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YEAR 5: HAEM > Haem: Haematology of Systemic Disease (Laz) > Flashcards

Haem: Haematology of Systemic Disease (Laz) Flashcards

1
Q

List some ways in which lymphoma can cause jaundice.

A
  • Direct liver involvement
  • Compression of the bile duct
  • Causing autoimmune haemolytic anaemia
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2
Q

Which types of anaemia can be cause by cancer?

A
  • Iron deficiency
  • Anaemia of chronic disease
  • Haemolytic anaemia
  • Leucoerythroblastic anaemia

anaemia is a symptom not a disease

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3
Q

Which types of cancer are associated with causing secondary polycythaemia?

A
  • Renal cell carcinoma
  • Liver cancer
  • Due to the production of EPO
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4
Q

What is the most common cause of iron deficiency anaemia?

A

Occult blood loss (e.g. GI cancers, urinary tract cancers)
GI - peptic ulcers, gastric cancer, colon cancer, IBD
urinary tracts

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5
Q

What are the typical laboratory findings of iron deficiency anaemia?

A
  • Microcytic hypochromic anaemia
  • Low ferritin
  • Low transferrin saturation
  • High TIBC

Ferritin may be ok - malignant - inflammatory - acute phase protein

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6
Q

What is leucoerythroblastic anaemia?

A

Anaemia is characterised by the presence of red and white cell precursors

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7
Q

What are the morphological features of leucoerythroblastic anaemia seen on blood film?

A
  • Tear drop red blood cells (aniso- and poikilocytosis)
  • Nucleated RBCs
  • Immature myeloid cells

causes are broad - but there is a serious probelm

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8
Q

What does leucoerythroblastic anaemia tend to be caused by?

A
  • Bone marrow infiltration (leukaemia, lymphoma, myeloma, solid tumours, myelofibrosis, military TB, severe fungal infection)
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9
Q

Define haemolytic anaemia.

A

Anaemia caused by reduced red blood cell survival

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10
Q

List some key laboratory findings in haemolytic anaemia.

A
  • Anaemia
  • Raised reticulocytes
  • Raised unconjugated bilirubin
  • Raised LDH
  • Low haptoglobins

NOTE: LDH is an intracellular enzyme that is released when RBCs are destroyed

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11
Q

What are the two main groups of haemolytic anaemia? List some examples.

A

Inherited (defects with the cell)

  • Hereditary spherocytosis (membrane problem)
  • G6PD deficiency (enzyme problem)
  • Sickle cell disease, thalassemia (haemoglobin problem)

Acquired (defects with the environment)

  • Immune-mediated
  • Non-immune mediated
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12
Q

Which test distinguishes immune-mediated and non-immune mediated haemolytic anaemia?

A

DAT or Coombs’ test

DAT +ve means that the haemolytic anaemia is mediated through immune destruction of red cells

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13
Q

What morphological change is seen on the blood film of patients with autoimmune haemolytic anaemia?

A

Spherocytes

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14
Q

List some systemic diseases that can cause autoimmune haemolytic anaemia.

A
  • Cancer involving the immune system (e.g. lymphoma)
  • Disease of the immune system (e.g. SLE)
  • Infections (disturbs the immune system)
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15
Q

List some causes of non-immune haemolytic anaemia.

A
  • Infection (e.g. malaria)
  • Microangiopathic haemolytic anaemia (MAHA)
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16
Q

List some key features of MAHA.

A
  • Usually caused by underlying adenocarcinoma
  • Red cell fragments
  • Low platelets
  • DIC/bleeding
17
Q

Outline the mechanism of MAHA.

A
  • An underlying adenocarcinoma produces procoagulant cytokines that activate the coagulation cascade
  • This leads to DIC and the formation of fibrin strands in various parts of the microvasculature
  • Red cells will be pushed through these fibrin strands and fragment

NOTE: always consider underlying adenocarcinoma in any patient presenting with MAHA

18
Q

List some causes of secondary polycythaemia.

A
  • Cancer (renal, hepatocellular, bronchial)
  • High altitude
  • Hypoxic lung disease
  • Congenital cyanotic heart disease
19
Q

What is the main difference seen in the blood film of patients with acute and chronic leukaemia?

A
  • Chronic - mature white cells are raised
  • Acute - immature blast cells are raised
20
Q

List some causes of neutrophilia.

A
  • Pyogenic Infection
  • Corticosteroids (due to demargination - normally 60% of neutrophils are attached to vascular endothelium, demarginated in response stress hormones)
  • Underlying neoplasia
  • Tissue inflammation (e.g. colitis, pancreatitis)
  • Myeloproliferative/leukaemia disorder
21
Q

List some infections that characteristically do not cause neutrophilia.

A
  • Brucella
  • Typhoid
  • Many viral diseases
22
Q

List some key features of a reactive neutrophilia on a blood film.

A
  • Band cells (presence of immature neutrophils (band cells) show that the bone marrow has been signalled to release more WBCs)
  • Toxic granulation
  • Clinical signs of infection/inflammation
23
Q

What are some key blood film and clinical features suggestive of a myeloproliferative disorder?

A
  • Neutrophilia
  • Basophilia
  • Immature myelocytes
  • Splenomegaly

NOTE: you may see raised Hb and raised platelets in CML if it affects those lineages

24
Q

What are some key blood film features suggestive of AML?

A
  • Neutrophilia
  • Myeloblasts
25
Q

List some causes of monocytosis.

A
  • Bacteria: TB, Brucella, typhoid
  • Viral: CMV, VZV
  • Sarcoidosis
  • Chronic myelomonocytic leukaemia (type of MDS)
26
Q

List some causes of reactive eosinophilia.

A
  • Parasitic infection
  • Allergy (e.g. asthma, rheumatoid arthritis)
  • Underlying neoplasms (e.g. Hodgkin’s lymphoma, T cell lymphoma, NHL)
  • Drug reaction (e.g. erythema multiforme)
27
Q

Which gene mutation causes chronic eosinophilic leukaemia?

A

FIP1L1-PDGFRa fusion gene

really rare

28
Q

Which type of virus typically causes basophilia?

A

Pox viruses

29
Q

What investigations are typically used when investigating lymphocytosis?

A
  • Clinical examination
  • FBC
  • Light microscopy
  • Flow cytometry (identify lineage and stage of differentiation)
  • Molecular genetics (TCR or Ig gene)
30
Q

List some causes of reactive lymphocytosis.

A
  • Infection (EBV, CMV, toxoplasmosis, rubella, HSV)
  • Autoimmune diseases (NOTE: these are more likely to cause lymphopaenia)
  • Sarcoidosis
31
Q

How would the lymphocytes seen on a blood film due to a viral infection be different from leukaemia/lymphoma?

A
  • Viral infection: mature - reactive or atypical lymphocytes (EBV)
  • CLL or NHL: mature - small lymphocytes and smear cells
  • ALL - lymphoblasts
32
Q

List causes of lymphopaenia

A
  • **Infection - HIV
  • Drugs - chemotherapy**
  • Auto-immune disorders
  • Inherited immune deficiency syndromes
33
Q

Outline how flow cytometry is used to identify cell types.

A
  • Fluorescently labelled monoclonal antibodies targeted at different antigens are washed over the cells
  • Cells are passed through the flow cytometer and the fluorescence is recorded
  • Dependent on the antigens present on the cells, you can identify the stage of maturation
34
Q

What is light chain restriction?

A
  • An individual B cell will either express kappa or lambda light chains (not both)
  • In response to an infection, you will get polyclonal B cell response so there will be a roughly even mixture of kappa and lambda light chains
  • In lymphoproliferative disorders, monoclonal proliferation of a B cell expressing only one type of light chain (e.g. kappa) will mean that the proportion of kappa relative to lambda will increase (e.g. showing an overwhelming majority of kappa)

YEAR 5: HAEM (20 decks)

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