Haem Flashcards
Management of Heparin-Induced Thrombocytopenia (HIT)
Switch to argatroban or danaparoid
Indication for treatment in CLL
Constitutional symptoms
Bone marrow failure
Symptoms due to LN/spleen/liver elargement
Weight loss > 10% in 6 months
AI anaemia/ thrombocytopenia not responding to prednisolone
Lymphocyte doubling in <6m, or 50% increase in 2m
Indication for use of Ibrutinib (BTK inhibitor) in CLL
TP53 mutation
Pentad of features in TTP (Thrombotic Thrombocytopenic Purpura)
- Thrombocytopenia
- MAHA (anaemia + schistocytes)
- Fever
- Fluctuating neuro signs
- Renal impairment
Causes of MAHA (schistocytes seen on film)
TTP
HUS
DIC
Pre-eclampsia
Presentation of HUS
Haemolytic anaemia (MAHA)
Thrombocytopenia
Severe AKI
Following bloody diarrhoea
AL amyloidosis presents as
Nephrotic syndrome Cardiomyopathy Peri-orbital purpura (Macroglossia) (Urine free light chains) Without features of MM
Waldenstrom’s macroglobulinaemia (lymphoplasmacytoid malignancy) presents as
Monoclonal IgM paraproteinaemia
Hyperviscosity
Systemic upset
Commonest initial treatment for CLL
Fludarabine + cyclophosphamide + rituximab (FCR)
Other options for CLL treamtent, when FCR not appropriate
Bendamustine
Chlorambucil
Anti-CD20 (obinutuzumab)
Management of AI anaemia/thrombocytopenia in CLL
Prednisolone
Treatment of Waldenstrom macrogolubulinaemia
Cyclophosphamide + dexamethasone + rituximab
Features of monoclonal gammopathy of unknown significance (MGUS)
Paraproteinaemia
Asymptomatic/neuropathy
Normal immune function
No bone lesions/renal impact
Schnitzler’s syndrome
Chronic urticaria
Monoclonal raised IgM
Features of methaemoglobinaemia
Cyanosis
Low O2 sats with normal PaO2
Ischaemia
R-CHOP is
Rituximab Cyclophosphamide Doxorubicin Vincristine Prednisolone
Management of NHL - low-grade and asymptomatic
Watch and wait
Vaccinate (flu, haemophilus, pneumococcus, meningococcus)
Chemo options for NHL
R-CHOP
FCR
Management of primary CNS lymphoma
High-dose methotrexate + dexamethasone
Imatinib is chemotherapy agent used in
CML
MALT-lymphoma
c-kit melanoma
Non-Hodgkins Lymphoma with CNS involvement
R-CHOP + intrathecal methotrexate
Curative treatment for myelofibrosis
Allogenic stem-cell transplant
Drugs used in control of myelofibrosis
Hydroxyurea
IFN-a
JAK inhibitors
Diagnostic criteria for HHT (Osler-Weber-Rendu)
Need 3 for definite diagnosis.
Epistaxis
Telangiectasia
AVMs or GI telangiectasia
1st-degree family history
Impaired platelet aggregation with Ristocetin, suggests
von Willebrand’s disease
BCR-ABL mutation is diagnostic for
CML
BCL2 mutation seen in
Diffuse large B cell lymphoma
TP53 mutation seen in
Diffuse large B cell lymphoma
C-MYC mutation seen in
Burkitt’s lymphoma
Commonest mutation seen in myelofibrosis
JAK2
Lysosomal storage disorder which causes massive splenomegaly
Gaucher disease
Lysosomal storage disorder which causes massive splenomegaly
Gaucher disease
Causes of warm AIHA
Autoimmune (eg SLE)
CLL, lymphoma
Methyldopa
Causes of cold AIHA
Mycoplasma
EBV
Lymphoma
Prophylactic antimicrobials given when starting chemotherapy (FCR)
Co-trimoxazole
Aciclovir
Fluconazole
CLL - Poor prognostic factors (median survival 3-5 years)
Male >70yo Lymphocyte count >50 Polymorphs >10% Doubling time <12m Raised LDH CD38 positive TP53 mutation
