Haem Flashcards
Blood features of Hereditary Spherocytosis
Type of haemolytic anaemia
Can present at any age
Increased unconjug bilirubin Increased urinary urobilinogen Increased LDH Increased reticulocytes Increased MCHC Decreased haptoglobin
VTE RFs
Surgery Trauma Immobility Malignancy OCP/HRT Pregnancy IBD Nephrotic syndrome Obesity Inherited thrombophilia: FVL, pCS deficiency, Antithrombin deficiency
6mo old girl with FTT, anaemia, frontal bossing
Dx and Rx
Cooley’s Anaemia AKA. Beta thalassaemia MAJOR (px in first year of life)
Lifelong transfusion + desferrioxamine
NB. Betathal minor is asymptomatic carrier state
Betathal intermedia has anaemia and moderate splenomegaly
Disoder causing bleeds into joints and muscles eg. massive haemarthrosis
Haemophilia
In warfarin toxicity, when to give vitamin K?
If minor bleeding present
OR
If INR >8
target cells, other names and causes?
codocytes
leptocytes
Mexican hat cells
Thalassaemia
Iron deficiency
Splenectomy
Liver disease
Auer rods, Dx?
AML
Reed-Sternberg cells, Dx?
Hodgkins lymphoma
APL Rx + if pregnant?
Warfarin
If pregnant: Aspirin + LMWH
40-60yo
abdo pain
massive splenomegaly
WCC HIGH +/- low Hb/platelets
Dx and Rx
CML
(Ph chromosome t(9:22) in 80%)
Rx:
Chemo (imatinib)
SCT
65+yo w/l painless LNopathy lymphocytosis HSM
Dx and Rx
CLL - often asymptomatic
Rx: no curative option
Chlorambucil
Fludarabine
Monitor if no symptoms
Smear cells
CLL
Lymphocytes with ruptured cell membranes
Teardrop cells
Myelofibrosis
immature erythroid and myeloid cells also seen
Myelofibrosis important complication
10% risk transformation to AML
Mycoplasma complications
Cold agglutinin (IgM) haemolytic anaemia Erythema nodosum Erythema multiform Mycocarditis Meningo-encephalitis
Ileal resection + hypersegmented polymorphs
B12 deficiency
folate also causes hypersegmented polymorphs but is instead digested in duodenum and proximal jejunum
What is a paraproteinaemia and examples
Presence of immunoglobulins produced by single clone of plasma cells
eg. MM, primary amyloidosis, Waldenstroms macroglobulinaemia, heavy chain disease
Definitive Ix for Dx of Amyloidosis
Biopsy of affected tissue
Red congo stain
Red-green birefringence under polarised light microscopy
SLE or Hep B - which can cause BM failure?
Hep B
Treatment options for Hodgkins
Chemo + radio (no rituximab)
Staging system for Lymphoma
Arbor staging:
Stage I: single lymphatic organ/extranodal site
Stage II: two or more regions same side of diaphragm
Stage III: LN involvement both sides of diaphragm
Stage IV: disseminated, with extra nodal site involvement eg. BM, liver
Indication and Rx for treating thrombocythaemia
Platelets >1000
Rx:
Low dose Aspirin
Hydroxycarbamide if >60yo or previous thrombosis
Definition of hyperviscosity syndrome
When viscosity of blood gets thick enough to impair microcirculation
eg. lethargy, confusion, GI or GU bleed, visual disturbance
When to consider PCA in SC crisis
If had two doses strong opioid in 2 hours
NB. Pethidine c/I in SCD
High-grade Non Hodgin’s Rx
CHOP: Cyclophosphamide Hydroxydaunorubacin Vincristine Prednisolone
+/- Rituximab
Lead poisoning definitive features
Sideroblasts
High ferritin
Curative treatment for CML
Allogeneic BM transplant
ie. first line in younger patients
(NB. Not imatinib)
Patient APML
?cytogenetics finding
?Rx
t(15:17)
All trans-retinoic acid
CLL - if to treat with one agent, which one?
Chlorambucil - reduces lymphocytes, LN size, improve function
Transfusion related complication of Beta Thal Major, and Rx
Splenomegaly, causes increased uptake of RCs ie. become refractory to transfusion
Rx: splenomegaly
Endo complications of beta thal, and Rx
- Pituitary dysfunction -> delayed puberty and development
Rx: somatotrophin - Osteoporosis
Rx: bisphosphonates
Heinz body
G6PD deficiency
G6PD diagnostic test
Beutler fluorescent spot
Blood tests suggesting parasitic infection
Eosinophilia
Lymphopaenia causes
AIDS Steroids Chemo Radio Malignancy Renal failure Liver failure Sarcoidosis
Investigation for plasma viscosity
ESR
Thalassaemia patient with vomiting, abdo pain, polydipsia, hyperglycaemia
Iron overload
deposition into pancreas, heart, liver, pituitary
Causes and Rx of aplastic anaemia
Radio Chemo AI Drugs: -chloramphenicol -carbamazapine -phenytoin -quinine
Rx: antithymocyte globulin
PCV Rx
Asymptomatic:
-Venesection
Immunosuppression/Cytotoxic IF:
Symptomatic +/- organomegaly
Splenectomy if symptoms severe, as last resort
Asymptomatic with ET
Surveillance
Aspirin ONLY if evidence of vascular occlusion
(plasmapheresis used for urgent reduction of platelets)
AI thrombocytopenia Rx to reduce risk of splenectomy
Rituximab
Only given if condition severe enough
(NB. No role for steroids of Igs)
Aggressive NHL Rx
Options include: biologics radio chemo BMT
If aggressive and young patient, eg. with b symptoms, best option for remission is BMT
Common blood disease in Mediterranean?
Thalassaemia
