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CP1 > Haematology > Flashcards

Haematology Flashcards

1
Q

Causes of microcytic anaemia

A

Inadequate intake, thalassaemia, anaemia of chronic disease

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2
Q

causes of normocytic anaemia

A

Anaemia of chronic disease, acute blood loss, bone marrow disorder, haemolysis, combined B12/Fe deficiency

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3
Q

Causes of macrocytic anaemia

A

B12/folate deficiency, myelodysplasia, alcohol excess, haemolysis, DNA synthesis defect (e.g. chemo), hypothyroidism

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4
Q

Haemolysis investigation

A

High LDH, low haptoglobin, high bilirubin.

Direct antigen test (DAT) may be positive

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5
Q

Iron absorption

A

In duodenum, promoted by gastric HCl.. Ferritin (soluble) storage, transferrin (insoluble) transports around body

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6
Q

Iron deficiency causes

A

Inadequate intake, increased requirement (pregnant), coeliac, gastrectomy, chronic haemorrhage (GI bleed/menorrhagia)

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7
Q

Iron deficiency investigations

A 
Blood film (hypochromic, microcytic, pencil cells)
Ferritin levels (but increases in inflammation and malignancy, so can be normal/raised)
transferrin saturation (reduced in IDA)

Post menopausal women and men should get referral for endoscopy or coloscopy

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8
Q

Treating IDA

A

Oral preps if ferritin <25, or TF sat <20. Continue for 3 months.
Start on od, then titrate up due to ADEs (constipation)
If not absorbing then can use IV

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9
Q

B12 absorption

A

Pepsin releases B12 from protein in stomach, but needs parietal cell IF for absorption in terminal ileum. Stores for 2 years.

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10
Q

B12 deficiency causes

A

Inadequate intake, Pernicious anaemia (against IF and/or gastric parietal cells), gastrectomy, Malabsorption (Crohns/ileal resection)

Can also APPEAR low in COC use or HRT use

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11
Q

B12 diagnosis

A

Raised MCV
Blood film : hypersegmented (5+ segments) neutrophil, oval macrocyte, tear drop cell.
Low B12
IF antibodies
Gastric parietal cell antibodies (but can be FP in 10%)

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12
Q

B12 Management

A

Can use oral supplements, but if PA then IM hydoxocobalamin for life

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13
Q

Folate absorption

A

Absorbed in duodenum and jejunum. Body has 5-6 month stores

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14
Q

Folate deficiency causes

A

Inadequate intake, increased requirement (pregnancy, Haemolytic anaemia), malabsorption (coeliac disease, jejunal reabsorption)

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15
Q

Folate investigations

A

Raised MVC
Blood film : Macrocytes, hypersegmented neutrophils
Reduced folate (serum is more sensitive to short term imbalance, but red cell folate is more reliable assessment)

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16
Q

Management of folate deficiency

A

5mg daily for 3 months

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17
Q

ABO antibodies

A

Present against antigens the person doesn’t have. Uses IgM. Present from 3 months

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18
Q

ABO antigens

A

Present at 6 weeks gestation, so from birth too

19
Q

Rhesus antibodies

A

IgG (small) antibodies. Only occur in Rhesus negative individuals if exposed to Rh+ blood/platelets by transfusion or from a D+ fetus

20
Q

Group and Screen/Save

A

Test blood group
Screen with coombs reagenent (antiglobulin that binds to human immunoglobulins) for serum screen (look for agglutination)
Then final test against donor RBCs with recipient serum

21
Q

Electronic cross match

A

Uses previous ABO and RhD testing as well as negative antibody screen for electronic match against blood bank

22
Q

Transfusion reactions

A

Almost always patient ID failure
Reaction activates complement pathway, causes intravascular haemolysis and release of inflammatory cytokines. Can cause shock, renal failure, DIC and death

23
Q

Frequency of White cells

A 
Neutrophil
Lymphocytes
monocytes
Eosinophils
Basophils

Never let monkeys eat bananas

24
Q

Neutrophilia causes

A

Acute: Reactive (infection/inflammation, neoplasia, bleeding, infarction, smoking, burns, drugs (glucocorticoids)
Chronic: reactive, drugs, high BMI, metabolic syndrome, haematological disorder (myeloproliferative or CML)

25
Q

Isolated neutropoenia

A

Viral infection
Drugs (carbimazole (thyrotoxicosis), chemo)
B12/folate (but often affects other lineage)
Autoimmune/Felty’s syndrome in RA
Cyclical neutropoenia
Haematological malignancy (acute leukaemia, myelodysplasia)
Hereditary (african origin)
Congenital bone marrow failure syndrome (Lostmann’s syndrome)

26
Q

Neutropoenia levels

A

1.0-1.7 (mild neutropnoea, but ~ethnicity)
0.5-1.0 mod
<0.5 is severe, infection risk

27
Q

Neutropoenic sepsis

A

Fever >38
Neutrophils <1.0
Emergency, urgent admin, broad spec IV abx

28
Q

Lymphocyte distrubution

A

80% T (thymus derived, circulate in blood - little cytoplasm, few ribosome/ER)
20% B lymphocytes (plasma cells have more rough ER), mainly in lymph nodes
NK cells

29
Q

Lymphocytosis primary causes

A

lymphoid malignancy (CLL, lymphomas, monoclonal B lymphocytosis)

30
Q

Lymphocytosis Reactive and chronic

A

Viral (EBV, CMV, HSV, VZV)
Whooping cough
TB
Brucellosis
Stress lymphocytosis (drug induced (e.g. phenytoin), septic shock, MI, trauma)
Chronic: cigarette smoking, autoimmune disorder, chronic inflammation, sarcoid, raised BMI/metabolic syndrome

31
Q

Lymphocytosis managment

A

Consider haematological cancer, more concerning if clonal than polyclonal

32
Q

Monocytosis causes

A

Atypical infections (e.g. TB)
Inflammation
Autoimmune disease
Haematological malignancy (Chronic myelomonocytic leukaemia - CMML)

33
Q

Eosinophils

A

parasites. React to complement, antibodies and histamine

34
Q

Eosinophilia causes

A

Parasitic infections, asthma, drugs, eczema, haematological malignancies (Hodgkins disease, CML)

35
Q

Basophil

A 
Granules enclosed by membrane
Allergy symptoms (heparin and histamine secretion, histamine causes vasoconstriction, bronchoconstriction and intestinal constriction). Gives parasitic immunity
36
Q

Basophilia

A

Very rare, usually only in CML

37
Q

Abnormal WCC urgent referral criteria

A

WCC>50
Blood film featues of CML/CMML
Mention of blasts on film
Neutrophils <0.5

38
Q

Abnormal WCC, consider referral

A 
Chronic neutrophilia (>20)
Lymphocytosis (>10)
Chronic monocytosis (>1)
Chronic eosinophilia (>2)
Persistent basophilia (May be CML)
Neutrophils <1.0 with no clear cause
39
Q

Leukostasis

A

High WCC causes occlusion in vessels. Needs urgent chemotherapy to reduce WCC.
See papilloedema, retinal venous distension, may get pulmonary oedema.
Can be complication of AML and blast phase of CML

40
Q

CML

A

Raised WCC, pancytopaenia, immature myelocytes and metamyelocytes in blood (instead of marrow only)
Philadelphia chromosome (9-22).
Insidious onset. splenomegaly

41
Q

Aplastic anaemia

A

Pancytopoenia.

Can be due to autoimmmune disorder, toxins, radiation, infections (EBV, HIV)

42
Q

Glandular fever

A

EBV infection of B cells, circulate in blood (normally only see T cells circulating). Confirm with monospot test (detects heterophile antibodies)
B cells are EBV reservoir, cna reactivate during immune suppression (causing B cell malignancy)

43
Q

Acute leukaemia vs chronic

A

No differentiation, see primative blasts.
In chronic, see normal differentiation into mature white cells

Children almost always get acute leukaemia, and generally ALL.
AML>ALL in adults. CLL>AML in adults.
CLL is most common leukaemia in adults

44
Q

Features of acute leukaemia

A

May have symptoms over 1-2 weeks, but can have fatigue for longer (may then have antecedent haematological disorder e.g. MDS). Symptoms of bone marrow failure : aenaemia, neutropoenia, thrombocytopoenia.

Lab features:
anaemia
Low/high WCC
thrombocytopnoenia
Pancytopoenia
blasts on film

CP1 (8 decks)

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