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3a > Haematology > Flashcards

Haematology Flashcards

1
Q

What does bone marrow require iron to produce?

A

Haemoglobin

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2
Q

What are the causes of iron deficiency?

A

Insufficient dietary iron
Iron requirements increase e.g. pregnancy
Bleeding - menorrhagia, GI cancer, gastritis, IBD
Inadequate absorption
Hookworm

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3
Q

Where is iron absorbed in the small intestine?

A

Duodenum and jejunum

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4
Q

Which carrier protein carries iron?

A

Transferrin

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5
Q

Total iron binding capacity (TIBC) means the total space on the transferrin molecules for the iron to bind. How would you calculate transferrin saturation?

A

Transferrin Saturation = Serum Iron / Total Iron Binding Capacity

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6
Q

What form does iron take when it is stored in cells?

A

Ferritin

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7
Q

What is suggestive of a high ferritin level?

A

Inflammation
Infection
Cancer

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8
Q

What happens to TIBC and transferrin levels in iron deficiency anaemia?

A

Levels increase

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9
Q

What is the normal range of serum ferritin?

A

41-400 ug/L

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10
Q

What is the normal range of serum iron?

A

12-30 umol/L

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11
Q

Which events can increase serum iron levels?

A

Iron supplementation

Acute liver damage

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12
Q

What are the signs and symptoms of iron deficiency anaemia?

A 
Kolionychia 
Glossitis 
Pallor
Angular stomatitis 
Tachycardia
Symptoms:
Fatigue 
Breathlessness 
Dizziness 
Headache
Palpitations
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13
Q

How would iron deficiency anaemia appear on a blood film?

A

Microcytic (MCV <80) hypochromic RBCs

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14
Q

How would you manage iron deficiency anaemia?

A

Oral ferrous sulfate
Iron infusion
Blood transfusion

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15
Q

What are the side effects of oral ferrous sulphate?

A

Constipation

Black coloured stools

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16
Q

Name some causes of microcytic anaemia.

A 
TAILS
T - thalassaemia
A - anaemia of chronic disease
I - iron deficiency anaemia 
L - lead poisoning 
S - sideroblastic anaemia
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17
Q

Name some causes of normocytic anaemia.

A 
Acute blood loss
Anaemia of chronic disease
Aplastic anaemia
Haemolytic anaemia
Hypothyroidism
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18
Q

What are the two broad types of macrocytic anaemia?

A

Megaloblastic - impaired DNA synthesis

Normoblastic

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19
Q

Name some causes of megaloblastic macrocytic anaemia.

A

B12 deficiency

Folate deficiency

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20
Q

Name some causes of normoblastic macrocytic anaemia.

A

Alcohol
Reticulocytosis
Hypothyroidism
Liver disease

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21
Q

Name some causes of anaemia of chronic disease.

A 
Chronic infection
Vasculitis 
RA
Malignancy
Renal failure
22
Q

How can you manage anaemia of chronic disease?

A

Treat underlying cause
Epo to raise Hb levels
Hepcidin inhibitors

23
Q

What are the causes of folate deficiency?

A 
Poor dietary intake 
Increased demand e.g. pregnancy 
Increased cell turnover e.g. malignancy, haemolysis
Coeliac disease
Alcohol excess
24
Q

Why is B12 and folate needed to make RBCs?

A

B12 and folate is needed for DNA synthesis. Without this, the RBCs cannot make enough DNA to divide and become arrested in development

25
Q

What does maternal folate deficiency lead to in the foetus?

A

Neural tube defects

26
Q

How would you manage folate deficiency?

A

Oral folic acid 5mg daily

27
Q

Outline the pathophysiology of pernicious anaemia.

A

Autoimmune condition where antibodies form against the parietal cells in the stomach. These cells can therefore not produce intrinsic factor which is needed for the absorption of vitamin B12

28
Q

Where is vitamin B12 absorbed?

A

Ileum

29
Q

What are the signs of pernicious anaemia?

A 
Mood changes: depression, irritability 
Paraesthesiae 
Peripheral neuropathy
Loss of vibration sense
Psychosis
30
Q

How would an FBC appear for pernicious anaemia?

A

Very low Hb
Very high MCV
Low WCC and platelets

31
Q

What is the gold standard test for diagnosing pernicious anaemia?

A

IF auto-antibodies

Gastric parietal cell auto-antibodies

32
Q

How would you manage pernicious anaemia?

A

Oral B12 in dietary deficiency = Cyanocobalamin

IM hydroxycobalamin in pernicious anaemia

33
Q

If there is also folate deficiency it is important to treat the B12 deficiency first before correcting the folate deficiency. Treating patients with folic acid when they have a B12 deficiency can lead to what?

A

Subacute combined degeneration of the cord

34
Q

Name the two cell lines in leukaemia

A

Myeloid

Lymphoid

35
Q

In leukaemia, there is excessive production of a single type of cell, which can lead to suppression of the other cell lines causing underproduction of other cell types. What will this show on a FBC?

A

Pancytopenia: anaemia, leukopenia and thrombocytopenia

36
Q

Which age does ALL present in?

A

Under 5 and over 45

37
Q

Which age does CLL present in?

A

Over 55

38
Q

Which age does CML present in?

A

Over 65

39
Q

Which age does AML present in?

A

Over 75

40
Q

What are the signs of leukaemia?

A 
Fatigue
Weight loss
Fever
Failure to thrive 
Pallor
Petechiae 
Abnormal bruising 
Abnormal bleeding 
Lymphadenopathy
Hepatosplenomegaly
41
Q

Petechiae causes thrombocytopenia. What are the differential causes of petechiae?

A 
Leukaemia
Meningococcal septicaemia
Vasculitis 
HSP
ITP
Non-accidental injury
42
Q

What investigations would you do if you suspect leukaemia?

A 
FBC, blood film
LDH = lactate dehydrogenase
Bone marrow biopsy - gold standard
Lymph node biopsy 
Lumbar puncture 
CT
43
Q

What chromosome is associated with ALL and CML?

A

Philadelphia chromosome (t(9:22) translocation)

44
Q

What condition is associated with ALL?

A

Down’s syndrome

45
Q

Which cell proliferation is associated with ALL and CLL?

A

B-lymphocytes

46
Q

Which disease can CLL develop into?

A

High grade lymphoma = Richter’s transformation

47
Q

What are the three phases of CML?

A

Chronic phase - asymptomatic
Accelerated phase
Blast phase

48
Q

What characteristic feature do blast cells in AML have?

A

Auer rods

49
Q

How would you manage leukaemia?

A

Chemotherapy
Steroids
Radiotherapy
Bone marrow transplant

50
Q

What are the complications of chemo?

A

Stunted growth and development
Infections
Infertility
Tumour lysis syndrome

51
Q

In tumour lysis syndrome, cells release a substance - what is this?

A

Uric acid

3a (13 decks)

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