Haem Flashcards
what is the life span of red blood cells
120 days
what is ferritin in relation to infection
acute phase protein
- will increase in infection and malignancy
what is DDx for microcytic anaemia
iron deficiency - low ferritin, low iron, TIBC high = Tx with ferrous sulphate 200mg / 8h PO
thalassemia - is the under production or no production of one globin chain
sideroblastic (rare) - consider when patient not responding to iron
what is DDx for normocytic anaemia
acute haemorrhage anaemia of chronic disease bone or renal failure hypothyroidism pregnancy
what is DDx for macrocytic anaemia
B12/folate deficiency
cytotoxic and anti-folate
alcohol excess = most common
reticulocytosis
myelodysplastic syndrome
marrow infiltrations
hypothyroidism (may ask be normocytic)
what are potential side effects of blood transfusions
bacterial contamination
Febrile/allergic reactions [non-haemolytic febrile transfusion reaction]
fluid overload
TRALI = transfusion related acute lung injury
incompatibility (ABO, Rh)
what is mx for blood transfusions
stop transfusion
confirm identity and blood
ABCDE
tell haematologist/anaesthetist
retain unit transfusion
give furosemide/chlorphenamine/oxygen
summary of AML
marrow failure, fast progression, organic infiltration (classically gum hypertrophy)
most common form in adults
may present with pancytopenia
Mx = chemotherapy
Ix [and buzzword] for AML
Marrow Biopsy = >30% blasts is diagnostic
[buzzword = Auer Rods]
summary of ALL [and buzzword]
B or T cells implications - marrow failure, fast progression, organic infiltration
Blast cells seen on bone marrow biopsy = diagnostic [buzzword = Philadelphia chromosome]
Ix shows = leukocytosis,
TK activity seen [targeted with IMATINIB]
most common in kids - peak age 2-5
summary of CML [and buzzword]
[buzzword = Philadelphia chromosome. Translocation of Chr 9 on Chr 22]
occur more frequently in men 40-60 years of age
insidious [weight loss, sweat, tiredness, fever] with possible spelnomeglay
Tx = TK activity seen [can be targeted with Imatinib]
summary of CLL [and buzzword]
mature B cells, most common leukaemia seen in older patients
often asymptomatic = lymphadenopahy, splenomegaly, hepatomegaly
increased WCC with late features of marrow infiltration and autoimmune haemolysis. Patient at risk of RECURRENT INFECTIONS.
Ix = immunophenotyping
Mx = chemotherapy, radiotherapy
what are the risks of leukaemia
increased risk of infection, bleeding, hyper viscosity
Tumour lysis syndrome
DIC = consumption of platelets
what are the two types of lymphoma
Hodgkins
Non-Hodgkins
what is lymphoma due to
malignant lymphocytes producing lymphadenopathy
what is the buzzword for Hodgkins lymphoma
Reed-Sternberg cells
how does Hodgkins lymphoma present
Present with painless rubbery enlarge lymph nodes but note ‘B’ symptoms as prognostically significant
Mx of Hodgkins lymphoma
chemoradiotherapy
how is the Histological diagnosis of lymphoma done
Ann-Arbor Staging (radiological), relative to spread beyond diaphragm or lymph tissue
what is Non-Hodgkins associated with
Association with HIV/EBV, immunodeficiency (Burkitt’s)
High grade are usually more aggressive but often curable; low grade are indolent, widely disseminated and often incurable
what is myeloma
abnormal proliferation of plasma or lympho-plasmacytic cells leading to immunoglobulin (Ig) or fragment secretion
classification based on immunoglobulin (most common IgG)
buzzword for myeloma
Bence Jones protein in urine
Sx of myeloma
Osteolytic bone lesions
Marrow infiltration of plasma cells (pancytopenia) and associated infections
Renal impairment secondary to BJPs
Ix for myeloma
Bone survey -
radiological lytic lesions;
serum/urine electrophoresis (monoclonal banding)
marrow biopsy
Mx for myeloma
Supportive, chemotherapy (including thalidomide)
63 year old woman, progressive tired and fatigue, numbness and unsteadiness in her feet. Family history of thyroid problems. Conjunctivae pale, sclerae are yellow. Evident symmetrical distal weakness affecting her arms and legs and sensory loss in her hands and feet bilaterally, with severe loss of joint position sense. ?diagnosis
Hb, platelet, WCC = low
Macrocytic Anaemia
High bilirubin = ?haemolysis
LFTs = normal
would check B12 and Folate
B12 deficiency
A 73-year-old man presents with an uncomfortable enlarging ulcer over his left calf of 6 weeks’ duration. He is known to have type 2 diabetes mellitus (dietary- controlled), and after complaining to his GP of being tired, he recently had blood samples sent for analysis:
Hb = low
MCV = slightly high
WCC = low normal
B12 and folate = normal
Anaemic = where is likely source of anaemia
Bone marrow
- pancytopenia = bone marrow problem
A 24-year-old man presents to his GP with an intermittent fever and rigors over the past 3 days. This has been present on and off for 3 days. Upon questioning, he states he’s previously had hepatitis and glandular fever. He drinks alcohol and smokes but denies intravenous drug abuse. The only medicines he is on are malaria prophylaxis for a recent trip to Nigeria 3 weeks prior. On examination he looks unwell however is haemodynamically stable. He has a tender right upper quadrant but otherwise has no other examination findings.
Hb = low MCV = slightly high Platelets = low Bilirubin = raised
?malaria = causes intravascular haemolytic anaemia
how to tell the difference between iron deficiency anemia and anemia of chronic disease
look at TIBC
is high in iron deficiency
is low/normal in chronic disease
A couple attend the GP practice seeking advice as they are currently pregnant with their first son. The father suffers from haemophilia A and is worried about the risk of passing this disease onto his son. The mother is not a carrier and has no family history of any disorders. What is the percentage chance of the baby inheriting haemophilia A?
0%
There is no male-to-male transmission in X-linked recessive conditions
blood cells seen in hyposplenism
howell-jolly bodies
target cells
pappenheimer bodies
blood cells seen in iron deficiency anaemia
target cells
pencil “poikilocytes”
