Haem/ onc Flashcards
Which cytotoxic drug has the side effect of haemorrhagic cystitis?
Cyclophosphamide
Which cytotoxic drug has the side effect of pulmonary fibrosis?
Bleomycin
Which cytotoxic drugs have the side effect of peripheral neuropathy?
Vincristine, cisplatin
What are the most common causes of cancer death in the UK?
- Lung
- Colorectal
- Breast
- Prostate
- Pancreas
- Oesophagus
- Stomach
- Bladder
- Non-Hodgkin’s lymphoma
- Ovarian
Which cytotoxic drug causes hypomagnesaemia?
Cisplatin
Which cytotoxic drug causes myelosuppression, liver fibrosis and oral mucositis?
Methotrexate
Which cytotoxic drug causes myopathy?
Doxorubicin
Raised beta-human chorionic gonadotropin with a raised alpha-feto protein level is seen in which cancer?
Non-seminomatous testicular cancer
Raised AFP levels in women are suggestive of which cancer type?
Liver cancer
Calcitonin is a tumour marker of which thyroid cancer?
Medullary thyroid
Which cytotoxic drug causes ototoxicity?
Cisplatin
Which type of cancer is associated with aniline drugs?
Transitional cell carcinoma
Nitrosamines are chemical compounds found in food/ water/ medicaitons. Which cancer are they linked to?
Gastric/ oesophageal
Ca 15-3 is a tumour marker for which type of cancer?
Breast
AFP is associated with which cancers?
Liver
Testicular
Alflatoxin has been linked to which cancer type?
Hepatocellular
How to manage antiphospholipid syndrome in pregancy?
Aspirin + LMWH
What is the abx of choice empirically for neutropenic sepsis?
Piptaz
What medication can be given prior to chemo to help prevent tumour lysis syndrome?
Allopurinol
What is an acute haemolytic reaction?
Reaction to ABO incompatible blood
Occurs within minutes
Fever, abdo pain, hypotension
Send blood for coomb’s test
Fluid resuscitation
What is a non haemolytic febrile reaction?
Thought to be caused by antibodies reacting with white cell fragments in the blood product and cytokines that have leaked from the blood cell during storage
Fever chills
Stop or slow transfusion, paracetamol
What is aplastic crisis in sickle cell?
caused by infection with parvovirus
sudden fall in haemoglobin
bone marrow suppression causes a reduced reticulocyte count
What is sequestration crisis in sickle cell?
Caused by infection with parvovirus
Bone marrow suppression causes a reduced reticulocyte count
Sickle cells cause the spleen to become grossly enlarged > causes abdominal pain
Severe anaemia
Cardiovascular collapse due to loss of effective circulating volume
what is thrombotic crisis in sickle cell?
also known as painful crises or vaso-occlusive crises
precipitated by infection, dehydration, deoxygenation (e.g. high altitude)
painful vaso-occlusive crises should be diagnosed clinically - there isn’t one test that can confirm them although tests may be done to exclude other complications
infarcts occur in various organs including the bones (e.g. avascular necrosis of hip, hand-foot syndrome in children, lungs, spleen and brain
Howell-Jolly bodies are associated with which condition?
Hyposplenism
Alpha thalassaemia - what are the three ways this can present?
A thalassaemia trait
HBH disease - microcytic anaemia, splenomegaly, jaundice, growth retardation
Severe cases need splenectomy + transfusions
Hb barts hydrops fetalis syndrome - severe, almost all die in utero
Beta thalassaemia - what are the three ways this can present?
B thalassamia trait - asymptomatic
B thalassaemia intermedia - similar picture to HBH disease - require transfusions
B thalassaemia major - severe lifelong transfusion dependency, can develop iron overload - requiring iron chelating drugs
Sickle disease - how does trait/ sickle cell anaemia and sickle cell disease present?
Sickle cell trait - asymptomatic
Sickle cell anaemia - risk of sickle crisis, chronic haemolysis, hypsplenism (due to splenic infarcts)
Sickle cell disease - both sickle cell and thallassaemia . Big clot risk.
What vaccines should be given to those with sickle cell disease?
Pneumococcous, meningococcus, haemophilus
This is because they have hyposplenism due to repeated splenic infarcts. They should also be on lifelong prophylactic penicillin.
What investigations are there for haemolysis?
Reticulocyte count
Serum unconjugated bilirubin
Serum haptoglobins
Urinary urobilinogen
Blood film
Coomb’s test - identifies antibodies bound to own red blood cells
What might cause a prolonged prothrombin time?
Clotting factor deficiency
Warfarin
Liver disease
Vitamin K deficiency
What might cause a prolonged APTT?
Deficiency in clotting factors 8 and 9
Heparin
Haemophilia
VWB disease
Antiphospholipid syndrome
Which conditions are included in the hereditary thrombophilias? (cause clots)
Factor V Leiden
Antithrombin deficiency
Protein C + S deficiency
What are the three things you see in antiphospholipid syndrome?
Recurrent thromboses
Recurrent miscarriage
Mild thrombocytopenia
Tx is aspirin/ warfarin - heparin in pregnancy
What form of inheritance dose VWF deficiency (bleeding disorder - too bleedy) show?
What about haemophilia?
VWF deficiency - Autosomal dominant - men and women
Hameophilia - X- linked - men
What drug is used for heparin reversal?
Protamine sulphate
What conditions cause splenomegaly?
Infection - EBV, malaria
Congestion - Hepatic cirrhosis, cardiac failure
Haematological - Lymphoma, leukaemia, haemolytic anaemia, ITP, myeloproliferative disorders
Inflammatory disease - RA/ SLE
What is MGUS - Monoclonal gammopathy of undetermined significance
What is myelodysplastic syndrome
What is myelofibrosis
?
MGUS - Paraprotein band on bloods but asymptomatic, can go on to develop myeloma.
Myelodyasplasia - Mild anaemia or can develop pancytopenia.
Myelofibrosis - fibrotic tissue in bone marrow so liver and spleen take over. Anaemia, fevers, gout, splenomegaly. Can progress to AML.
What is richter’s transformation?
Ritcher’s transformation occurs when leukaemia cells enter the lymph node and change into a high-grade, fast-growing non-Hodgkin’s lymphoma. Patients often become unwell very suddenly.
Heinz bodies are associated with which condition?
Thalassaemia and G6PD deficiency
What is the reversal agent for dabigatran?
Idarucizumab
What is acute sickle chest syndrome?
New pulmonary infiltrates on chest x-ray
Fever, cough, sputum, dyspnoea, hypoxia
In patients with both B12 and folate deficiency - which must you replace first?
Must replace B12 first due to risk of cord degeneration
Shisctocytes are associated with which bleeding disorder?
DIC
What blood film abnormalities are seen in hyposplenism?
Howell-Jolly bodies
target cells
Pappenheimer bodies
acanthocytes
siderotic granules
What are the biochemical signs of tumour lysis syndrome?
High potassium
High phosphate
Low calcium
Allopurinol is sometimes used as prophylaxis
What is the transfusion threshold for patients with ACS?
80
Which blood component has the highest risk of bacterial contamination?
Platelets
How long before an operation should you stop the oral contraceptive pill?
4 weeks
Deficiency in which clotting factors cause haemophilia?
Haemophilia A - VIII (8)
Haemophilia B - IX (9)
What are the inherited versus acquired thrombophilias?
Inherited
Factor V Leiden
Protein C or S deficiency
Acquired
Antiphospholipid syndrome
Essential thrombocythaemia
What is the preferred anticoagulant for antiphospholipid syndrome?
Warfarin
What is the treatment for sickle cell disease?
Hydroxyurea
*Main SE is reduced sperm count in males (returns to normal after drug cessation)
Folic acid and Vit D replacement
Vaccinations
What are the two types of sickle cell?
SS - can lead to severe crisis, all patients need to be on hydroxyurea if symptomatic
Sc - ophthalmology problems - need to refer to them, don’t all need to be on hydroxyurea
What should you suspect if the MCV is ‘too low’ for the anaemia - eg Hb 100 but MCV 60?
Thalassaemia
Which blood test changes might you see in haemolysis?
Normocytic anaemia
High bilirubin
Which medications can cause B12 deficiency?
Colchicine
Metformin
PPI
Pregabalin
topiramate
What is MGUS?
Monoclonal gammopathy - Paraprotein band but bence jones -ve
Low risk of transformation to myeloma and asymptomatic
**Note polyclonal gamopathy is different and doesn’t need investigated - it usually is just some sort of reactive change
What is MBL?
Monoclonal B cell lymphocytsosis
Lymphocytes <5 (in CLL would be >5)
Small risk of progression to CLL
Which cells are abnormal in myeloma?
Plasma cells
What is Waldenstrom’s macroglobulinaemia?
