Haem / Onco Flashcards
4 causes of microcytic anaemia
TICS
- Thalassaemia
- Iron deficiency
- anaemia of Chronic disease
- Sideroblastic anaemia
An elderly man with hypochromic, microcytic anaemia is asymptomatic. Diagnostic tests?
Faecal occult blood test & sigmoidoscopy
Suspect colorectal cancer
Precipitants of haemolytic crisis in patients with G6PD deficiency
Sulphonamides, antimalarial drugs, fava beans
The most common inherited cause of hypercoagulability
Factor 5 Leiden mutation
The most common inherited haemolytic anaemia
Hereditary spherocytosis
Diagnostic test for hereditary spherocytosis
Osmotic fragility test
Pure RBC aplasia. Diagnosis?
Diamond-Blackfan anaemia
Anaemia associated with absent radii and thumbs, diffuse hyperpigmentation, cafe au lait spots, microcephaly & pancytopenia
Fanconi anaemia
Medications and viruses that lead to aplastic anaemia
Chloramphenicol, sulphonamides, chemo, radiation
HIV, hepatitis, parvovirus B19, EBV
How to distinguish polycythemia Vera from secondary polycythemia
Both have raised Hct & RBC mass BUT
PV should have normal oxygen sats and low Epo
Thrombotic thrombocytopenic purpura (TTP) pentad
FAT RN
- Fever
- Anaemia
- Thrombocytopenia
- Renal dysfunction
- Neurological abnormalities
Haemolytic uraemic syndrome (HUS) triad
Anaemia
Thrombocytopenia
Acute renal failure
Treatment for TTP
Emergency large volume plasmapheresis, corticosteroids, anti platelet drugs
Platelet transfusion is CONTRAINDICATED
Treatment for idiopathic thrombocytopenic purpura (ITP) in kids
Usually resolves spontaneously
May require IVIG and/or corticosteroids
Patten of fibrin split products, D-dimer, fibrinogen, platelets and Hct in DIC
Raised: FSP & D-dimer
Low: plts, fibrinogen & Hct
8yo boy presents with hemarthrosis and high PTT with normal PT and bleeding time.
Diagnosis?
Treatment?
Haemophilia A or B
Desmopressin (haemophilia A) OR factor 8 or 9 supplements
14yo girl presents with prolonged bleeding after dental surgery and with menses, normal PT, normal or raised APTT, and raised bleeding time
VWD
Tx: desmopressin, FFP or cryoprecipitate
60 yo African American man presents with bone pain.
Work up for multiple myeloma?
Monoclonal gammopathy
Bence-Jones proteinuria
Punched out lesions on radiographs of skull and long bones
Reed-Sternberg cells
Hodgkin’s lymphoma
10yo boy presents with fever, weight loss, night sweats. O/E anterior mediastinal mass
Non-Hodgkin lymphoma
Microcytic anaemia with low serum Fe, low TIBC, normal/high ferritin
Anaemia of chronic disease
Microcytic anaemia with low serum Fe, low ferritin and high TIBC
Fe deficiency anaemia
80yo man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis
CLL
Patient with fatigue is found to have a low Hb and raised MCV
B12 deficiency
- pernicious anaemia
- vegetarian diet
- Crohns/GI disorder
Folate
- alcoholics
Late, life-threatening complication of CML
Blast crisis (fever, bone pain, splenomegaly, pancytopenia)
Auer rods on blood smear
AML
AML subtype associated with DIC. Tx?
M3
Tx: retinoic acid
Electrolyte changes in tumour lysis syndrome
Low Ca
High K, Pi, uric acid
50yo man presents with early satiety, splenomegaly and bleeding. Cytogenetics show t(9,22). Dx?
CML
A patient on the chemotherapy service with an absolute neutrophil count (ANC) of 1000 is noted to have a fever of 38.8 (102.1).
Next best step?
Neutropenic sepsis is a medical emergency
Start broad-spec Abx
Virus associated with aplastic anaemia in patients with sickle cell anaemia
Parvovirus B19
A 25yo African American man with sickle cell anaemia has sudden onset of bone pain. Management?
Oxygen, analgesia, hydration,
Transfusion (severe)
A significant cause of morbidity in thalassaemia patients. Tx:
Iron overload use desferrioxime
