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Aaska's path > HAEM > Flashcards

HAEM Flashcards

1
Q

blood film heinz bodies

A

g6pd deficiency

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2
Q

howell jolly bodies

A

post splenectomy
megaloblastic anaemia

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3
Q

pelger huet cells/pseu pegler huet cells

A

congenital
myelodysplastic syndromes

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4
Q

right shift of RBCs

A

megaloblastic anaemia

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5
Q

rouleaux bodies

A

myeloma

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6
Q

target cells

A

liver disease
hyposplenism
thalassaemia
IDA

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7
Q

anaemia Hb men and women

A

men= <135
women= <115

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8
Q

murmur in severe anaemia

A

ejection systolic
loudest over apex

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9
Q

microcytic anaemia acronym

A

FAST
iron deficiency
anaemia of chronic disease
sideroblastic
thalassaemia

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10
Q

macrocytic anaemia acronym

A

FATRBC
fetus (pregnancy)
antifolates (phenytoin)
thyroid (hypothyroid)
reticulocytosis
b12/folate deficiency
cirrhosis

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11
Q

cause of IDA

A

bleeding until proven otherwise

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12
Q

2WW for colorectal cancer anaemia

A

anyone over 60 with IDA

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13
Q

anaemia of chronic disease moa

A

cytokine driven inhibtion of RBC synthesis
kidney failure= reduced EPO synthesis

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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

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15
Q

what transferrin saturation indicates iron deficiency

A

<20%

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16
Q

ferritin levels in inflammation

A

high

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17
Q

what vitamin can be given to promote RBC production

A

B6
pyroxidine

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18
Q

if there is pancytopenia with splenomegaly what is implicated

A

myelofibrosis
lymphoproliferative disorders

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19
Q

malabsorption of B12 in stomach causes what anaemia

A

pernicious anaemia
lack of IF

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20
Q

most common cause of macrocytic anaemia in western world

A

pernicious

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21
Q

what cells produce intrinsic factor

A

gastric parietal cells

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22
Q

what do you need to check before giving folate

A

B12 levels- must be normal or folate will exacerbate B12 neuropathy

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23
Q

normal RBC lifesoan

A

120 days

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24
Q

inherited causes of haemolytic anaemia

A

membrane= hereditary spherocytosis/elliptocytosis
enzyme= G6PD, pyruvate kinase deficiency
haemoglobinopathies= sickle cell, thalassaemia

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25
Q

acquired causes of haemolytic anaemia

A

immune= autoimmune warm/cold, alloimmune transfusion reactions
non immune= infections, drugs, mechanical eg valves trauma, MAHA

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26
Q

intravascular haemolytic anaemia bloods

A

high free plasma Hb
low haptoglobin

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27
Q

extravascular haemoytic anaemia bloods

A

splenomegaly

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28
Q

hereditary spherocytosis associated with what condition

A

parovirus b19

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29
Q

hereditary spherocytosis/elliptocytosis inheritance

A

autosomal dominant

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30
Q

G6PD deficiency inhertiance

A

x linked

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31
Q

G6PD precipitated by what molecules

A

oxidants

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32
Q

heinz body

A

gdpd deficiency

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33
Q

g6pd full form

A

glucose 6 phosphate dehydrogenase

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34
Q

how many genes for alpha globin

A

4

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35
Q

how many genes for beta globin

A

2

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36
Q

Hb molecule is comprised of

A

4 globin chains
1 heme

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37
Q

globin chains in HbA, HbA2, HbF

A

HbA= 2 alpha 2 beta
HbA2= 2 alpha 2 delta
HbF= 2 alpha 2 gamma

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38
Q

what haemoglobinopathies affect beta globin

A

sickle cell
beta thalassaemia

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39
Q

sickle cell inheritance

A

autosomal recessive

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40
Q

sickle cell mutation and result

A

codon 6 of beta chain
glu to val

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41
Q

all sickle cell patients should be taking

A

penicillin v
folic acid
pneumovax
HIB vax

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42
Q

bone changes in beta thalassaemia

A

skull bossing
maxillary hypertrophy
hairs on end skull xray

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43
Q

type of anaemia in beta thalassaemia and why

A

microcytic
erythropoiesis in ineffective

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44
Q

3 types of Hb

A

HbA= normal
HbA2
HbF

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45
Q

beta thalassaemia diagnosis

A

Hb electrophoresis
guthrie test at birth

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46
Q

warm autoimmune haemolytic anaemia immunoglobulin affected

A

IgG
cos if the weathers warm its nice its a g

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47
Q

cold autoimmune haemolytic anaemia immunoglobulin affected

A

IgM

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48
Q

test for autoimmune haemolytic anaemia (full form)

A

direct antiglobulin test

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49
Q

temperature for warm vs cold autoimmune haemolytic anaemia

A

warm= 37 degrees
cold= under 37 degrees

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50
Q

donath landsteiner antibodies

A

paroxysmal cold haemoglobinuria

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51
Q

blood film in MAHA

A

shistocytes

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52
Q

phases of clotting cascade

A

initiation
amplification
propagation and thrombin burst
stable clot

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53
Q

intrinsic pathway is measure by

A

APTT

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54
Q

extrinsic pathway is measure by

A

PT

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55
Q

common pathway is measured by

A

TT

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56
Q

intrinsic pathway starts with

A

factor 12

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57
Q

extrinsic pathway starts with

A

factor 7

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58
Q

common pathway starts with

A

activated factor 5

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59
Q

normal platelet count

A

150-400 x 10^9 g/l

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60
Q

2 types of ITP

A

acute (kids)
chronic (adults)

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61
Q

whats christmas disease

A

haemophilia B

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62
Q

haemophilia A inheritance

A

x linked recessive

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63
Q

haemophilia A is deficiency of

A

factor VIII

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64
Q

haemophilia B is deficiency of

A

factor IX

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65
Q

what carries factor VIII in circulation

A

vWF

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66
Q

types of vWD

A

1= reduced production
2= defective function
3= absence

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67
Q

what clotting factor is reduced in vWD and why

A

factor 8
vWF carried factor 8 in circulation

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68
Q

aptt full form

A

activated partial thromboplastin time

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69
Q

pt full form

A

prothrombin time

70
Q

risocetin co factor

A

vWD

71
Q

high levels of what clotting factors in liver disease

A

VIII
vwF

72
Q

chronic liver disease bleeding or prothrombotic

A

prothrombotic despite high INR/PT

73
Q

how to remember what vit K is needed for

A

buses that go down high street ken
27, 9 and 10

therefore factors 2/7/9/10

74
Q

APTT is used to measure what drup therapy

A

heparin

75
Q

PT is used to measure what drug therapy

A

warfarin

76
Q

what drug causes low vit K

A

warfarin

77
Q

virchows triad for haemostasis

A

endothelial injury
stasis
hypercoagulability

78
Q

wells score for DVT/PE interpretation

A

> 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
Q

DVT prophylaxis

A

LMWH and TED stockings

80
Q

DVT mx

A

LMWH treatment dose
long term DOAC (3 months if provoked, 6 months if not)

81
Q

heparin moa

A

potentiates antithrombin III
inactivates thrombin, factors 9/10/11

82
Q

heparin antidote

A

protamine sulfate

83
Q

monitor what when on herpain

A

APTT

84
Q

warfarin moa

A

inhibits vitamin K epoxide reductase
active vit K not formed
no factors 2/7/9/10, protein C/S/Z

85
Q

warfarin reversal

A

IV vit K

86
Q

what potentiates warfarin

A

liver disease
cranberry juice
NSAIDs

87
Q

target INRs in DVT/PE

A

2-3= first episode
2.5-3.5= recurrent episodes

88
Q

which immunoglobulin can cross the placenta

A

IgG

89
Q

what will be low in bloods in normal physiological pregnancy

A

Hb
haematocrit
factor 11
protein S

90
Q

3 main features of BM failure

A

anaemia
thrombocytopenia= bleeding
neutropenia= infection

91
Q

ix for haem malignancys

A

cytochemistry/morphology- stains
immunophenotyping used flow cytometry- lineage/differentiation
cytogenetics
molecular genetics

92
Q

what ix will differentiate between AML and ALL

A

immunophenotyping

93
Q

> 20% blast cells in BM

A

ALL or AML

94
Q

auer rods

A

AML

95
Q

M3 type AML

A

acute promyeolytic
15;17 mutation
prone to DIC and bleeding

96
Q

M3 AML gene mutation

A

15;17

97
Q

M4+M5 AML

A

monoblasts and monocytes
skin/gum infiltration, hypokalemia

98
Q

ALL/AML general mx

A

induction remission chemo
maintenance chemo (this includes intrathecal in ALL)

99
Q

philadelphia chromosome

A

ALL
translocation 9;22
BCRABL1 gene

100
Q

massive splenomegaly is associated with which leukaemia

A

CML

101
Q

philadelphia chromosome

A

CML

102
Q

CML stages and mx

A

stage 1= <5% blasts, easy remission with imatinib
stage 2= 10-20% blasts, less responsive to treatment
stage 3= >20% blasts, like AML

103
Q

richters transformation

A

when CLL transforms to large cell lymphoma

104
Q

CLL staging

A

binet
a= <3 groups of lymph nodes
b= >3 groups of lymph nodes
c= anaemia or thrombocytopenia

105
Q

reed stenberg cells

A

hodgkins lymphoma

106
Q

staging for hodgkins/non hodgkins lymphoma

A

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
Q

how to differentiate hodgkins vs non hodgkins lymphoma

A

hodgkins is painful after alcohol
non hodgkins= no pain after alcohol

108
Q

starry sky appearance on histolgy

A

burkitts lymphoma

109
Q

large sheets of b cells on histology

A

diffuse large b cell lymphoma

110
Q

angular/clefted cells on histology

A

mantle cell lymphoma

111
Q

MALT lymphoma is associated with

A

chronic antigen exposure
h pylori= gastric
sjogrens= parotid

112
Q

most common immunoglobulin produced in multiple myeloma

A

IgG

113
Q

features of multiple myeloma

A

CRAB
hypercalcaemia
renal failure
anaemia
bone pain

+hyperviscosity

114
Q

rouleaux bodies

A

multiple myeloma

115
Q

urinary bence jones proteins

A

mutliple myeloma

116
Q

multiple myeloma ix

A

serum electrophoresis= monoclonal IgG band

117
Q

MGUS and smoldering MM vs mutliple myeloma

A

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
Q

% blasts in myelodysplastic syndromes

A

<20%

119
Q

fanconi anaemia

A

inherited BM failure, causes pancytopenia
autosomal recessive

120
Q

dyskariosis congenita triad

A

skin pigmentation
nail dystrophy
oral leukoplakia

plus BM failure

121
Q

diamond blackfann syndrome

A

congenital aplastic anaemia

122
Q

schwamann diamond syndrome

A

congenital primary neutropenia

123
Q

philadelphia chromosome positive myeloproliferative disorders

A

CML

124
Q

philadelphia chromosome negative myeloproliferative disorders

A

polcythemia vera
myelofibrosis
essential thrombocytosis

125
Q

what mutation are philadelphia chromosome negative myeloproliferative disorders assoc w

A

JAK2

126
Q

polycythemia rubra vera mx

A

venesection
hydroxycarbamide

127
Q

tear drop poikilocytes

A

myelofibrosis

128
Q

myelofibrosis clinical sign

A

massive splenomegaly

129
Q

essential thrombocythaemia blood film

A

large platelets
megakaryocyte fragments

130
Q

essential thrombocythaemia mx

A

aspirin
anagrelide
hydroxycarbamide

131
Q

platelet precursores

A

megakaryocytes

131
Q

blood transfusion threshold

A

<70g/l if asymptomatic
<80g/l if symptomatic

131
Q

platelet transfusion threshold

A

<10bn/L

131
Q

only transfuse platelets if

A

someone is actively bleeding
(otherwise they will be destroyed)

132
Q

patient with what deficiency is at higher risk of tranfusion associated anaphylaxis

A

IgA

133
Q

tranfusion associated anaphylaxis mediated by what anitobody

A

IgE

134
Q

ABO incompability transfusion reaction mediated by what anitobody

A

IgM (acute)

135
Q

transfusion assoc bacterial contamination are more associated with what tranfusions

A

platelet

136
Q

TRALI vs TACO

A

TRALI has fever and no cardiac failure
TACO has no fever and cardiac failure

137
Q

delayed haemolytic transfusion reaction is mediated by what antibody

A

IgG

138
Q

delayed vs acute transfusion reaction time period

A

24 hrs
acute <24
delayed >24

139
Q

graft vs host disease clinical defining feature

A

skin desquamation

140
Q

bleeding time in haemophilia

A

normal

141
Q

bleeding time and vwF levels in vwD

A

bleeding time prolonged
vwF levels may be normal or low (reduced function or number)

142
Q

t(8;14)

A

burkitts lymphoma

143
Q

t(15;17)

A

acute promyeolytic leukaemia

144
Q

t(9;22)

A

CML

145
Q

t(11;14)

A

mantle cell lymphoma

146
Q

t(14;18)

A

follicular lymphoma

147
Q

most common cause of IDA in developing world

A

hookworm

148
Q

blood test measure of fibrin degredation products

A

d dimer

149
Q

genetic conditions affecting synthesis of haem molecules

A

porphyrias

150
Q

rivaroxiban

A

adenexat alfa

151
Q

clotting factor with shortest half life

A

7

152
Q

anticoagulation for DVT first line

A

DOAC unless pregnant (then LMWH) or renal (warfarin)

153
Q

4 electrolytes in tumor lysis

A

phosphate
potassium
calcium
urate

154
Q

bilobed nucelus with red brown in cytoplasm

A

eosinophil

155
Q

LMWH reversal

A

protamine sulfate

156
Q

warfarin inhibits what enzyme

A

vitamin k epoxide reductase

157
Q

cml translocation

A

(9;22)

158
Q

smudge/smear cells

A

CLL

159
Q

oncogene for burkitts lymphoma

A

C MYC

160
Q

fanconi anaemia features

A

pancytopenia
cafe au lait spots
short stature
abnormal thumbs

161
Q

in ciruclation vwF binds

A

factor 8

162
Q

neutrophil on blood film

A

nucleus= 2-5 lobes
size= 3x RBC
granules= speckly

163
Q

monocyte on blood film

A

nucleus= kidney bean shaped and large
size= 3x RBC
granules= none

164
Q

basophil on blood film

A

nucleus= bilobed
size= 3xRBC
granules= blue

165
Q

eosinophil on blood film

A

nucleus= bilobed
size= 3x RBC
granules= red/purple acidic

166
Q

lymphocyte on blood film

A

nucleus= takes up majority of cell
size= same as RBC
granules= none

167
Q

main treatment for moderate ITP

A

prednisolone

168
Q
A

Aaska's path (9 decks)

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