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1
Q

Auer rods

A

AML

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2
Q

AML and ALL blood count

A

High white cell
Low HB
Low platelets
Blast cells

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3
Q

If not treated result in blast crises and transformation into acute leukaemia

A

CML

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4
Q

Massive splenomegaly

A

CML

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5
Q

CML cells

A

Neutrophilia

Elevated basophils and esinophils

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6
Q

Recurrent infections occurs in which leukaemia?

A

CLL

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7
Q

Hogkins presents as what?

A

PAINLESS cervical lymphadenopathy

May dislocalize to mediastinum

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8
Q

Ix for lymphadenopathy

A

CXR, CT, PET, bone marrow biopsy and bloods

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9
Q

Microcytic Anaemia

A

MCV<80
Iron deficiency anaemia
Anaemia of chronic disease
Thalassemia

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10
Q

Sign OE of iron deficiency anaemia

A

Angular glottitis
Stomatitis (iron, vit b12)
Koilonychia

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11
Q

Blood film in iron deficiency anaemia

A

LOW FERRITIN
hypochromic
anisocytosis (variation in size)
poikiocytosis (variation in shape)

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12
Q

HIGH or normal ferritin with microcytic or normocytic anaemia

A

Anaemia of chronic disease:
Infection: TB
Inflammation: RhA
Malignancy

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13
Q

Normocytic Anaemia

A

MCV: 80=100
Bone marrow failure –> Aplastic Anaemia
(Anaemia of chronic disease )

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14
Q

Define aplastic anaemia:

A

Diminished haemopoetic precursors in the bone marrow and deficiency of all blood cell elements = pancytopenia

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15
Q

Causes of aplastic anaemia

A

AI
Drugs: Anti epileptics
Viruses: Parvovirus B19

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16
Q

Clinical features of aplastic anaemia

A
  1. Anaemia: SOB, lethargy, tirdness
  2. Thrombocytopenia: bruising, petechiae
  3. Leukopenia: increased infections
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17
Q

Bloods in aplastic anaemia

A

Decreased HB, WCC, Platelets, Reticulocytes
Normocytic
NB. Dont forget to exclude leukaemia

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18
Q

Bone marrow trephine biopsy showing hypocellular marrow

A

Aplastic anaemia

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19
Q

Macrocytic Anaemia

A

MCV>100
Megaloblastic: Folate/VitB12 deficiency
Non Megaloblastic: Alcohol, haemolysis (raised reticulocytes)

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20
Q

Vit B12 Deficiency: clinical features and blood film

A

Clinical features: ataxia, peripheral neuropathy, glossitis

Blood film: Hypersegmented neutrophils

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21
Q

Folate Deficiency can be caused by what?

A
  1. Decreased intake: alcohol
  2. Increased demand: pregnancy or malignancy
  3. Decreased absorption: Coeliac
  4. Drugs: METHOTERXATE
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22
Q

Blood film in folate deficency

A

Hyper-segmented neutrophils

ALCOHOLIC

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23
Q

Haemolytic Anaemia

Hereditary Causes

A

Membrane defects: Hereditary Spherocytosis
Metabolic Defects: G6PD Deficiency
Haemoglobinopathies: Sickle Cell and Thalassemia

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24
Q

Haemolytic Anaemia

Acquired Causes

A

AI
Durgs: penicillin
Infection: malaria, sepsis
MAHA

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25
Hereditary Spherocytosis: Ix Key words
Ix: blood film and osmotic fragility test | Spherocytosis
26
G6PD Deficiency - thinks to look out for in Hx
TIGGERS - fava beans, moth balls, infections, drugs e.g. ANTIMALARIALS
27
Heinz Bodies
G6PD Deficiency
28
Autoimmune Haemolytic Anaemia Ix
Coombs Test/ Direct Antiglobulin Test (DAT) --> detects antibodies
29
Warm antibodies IgG agglutinating at 37C
SLE, lymphomas | AI Haemolytic Anaemia
30
Cold agglutinates
Infections eg EMW; lymphomas | AI haemolytic anaemia
31
Schistocytes and Reticulocytes on blood film
MAHA
32
increased reticulocytes
Haemolytic anaemia, Thalassemia
33
HUS Triad
MAHA + renal failure + thrombocytopenia (decrease platelets)
34
what does increased LDH show
haemolysis
35
TTP
MAHA + renal failure + thrombocytopenia (decrease platelets) + CNS signs + fever
36
what MCV is thalassemia
microcytic anaemia | --> beta trait or alpha thalassemia --> asymptomatic
37
What does thalassemia major present as?
Failure to thrive, anaemia and infections
38
Target Cells
Thalassemia or sickle cell disease
39
Hypochromic Anaemia
Thalassemia
40
Hb electophoresis in Thalassemia
decreased HbA | increased HbF
41
Hepatosplenomegaly occurs in which anaemia
Hameolytic anaemia
42
Sickle cell clinical features
splenic infarction abdominal pain dactylitis lungs - SOB (acute chest syndrome)
43
Reticulocytes in sickle cell
Increased in haemolytic crises | decreased in aplastic crises
44
Features of hyposplenism
Howell Jolly Body and Target cell | Both seen in sickle cell anaemia
45
Define: Thalassaemia and Sickle Cell
1. Thalassaemia: genetic disorders resulting in reduced globin chain synthesis 2. Sickle Cell: sickling of RBCs due to inheritance of HbS
46
Sudan Black Postitive
AML
47
Myeloid Stem Cells
RBC, Platlets, | Granulocytes: esinophils, neutrophils, basophils
48
Lymphoid Stem Cells
Plasma Cells T cells NK cells
49
Tissue infiltration: Headaches and gum swelling
AML | Along with: anaemia, thrombocytopenia, oppertunistic infections
50
CML bloods
Increased WCC | Increased basophils, eosinophils, neutrophils
51
Philadelphia chromosomes
t(9:22) | CML
52
CML clinical features
usually asymptomatic apart from systemic symptoms (weight loss and sweating) bone marrow failure signs: lethargy, SOB but INFECTION IS RARE NB you can differentiate the above signs from CLL as in CLL you get recurrent infections with systemic signs
53
Splenomegaly in which cancer
CML
54
ALL
Children, lymphoblasts
55
ALL signs of organ infiltration
lymphadenopathy, testicular cancer, heptosplenomegaly
56
Acute = signs of infiltration
``` AML = tissue infiltration --> gum swelling, CNS involvement, headaches ALL = organ infiltration --> lymphadenopathy, testicular swelling, hepatosplenomegaly ```
57
Smudge / Smear Cells
CLL
58
Rai and Binet Staging
CLL
59
Huge increase in lymphocytes
CLL
60
Reed Sternberg cells aka
Hodkins Lymphoma | Owl Eyes
61
Painless mass in neck which is painful after alcohol
Hodgkins Lymphoma
62
Hodgkins staging and NON HL
Ann Arbor
63
Non Hodgkins Lymphoma
Painless mass in neck/axilla/groin B symptoms Hepatosplenomeglay EXTRA NODAL DISEASE: SKIN RASH, sore throat, abdomen discomfort, testicular swelling
64
Parapotienaemia
Bence Jones PRotiens in multiple myeloma
65
Ix for multiple myeloma
- Urine: bence jones protiens - Serum electrophoresis: serum paraprotein - Blood film: roleux formation - Bone marrow aspirate and trephine biopsy: increased plasma cells
66
Roleux formation
Multiple Myeloma
67
Myelodysplasia
PANCYTOPENIA WITH NORMAL SPLEEN and decreases reticulocytes
68
decreased granulocytes (esinophils or basophils)
myelodyplasia
69
Bone marrow biopsy of myelodysplasia
hypercellular | ringed sideroblasts
70
Myeloidysplasia aeitology
- primary | - previous radio or chemotherapy
71
Tear drop polkiocyte
Myeloidfibrosis
72
"Dry Tap"
Bone marrow aspiration is uncessful in myeloid fibrosis
73
Massive hepatosplenomegaly
myeloidfibrosis
74
Polycythemia Ix
Bloods: increased Hb, heamatocrit | decreased MCV
75
Polycythemia Rubera Vera Ix
increased WCC Increased platelets decreased serum electrophoresis
76
serum electrophoresis in polycythemia
decreased in rubera vera | increased in secondary
77
Plethora
Polycythemia
78
Ringed Sideroblasts
Myeloidysplasia
79
Splenic changes in myeloid disease
Normal spleen in myeloiddysplasia | Massive splenomegaly in myeloid fibrosis
80
Superfical bleeding in which bleeding disorders
easy bruising, bleeding gums, nose bleeds Immune Thrombocytopenia Pupura: Normal PT and APTT. decreased platelets Von Willeband disease: increased APTT, decreased Factor VIII
81
sepsis and increased fibrin degradation products
DIC increased PT and APTT, decreased fibrinogen and increased FDP petichiae, pupura, ecchymoses, fever, shock
82
Increased APTT and bleeding into joints
Haemophillia
83
Clinical features of haemophilia
Haemarthrosis Swollen painful joints Haematuria Muscle Haematomas
84
APTT
Intrinsic Pathway (12, 11, 9, 8)
85
PT
Extrinsic (7)
86
Common pathway
10, 5, 2, fibrinogen
87
Anaemia HB cut off
<135g for men | <115g for women
88
Sideroblastic Anaemia
Microcytic | Dimorphic blood film with hypo chromic cells
89
Pernicious anameia Tx
IM hydroxycobalamin (treat first over folic acid deficiency)
90
Haemochormatosis
Presents mainly in middle aged men Arthalgia (pseudogout) Grey Slate pigmentation, hepatosplenomeglay, decreased erections, hypogonadism increased serum ferritin
91
main cause of HUS
E coli infection diarrhoea --> turns bloody after 3 days MAHA + Renal Failure + thrombocytopenia schistocytes and stool culture
92
Haemophilia Ix
Increased APTT decreased F8 or 9 Assay PT normal
93
Define ITP
Isolated thrombocytopenia in the absence of other causes or disorders that may be associated with thrombocytopenia (decreased platelets but normal ATT/PT and no evidence of malignancy)
94
Gout features in which leukaemia
CML due to purine breakdown
95
Mediastinal shift
Hodgkins lynphoma
96
Types of Non Hodgkins Lymphoma
1. Burkitts 2. Diffuse Large B Cell Lymphoma 3. Other e.g. follicular
97
Burkitts
African child, jaw involvement, starry skin apprearnce, EBV associated TX: Chemo, rituximab
98
Diffuse large B cell lymphoma
sheets of large lymphoid cells | Richter's transformation
99
Multiple Myeloma causes what
proliferation of plasma cells resulting in bone lesions and production of monoclonal immunoglobulins IgA or IgG Afro carribean> Caucasian > Asian
100
Features of thrombosis
Polycythemia --> arterial or venous --> stroke/MI/PE/DVT
101
Low ferritin and thus iron deficency can cause what symptom?
pruritis Other causes: hypo/hyperthyroidism . polycythemia vera, leukaemia, lymphoma, anaemia, CKD, anxiety, bile salts etc NB electrolyte abnormalities do not cause puritis!
102
The classical triad of haemochromatosis is
bronze skin pigmentation, | hepatomegaly and diabetes mellitus.
103
Hereditary haemochromatosis has what mode of inheritance
autosomal recessive disease The diagnosis of haemochromatosis is made firstly from the haematinics, in which you would expect to see a raised ferritin, a reduced total iron binding capacity (due to saturation) and a transferrin saturation >60%. A liver biopsy will often show deposition of iron within the cells. The genetic loci for the common genes for haemochromatosis have also been located, with the two common mutations for the HFE gene being known. This can be useful in screening family members.
104
Abx contraindicated in pregnancy
Ciprofloxacin, Tetracyclines(teeth) Trimethoprim is a folate antagonist and thus carries risk of teratogenicity.

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