Haematology Flashcards
1
Q
When will you see target cells on a blood film?
A
Iron deficiency anaemia
Hyposplenism
Sickle cell anaemia
Liver disease
2
Q
What do Heinz bodies on a blood film indicate?
A
G6PD deficiency
Alpha thalassaemia
May also be a feature of splenectomy/hyposplenism
3
Q
What do Howell-Joly Bodies on a blood film indicate?
A
Post-splenectomy (hyposplenism)
Megaloblastic anaemia (bone marrow produces unusually large and structurally abnormal red blood cells - megaloblasts) - B12/folate deficiency
4
Q
When do you see schistocytes on a blood film?
A
All types of haemolytic anaemia - sickle cell, G6PD, hereditary spherocytosis, hereditary elliptocytosis, autoimmune haemolytic anaemia
Also DIC/TTP
5
Q
When do you see sideroblasts on blood film?
A
Myelodysplastic syndrome
Sideroblastic anaemia
6
Q
What does smudge cells on a blood film indicate?
A
Chronic lymphocytic leukaemia
7
Q
What does tear drop poikilocytes on blood film indicate?
A
Myelofibrosis and Myelodysplastic syndromes
Also possibly iron deficiency anaemia
8
Q
What are causes of microcyctic anaemia?
A
Iron-deficiency anaemia
Thalassaemia
Sideroblastic anaemia
Lead poisoning
9
Q
What are causes of normocytic anaemia?
A
Anaemia of chronic disease (CKD, Myeloma, sickle cell)
Acute blood loss
Haemolytic anaemia (G6PD, spherocytosis)
10
Q
What are causes of macrocytic amaemia?
A
Megaloblastic:
B12 or folate deficiency
Normoblastic:
Alcohol
Liver disease
Pregnancy
Reticulocytosis
Myelodysplasia
Hypothyroidism
11
Q
What are causes of iron-deficiency anaemia?
A
Insufficient dietary iron
Increased iron requirements (eg pregnancy)
Iron being lost (eg slow bleeding from heavy periods or a colon cancer)
Inadequate iron absorption (eg IBD/coeliac)
12
Q
What is seen on iron studies in iron deficiency anaemia?
A
Low ferritin
Low transferrin saturation
High total iron binding capacity
13
Q
What is seen on blood film in iron deficiency anaemia?
A
Target cells
Pencil poikilocytes
14
Q
What is the management of iron deficiency anaemia?
A
Iron supplementation e.g. ferrous sulphate / ferrous fumarate
15
Q
What is the main side effect of iron supplementation?
A
Constipation
16
Q
What are causes of vitamin b12 deficiency?
A
Pernicious anaemia
Inflammatory bowel disease/coeliac disease
Vegan diet
17
Q
What type of anaemia does a vitamin b12 deficiency cause?
A
Megaloblastic macrocytic anaemia
18
Q
How does vitamin B12 deficiency present?
A
Symptoms of anaemia (fatigue, pallor, postural hypotension)
Neurological symptoms - distal parasthaesia, mood changes, peripheral neuropathy, vision changes
Glossitis (swollen tongue)
19
Q
What is pernicious anaemia?
A
A cause of b12 deficiency
Intrinsic factor autoantibodies
Intrinsic factor is needed for b12 deficiency
20
Q
How is pernicious anaemia diagnosed?
A
Intrinsic factor antibody testing
Also maybe gastric parietal cell antibodies
21
Q
How is vitamin b12 deficiency managed?
A
If due to diet - oral cyanocobalamin
If not due to diet - IV Hydroxycobalamin
22
Q
How is pernicious anaemia treated?
A
IV Hydroxycobalamin
23
Q
What condition does pernicious anaemia predispose to?
A
Gastric carcinoma
24
Q
What type of hereditary pattern does hereditary spherocytosis have?
A
Autosomal dominant
25
How does hereditary spherocytosis present?
At birth with neonatal jaundice
Splenomegaly
Aplastic crisis if Parvovirus B19 infection
26
What GI condition is associated with hereditary spherocytosis?
Gallstones
27
How is hereditary spherocytosis diagnosed?
EMA binding tests
28
How is hereditary spherocytosis managed?
Folate supplementation
Splenectomy
29
What inheritance pattern does G6PD deficiency have?
X-linked recessive
30
What type of anaemia does G6PD deficiency cause?
Normocytic haemolytic anaemia
31
How does G6PD deficiency present?
Neonatal jaundice (due to blood cell breakdown)
Splenomegaly (due to haemolysis)
32
Which medications cause crises in G6PD deficiency?
Sulf- drugs
Ciprofloxacin
Anti-malarials
33
Which food causes a crises in G6PD deficiency?
Broad beans (fava beans)
34
What type of inheritance pattern does thalassaemia have?
Autosomal recessive
35
Which features can be seen in beta thalassaemia major?
Severe symptomatic anaemia
Frontal bossing
Maxillary overgrowth
Extramedullary haematopoiesis
36
What type of anaemia does thalassaemia cause?
Microcytic anaemia
| MCV may be disproportionately low to Hb --> Sign of thalassaemia rather than other causes of microcytic anaemia
37
How is thalassaemia diagnosed?
FBC - haemolytic anaemia
| Haemoglobin electrophoresis
38
How is thalassasmia managed?
If severe microcytic anaemia=
Regular transfusions
Iron chelation (in case of iron overload)
Splenectomy
In beta thalassaemia trait = no management required
39
How can iron overload in thalassaemia present?
Similar to haemochromatosis
Liver cirrhosis
Infertility/impotence
Arthritis
DM
40
What inheritance pattern does sickle cell anaemia have?
Autosomal recessive
41
What type of anaemia does sickle cell disease cause?
A haemolytic normocytic anaemia
42
How is sickle cell disease diagnosed?
Usually picked up on newborn screening
Haemoglobin electrophoresis
Schistocytes on blood film
43
How is sickle cell disease managed?
Hydroxycarbamide - stimulates production of fetal haemoglobin
Pneumococcal vaccine every 5 years
Avoid dehydration
If severe anaemia - blood transfusion
44
How does an aplastic crisis present?
Usually due to Parvovirus B19 infection
Low Hb
Low platelets
Low WCC
Low reticulocytes
45
How does a vaso-occlusive crisis in sickle cell present?
Pain in extremities
Can cause priapism
Usually triggered by dehydration
46
How does a splenic sequestration crisis in sickle cell present?
Acute drop in haemoglobin
Splenomegaly
High reticulocytes
Can cause hypovolaemic shock
47
How does acute chest syndrome in sickle cell present?
Hypoxia
Chest pain
Dyspnoea
New infiltrates on CXR
48
What kind of inheritance pattern does fanconi anaemia have?
Autosomal recessive
49
What are features of fanconi anaemia?
Haematological - aplastic anaemia, increased risk of AML
Skeletal abnormalities -short stature, thumb abnormalities
Cafe au lait spots
50
What type of anaemia does Sideroblastic anaemia cause?
Microcytic anaemia
51
What is seen on iron studies in sideroblastic anaemia?
Raised ferritin
Raised transferrin saturation
52
What is seen on blood film in sideroblastic anaemia?
Basophilic stippling of RBCs
53
What is seen on bone marrow biopsy in sideroblastic anaemia?
Ringed sideroblasts
54
How is sideroblastic anaemia treated?
Supportive - transfusions may be needed (+Iron chelation with Desferrioxamine)
Pyirodixine
55
What is the most common type of Hodgkin’s Lymphoma?
Nodular sclerosing
56
How does Hodgkin’s Lymphoma present?
Non-tender lymphadenopathy associated with alcohol induced pain
B symptoms: fever, weight loss, night sweats
57
What is seen on lymph node biopsy in Hodgkin’s Lymphoma?
Reed-Sternberg cells
58
How is Hodgkin’s Lymphoma diagnosed?
Reed-Sternberg cells on lymph node biopsy
59
Which marker may be raised in lymphoma?
Lactate dehydrogenase
60
How is Lymphoma staged?
Ann Arbor staging
I: single lymph node
II: 2 or more lymph nodes on the same side of the diaphragm
III: Lymph nodes on both sides of the diaphragm
IV: spread beyond the lymph nodes
All stages can be A or B
B = Presence of B symptoms
61
How does Non-Hodgkin’s Lymphoma present?
Painless lymphadenopathy
B symptoms (these present later than in Hodgkin’s)
62
What conditions are associated with Non-Hodgkin’s Lymphoma?
Gastric MALT
HIV
EBV
63
How is Non-Hodgkin’s Lymphoma treated?
R-CHOP
```
Rituximab
Cyclophosphamide
Doxorubicin
Vincristine
Prednisolone
```
64
What is seen on microscopy in Burkitt’s lymphoma?
Starry sky appearance
65
What is the differential diagnosis for petechiae?
Leukaemia
Meningococcal septicaemia
Vasculitis
HSP
ITP
Non-accidental injury
66
Which leukaemia is most common in children?
Acute Lymphoblastic Leukaemia
67
What genetic condition is associated with ALL?
Down Syndrome
68
What is seen on blood film in ALL?
Blast cells
69
Which leukaemia is most common in adults overall?
Chronic Lymphocytic Leukaemia
70
What is seen on blood film in chronic lymphocytic leukaemia?
Smudge cells
71
What is Richter’s transformation?
Chronic lymphocytic leukaemia transforms into high grade lymphoma
72
What is seen on blood film in acute myeloid leukaemia?
Blast cells with Auer rods
73
Which conditions puts someone at risk of developing acute myeloid leukaemia?
Myeloproliferative disorders - essential thrombocytosis, myelofibrosis, polycythaemia vera
74
Which chromosome is associated with chronic myeloid leukaemia?
Philadelphia chromosome (9;22 translocation)
75
Which leukaemia is associated with Philadelphia chromosome?
Chronic myeloid leukameia
76
Which marker may be decreased in chronic myeloid leukaemia?
Leukocyte alkaline phosphatase
77
How is chronic myeloid leukaemia treated?
Imatinib
78
Which type of leukaemia has raised lymphocytes?
ALL and CLL
79
What is seen on blood film in chronic myeloid leukaemia?
Band cells
80
What type of leukaemia has all stages of granulocyte maturation?
Chronic leukaemia
81
What is tumour lysis syndrome?
Life threatening condition related to treatment of leukaemia and lymphoma (usually triggered by chemo)
Due to release of uric acid from cells
82
What is tumour lysis syndrome and how does it present?
Life threatening complication of chemotherapy to lymphomas/leukaemias
Due to release of uric acid from cells being destroyed by chemo
AKI (raised creatinine)
Abdominal pain
May be arrhythmia/seizure
High uric acid
Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia
83
What are the 4 main features of multiple myeloma?
CRAB
Raised calcium
Renal failure
Anaemia
Bone pain
84
How does multiple myeloma present?
Often presents with persistent lower back pain
85
What is seen in urine protein electrophoresis in multiple myeloma?
Bence-Jones protein
86
What is seen in serum protein electrophoresis in multiple myeloma?
Increased monoclonal IgG
87
Which 4 tests do you need to do to investigate multiple myeloma?
BLIP
Bence Jones protein (urine electrophoresis)
Serum-free light assay
Serum immunoglobulins
Serum protein electrophoresis
88
How is multiple myeloma definitively diagnosed?
Bone marrow biopsy
89
What blood lab results are seen in multiple myeloma?
FBC - anaemia, low WCC
Raised calcium
Raised ESR
Raised plasma viscosity
90
Why is plasma viscosity increased in multiple myeloma?
Due to the presence of proteins in the blood (immunoglobulins and fibrinogen)
91
Why does renal failure occur in multiple myeloma?
Immunoglobulins blocking flow through the renal tubules
Hypercalcaemia
92
Why does raised calcium and bone pain occur in multiple myeloma?
Increased osteoclast activity
Decreased osteoblast activity
93
What X-ray signs are seen in multiple myeloma?
Punched out lesions
Lytic lesions
Raindrop skull
94
How is multiple myeloma managed?
Chemotherapy
Bisphosphonates
Analgesia
IV fluids for hypercalcaemia
95
What is neutropenic sepsis?
A common complication of chemotherapy - raised temperature and other signs of sepsis
96
How is neutropenic sepsis managed?
IV Tazocin
97
What is myelodysplastic syndrome?
Myeloid bone marrow cells don’t mature properly - lead to anaemia, neutropaenia and thrombocytopaenia
98
What is a complication of myelodysplastic syndrome?
Development of AML
99
Which haematological conditions are associated with a JAK2 mutation?
Primary myelofibrosis
Polycythaemia Vera
Essential thrombocytosis
100
What is seen on blood film in primary myelofibrosis?
Tear drop poikilocytes
Blasts
101
How is primary myelofibrosis diagnosed?
Bone marrow biopsy
Will get a dry tap
102
What are causes of thrombocyosis?
Reactive - in response to severe infection/surgery, iron-deficiency anaemia
Malignancy
Essential thrombocytosis or another myeloproliferative disorder
Hyposplenism
103
How does thrombocytosis present?
Thrombosis
Bleeding
Headache
Dizziness
Burning/tingling sensation in hands and feet
Splenomegaly
Livedo reticularis
104
How is essential thrombocytosis managed?
Hydroxycarbamide / Hydroxyurea (same thing)
Low dose aspirin (to reduce thrombus risk)
105
What is polycythaemia?
Increased red blood cells
Raised Hb and raised haematocrit
106
What are causes of polycythaemia?
Primary polycythaemia (polycythaemia Vera)
Secondary polycythaemia - increased EPO production, COPD, altitude, obstructive sleep apnoea ((body increases red blood cell production to compensate for low oxygen levels)
Reactive polycythaemia (due to low blood plasma)
107
What is polycythaemia rubra vera / polycythaemia vera?
Primary cause of polycythaemia
Myeloproliferative disorder - JAK2 mutation
108
How does polycythaemia present?
Headache
Visual disturbances
Pruritus especially after a hot bath
Splenomegaly
Ruddy complexion
Conjunctival plethora (excessively red conjunctiva)
109
What lab results are seen in polycythaemia vera?
Raised haemoglobin
Raised haematocrit/red cell mass
Raised neutrophils, basophils and platelets
Low ESR
Raised leukocyte alkaline phosphatase
110
How is polycythaemia vera managed?
Venesection to reduce Hb
| Aspirin to reduce risk of thrombotic events
111
What is immune thrombocytopenic purpura?
Idiopathic autoimmune mediated thrombocytopenia leading to purpura
112
What type of hypersensitivity reaction is ITP?
Type II
113
How does ITP present?
Bleeding (from gums, epistaxis or menorrhagia)
Bruising
Petechiae/purpura
Can sometimes be triggered by a viral infection
114
How is ITP managed?
Oral prednisolone
IV Immunoglobulins
If unstable - blood transfusions
115
What is thrombotic thrombocytopenic purpura?
Blood clots develop throughout the small vessels of the body - using up platelets
116
Which protein is deficient in thrombotic thrombocytopenic purpura?
ADAMTS13
117
How is TTP managed?
Plasma exchange
Oral steroids
118
What are causes of TTP?
Post infection
Tumours
SLE
HIV
Medication
119
What is the most common inherited bleeding disorder?
von Willebrand’s disease
120
What is the inheritance pattern of von willebrand’s?
Autosomal dominant
121
How does von Willebrand’s disease present?
Epistaxis and menorrhagia
| Bleeding into joint and muscle is rare
122
What clotting results are seen in vWD?
Prolonged bleeding time
Prolonged APTT
Normal prothrombin time
123
How is Von Willebrand’s disease managed?
Desmopressin - stimulates release of vWF
Tranexamic acid for menorrhagia
VWF infusion
124
What is the inheritance pattern of haemophilia?
X-linked recessive
125
What is haemophilia A?
Lack of factor VIII
126
What is haemophilia B?
Lack of factor IX
127
What clotting test results are seen in haemophilia?
Raised APTT
Normal bleeding time
Normal prothrombin time
128
How does haemophilia present?
Bleeding into joints (haemarthroses) and muscle haematomas
129
How is haemophilia managed?
Desmopressin/tranexamic acid for bleeding
IV infusion of factor VIII/IX
130
What is factor V Leiden?
The most common inherited cause of thrombocytosis
Activated protein C resistance - activated factor V is inactivated 10 times more slowly than normal
Increased risk of VTE
131
What clotting results are seen in vitamin K deficiency?
Raised APTT
Raised prothrombin time
Normal bleeding time
132
What is disseminated intravascular coagulation?
Inappropriate activation of the clotting cascade - thrombus formation and depletion of platelets
133
How does DIC present?
Excess bleeding - epistaxis, gingival bleeding, haematuria, bruising, petechiae, bleeding from cannula site
134
What are causes of DIC?
Sepsis
Trauma
Obstetric complications e.g HELLP syndrome
Malignancy
135
What clotting results are seen in DIC?
Low platelets
Low fibrinogen
Prolonged prothrombin time
Prolonged APTT
Prolonged bleeding time
Raised D-dimer
136
What test is used to diagnose autoimmune haemolytic anaemia?
Direct coombs test will be positive
137
Where does haemolysis usually occur in warm AIHA?
At the spleen
138
Which antibody is responsible in warm AIHA?
IgG
139
Which antibody is responsible in cold AIHA?
IgM
140
How does cold AIHA present?
Symptoms of Raynaud’s
141
Which type of AIHA is SLE associated with?
Warm
142
What is Graft versus Host disease?
Multi system complication of bone marrow transplantation
Can also occur after organ transplant or blood transfusion in immunocompromised patients
143
How does Graft versus Host disease present?
Painful maculopapular rash
Jaundice
Watery/bloody diarrhoea
Nausea and vomiting
144
Transfusion reactions: Fever and chills following a transfusion?
Non-haemolytic febrile reaction
Slow or stop the transfusion and give paracetamol
145
Transfusion reaction: Pruritus and urticaria following a blood transfusion?
Minor allergic reaction
Temporarily stop the transfusion and give anti-histamines
146
Transfusion reaction: hypotension, angioedema and wheezing following blood transfusion?
Anaphylactic reaction
Stop transfusion
IM Adrenaline, oxygen, IV fluids
147
Transfusion reaction: fever, abdominal pain and hypotension following a transfusion?
Acute haemolytic reaction
Stop transfusion
IV fluid resus
148
Transfusion reactions: pulmonary oedema and hypertension following a blood transfusion?
Transfusion-associated circulatory overload (usually in pre-existing heart failure)
Slow or stop transfusion
Consider a loop diuretic
149
Transfusion reactions: hypoxia, hypotension, fever, infiltrates on CXR following transfusion reaction?
Transfusion related acute lung injury
Stop transfusion, give oxygen
150
What is post-thrombotic syndrome? How is it managed?
A complication which can follow a DVT
Painful, heavy calves
Pruritus
Swelling
Varicose veins
Venous ulceration
Managed with compression stockings and keeping leg elevated
151
What is the transfusion threshold for packed red cells?
Hb of 70
Unless in ACS - then Hb threshold of 80
1 unit Packed red cells over 90-120 mins (if non urgent)
152
Which blood product can be used for emergency reversal of anticoagulation?
Prothrombin complex concentrate
E.g. Beriplex
153
When should platelet transfusion be offered?
In active bleeding - if platelets less than 30
If no active bleeding - if platelets less than 10
Pre-invasive procedure - if platelets less than 50 (or 100 of surgery at critical site)
Bleeding at critical site - less than 100
154
Patient on Warfarin: major bleeding
Stop warfarin
Give IV vitamin K 5mg
Prothrombin complex concentrate
155
Patient on warfarin: INR >8 and minor bleeding
Stop warfarin
IV Vitamin K 1-3mg
Repeat vitamin K if INR is still high after 24 hours
Restart warfarin when INR is less than 5
156
Patient on warfarin: INR >8 and no bleeding
Stop warfarin
Oral vitamin K
Restart warfarin when INR less than 5
157
Patient on warfarin: INR 5-8 and minor bleeding
Stop warfarin
IV vitamin K
Restart warfarin when INR less than 5
158
Patient on warfarin: INR 5-8 and no bleeding
Withhold one or two doses
Reduce subsequent doses
159
What are adverse effects of methotrexate?
Bone marrow suppression
Hepatotoxicity
Renal impairment
160
What are complications of chronic lymphocytic leukaemia?
Richters transformation
Bone marrow failure
Warm AIHA
Recurrent infection
161
What is seen on blood film in hyposplenism?
Target cells
Howell-Joly bodies
Siderotic granules
Acanthocytes
Pappenheimer bodies
162
What is seen on blood film in thalassaemia?
Heinz bodies
Target cells
Basophilic stippling
163
What is seen on blood film in lead poisoning?
Basophilic stippling
Clover leaf morphology
164
Which leukaemia is associated with massive splenomegaly?
Chronic myeloid leukaemia
165
How is autoimmune haemolytic anaemia diagnosed?
Direct Coombs Test
166
When are spherocytes seen on blood film?
Hereditary Spherocytosis
Autoimmune haemolytic anaemia
167
What is the reversal agent for Apixaban and Rivaroxaban?
Andexanet alfa
168
What is the target INR for AF?
2-3
169
What is the target INR for recurrent VTE e.g. antiphospholipid syndrome
3-4
170
Microcytosis which is disproportionate to the anaemia?
Consider beta thalassaemia trait
171
What chromosome is affected in thalassaemia?
Alpha thalassaemia = chromosome 16
| Beta thalassaemia = chromosome 11
172
Which haematological conditions cause pathological neonatal jaundice? (<24 hours)
```
G6PD
Hereditary spherocytosis/elliptocytosis
Alpha thalassaemia
Sickle cell disease
(Also ABO haemolytic diseae and rhesus haemolytic disease)
```
173
Aplastic crisis vs. Splenic sequestration crisis
Aplastic crisis = Low reticulocytes
| Splenic sequestration crisis = High reticulocytes, splenomegalyy
174
Why does haemolytic anaemia lead to gallstones?
Haemolysis --> Increased bilirubin --> Excreted into the bile
175
Which lymphoma is associated with alcohol induced pain?
Hodgkin’s
176
How is autoimmune haemolytic anaemia managed?
Corticosteroids
