HUS + TTP features MAHA (low Hb, schistocytes) Thrombocytopenia AKI (raised Cr) +/- Fever +/- CNS sign

G6PD features Aetiology Triggers Features Ix

G6PD X linked recessive Triggered by Fava beans / Moth balls / Nitrofurantoin Fever Haematuria Ix: G6PD levels, Heinz bodies, reduced Haptoglobin

Haematology Flashcards by Richard Wu

Anaemia, Leucopenia

Leucoerythroblastic film

Tear drop poikilocytes

Dx?

Myelofibrosis

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Burkitt’s lymphoma - translocation?

T8;14

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CML - Translocation?

Chronic myeloid leukaemia

T9:22

BCL-ABL

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Acute pro-myelocytic leukaemia - translocation?

Acute pro-myelocytic leukaemia

T15:17

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Reed-Sternbeg cells

Which cell marker?

Reed-Sternbeg cells

CD15

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Prevention of further sickle cell crises

Hydroxycarbamide (increases HbF production)

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Oxygen dissociation curve

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Target cells

Thalassaemia

Iron defiency

Liver disease / Alcohol

Post-splenectomy

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Aplastic anaemia

Features

Cause

Pancytopenia

Bone marrow biopsy: Hypocellular bone marrow

Caused by Parvovirus B19

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Types of haemolytic anaemia

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HUS + TTP features

MAHA (low Hb, schistocytes)
Thrombocytopenia
AKI (raised Cr)
+/- Fever
+/- CNS sign

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Iron studies

IDA

AoCD

Thal trait

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Pencil cells

Iron deficiency anaemia

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Raised HbA2

Diagnostic for Beta thalassaemia

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Anaemia + Hepatosplenomegaly

3-6 months old

Diagnosis?

Beta thalassaemia major

Transfusion dependent

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MCH < 25

alpha thalssaemia

DNA analysis to confirm

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Tear drop poikilocyte

Myelofibrosis

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Causes of Vitamin B12 deficiency

Reduced intake - Vegan
IF - Pernicious anaemia
Terminal ileum - Crohn’s disease

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G6PD features

Aetiology

Triggers

Features

G6PD

X linked recessive

Triggered by Fava beans / Moth balls / Nitrofurantoin
Fever
Haematuria

Ix: G6PD levels, Heinz bodies, reduced Haptoglobin

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Causes of Warm autoimmune haemolytic anaemia

Causes of Cold autoimmune haemolytic anaemia

Warm autoimmune haemolytic anaemia

Idiopathic
CLL
RhA
SLE

Cold autoimmune haemolytic anaemia

Mycoplasma

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Herediatry spherocytosis inheritence

Autosomal dominant

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Low Platelets

High FDP

High D dimer

Prolonged PT / APTT

Low Antithrombin / Protein C

Diagnosis?

DIC

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Pancytopenia

Thromboembolic events

Haemolytic anaemia / Haemoglobinuria

But no RBC on Urine microscopu

Diagnosis? Cause? Ix?

Paroxysmal nocturnal haemoglobinuria

–> Lack of complement regulatory GPI anchored proteins (CD55, CD59)

Ix: Flow cytometry + Fluorescent aerolysin

JAK2 V617F

Associations

Polycythaemia rubra vera

JAK2 V617F

Raised Haematocrit

Associated with Budd-Chiari syndrome (hyperviscosity)

APTT vs PT What pathway

**APPT intrinstic** pathway **PT extrinsic** pathway

Recent viral infection **Low platelets (isolated abnormality)** **Normal AP and APTT** Diagonsis? Ix?

**Immune thrombocytonpenic purpura** (ITP) Ix: Diagnosis of exclusion Anti-platelet antibody Anti-Glp IIb antibody +ve | Anti-Glp IIIa antibody | Anti-Glp Ib complex antibody

Prolonged APTT, normal PT

Haemophilia

**Prolonged or excessive bleeding after minor procedure** (e.g. dental) Diagnosis? Inheritence?

**Von Willebrand disease** Autosomal dominant

Myelodysplasia vs AML Blasts

Myelodysplasia \< 20% blasts Acute leukaemia (AML/ALL) \> 20% blasts

TdT +ve

ALL (lymphoid)

**Auer rods** = crystallised MP

AML (myeloid)

Blasts in _peripheral_ blood film

Acute leukaemia

Down's syndrome and Leukaemia

AML and Down's syndrome

Sudan black +ve

AML

Tx for APML

All trans-retinoic acid (ATRA)

T(15;17)

**acute pro-myelocytic leukaemia** (APML) Good prognosis

**Children** **Organ infiltration** (Testicular, Thymic, Hepatosplenomegaly) Anaemia, Thrombocytopenia WCC high / low / normal

**ALL**

t(9,22)

**CML** t(9,22) --\> BCR-ABL Philadelphia chromosome

**Asymptomatic** **_Splenomegaly_** **Anaemia, Thrombocytopenia** Diagnosis? Complications?

**CML** t(9,22) --\> BCR-ABL --\> Philadelphia chromosome Complications: Blast crisis (CML --\> AML/ALL)

**Teenager** **Cervical or mediastinal lymphadenopathy** **B symptoms** (Fever, Night sweats, Weight loss) **Pruritis** Diagnosis? Characteristic?

**Hodgkin's lymphoma** **Reed-sternbeg cell (CD 15 +ve)**

**EBV** **Hepatosplenomegaly** **B symptoms** Diagnosis?

Non-Hodgkin's lymphoma

**Burkitt's lymphoma** Key features

**Burkitt's lymphoma (NHL)** **EBV** **c-Myc overexpression** Due to **t(8,14)**

**HTLV-1** **Flower cells**

**ATLL**

**Bence Jones protein +ve** **NO bone pain** **Hyperviscosity**

Waldenstrom's macroglobulinaemia

T8:14

**Burkitt's lymphoma**

T14:18

Follicular lymphoma

T11:14

Mantle cell lymphoma

**Hypercalcaemia** **AKI** **Anaemia** **Bone pain** Diagnosis? Ix?

**Multiple myeloma** **Protein electrophoresis: monoclonal band** Urinary: Bence Jones protein

Rouleaux formation

Multilple Myeloma

Monoclonal serum protein \< 30g/L No complications (CRAB)

Monoclonal Gammopathy of Undetermined Significance (MGUS)

Monoclonal serum protein \> 30g/L No complications (CRAB)

Smouldering myeloma

**Ringed sideroblasts** Normal spleen

Myelodysplasia

**Leucoerythroblastic film** | (reticulocytes + myelocytes)

**Myelofibrosis** or **Bone marrow metastases**

**wheal on rubbing** **Flushing** **Anaphylaxis** Diagnosis? Initial Ix? Definitive Ix?

**Mastocytosis** Initial Ix --\> **urinary histamine** Definitive Ix --\> **Bone marrow biopsy** (mast cell infiltration)

Ix for sickle cell

**Hb isoelectric focusing**

Tx to prevent sickle cell crises

**Hydroxycarbamide**

Plasmapheresis S/E

Plasmapheresis S/E: **Hypocalcaemia** * Due to the presence of citrate used as an anticoagulant for the extracorporeal system * Citrate binds to calcium --\> ↓ Ca2+