Haem COPY Flashcards
Smear cells
CLL
Philadelphia chromosome
9:22
BCR-ABL
CML (but can be associated with AML/ALL)
Imatinib (TK inhibitor)
Auer rods
AML
Tear drop poikilocytes and JAK2
Myelofibrosis
pruritis and raised haemoglobin after shower (aquagenic pruritis)
Polycythaemia (Rubra) Vera
Acute promyelocytic leukemia (APML)
- translocation and its name
- common presentation
t(15:17)
PML-RARA translocation
Still has Auer rods like AML
Presents with bleeds (DIC common)
61yo with CLL
Presents with pneumonia, haemoptysis, endobronchial mass, anaplastic large cell lymphoma
Richter’s transformation
Diffuce B cell Lymphoma (DBCL)
Sheets of large lymphoid cells
Clumsiness, progressive weakness, personality change after chemo
Progressive multifocal leukencephalopathy (JC virus)
Massive splenomegaly (classically which leukemia? which other haem condition?)
CML, Myelofibrosis
High calcium, CLOVER LEAF nuclei, LNs
Adult T cell Lymphoma
HTLV-1
Adult T cell Lymphoma
Paraprotein IgM
Waldenstroms macroglobulinaemia
Paraprotein IgG
Multiple Myeloma (or MGUS or Smouldering depending on blasts and symptoms)
<30g/dl IgG and <10% blasts for MGUS
>30g/dl IgG and >10% blasts for SM or MM
Only MM is CRAB Sxs
AA vs AL amyloidosis
AA = Chronic illness e.g. RA, IBD
AL = Multiple Myeloma
Amyloidosis is a paraproteinaemia!! Can see raised paraproteins (often less than 30)
Post transplant EBV
PTLD (Post transplant lymphoproliferative disease)
Anaplastic lymphom
Alk 1
Past histort of DVT, easy bruising, LOADS of platelets
ET (essential thrombocythaemia)
Pregnant woman with low platelets, schistocytes, neuro sxs (headache and seizures), but LOW BP
TTP
Pregnant patient with slightly low platelets in 3rd trimester (asymptomatic)
Gestational thrombocytopenia (not same as physiological but it is benign and no tx is needed. It is the most common cause of low platelets in pregnancy. If platelets <70 think HELLP or ITP)
Can’t breathe and DIC
Amniotic fluid embolism
Normal heam values in preg for
- Hb
- MCV
- WCC
- Platelets
- Plasma volume
Normal heam values in preg for
- Hb low
- MCV normal or high (macrocytosis)
- WCC high
- Platelets low
- Plasma volume high
Prolonged APTT, normal PT, prolonged bleeding time
vWD
Prolonged APTT, normal PT, normal bleeding time
Haemophilia
INR Targets
- AF/cardioversion
- MI!!
- Single DVT
- Recurrent DVTs
- Prosthetic valve
INR Targets
- AF/cardiov 2.5
- MI 2.5
- Single DVT 2.5
- Recurrent DVTs 3.5
- Prosthetic valve 3.5
Lower = more clots
INR within 0.5 of target is satisfactory
Rule of thumb - everything except recurrent DVTs/PEs and some prosthetic valves is 2.5 target!
Is heparin intrinsic/extrinsic pathway and APTT or PT
intrinsic pathway and APTT
Is warfarin intrinsic/extrinsic pathway and APTT or PT
Extrinsic and PT
Anaemic with frontal bossing and XR: hairs on end
Thalassaemia
osmotic fragility
hereditary spherocytosis
Membrane defect RBCs
Spectrin deficiency –> hereditary sphero/elliptocytosis
Heinz bodies
G6PD
Warm haemolytic anaemias
- antibody type
- blood film
- causes
- IgG
- Spherocytes
- CLL, SLE, methyldopa
Cold Agglutinin disease (Cold HA)
- antibody type
- Associated with
- causes
- IgM
- Raynaud’s
- Mycoplasma, EBV
Donath-Landsteiner antibodies
Paroxysmal cold haemoglobinuria (PCH)
Ham’s test or immunophenotype
Paroxysmal nocturnal haematuria
complement mediated, morning haematuria
Hypercellular BM
CML (but maybe other leukemias too)
Prognostic factors in CLL
Good: hypermutated Ig gene, 13q14 deletion
Bad: CD38+ve, 11q23, 17p, LDH raised
Owl eyed cells
Reed Sternberg
HL
What would you give these patients (transfusion)?
- triple AAA surgery
- C/S
- Past transfusion, allergy to plasma proteins
- X-match
- G&S
- Washed red cells
Transfusion
Acute SOB, dry cough, hypoxia
TRALI
Transfusion
Febrile with collapse
Bacterial infection
Transfusion
RTA, jaundice and anaemia a few days later
Delayed haemolytic reaction
Thalaessaemia pt with tan and diabetes
Haemosiderosis (focal iron overload)
SCC pt with short stature and poor cardiac function
Iron overload
Old lady gets 4 units of blood and feels unwell + basal creps+ankle oedema
Fluid overload
Seizures and schistocytes
TTP
Pelger Huet cells, hyposegmented neutrophils
MDS
> 20% blasts
leukemia
haemolysis after antimalarials
G6PD
6 features of myelofibrosis
- pancytopenia
- leucoerythroblastic picture
- Massive splenomegaly
- dry tap
- tear drop (poikilocytes/dacrocytes)
- Some are JAK2+
Cabot rings
Megaloblastic anaemia
Factor V Leiden pathogenesis
Impaired degradation of factor V by protein C
Buerger disease
Vasculitis in smokers (corkscrew arteries)
Dry cough, dyspnoea and fever post transfusion
TRALI
Tartrate resistance acid phosphatase (TRAP) ass with which condition?
Hairy cell leukemia
Clover leaf appearance and high calcium
Adult T cell lymphoma
Smudge/smear cells
CLL
Bleeding and thrombosis with high platelets
Essential
Thrombocythaemia
ET treatment
Hydroxyurea + anagrelide
Macrocytic anaemia and stomatitis
B12 deficiency
Pregnant greek patient with father who is on warfarin and sister had a DVT
Antithrombin III deficiency
Transfusion in past with allergy plasma proteins
Washed red cells
Sickle cell transfusion
?Group in C,E,K crossmatch/anti-CcRR Abs
Splenectomy is useful in
The PIIES - what does the acronym stand for?
Thalessaemia
Pyruvate kinase deficiency ITP Immune HA Elliptocytosis Spherocutosis
Cold AI HA causes
Cold LID
Lymphoproliferative disease (lymphomas and leukaemias)
Infections (mycoplasma/EBV)
Don’t know (idiopathic)
PNH Signs
PNH is also the acronym
Pancytopenia
New thrombus
Haemolytic anaemia
Basophilic stripping
ß-thal and lead poisoning
Acanthocytes
- another name
- when do you see?
- Spur cells
2. Hyposplenism
Anisopoikilocytosis
- meaning
- conditions associated
- different size and shapes (respectively)
- anaemias e.g. IDA
ßthal
hereditary spherocytosis
B12 deficiency
Target cells seen in which 3 conditions?
3 Hs
Hepatic pathology
Hyposplenism
Haemoglobinopathies
Paroxysmal cold haemoglobinuria
Children, acute onset haemolysis in cold temperatures
Aplastic anaemia causing drugs (4)
4 C’s
Carbamazepine
Chloramphenicol
Cytotoxics
anti-Convulsants (e.g. phenytoin)
ALP in MM
NORMAL despite bone lesions (but raised calcium)
MM activates osteoclasts but shuts off ALP producing osteoblasts hence just destruction and no rebuilding which would cause the raised ALP
TTP signs and symptoms
MARCH Low platelets
MAHA A fever Renal failure CNS signs --> seizures etc. Haematuria/proteinuria
Massive transfusion with low platelets after
Happens if you don’T replace platelets too
Smoker with COPD, high Hb and Hct (low plasma volume)
Combined polycythaemia
high plasma volume AND high Hb
Polycythaemia and not dehydrated, what happens to RBC mass?
Increases
ßthal minor presentation
35 year old with tiredness
Mild vWD - which drug can they take before seeing the dentist?
Desmopressing (releases intracellular store of vWF)