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YEAR 5: Haematology PM > Haem: Interactive Cases > Flashcards

Haem: Interactive Cases Flashcards

1
Q

% Myeloblast that is abnormal

% Lymphoblasts abnormal

A
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2
Q

How to interpret FBC

A
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3
Q

B cell markers

A

CD19 - epitope for car t cells

CD20 - epitope for rituximab

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4
Q

T cell markers

A

All are CD3+

CD4 - Helper

CD8 - Cytotoxic

CD5

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5
Q

Markers of lympod differentiation

A

TdT marker of immature T an B lymphoblasts

Surface IgG is a marker of mature cells

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6
Q

List some general clinical signs of anaemia.

A
  • Pale mucous membranes
  • Tachycardia
  • Cardiomegaly/CCF
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7
Q

List some specific clinical signs of anaemia.

A
  • Koilonychia
  • Glossitis (B12 deficiency - B12 is needed for epithelial cell replacement)
  • Jaundice (haemolysis)
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8
Q

List some causes of microcytic anaemia.

A
  • Iron deficiency
  • Thalassemia
  • Anaemia of chronic disease
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9
Q

List some investigationsthat are used for anaemia.

A
  • FBC
  • Blood film
  • Reticulocyte count
  • Haemoglobin electrophoresis
  • Iron studies
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10
Q

List some physiological triggers for reticulocytosis.

A
  • Haemolysis
  • Haemorrhage
  • Haematinics (agents that stimulate RBC production)
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11
Q

List some conditions in which reticulocytes are absent.

A
  • Inadequate haematinics
  • Bone marrow failure
  • Acute major haemorrhage (reticulocyte response takes at least 6 hours)
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12
Q

What are the typical haemoglobin electrophoresis findings of thalassemia?

A
  • High HbA2 and HbF
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13
Q

List some blood film features of iron deficiency anaemia.

A
  • Pencil cells
  • Anisocytosis
  • Poikilocytosis
  • Hypochromic
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14
Q

List some causes of pancytopaenia.

A
  • Aplastic anaemia
  • Leukaemia
  • Infiltration (e.g. lymphoma, carcinoma)
  • Drugs (e.g. chemotherapy)
  • B12/folate deficiency
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15
Q

List some investigations for pancytopaenia.

A
  • Blood film
  • Vitamin B12 and folate
  • Bone marrow biopsy
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16
Q

What is a defining feature of myeloid cells?

A
  • Auer rods
  • NOTE: the presence of Auer rods means that cytochemistry and immunophenotyping is not necessary
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17
Q

Which type of major infection is classically seen in AML?

A

Gram-negative septicaemia

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18
Q

What are the principles of management of AML?

A
  • Supportive - red cell and platelet transfusions, isolation
  • Chemotherapy
19
Q

Normal vs Myeloma pathology

A
20
Q

List some causes of thrombocytopaenia.

A
  • Defect in platelet production - drugs, bone marrow disorders (e.g. leukaemia, myelodysplasia)
  • Increased platelet destruction - ITP, DIC, heparin-induced thrombocytopaenia
21
Q

List some investigations for thrombocytopaenia.

A
  • Coagulation screen
  • Blood film
  • Bone marrow aspirate
  • ANA/RAPA/anti-platelet antibodies (check for rheumatoid arthritis, SLE)
  • HIV (common cause of isolated platelet destruction worldwide)
22
Q

List some causes of low platelets with abnormal clotting.

A
  • DIC
  • Alcohol
  • Drugs
  • Leukaemia
23
Q

List some investigations for suspected DIC.

A
  • Blood film
  • D-dimer
  • Fibrinogen
  • Septic screen
  • LFTs
24
Q

How is DIC managed?

A
  • Antibiotics
  • Blood products
  • Regular blood tests to assess response
25
Q

How you get spherocytes

A
  1. Hereditary
  2. Autoimmune haemolytic anaemia
26
Q

Causes of aquired haemolytic anaemia

A

Non-immune

Microangiopathic haemolytic ureamic syndrome (MAHA)

Malaria

Prostetic heart valves

Drugs: Dapsone

Immune Mediated
Autoimmune: warm/cold antibody type

Alloimmune (post blood transfusion)

Drug: methyldopa, penicillin

27
Q

Causes of inherited haemolytic anaemia

A

Defect in:

Hb

Sickle cell

Thalassaemia

Membrane

Hereditary spherocytosis

RBC Enzymes

G6PD deficiency - would protect from oxidative stress

28
Q

Causes of inherited haemolytic anaemia

A

Defect in:

Hb

Sickle cell

Thalassaemia

Membrane

Hereditary spherocytosis

RBC Enzymes

G6PD deficiency - would protect from oxidative stress

29
Q

Biochemistry in Fe deficiency

A

Ferritin - needs to be low (high doesnt rule out)

Transferrin = High

30
Q

Haematological picture of Pernicious anaemia

A

Pernicious anaemia = b12 defieicny

B12 required for DNA synthesis

1st - RBC

2nd - WBC, Platelets = Pancytopenia

31
Q
A

Leukoerythroblastic blood film

Amongst RBC - teardrop cells

+ premature RBC (top Left)

Myelocyte - premature - Top Right

32
Q

Causes of Pancytopenia

A
33
Q
A

Leukaemia - High WCC

Many myelocyte precursors???

Chronic Myeloid Leukaemia (CML)

34
Q

Clinical picture of CML

+ Blood film

A

As a result of BCR-ABL fusion between 9 and 22

Detected on RT-PCR

35
Q

At diagnosis how do you treat CML

A

Imatinib

inhibitor of tyrosine kinase associated with BCR-ABL

v high respionse rate in the chronic phase

36
Q

Month 60 after CML, developing blasts

A

Blast crisis

(acquisition of new mutations)

37
Q
A

Jak2V61F mutation

Polycythemia Vera

38
Q
A

Immunophenotyping - CLL

CD19 and CD5 - Both positive

Leukocytosis with all lymphocytes

Not pan = chronic

Peripheral blood - mature lymphocytes + smear/smudge cells

39
Q

Gravest cytogenic rognosis

A

p53 (Chromosome 17 deletion)

40
Q

Management of CLL based on “Brutons agammaglobinaemia”

A

Ibrutinib - “nib” = tyrosine kinase inhibitors

inhibitors brutons tyrosine kinase

recreating phenoytpe of inherited Brutons X linked agammaglobinaemia???

41
Q
A

Multiple Myeloma

1 immunoglobulin raised, others are reduced = immune paresis

42
Q
A

No

Myeloma cannot be excluded

Havent excluded light chain only myeloma -

Need to check serum free light chains or urine for bence jones proteins

43
Q
A

Cast nephropathy

NOT AL Amyloid

Cast nephropathy is statistically the most common cause of renal failure in myeloma

Super high SFLC Kappa - light chains pass through basement membrane and prescipitate in renal tubules

AL amyloid - would see congo red / apple green bifringent depositions in kidney biopsy or small bowel or heart

44
Q

Bleeding from wound and venepuncture sites withou stopping

which blood product to use?

PT and APTT is normal

Fibrinogen low

A

Cryoprecipitate

(has higher fibrinogen than FFP)

Higher APTT etc - give FFP

YEAR 5: Haematology PM (18 decks)

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