haem Flashcards
what are the 2 main types of leukaemia?
acute myeloid leukaemia
acute lymphoblastic leukaemia
the acute leukaemia present with signs of what?
bone marrow failure
define neutropaenia
low neutrophil count in the blood
what is thrombocytopaenia?
condition characterized by abnormally low levels of thrombocytes (aka platelets) in the blood
what are signs of bone marrow failure? (3)
anaemia
neutropaenia
thrombocytopaenia
what are the additional signs of acute leukaemia?
high temp
weight loss
sweats
bony pains
headaches
seziures
swelling of lymph glands
list some risk factors of acute leukaemia?
radiation
benzene
smoking
prior blood disorders
genetic conds eg DW
previous chemo/radio
diagnosis of acute leukaemia is mainly based on what?
more than 20% blasts on bone marrow exam
taking which blood test may be all it takes to diagnose leukaemia?
FBC
what does AML stand for?
acute myeloid leukaemia
what is AML?
a type of cancer in which the bone marrow makes abnormal myeloblasts (type of WBC), RBC or platelets
what is AML a cancer of
the blood n bone marrow
AML can develop from which cells?
myeloid stem cell or myeloid blast
how can AML be diagnosed?
blood tests or bone marrow aspirate/trephine biopsy
how can AML be treated?
chemotherapy supportive measures
what are some symptoms of lymphomas?
LN enlargement
loss of appetite
loss of weight
night sweats
what are signs of lymphoma?
LN enlargement
hepatosplenomegaly
what are some investigations of lymphoma?
biopsy
blood tests
scan
bone marrow biopsy
what is LN?
lymph node
define lymphoma
a malignant growth of WBC (predominantly in lymph nodes) but also can be in blood/bone marrow, liver, spleen
cancer affecting blood/bone marrow = ?
leukaemia
cancer affecting blood cells = ?
lymphoma
how are lymphomas diagnosed?
blood film n bone marrow or lymph node biopsy (diagnosis is complex)
how do u assess bloods of a lymphoma patient
fbc
u&es
LFT
viral serology (HIV, hep B, hep C)
what are the 2 types of lymphoma
hodgkin’s
NHL
what are the types of NHL
low grade
high grade
v high grade
how can we quantify cancer patients’ general well-being and activities of daily life?
(WHO) performance status
why is performance status used?
to determine whether patient can receive chemotherapy, whether dose adjustment is necessary, and as a measure for the required intensity of palliative care
what are the different categories of performance status?
0 - asymptomatic
1 - symptomatic but completely ambulatory
2 - symptomatic, <50% in bed during the day
3- symptomatic, >50% in bed, but not bed bound
4 - bedbound
5 - death
what is stage 0 of the WHO performance status?
asymptomatic
what is stage 1 of the WHO performance status?
symptomatic but completely ambulatory (restricted strenuous activity but able to carry out work of a light nature)
what is stage 2 of the WHO performance status?
symptomatic, <50% in bed during the day (ambulatory and capable of all self care but unable to carry out any work activities. up n about for more than 50% of waking hrs)
what is stage 3 of the WHO performance status?
symptomatic, >50% in bed, but not bedbound (limited self-care, confined to bed or chair 50%+ of waking hrs)
what is stage 4 of the WHO performance status?
bedbound (cannot carry on any self-care. totally confined to bed or chair)
what is stage 5 of the WHO performance status?
death :/
how many clinical stages in Hodgkin’s lymphoma?
4
what is diff btwn A and B Hodgkin’s lymphoma
A = absence of symptoms
B = presence of ‘B’ symptoms
how do u treat Hodgkin’s lymphoma?
depends on clinical stage
what are some late effects of Hodgkin’s lymphoma
infertility
second cancers
psych issues
drug side effects
what is non-hodgkin’s lmyphoma like?
more varied
more categories
what is an example of low grade NHL
follicular lymphoma
can low-grade NHL be cured
no its usually advanced at presentation can’t do nothing
what does ABVD stand for
adriamycin
bleomycin
vinblastine
dacarbazine
what is the chemotherapy regimen used in 1st line treatment for Hodgkin’s lymphoma
ABVD
where are most non-hodgkin’s lymphoma derived from
B cell lines
DEFINE anaemia
reduced cell mass (with or without Hb concentration)
what is the normal range of Hb for men?
131-166g/L
what is the normal range of Hb for women?
110-147g/L
what are some consequences of anaemia?
reduced oxygen transport
tissue hypoxia
compensatory changes
what are some compensatory changes as a result of anaemia
increased tissue perfusion
increase oxygen transfer to tissues
increased rbc production
what are some pathological consequences of anaemia :(
myocardial fatty change
fatty change in liver
aggravated angina/claudication
skin n nail atrophic changes
CNS cell death
what is the lifespan of rbc
approx 120days
how are rbc removed from the body?
spleen
liver
bone marrow
blood loss
where are rbc produced?
bone marrow
in clinical practice, how do we approach anaemia? (3 types)
- microcystic
- normocytic
- macrocytic
why may microcytic anaemia happen?
iron deficiency
chronic disease
thalassaemia
why may normocytic anaemia occur?
acute blood loss
anaemia of chronic disease
combined haematinic deficiency
why may macrocytic anaemia occur?
b12/folate deficiency
alcohol excess/liver disease
hypothyroid
haematological causes: anti met therapy, haemolysis, bone marrow failuer
how do u investigate B12 deficiency?
IF antibodies
schilling test
coeliac antibodies
what are IF antibodies?
proteins produced by the immune system that are associated with pernicious anemia.
this test detects IF antibody circulating in blood
when may a schilling test be done? (procedure to see whether or not ur absorbing vii D properly)
vit D deficiency
pernicious anaemia
what are reticulocytes
RBC precursor
a small decease in red cell survival can be compensated by what?
increased EPO
reduced apoptosis
a large decrease in red cell survival can be compensated by what?
can’t –> haemolytic anaemia
what are haemoglobinopathies
genetic defect that results in a disorder of Hb structure can be a disorder of quality or quantity
name a disorder of Hb quality (haemoglobinopathies)
sickle cell disease
name a disorder of Hb quantity (haemoglobinopathies)
alpha/beta thalassaemia
what is the diff btwn alpha n beta thalassaemia?
alpha - reduced or absent synthesis of alpha globin chains
beta - reduced or absent synthesis of beta globin chains
which ethnic pops are more likely to get alpha thalassaema?
eastern mediterranean, far east
what are the diff types of thalassaemia?
major (transfusion dependent)
intermedia (less severe anaemia, can survive w/o transfusions regularly)
carrier/heterozygote (asymptomatic)
what is the age of presentation for beta thalassaemia (major)?
6-12m
what are some complications of beta thalassaemia?
transfusion-transmitted infections
hypopituitarism/hypothyroidism/parathyroidism
pul hypertension/embolism
cardiomyopathy
splenomegaly
DM
osteoporosis
short stature
what is some supportive therapy for beta thalassaemia?
transfusion
hormone replacement
vitamin d (osteoporosis)
which organs may be affected by iron overload?
pit/thyroid/parathyroid/adrenal gland
heart n circulation
liver
pancreas
testis
ovary
carriers of HbS (sickle cell) are what?
symptom free
carriage of HbS (sickle cell) offers protection against what?
falciparum malaria
sickle cell diseases arise when
homozygous state (SS) combined heterozygotes (SC or Sbeta thalassaemia)
what are some acute complications of sickle cell?
painful crisis
sickle chest syndrome stroke :/
what are some chronic complications of sickle cell?
renal impairment
pulmonary hypertension
joint damage
what is the most common inherited disease in england
sickle cell
where are platelets produced
bone marrow
what is platelet production regulated by??
thrombopoietin
where is thrombopoietin produced
liver
what is the lifespan of platelets?
7-10days
what are some surface proteins of platelets
ABO
HPA
HLA
class I glycoproteins
what are platelets activated by?
adhesion to collagen via GPIa
adhesion to vWF via GPIb and IIb/IIIa
what does platelet activation lead to
release of alpha granules containing eg fibrinogen, vWF release of dense granules
cross-linking of activated platelets that have aggregated together is mediated by what?
fibrin
activated platelets provide a neg charged phospholipid surface. this allows what?
coagulation factors to bind enhances clotting cascade
how can the number of platelets be tested?
FBC
how can appearance of platelets be tested?
blood film
list some problems that cause bleeding
injury
vascular disorders
LOW PLATELETS
ABNORMAL PLATELET FUNCTION
defective coagulation
what are some clinical features of platelet dysfunction?
mucosal bleeding (nose/gum bleeds)
easy bruising
traumatic haematomas
what is epistaxis?
nose bleed
what is menorrhagia?
excessive menstrual bleeding
what are some causes of low platelets?
production failure (congenital/acquired eg drugs, marrow failure)
increased removal (immune, consumption, splenomegaly)
artifactual
what are some causes of impaired platelet function?
congenital (platelet disorders, von willebrand disease)
acquired (uraemia, drugs)
define uraemia
raised level in the blood of urea and other nitrogenous waste compounds that are normally eliminated by the kidneys
what is thrombocytopenia?
abnormally low levels of platelets
what are thrombocytes?
platelets
b12 and folate contribute to what?
DNA synthesis
what are some types of thrombocytopenia?
decreased production
increased destruction
