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”
what do “tear-drop” poikilocytes suggestive
myelodysplasia
what do schistocytes suggest
intravascular haemolysis
what do hypersegmented neutrophils suggest
megaloblastic anaemia
what can cause ginigival hyperplasia
AML
Drugs = phenytoin, CCB, ciclosporin
what is seen on blood film suggestive of G6PD deficiency
Heinz bodies
Bite cells
Blister cells
what is seen on blood film suggestive of hereditary spherocytosis deficiency
spherocytes
where is B12 absorbed in the body
ileum
where is folate absorbed in the body
duodenum
jejunum
what is common in hereditary spherocytosis that is not common in G6PD
splenomegaly
old person, iron deficiency anaemia, investigations?
1st line = sigmoid colonoscopy
2nd line = endoscopy
side effects of ferrous sulphate
black stool/green
diarrhoea
N+V
stomach cramps
what is direct coombs test an investigation for
intravascular haemolysis
what cells makes platelets
megakarycytes
what cells makes macrophages
monocytes
what does neutrophilia and neutropenia mean
neutrophilia = high number of neutrophils
neutropenia = low number of neutrophils
antibodies seen in pernicious anaemia and treatment
anti gastric parietal cells
anti intrinsic factor
Tx = B12 injections [hydroxycobalamin]
what is Jak 2 mutation associated with
PCV
ET
Idiopathic myelofibrosis
what does a prolonged PT time suggest
problem with TF or Factor VIIa (factor 7)
what does a prolonged APTTq time suggest
problem with Factor 8 or 9
what is used to measure warfarin affect and why and what is the antidote
PT = as warfarin affects factor 7 the most
antidote = vitamin K
what is used to measure heparin affect and why and what is the antidote
APPT = works by making anti-thrombin better
cleared through kidneys
antidote = protamine sulphate
Blood results [INR, APTT, PT Time, Bleeding time] - heparin
INR = normal
APTT = prolonged
PT = prolonged
Bleeding time = normal
Blood results [INR, APTT, PT Time, Bleeding time] - warfarin
INR = aiming for 2-3
APTT = normal
PT = prolonged
Bleeding time = increased
Blood results [INR, APTT, PT Time, Bleeding time] - DIC
INR = prolonged
APTT = prolonged
PT = prolonged
Bleeding time = prolonged
Blood results [INR, APTT, PT Time, Bleeding time] - liver disease
INR = prolonged
APTT = prolonged
PT = normal/prolonged
Bleeding time = normal/prolonged
Blood results [INR, APTT, PT Time, Bleeding time] - V Willebrand Disease
INR = normal
APTT = prolonged
PT = normal
Bleeding time = prolonged
Blood results [INR, APTT, PT Time, Bleeding time] - Haemophilia
INR = normal
APTT = prolonged
PT = normal
Bleeding time = normal
mx of patient on warfarin with major bleed
Stop warfarin
Give IV Vit K 5mg
Give Prothrombin complex [or FFP if not available]
mx of patient on warfarin with INR >8 and minor bleed
Stop warfarin
Give IV Vit K 1-3mg
Restart warfarin when INR < 5
mx of patient on warfarin with INR >8 and no bleed
Stop warfarin
Give PO Vit K 1.5mg
Restart warfarin when INR < 5
mx of patient on warfarin with INR 5-8 and no bleed
Withhold 1 or 2 doses of warfarin
reduce subsequent maintenance dose
what antibiotic can interact with warfarin
clarithromycin = raises INR
cranberry juice can also raised INR
what marrow disorder can transform to AML
myelodysplasia
buzzword for CLL and what can it progress to
smear or smudge cells on blood film
non-hodgkins lymphoma
buzzword for CML
Philadelphia chromosome
buzzword for AML
Auer rods
when does incidence of PCV peak, what is basic pathology and what are symptoms
6th decade - increase in red cell volume
hyperviscosity
pruritus, typically after a hot bath
splenomegaly
haemorrhage
tx of PCV
1st line = venesection
= plus aspirin
what is ET
Essential thrombocytosis is one of the myeloproliferative disorders
Megakaryocyte proliferation results in an overproduction of platelets.
Sx of ET
platelet count > 600 * 109/l
both thrombosis (venous or arterial) and haemorrhage
burning sensation in the hands
what is IMF and what are the symptoms of it
Myelofibrosis - get scarring of the bone marrow
Sx = elderly person with signs of anaemia, massive splenomegaly, hypermetabolic symptoms: weight loss, night sweats
Ix = teardrop polikocytes
what is von willebrand disease
most common inherited bleeding disorder - autosomal dominant
characteristically behaves like a platelet disorder
Sx of Von Willebrand disease and what is seen on Ix and Mx
epistaxis
menorrhagia
Ix = prolonged bleeding time and APTT
Mx = tranexamic acid for mild bleeding
what inheritance is Haemophilia and what does this mean
X-Linked
Dad who has the condition can not pass it on too his son
what is deficient in Haemophilia A
Factor 8
what is deficient in Haemophilia B and what is it also called
Factor 9
Christmas Disease
Sx of haemophilia and what is seen on Ix
haemoarthroses, haematomas
prolonged bleeding after surgery or trauma
Ix = prolonged APTT
= bleeding time, thrombin time, prothrombin time normal
Ix for hereditary spherocytosis
EMA binding
