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Haem Flashcards

1
Q
  1. What is the lifespan of a RBC ?
A
  • 3 months
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2
Q
  1. What is the lifespan of a platelet ?
A
  • 10 days
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3
Q
  1. What condition is anisocytosis associated with ?
A
  • Myelodysplastic syndrome
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4
Q
  1. What condition are target cells associated with ?
A
  • Iron deficiency anaemia
  • Post-splenectomy
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5
Q
  1. What condition are Heinz bodies associated with ?
A
  • G6PD deficiency
  • Alpha-thalassemia
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6
Q
  1. What conditions are reticulocytes associated with ?
A
  • Haemolytic anaemia
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7
Q
  1. What is normal hemoglobin ranges for men and women ?
A
  • 130-180g/L Men
  • 120 – 165g/L Women
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8
Q
  1. What is the normal MCV range ?
A
  • 80-100 femtolitres
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9
Q
  1. What can cause microcytic anaemia ?
A
  • Thalassemia
  • Anaemia of chronic disease
  • Iron deficiency
  • Lead poisoning
  • Sideroblastic anaemia
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10
Q
  1. What can cause normocytic anaemia ?
A
  • Haemolytic anaemia
  • Hypothyroidism
  • Acute blood loss
  • Aplastic anaemia
  • Anaemia of chronic disease
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11
Q
  1. Megaloblastic anaemia ?
A
  • B12 deficiency
  • Folate deficiency
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12
Q
  1. Normoblastic macrocytic anaemia ?
A
  • Reticulocytosis e.g. .due to haemolysis
  • Alcohol abuse
  • Hypothyroidism
  • Liver disease
  • Drugs e.g. azathioprine
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13
Q
  1. A 28 yo presents with tiredness and hair loss. Blood results should a hypochromic microcytic anaemia. What is the diagnosis ?
A
  • Iron deficiency anaemia
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14
Q
  1. What clinical signs appear with iron deficiency anaemia ?
A
  • Koilonychia (abnormally thin nails)
  • Angular chelitis
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15
Q
  1. What is the initial diagnostic test for iron deficiency anaemia ?
A
  • Serum ferritin
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16
Q
  1. What are possible underlying causes of iron deficiency anaemia ?
A
  • Inadequate dietary iron
  • Inadequate iron absorption e.g. coeliac
  • Increased iron requirement e.g. pregnancy
  • Bleeding e.g. heavy periods or GI cancer
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17
Q
  1. What is management of iron deficiency anaemia when the cause isn’t clear ?
A
  • Urgent OGD and colonoscopy to exclude GI cancer
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18
Q
  1. What condition are smudge cells associated with ?
A
  • Chronic lymphocytic leukaemia
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19
Q
  1. What treatment options are available for iron deficiency anaemia ?
A
  • Oral iron (ferrous sulfate)
  • Iron infusion
  • Blood transfusion (if very low)
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20
Q
  1. What condition is +ve intrinsic factor antibodies associated with ?
A
  • Pernicious anaemia
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21
Q
  1. Where is intrinsic factor produced ?
A
  • Parietal cells of the stomach
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22
Q
  1. What is the key symptom associated with pernicious anaemia ?
A
  • Peripheral neuropathy
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23
Q
  1. How does pernicious anaemia present ?
A
  • Anaemia features – lethargy, pallor and dyspnoea
  • Neurological features – pins and needles, weakness, ataxia and paresthesia
  • Neuropsychiatric features – memory loss, poor concentration, confusion, depression and irritability
  • Mild jaundice + pallor = lemon tinge
  • Atrophic glossitis
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24
Q
  1. How is pernicious anaemia treated and which medication is given first and why ?
A
  • Intramuscular hydroxycobalamin injections (IM B12)
  • Folic acid supplementation may be required
  • Treat B12 first as treating folate first can cause subacute combined degeneration of the spinal cord
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25
Q
  1. What is autoimmune haemolytic anaemia ?
A
  • When antibodies develop against RBC cells causing haemolysis
  • What activates the antibodies depends on the temperature
  • 2 types – hot or cold haemolytic anaemia
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26
Q
  1. What is warm autoimmune haemolytic anaemia ?
A
  • The MC
  • Haemolysis caused by IgG
  • Haemolysis tends to occur in extravascular sites like the spleen
  • Can be caused by SLE, lymphoma, CLL and methyldopa (idiopathic)
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27
Q
  1. How is warn autoimmune haemolytic anaemia managed ?
A
  • Treatment of underlying disorder
  • Steroids (+/- rituximab) are 1st line
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28
Q
  1. What is cold autoimmune haemolytic anaemia ?
A
  • The antibody in cold AIHA is usually IgM and causes haemolysis best at 4 deg C.
  • Haemolysis is mediated by complement and is more commonly intravascular.
  • Features may include symptoms of Raynaud’s and acrocynaosis.
  • Patients respond less well to steroids
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29
Q
  1. What can cause cold autoimmune haemolytic anaemia ?
A
  • Neoplasia: e.g. lymphoma
  • Infections: e.g. mycoplasma, EBV
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30
Q
  1. What is found on blood films of autoimmune haemolytic anaemia ?
A
  • Raised reticulocytes
  • Schistocytes
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31
Q
  1. What are inherited causes of haemolysis ?
A
  • Hereditary spherocytosis
  • Hereditary elliptocytosis
  • Thalassaemia
  • Sickle cell anaemia
  • G6PD deficiency
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32
Q
  1. What condition causes defective globin chains ?
A
  • Thalassaemia
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33
Q
  1. What types of thalassaemia are there ?
A
  • Alpha thalassaemia
  • Beta thalassaemia
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34
Q
  1. What is the inheritance pattern of thalassaemia ?
A
  • Autosomal recessive
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35
Q
  1. How would thalassaemia present in the abdomen, sclera, conjunctiva and FBC ?
A
  • Splenomegaly
  • Jaundice
  • Pallor
  • Microcytic anaemia
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36
Q
  1. What is the diagnostic test for thalassaemia ?
A
  • Haemoglobin electrophoresis
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37
Q
  1. What management is there for thalassaemia ?
A
  • Blood transfusion
  • Splenectomy
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38
Q
  1. Why is serum ferritin monitored in thalassemia ?
A
  • Risk of iron overload
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39
Q
  1. What is a potential cure for thalassemia ?
A
  • Bone marrow transplant
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40
Q
  1. What is the name for when you have one sickle cell gene ?
A
  • Sickle cell trait
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41
Q
  1. What antibiotic is given as prophylaxis in children with sickle cell ?
A
  • Penicillin V
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42
Q
  1. What medication stimulates Hbf production ?
A
  • Hydroxycarbamide
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43
Q
  1. What is a potential cure of sickle cell ?
A
  • Bone marrow transplantation
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44
Q
  1. What types of sickle cell crises are there ?
A
  • Acute chest syndrome
  • Vaso-occlusive crisis
  • Splenic sequestration crisis
  • Aplastic crisis
45
Q
  1. A 75 yo presents with fatigue, pallor and abnormal bruising. What is the diagnosis ?
A
  • Acute myeloid leukaemia
46
Q
  1. What are the types of leukaemia ?
A
  • Acute myeloid leukaemia
  • Acute lymphoblastic leukaemia
  • Chronic myeloid leukaemia
  • Chronic lymphocytic leukaemia
47
Q
  1. What causes bruising in acute myeloid leukaemia ?
A
  • Thrombocytopenia (low platelet)
48
Q
  1. What is the diagnostic test for acute myeloid leukaemia ?
A
  • FBC for initial
  • Bone marrow biopsy is definitive
49
Q
  1. What type of leukaemia is associated with Philadelphia chromosome ?
A
  • ALL and CML
50
Q
  1. What type of leukaemia is associated with smudge cells ?
51
Q
  1. What type of leukaemia is associated with myelofibrosis ?
52
Q
  1. What type of leukaemia is associated with Richter’s transformation ?
53
Q
  1. What are the main treatments for leukaemia ?
A
  • Chemotherapy
  • Steroids
54
Q
  1. What is the cause of increased uric acid in leukaemia ?
A
  • Tumour lysis syndrome
55
Q
  1. A 24 yo presents with enlarged rubbery non-tender lymph nodes. Pain is worse with alcohol use. What is the diagnosis ?
A
  • Hodgkins lymphoma
56
Q
  1. What viruses are associated with Hodgkins lymphoma ?
A
  • HIV
  • Epstein-Barr
57
Q
  1. What is the diagnostic test for Hodgkins lymphoma ?
A
  • Lymph node biopsy
58
Q
  1. What is the special cell seen on histology in Hodgkins lymphoma ?
A
  • Reed-Sternberg cells
59
Q
  1. What is the staging system used in Hodgkins lymphoma ?
A
  • ANN Arbor has been replaced by Lugano classification
60
Q
  1. What is the main treatments for Hodgkins lymphoma ?
A
  • Chemo and radio
61
Q
  1. What type of lymphoma is associated with EPV ?
A
  • Burkitt Lymphoma
62
Q
  1. What type of lymphoma is associated with H.pylori ?
A
  • Malt lymphoma
63
Q
  1. What type of lymphoma is associated with a rapidly growing painless mass ?
A
  • Diffuse large B-cell lymphoma
64
Q
  1. A 67 yo presents with vague symptoms of weight loss, tiredness and bone pain. What is the most likely diagnosis ?
A
  • Multiple myeloma
65
Q
  1. What are the key features of multiple myeloma ?
A
  • CRAB
  • Calcium elevated
  • Renal failure
  • Anaemia
  • Bone lesions/bone pain
66
Q
  1. What are the initial lab tests for multiple myeloma ?
A
  • Serum protein electrophoresis
  • Serum-free light chain assay
  • Urine Bence-Jones protein
67
Q
  1. What test is used to confirm the diagnosis of multiple myeloma ?
A
  • Bone marrow biopsy
68
Q
  1. What would the skull look like on X-ray of multiple myeloma ?
A
  • Raindrop skull
69
Q
  1. What is 1st line chemo in multiple myeloma ?
A
  • Bortezomib
  • Thalidomide
  • Dexamethasone
70
Q
  1. A 62 yo presents with itching, bruising and excessive sweating. His Hb is 208g/L. What is the diagnosis ?
A
  • Polycythaemia vera
71
Q
  1. From what cell line are RBCs produced ?
A
  • Erythroid cells
72
Q
  1. What is the key gene mutation in polycythaemia vera ?
73
Q
  1. What is the diagnostic test for polycythaemia vera ?
A
  • Bone marrow biopsy
74
Q
  1. What is the key complication of polycythaemia vera ?
A
  • Thrombosis
75
Q
  1. What is the key management of polycythaemia vera ?
A
  • Venesection
  • Aspirin
  • Chemotherapy
76
Q
  1. What myeloproliferative disorders are there ?
A
  • Polycythaemia vera
  • Primary myelofibrosis
  • Essential thrombocythemia
77
Q
  1. What can potential myeloproliferative disorders potentially malignantly transform into ?
A
  • Acute myeloid leukaemia
78
Q
  1. A 50yo women with 2 weeks of bruising rash and nosebleeds presents with a platelet count of 16x10(9)/L. What is the diagnosis ?
A
  • Immune thrombocytopenia purpura
79
Q
  1. How is immune thrombocytopenia purpura treated ?
A
  • Steroids
  • IV immunoglobulins
  • Rituximab
  • Splenectomy
80
Q
  1. What can cause low platelets ?
A
  • B12 or folate deficiency
  • Alcohol
  • Heparin induced thrombocytopenia
  • Thrombotic thrombocytopenic purpura
81
Q
  1. A 28 yo women with a history of heavy periods and epistaxis presents. Her mother had a hysterectomy at 40 for heavy periods. What is the most likely diagnosis ?
A
  • Von Willebrand disease
82
Q
  1. What can cause abnormal or prolonged bleeding ?
A
  • Thrombocytopenia
  • Von Willebrand disease
  • Haemophilia A or B
  • Disseminated intravascular coagulopathy
83
Q
  1. What treatment is required for Von Willebrand disease ?
A
  • Desmopressin
  • Von Willebrand factor infusion
  • Factor 8 infusion
84
Q
  1. What is the underlying pathology in haemophilia ?
A
  • A  Factor 8 deficiency
  • B  Factor 9 deficiency
85
Q
  1. A 32 yo with a history of 3 miscarriages presents with a swollen and tender leg. What is the diagnosis ?
86
Q
  1. What difference in leg circumference is significant in deep vein thrombosis ?
87
Q
  1. A 32 yo with a history of 3 miscarriages presents with a swollen and tender leg. What is likely the underlying cause of the DVT ?
A
  • Antiphospholipid syndrome
88
Q
  1. In antiphospholipid syndrome. What is the test, treatment and treatment in pregnancy ?
A
  • Test = antiphospholipid antibodies
  • Treatment = long term warfarin
  • Pregnancy = low molecular weight heparin and aspirin
89
Q
  1. What is disseminated intravascular coagulopathy
A
  • Dysregulation in the process of coagulation and fibrinolysis resulting in widespread clotting with resultant bleeding
90
Q
  1. What is the pathophysiology of DIC
A
  • Tissue factor (TF) is present on many cell types and not normally in contact with general circulation but is exposed to after vascular damage
  • Upon activation TF binds with coagulation factors that then trigger the extrinsic pathway (Via F7) which subsequently triggers the intrinsic pathway (12 to 11 and 9) of coagulation
91
Q
  1. What can DIC ?
A
  • Sepsis
  • Trauma
  • Obstetric complications e.g. haemolysis, elevated liver FT, low platelets (HELLP) syndrome
92
Q
  1. What does a typical blood picture look like in DIC ?
A
  • Decreased platelets and fibrinogen
  • Increased PT, APTT and fibrinogen degradation products
  • Schistocytes due to microangiopathic haemolytic anaemia
93
Q
  1. What is thrombotic thrombocytopenic purpura ?
A
  • A condition where tiny thrombi develop through the small vessels using up platelets. As the problem is in the small vessels it is described as a microangiopathy causing:
  • Thrombocytopenia, purpura and tissue ischaemia with end organ damage
94
Q
  1. What is the pathogenesis of Thrombotic thrombocytopenic purpura ?
A
  • Abnormally large and sticky multimers of von Willebrand’s factor cause platelets to clump within vessels
  • In TTP there is a deficiency of ADAMTS13 (a metalloprotease enzyme) which breakdowns (‘cleaves’) large multimers of von Willebrand’s factor
  • overlaps with haemolytic uraemic syndrome (HUS)
95
Q
  1. What are features of thrombotic thrombocytopenic purpura ?
A
  • Rare – typically adult females
  • Fever
  • Fluctuating neuro signs (microemboli)
  • Microangiopathic haemolytic anaemia
  • Thrombocytopenia
  • Renal failure
96
Q
  1. What are potential causes of thrombotic thrombocytopenic purpura ?
A
  • Post-infection e.g. urinary, GI
  • Pregnancy
  • Drugs: ciclosporin, oral contraceptive pill, penicillin, clopidogrel and aciclovir
  • Tumours
  • SLE
  • HIV
97
Q
  1. How is thrombotic thrombocytopenic purpura treated ?
A
  • Guided by haematologist
  • This may involve plasma exchange, steroids and rituximab
98
Q
  1. What is Immune thrombocytopenia purpura ?
A
  • A condition where antibodies are created against platelets leading to their destruction and thrombocytopenia
  • It is characterised by purpura which are non-blanching lesions caused by bleeding under the skin
99
Q
  1. How can immune thrombocytopenia purpura be managed ?
A
  • Prednisolone (steroids)
  • IV immunoglobulins
  • Thrombopoietin receptor agonists e.g. avatrombopag
  • Rituximab
  • Splenectomy
100
Q
  1. Why is rituximab useful in autoimmune disease ?
A
  • B cells produce antibodies
  • Reducing B cell numbers reduces inflammation
101
Q
  1. What is heparin-induced thrombocytopenia ?
A
  • The development of antibodies against platelets in response to heparin (usually unfractionated heparin but can also occur with low-molecular-weight heparin)
  • Heparin-induced antibodies target protein on platelets called platelet factor 4 (PF4)
102
Q
  1. What is the pathophysiology of heparin-induced thrombocytopenia ?
A
  • HIT antibodies bind to platelets activating the clotting system causing a hypercoagulable state and thrombosis
  • They also break down platelets causing thrombocytopenia
  • There is then a counterintuitive situation where a patient is on heparin, has a low platelet count, and develops abnormal blood clots
103
Q
  1. When does heparin-induced thrombocytopenia usually occur ?
A
  • The condition typically presents around 5-10 days after starting treatment with heparin
104
Q
  1. How is heparin-induced thrombocytopenia managed ?
A
  • Stopping heparin and using an alternative anticoagulant guided by a specialist e.g. fondaparinux or argatroban
105
Q
  1. What would the blood results be in terms of prothrombin time, APTT, bleeding time and platelet count for a patient on warfarin ?
A
  • PT – prolonged
  • APTT, bleeding time and platelet count – normal
106
Q
  1. What would the blood results be in terms of prothrombin time, APTT, bleeding time and platelet count for a patient on aspirin ?
A
  • Prothrombin time, APTT and platelet count normal
  • Prolonged bleeding time
107
Q
  1. What would the blood results be in terms of prothrombin time, APTT, bleeding time and platelet count for heparin ?
A
  • Prothrombin time – normal but can be prolonged
  • APTT and platelet count – normal
108
Q
  1. What would the blood results be in terms of prothrombin time, APTT, bleeding time and platelet count for DIC ?
A
  • Prothrombin time, APTT, bleeding time – prolonged
  • Platelet count – low

Phase 4 (17 decks)

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