
pneumovax
HIB vax
42
bone changes in beta thalassaemia
skull bossing
maxillary hypertrophy
hairs on end skull xray
43
type of anaemia in beta thalassaemia and why
microcytic
erythropoiesis in ineffective
44
3 types of Hb
HbA= normal
HbA2
HbF
45
beta thalassaemia diagnosis
Hb electrophoresis
guthrie test at birth
46
warm autoimmune haemolytic anaemia immunoglobulin affected
IgG
cos if the weathers warm its nice its a g
47
cold autoimmune haemolytic anaemia immunoglobulin affected
IgM
48
test for autoimmune haemolytic anaemia (full form)
direct antiglobulin test
49
temperature for warm vs cold autoimmune haemolytic anaemia
warm= 37 degrees
cold= under 37 degrees
50
donath landsteiner antibodies
paroxysmal cold haemoglobinuria
51
blood film in MAHA
shistocytes
52
phases of clotting cascade
initiation
amplification
propagation and thrombin burst
stable clot
53
intrinsic pathway is measure by
APTT
54
extrinsic pathway is measure by
PT
55
common pathway is measured by
TT
56
intrinsic pathway starts with
factor 12
57
extrinsic pathway starts with
factor 7
58
common pathway starts with
activated factor 5
59
normal platelet count
150-400 x 10^9 g/l
60
2 types of ITP
acute (kids)
chronic (adults)
61
whats christmas disease
haemophilia B
62
haemophilia A inheritance
x linked recessive
63
haemophilia A is deficiency of
factor VIII
64
haemophilia B is deficiency of
factor IX
65
what carries factor VIII in circulation
vWF
66
types of vWD
1= reduced production
2= defective function
3= absence
67
what clotting factor is reduced in vWD and why
factor 8
vWF carried factor 8 in circulation
68
aptt full form
activated partial thromboplastin time
69
pt full form
prothrombin time
70
risocetin co factor
vWD
71
high levels of what clotting factors in liver disease
VIII
vwF
72
chronic liver disease bleeding or prothrombotic
prothrombotic despite high INR/PT
73
how to remember what vit K is needed for
buses that go down high street ken
27, 9 and 10
therefore factors 2/7/9/10
74
APTT is used to measure what drup therapy
heparin
75
PT is used to measure what drug therapy
warfarin
76
what drug causes low vit K
warfarin
77
virchows triad for haemostasis
endothelial injury
stasis
hypercoagulability
78
wells score for DVT/PE interpretation
>4= high, US suspected limb or CTPA for PE
4 or <4= low, d dimer then consider US suspected limb or CTPA for PE
79
DVT prophylaxis
LMWH and TED stockings
80
DVT mx
LMWH treatment dose
long term DOAC (3 months if provoked, 6 months if not)
81
heparin moa
potentiates antithrombin III
inactivates thrombin, factors 9/10/11
82
heparin antidote
protamine sulfate
83
monitor what when on herpain
APTT
84
warfarin moa
inhibits vitamin K epoxide reductase
active vit K not formed
no factors 2/7/9/10, protein C/S/Z
85
warfarin reversal
IV vit K
86
what potentiates warfarin
liver disease
cranberry juice
NSAIDs
87
target INRs in DVT/PE
2-3= first episode
2.5-3.5= recurrent episodes
88
which immunoglobulin can cross the placenta
IgG
89
what will be low in bloods in normal physiological pregnancy
Hb
haematocrit
factor 11
protein S
90
3 main features of BM failure
anaemia
thrombocytopenia= bleeding
neutropenia= infection
91
ix for haem malignancys
cytochemistry/morphology- stains
immunophenotyping used flow cytometry- lineage/differentiation
cytogenetics
molecular genetics
92
what ix will differentiate between AML and ALL
immunophenotyping
93
>20% blast cells in BM
ALL or AML
94
auer rods
AML
95
M3 type AML
acute promyeolytic
15;17 mutation
prone to DIC and bleeding
96
M3 AML gene mutation
15;17
97
M4+M5 AML
monoblasts and monocytes
skin/gum infiltration, hypokalemia
98
ALL/AML general mx
induction remission chemo
maintenance chemo (this includes intrathecal in ALL)
99
philadelphia chromosome
ALL
translocation 9;22
BCRABL1 gene
100
massive splenomegaly is associated with which leukaemia
CML
101
philadelphia chromosome
CML
102
CML stages and mx
stage 1= <5% blasts, easy remission with imatinib
stage 2= 10-20% blasts, less responsive to treatment
stage 3= >20% blasts, like AML
103
richters transformation
when CLL transforms to large cell lymphoma
104
CLL staging
binet
a= <3 groups of lymph nodes
b= >3 groups of lymph nodes
c= anaemia or thrombocytopenia
105
reed stenberg cells
hodgkins lymphoma
106
staging for hodgkins/non hodgkins lymphoma
ann arbor
1= one group of nodes
2= 2 or more groups of nodes on same side of diaphragm
3= 2 or more groups of nodes on diff sides of diaphragm
4= extra nodal sites
a= no constitutional sx
b= constitutional sx
107
how to differentiate hodgkins vs non hodgkins lymphoma
hodgkins is painful after alcohol
non hodgkins= no pain after alcohol
108
starry sky appearance on histolgy
burkitts lymphoma
109
large sheets of b cells on histology
diffuse large b cell lymphoma
110
angular/clefted cells on histology
mantle cell lymphoma
111
MALT lymphoma is associated with
chronic antigen exposure
h pylori= gastric
sjogrens= parotid
112
most common immunoglobulin produced in multiple myeloma
IgG
113
features of multiple myeloma
CRAB
hypercalcaemia
renal failure
anaemia
bone pain
+hyperviscosity
114
rouleaux bodies
multiple myeloma
115
urinary bence jones proteins
mutliple myeloma
116
multiple myeloma ix
serum electrophoresis= monoclonal IgG band
117
MGUS and smoldering MM vs mutliple myeloma
MGUS= <30g m spike, <10% clonal cells, no CRAB or organ damage
smouldering MM= >30g m spike, >10% clonal cells, no CRAB or organ damage
118
% blasts in myelodysplastic syndromes
<20%
119
fanconi anaemia
inherited BM failure, causes pancytopenia
autosomal recessive
120
dyskariosis congenita triad
skin pigmentation
nail dystrophy
oral leukoplakia
plus BM failure
121
diamond blackfann syndrome
congenital aplastic anaemia
122
schwamann diamond syndrome
congenital primary neutropenia
123
philadelphia chromosome positive myeloproliferative disorders
CML
124
philadelphia chromosome negative myeloproliferative disorders
polcythemia vera
myelofibrosis
essential thrombocytosis
125
what mutation are philadelphia chromosome negative myeloproliferative disorders assoc w
JAK2
126
polycythemia rubra vera mx
venesection
hydroxycarbamide
127
tear drop poikilocytes
myelofibrosis
128
myelofibrosis clinical sign
massive splenomegaly
129
essential thrombocythaemia blood film
large platelets
megakaryocyte fragments
130
essential thrombocythaemia mx
aspirin
anagrelide
hydroxycarbamide
131
platelet precursores
megakaryocytes
131
blood transfusion threshold
<70g/l if asymptomatic
<80g/l if symptomatic
131
platelet transfusion threshold
<10bn/L
131
only transfuse platelets if
someone is actively bleeding
(otherwise they will be destroyed)
132
patient with what deficiency is at higher risk of tranfusion associated anaphylaxis
IgA
133
tranfusion associated anaphylaxis mediated by what anitobody
IgE
134
ABO incompability transfusion reaction mediated by what anitobody
IgM (acute)
135
transfusion assoc bacterial contamination are more associated with what tranfusions
platelet
136
TRALI vs TACO
TRALI has fever and no cardiac failure
TACO has no fever and cardiac failure
137
delayed haemolytic transfusion reaction is mediated by what antibody
IgG
138
delayed vs acute transfusion reaction time period
24 hrs
acute <24
delayed >24
139
graft vs host disease clinical defining feature
skin desquamation
140
bleeding time in haemophilia
normal
141
bleeding time and vwF levels in vwD
bleeding time prolonged
vwF levels may be normal or low (reduced function or number)
142
t(8;14)
burkitts lymphoma
143
t(15;17)
acute promyeolytic leukaemia
144
t(9;22)
CML
145
t(11;14)
mantle cell lymphoma
146
t(14;18)
follicular lymphoma
147
most common cause of IDA in developing world
hookworm
148
blood test measure of fibrin degredation products
d dimer
149
genetic conditions affecting synthesis of haem molecules
porphyrias
150
rivaroxiban
adenexat alfa
151
clotting factor with shortest half life
7
152
anticoagulation for DVT first line
DOAC unless pregnant (then LMWH) or renal (warfarin)
153
4 electrolytes in tumor lysis
phosphate
potassium
calcium
urate
154
bilobed nucelus with red brown in cytoplasm
eosinophil
155
LMWH reversal
protamine sulfate
156
warfarin inhibits what enzyme
vitamin k epoxide reductase
157
cml translocation
(9;22)
158
smudge/smear cells
CLL
159
oncogene for burkitts lymphoma
C MYC
160
fanconi anaemia features
pancytopenia
cafe au lait spots
short stature
abnormal thumbs
161
in ciruclation vwF binds
factor 8
162
neutrophil on blood film
nucleus= 2-5 lobes
size= 3x RBC
granules= speckly
163
monocyte on blood film
nucleus= kidney bean shaped and large
size= 3x RBC
granules= none
164
basophil on blood film
nucleus= bilobed
size= 3xRBC
granules= blue
165
eosinophil on blood film
nucleus= bilobed
size= 3x RBC
granules= red/purple acidic
166
lymphocyte on blood film
nucleus= takes up majority of cell
size= same as RBC
granules= none
167
main treatment for moderate ITP
prednisolone
168
