Haematology Flashcards
Lab criteria APLS
- Lupus anticoagulant
> Prolonged APTT that fails to correct with mixing with prolonged reptiliase time - Anticardiolipin antibody >99th percentile
- Anti-B2 glycoprotein -1 antibody >99th percentile
Must be present on 2 occasions 12 weeks apart
Clinical criteria APLS
One or more arterial, venous thrombosis
One of more unexplained fetal deaths over 10 weeks gestation
One or more Premature birth before 34 weeks
Three or more unexplained miscarriages before 10 weeks
Anticoagulation for Antiphospholipid Ab and 1 foetal loss at ten weeks
Low dose aspirin/prophylactic LMWH during pregnancy
Post partum prophylaxis
Antiphospholipid Ab and no thrombosis or pregnancy complications
Post partum prophylaxis for 6/52
Pregnancy anticoagulation for Lab criteria + Clinical pregnancy criteria of 3 or more pregnancy losses
Antepartum prophylactic clexane + aspirin
Dabigatran benefit over warfarin in AF
Less ICH
Increased GI bleeding
Small increase in myocardial infarction
Dabigatran reversal agent
Idarucizumab 5g
Factors in Prothrombin X
IX, X, II
Tranexamic acid mechanism
inhibits the activation of plasminogen via binding at several distinct sites, the latter of which is a lysin residue involved in its binding to fibrin
FXa inhibitor antidote
Andexanet alpha
Antedote for apixaban, rivaroxaban
Factor 13
Coagulation factor XIII (FXIII) is converted by thrombin and Ca(2+) into an active transglutaminase (FXIIIa) in the final phase of coagulation cascade. Its main function is the mechanical stabilization of fibrin clot and its protection from fibrinolysis by cross-linking of fibrin chains and α(2)-plasmin inhibitor to fibrin
Haemophilia C
Factor 11 deficiency
FVIII/IX deficiency severity
<1 severe- spontaneous
1-5% mod - surgery/minor trauma
>5 mild - major trauma
Cryoprecipitate contents
Factor VIII, fibrinogen, Factor XIII, vWF and fibronectin from the FFP
Only used to replace fibrinogen nowdays
Biostate contents
FVIII + vWF
Factor IX replacements
MonoFIX - plasma derived
Benefix - recombinant
Desmopressin/ DDAVP (ADH)
Increases in FVIII and vWF
Treatment in mild T1 vWFD
Treatment of acquired inhibitors
Novoseven
Bernard-Soulier syndrome
Abnormality of platelet glycoprotein 1b-IX-V, a receptor for vWF
Glanzmann thrombasthenia
Defect in glycoprotein IIb/IIIa complex
Peak timing of thrombocytopaenia in gestational thrombocytopaenia
2 and 3rd trimester
Mechanism and treatment of idiopathic TTP
Autoimmune ADAMTS13 deficiency
Treated with PLEX
Treatent of HITTS
Fondaparinux
Bivalirudin - renal impaired
action of hepcidin in Anaemia CD
Increased hepcidin
Blocks ferroportin
Unable to absorb iron
HbH
Beta tetramers
Hb Barts
Gamma tetramers
HbA2
Alpha x2 Delta x 2
Intravascular haemolytic
Urine haemosiderin
Emicizumab
Treatment for haemophilia A
Bridges factor 9 and 10 in similar mechanism to factor 8
Smudge/smear cells
CLL
Lab/imaging reasons to treat MM
60% plasma cells
Serum free light chains >100
reater than one focal lesion on MRI
APML mutation
t(15;17)
APML RX
ATRA
Arsenic
Auer rods
AML
Mode of inheritance vWD
Autosomal dominant
CML cytogenetic abnormality
t(9;22)
Antibody involved in haemolytic transfuion reactions
IgM
Follicular lymphoma cytogenetic abnormality
t(14;18)
Vincristine mechanism of action
Metaphase is the phase of the cell cycle when the chromosomes align at the middle of the cell and then begin to separate. Vincristine disrupts this process by binding to the tubulin protein, preventing the formation of microtubules and preventing the initiation of chromosome separation. The cell will then undergo apoptosis.
The herpes virus Epstein-Barr establishes latent infection in which immune cell
B-Cells
Pathogen associated with the development of adult T-cell leukaemia
HTLV-1
CD classes associated with Reed-steinberg cells
CD-15 CD-30
Marker that identifies peripheral stem cells
CD34
Best method for reducing transfusion related GVHD
Irradiation
Benefit of leukoreduction
Reduced TRALI
Reduced non-haemolytic transfusion reactions
Reduces CMV transmission
Reduces GVHD
Most common gene mutation in hereditary haemochromatosis
H63D mutation of the HFE gene
Absence of CD55 and CD 59 on RBC
Paroxysmal nocturna haemaglobinuria
Triad of PNH
- Haemolytic anaemia
- Venous thrombosis (especially intraabdominal)
- Deficient haematopoesis (often pancytopaenia)
Signs occurring after infection
PNH mechanism
Defective production of PIG-A which is essential for GPI anchor resulting in decreased CD55 and CD 59 on cells (protects from complement mediated lysis)
Treatment of PNH
Anticoagulation if thrombosis
Eculizumab (anti-C5)
Bites and blisters on film
X Linked
G6PD deficiency
Thorny apple cells
Autosomal recessive
Pyruvate kinase deficiency
Eliptocytes
Red cell membrane disorder
Clinical outcomes iron overload
- Cardiac failure
- skin pigmentation
- Endocrine failure: hypopituitary, hypogonadism, infertility, delyed puberty, failure to thrive, groath retardatin, diabetes, OP
Clinical outcomes B thalassaemia
Severe anaemia - require transfuions
Hepatosplenomegaly
Iron overload - require chelation
Good prognostic features AML
NPM + CEBPA + t(15:17) t(8:21) Inversion q16
Bad prognostic features AML
cKIT
FLT3 +
Del7q
Treatment for AML that targets FLT-3
Midostaurin - kinase inhibitor
APML genetics
t(15:17)
PML-RARa
CML genetis
t(9:22) BCR-ABL
MPD genetics
JAK-2 V617F mutation
MDS genetics (good prognosis)
Deletion 5q
SPARC and RPS14 deficiency
Treatment of CML
Tyrosine Kinase inhibitors
- imatinib (effusion/oedema)
- dasitinib (DM, long Qt, vascular events)
- nilotinid (PAH)
Good prognostic factor for ET/Primary myelofibrosis
CALR
Treatment of PRV
Phlebotomy until haematocrit <45%
Low dose aspirin
Cytogentic abnormality associated with response to lenolidamide in MDS
Deletion 5q
HHV8 cancer-associated
Primary effusion lymphoma
Hep C cancer association
Splenic marginal lymphoma
Burkitt’s lymphomac cytogenetics
t (8:14) translocation
Mantle cell lymphoma cytogenetics
t(11:14) translocation = cyclin D1
Follicular lymphoma cytogenetics
t(14:18) translocation = BCL-2
Treatment high-grade NH lymphoma
Radiotherapy
RCHOP
Rituximab if CD-20 positive
Transplant if relapse
Treatment of low-grade NHL
RTx
Single agent chemo
RCHOP
Rituximab Cyclophosphamide Hydroxydaunrubacin Vincristine Prednisolone
Hodgkin Lymphoma treatment
ABVD chemo
RTx
AutoSCT. ifrelapsed
AlloSCT if relapse post AUto
ABVD agents
Doxorubicin
Bleomycin
Vinblastine
Dacarbazine
CLL novel therapies
Obinutuzumab - mAB CD2-
Ibrutinib - B-TK inhibitor
Venetoclax - Inhibits Bcl-2 (TLS risk)
Idelalisib - PI3Kd inhibitor
Ig subclassess involved in MM
IgG>IgA>IgM (waldenstroms)
Bortezemib MOA/Indication / SE
MOA: Proteasome inhibitor
Indication: MM
SE: Peripheral neuropathy, diarrhoea, thrombocytopaenia
CLL film
Smear cells
When to consider treating CLL
Lymphocytes doubling in <6 months
Symptoms
Stage 3 - anaemia
Stage 4 - thrombocytopaenia
Coeliac cancer association
T Cell lymphoma
Treatment of ET
Aspirin
Consider cytoreduction if plt >1000
Cells involved in haemophagocytic lymphohistiocytosis
cytotoxic T cells & Natural Killer (NK) cells.