haem vol 3 Flashcards
define neutropaeina + signs and symptoms
absolute neutrophil count less than 1.5x10’9.
may be due to decreaced production
or increaced consumption
presents with frequent, prolongued infections which
freq involve skin and mucous membranes, staphlococcal, show minimal clinical features despite severe infection.
when to refer in neutropaenia
if unwell and less than 1x10’9
if presisting more than 1 week and well (1x10’9 <)
1-1.5 needs blood film + B12, folate, ferritin, ANA + a repeat in 4-6 weeks- if persisting then refer.
list some causes of decreaced production and increaced consuption in neutropenia
consumption- sepsis, hypersplenism, autoimmune.
reduced production- marrow aplasia/ infiltration, viral infection, TB, drugs.
investigation of neutropenia
evaluate for acute/ chronic infection
assess spleen size, CBC + reticulocite count.
look at bone marrow- aspiration/ biopsy.
define lymphocytosis, lymphadenopathy and splenomegaly. What linkes them all
lymphocytosis- increace in number of circulating lymphocites >5x10’9 (in adults, 7/ 9 in older/ younger children)
lymphadenopathy- swelling of the lymph nodes, usually 2’ to bacterial or viral infection
splenomegaly- an increace in the volume and size of the spleen to more than 400-500g
all occurs during acute/ chronic infection.
discuss lymphocitosis in more detail, causes, treatment, investigations.
most commonly- viruses (EBV, CMV, HIV)
bacteria (baronella, bordatella)
if monoclonal- chronic lymphocitic leukaemia
non-hodgkin lymphoma.
stress can also cause.
Ix: history is important
B-symptoms- think clonal issues
splenectomy- common after this.
CBC (anaemia, thrombocytopaenia indicate clonal) +PBS
flow cytometry to determine if they are clonal.
Rx:
somewhat dependent on underlying pathology- if stress/ infection then will likely resolve with infection
treat cancer as appropriate.
discuss lymphadenopathy
most often benign, however a pertinant finding.
localised- 75% (50% head and neck)
generalised- 2 distinct non conntected regions.
histology is useful for determining the cause of the lymphadenopathy.
also Use CT and labs to fully investigate.
if readily mobile they are less concerning fro a malignant condition.
Rx:
the underlying condition.
potential causes of:
infectious
malignant
autoimmune
medication
discuss stageing in lymphadenopathy/ lymphoma
1: found in one lymph organ or node
2: 2 or more groups of nodes on the same side of the diaphragm
3: both sides of the diaphragm
4: metastesised to one organ outside the lymphatic system.
Ann arbour classificaiton
causes of splenomegaly + specific cause of concern in the elderly
classified into 4 catorgries- congestive, infiltrative, immune, neoplastic.
liver disease (increaced pressure)
haematologic malignancies
thrombus
splenic sequestration - immune mediated destruction of RBC.
acute / chronic infection
connective tissue disorders.
thinner capsule leading to easier rupture.
presentation of splenomegaly + Ix + RX:
vague abdominal discomfort +/- LUQ pain.
symptoms of the underlying cause are more common.
Ix: CBC + PBS
imaging (CT/US)
Rx: underlying cause
can do splenectomy
main concern is rupture in splenomegaly.
what is multiple myeloma + S+S + Ix
a monoclonal proliferative disorder of plasma cells in the bone marrow
B cells.
presents with bone pain (back- think T spine pain), anaemia. frequent infections seen, significant fatigue.
investigations for:
Serum/urine protein electrophoresis.
bone marrow biopsy
calcium
MRI for bone lesions
FBC for anaemia + calcium.
mamagement of multiple myeloma
consideration of a stem cell tranplantation and initial work up for that. - autologous is prefered
they need induction (dec plasma cells in bone marrow) to occur- this can be done with chaemo or non chamo drugs.
(non- thalidomide, bortezomib, dex)
need a conidiotning regemen- 4-6 doses of drug (mephalan)
autologous usually lasts 2-3 years
allogenic lasts longer but has other side effects (GVhd)
chaemo in non transplant suitable paitents, depending on fitness
define lymphoma
malignant proliferation of lymphocytes accumulating in the lymph nodes.
presents with solid mass lesions/ enlarged lymph nodes.
most are B cell lymphocytes.
discuss hodgkins lymphoma in more detail. (RF, EPI, Clinical features)
hodgkin lymphoma has distinctive Reed-Sternberg cells (2 nuclei- look like an owl)
B cell lymphoma
Risk factors: affeccted sibling, EBV, SLE, post transplant.
Epi:
any age but peaks in 20s, males
clinical features: lymphadenopathy (painless, rubbery, asymetric)- Cervical > axillary > inguinal (upper body mostly)
alcohol-induced pain
splenomegaly + hepatomegaly = jaundice.
B Symptoms.
management of hodgkin lymphoma + prognosis
spread to other tissues is rare
1st line- radiotherapy (complication= lung fibrosis)
2nd- chaemo ABVD (adriamycin, bleomycin, vincristine, decarbazine)
3rd- stem cell transplant.
60-80% 5 year survival but depends on stage and grade.
