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CP3 Medicine > HAEM - Leucocytes and neutrophils > Flashcards

HAEM - Leucocytes and neutrophils Flashcards

1
Q

Fct neutrophils

A

Ingest and kill bacterial, fungal and cellular debris

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2
Q

Fct lymphocyte s

A

Produce antibodies for cell mediated immunity

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3
Q

Fct eosinophils

A

Role in allergic reactions

Defense of parasitic infection

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4
Q

Fct monocytes

A

Precursor tissue macrophages

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5
Q

Fct basophil

A

Release histamine in inflammatory reactions

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6
Q

Role spleen (5)

A

Reservoir of RBC
Site of B lymphocyte + antibody production
Reservoir platelets
Reservoir macrophages
Removes antibody coated bacteria and blood cells

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7
Q

Neutrophilia DDx >10 (5)

A 
bacterial infection 
Tissue damage - MI.PE, burn 
Physiological - exercise, during preg 
CCS + inflamm - Gout, RA, UC, Chron's 
Malig - CML/solid tumour
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8
Q

Neutropenia DDx <1.5 (7)

A 
Viral infection + severe bacterial infection - sepsis /typhoid 
Autoimmunity - commonly SLE
Felty's syndrome 
Black people 
Alcohol + other drugs. Methotrexate
ELA2 gene mutation 
BM failure
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9
Q

Neutropenic sepsis

A

Severe neutropenia leading to sepsis

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10
Q

Agranulocytosis

A

Complete abscence of circulating neutrophils

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11
Q

Which med is agranulocytosis a common SE of?

A

Carbimazole

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12
Q

Lymphocytosis DDx >5 (4)

A

Viral infections
Chronic infections - TB/toxoplasmosis/syphillis
Lymphoproliferative - CLL/some lymphomas
Post splenectomy

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13
Q

Lymphopenia DDx (5)

A 
HIV/autoimmunity 
CCS + inflamm - CT disease 
Chemotherpy + lymphoma
Renaal failure 
Transient - recent infection
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14
Q

Hx points - abnormal WCC (8)

A 
Age 
Duration Sx 
W loss >10% 6m
Drenching night sweats 
Unexplained fever 
Systemic disease - RA
Evidence malig 
Lymphadenopathy >6w + >2cm
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15
Q

Possible Ix - abnormal WCC (6)

A 
Blood film 
Immunophenotyping 
USS/CT
Microbiology 
LN biopsy 
BM biopsy
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16
Q

What are the 2 lineages a multipotent cell can go down

A

Common myeloid progenitor

Common lymphoid progenitor

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17
Q

Cells the common myeloid progenitor can DDx into (5)

A 
Erythrocyte
Mast cell 
Megakaryocytes 
Neutrophil 
MOnocyte
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18
Q

What do megakaryocytes further divide into

A

Platelets

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19
Q

What do common lymphoid progenitor cells DDx into

A

B cell
T cell
NK cell

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20
Q

What is immature cells in peripheral blood a sign of?

A

That the marrow is stressed

Hence pre-leukaemic

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21
Q

ALL

A

Malignancy of lymphoid cells of B/T lineage –> uncontrolled proliferation of immature blast cells, BM failure and tissue infiltration

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22
Q

Who gets ALL

A

Children - 3-7y/o

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23
Q

Which syndrome is ALL more common in?

A

Downs

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24
Q

Prognosis ALL

A

80% cure rate in kids <10

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25
Q

Indicators - poor prognosis ALL (4)

A

Older ps
Male
B cell disease
Philadelphia chromosome

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26
Q

Philadelphia chromosome

A

9:22

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27
Q

What is AML

A

Malignancy of blast cells fom marrow myeloid elements

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28
Q

RF AML (4)

A

Myeloproliferative disorders
Previous chemotherapy
IR
Genetic syndromes

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29
Q

Median age PS AML

A

65

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30
Q

Prognosis AML

A

20% 3 y survival after chemo

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31
Q

Sx - acute leukaemia (6)

A 
B Sx
Bone pain 
Anaemia --> SOB on exertion, weakness 
Leukopenia --> rec infections 
Thrombocytopenia --> bleeding + bruising 
HS megaly
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32
Q

Ix Acute leukaemia

A 
FBC
Blood film - BLASTS 
CXR 
BM aspiration 
PET scan - mets 
U/E, LFT, cardiac fct
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33
Q

What is diagnostic Ix result for acute leukaemia

A

Blast cells on blood film

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34
Q

ALL - CXR findings

A

Mediastinum widening

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35
Q

General supportive management - acute leukaemia

A 
Nurse
Hickman line 
High kcal diet
Freq blood + platelet transfusion 
Allopurinol 
Check blood/obs - signs infections
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36
Q

Use of ABx in acute leukaemias

A

If T>38’ on 2 occasions >1hr

Cephalosporin + gentamicin until afebrile 72hrs

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37
Q

Why give allopurinal to patients with acute leukaemia

A

To prevent tumour lysis syndrome due to chemo

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38
Q

Specific Mx ALL

A

High dose chemo
+ 2 y maintenance therapy
Consider transplant if poor prog/relapse

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39
Q

ALL cure if have Philadelphia chromosome

A

Transplant (BM)

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40
Q

Specific Mx AML

A

Intensive chemo

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41
Q

If poor prog AML - what Mx should be done

A

Allogenic marrow transplant after 1st round chemo

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42
Q

If intermediate prod AML - what Mx should be done

A

Autologous marrow transplant

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43
Q

Age - CML

A

40-60y/o

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44
Q

Which genetic linkage accounts for 95% cases CML

A

Philadelphia chromo

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45
Q

Sx CML

A

B Sx

Gout + abdo discomfort

46
Q

O/E CML

A

Massive HS megaly

Signs anaemia /thrombocytopenia

47
Q

Ix CML

A

FBC - WCC v high
Blood film
BM
CT/PET

48
Q

Blood film findings - CML

A

Spectrum myeloid cells

49
Q

BM findings - CML

A

Hypocellular

50
Q

Mx CML

A

Imantinib chemo

SC transplant

51
Q

Prognosis CML

A

Median survival 6y

52
Q

What are the 3 stages of CML

A

Chronic - few Sx for y
Accelerated- incr Sx
Blast transformation - features acute leukaemia + death

53
Q

What is the most common leukaemia

A

CLL

54
Q

M:F CLL

A

2:1

55
Q

Median age of PS - CLL

A

70 y/o

56
Q

Pathophysiology - CLL

A

Accumulation of mature B cells that have escaped apoptosis

Increased mass of immune competent cells –> BM failure

57
Q

Sx CLL

A

Often none

Anaemic/infection prone

58
Q

O/E CLL (2)

A

Large non-tender LN

HSmegaly

59
Q

Ix CLL

A

FBC - raised lymphocytes

Blood film

60
Q

Blood film results CLL

A

Smudge cells

61
Q

Mx CLL

A

Symptomatic Tx only
chemo
Radiotherapy for HS megaly

62
Q

How is prognosis of CLL determined

A

Rai stage

63
Q

Rai stage 0 + prognosis

A

Lymphocytosis alone

> 13y

64
Q

Rai stage 1 + prognosis

A

Lymphocytosis + lymphadenopathy

8 y

65
Q

Rai stage 2 + prognosis

A

Lymphocytosis + HSmegaly

5 y

66
Q

Rai stage 3 + prognosis

A

Lymphocytosis + anaemia

2 y

67
Q

Rai stage 4 + prognosis

A

Lymphocytosis + thrombocytopenia

1y

68
Q

What is multiple myeloma

A

Malignant clonal proliferation of plasma cells . Single clone of plasma cells –> single Ig –> monoclonal band

69
Q

Av age PS Multiple myeloma

A

70

70
Q

Which population have increased prevelance of multiple myeloma

A

Afro-Carribbean

71
Q

PS Multiple myeloma

A

Osteolytic bone lesions –> backache, patho fractures = hypercalcaemia
BM failure –> infections, Sx anaemia + bleeding
Renal impairment

72
Q

Ix Multiple myeloma

A 
FBC
Blood film 
ESR - raised
U/E - deranged
Ca - raised
ALP - norm 
Electrophoresis - paraprotein MC band 
Urine Bence Jones protein +ve 
Skeletal XR
BM biopsy >10% clonal plasma cells
73
Q

Blood film finding multiple myeloma

A

Rouleaux formation

74
Q

FBC finding multiple myeloma

A

Normochromic normocytic anaemia

Leukopenia

75
Q

Skeletal XR finding multiple myeloma

A

Pepper pot skull

76
Q

If BM biopsy in Multiple myeloma yields <10% plasma clone cells, what is the diagnosis

A

MGUS

77
Q

Mx multiple myeloma

A

Supportive
Chemo/radiotherapy
BM SC transplant if <70

78
Q

Prognosis multiple myeloma

A

3-4y

79
Q

What is lymphoma?

A

Malignant proliferation of lymphocytes

80
Q

% lymphoma which are Hodgkins lymphoma

A

15%

81
Q

What are Hodgkins lymphoma defining characteristic

A

Reed-Sternburg cells

82
Q

Age range Hodgkin’s lymphoma

A

20-35

83
Q

RF Hodgkin’s lymphoma (4)

A

Affected sibling
EBV
SLE
Obesity

84
Q

Sx Hodgkin’s lymphoma (3)

A

Enlarged, non-tender rubbery LN
B Dx
Mass effects/direct extension Sx from mediastinal LN

85
Q

What can induce LN pain in pt with Hodgkin’s lymphoma?

A

Alcohol

86
Q

O/E - Hodgkin’s lymphoma (4)

A

Lymphadenopathy
Anaemia
Cahexia
HS megaly (50%)

87
Q

How is Non-Hodgkin’s lymphoma different from Hodgkins

A

W/o presence Reed-Sternburg cells

88
Q

Peak age Non-Hodgkin’s lymphoma

A

70

89
Q

High grade Non-Hodgkin’s lymphoma

A

Divide rapidly
PPS rapid onset lymphadenopathy
> aggressive
Better prognosis if ID’d

90
Q

Low grade Non-Hodgkin’s lymphoma

A

Divide slowly
> Insidious
Widely disseminated at diagnosis + incurable

91
Q

Sx Non-Hodgkin’s lymphoma (4)

A

Superficial lymphadenopathy (75%)
Extranodal Sx - oropharynx, skin, CNS, gut, lung
B Sx
BM failure

92
Q

Ix Non-Hodgkin’s lymphoma (6)

A 
FBC,  ESR, U+E 
Ca2+ 
Film 
LDH 
LN excision biopsy 
Staging CT
93
Q

Mx Non-Hodgkin’s lymphoma

A

Chemo/radiotherapy
Or
Chemo-radiotherapy

94
Q

Poor prognostic factors non-hodgkin’s (3)

A

> 60
Disseminated disease
Raised LDH

95
Q

Staging for lymphomas

A

Ann Arbor

96
Q

What is meant by myeloproliferative disorders

A

Clones of SC proliferate in BM

yet retain ability to differentiate

97
Q

What is essential thrombocytosis

A

Clonal proliferation of megacaryocytes –> persistently raised platelets

98
Q

Sx essential thrombocytosis

A

Often astmp
Microvascular occlusion
Bleeding
aa/vv thrombosis

99
Q

What is polycythaemia rubra vera

A

Malig proliferation of clone derived from 1 pluripotent marrow cell –> erythroid progenitor offspring which don’t req EPO to avoid apoptosis

100
Q

Consequence of PCV on the blood

A

XS prod RBC, WBC and platelets –> hyperviscosity + thrombotic complications

101
Q

Diagnosis PCV (2)

A

Incr red cell mass

JAK2 mutation

102
Q

PS PCV

A 
Thrombosis 
rarer: 
hyperviscocity Sx: headache, dizzy, tinnitus, facial plethora, erythromelalgia 
Splenomegaly 
Gout
103
Q

Tx PCV

A

Venesection

Low dose aspirin

104
Q

How to DDx 1’ and 2’ PCV

A

In 2’ (e.g. b.c hypoxia//renal disease), only RBC count is raised

105
Q

What is primary myelofibrosis

A

Hyperplasia of megakaryocytes –> XS platelet derv’d GF –> marrow fibrosis + metaplasia

106
Q

Sx primary myelofibrosis

A

B Sx
Abdo discomfort (from massive HS megaly)
BM failure

107
Q

What is aplastic anaemia

A

Rare SC disorder –> pancytopenia and hypoplastic marrow

108
Q

Cause aplastic anaemia

A

Autoimmune - Dx, viruses, irradiation

Fanconi syndrome

109
Q

Sx aplastic anaemia

A

BM failure

110
Q

Diagnosis aplastic anaemia

A

BM biopsy

111
Q

Mx aplastic anaemia

A

Blood product transfusion

Immunosuppression

112
Q

extra Tx aplastic anaemia - younger pt

A

Allogenic BM transplant may cure

CP3 Medicine (29 decks)

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