Haematology Flashcards
What are the features of TTP
Features (ask the FAT RN): Fever, anaemia, thrombocytopaenia, renal impairment, neurological involvement [e.g. confusion])
What is the treatment of TTP?
Plasma exchange
What are thymomas associated with?
myasthenia gravis (30-40% of patients with thymoma)
red cell aplasia
dermatomyositis
also : SLE, SIADH
First line treatment CML?
Imatinib
Commonest type of hodgkin’s lymphoma
Nodular sclerosing
What’s seen on blood film in hyposplenism?
Howell-Jolly bodies
siderocytes
follicular lymphoma translocation
t(14;18)
What is the gold standard test for paroxysmal nocturnal haemaglobinuria? (COMMON Q)
flow cytometry of blood to detect low levels of CD59 and CD55
Treatment of VTE if patient has cancer?
6 months DOAC
VTE treatment length if provoked VTE?
DOAC Stop after 3 months (6 months if active cancer)
VTE treatment length in unprovoked VTE?
DOAC 6 months total
What drug is first line in VTE?
DOAC
When should you use LMWH in VTE? (i.e. when is DOAC contraindicated)
Severe renal impairment
Antiphospholipid syndrome
in haemolytic disease/anaemia, what blood level is low and why?
Haptoglobin (as it binds to free haemoglobin)
Key investigation/gold for CLL?
Flow cytometry (immunophenotyping)
What is a leukamoid reaction? how can you distinguish it from leukaemia?
reactive leucocytosis, often secondary to infection or inflammation
High leucocyte alkaline phosphatase (LAP)
what cytotoxic agent is associated with peripheral neuropathy?
Vincristine
Treatment for aplastic anaemia?
Supportive: blood + products
Anti-thymocyte globulin (ATG) and anti-lymphocyte globulin (ALG)
Stem cell Tx
In addition to vit K, what blood product should be given in emergency reversal of anticoagulation in patients with severe bleeding or a head injury?
Prothrombin complex concentrate
In major haemorrhage what blood product should be given if fibrinogen level is low <1.5?
Cryoprecipitate
When should FFP be used in haemorrhage?
prothrombin time (PT) ratio or activated partial thromboplastin time (APTT) ratio > 1.5
3 types of paraprotinaemias
myeloma
Waldenstorm’s macroglobinaemia
monoclonal gamopathy of unknown significance
How to differentiate myeloma from Waldenstorm’s?
Myeloma –> hypercalcaemia, lytic bone lesions, no organomegaly, usually not IgM
Waldenstorms –> organomegaly, no lytic bone lesiosn, normal calcium, hyperviscocity (DVT)
What is seen on blood film in myelofibrosis?
Tear drop poikilocytes
Similarities between Hereditary spherocytosis + G6PD Deficiency?
Both haemolytic anaemia may have gallstones + neonatal jaundice
HS: Splenomegaly present; northern european descent
G6PD: No splenomegaly + precipitant leading to haemolysis (e.g. quinolones e.g. ciprofloxacin) + middle eastern / African descent
Diagnostic tests for Hereditary spherocytosis?
EMA binding
Diagnostic tests for G6PD deficiency
Measure G6PD activity
When to discharge someone after anaphylaxis?
2 hours min after symptom resolution if good response to 1 dose IM adrenaline
6 hours minimum if 2 doses needed or previous biphasic reaction
12 hours minimum if >2 doses, presents at night, asthma,
What is the treatment for CLL? What are the indications for treatment?
FCR: fludarabine, cyclophosphamide and rituximab
Indications:
progressive marrow failure: the development or worsening of anaemia and/or thrombocytopenia
massive (>10 cm) or progressive lymphadenopathy
massive (>6 cm) or progressive splenomegaly
progressive lymphocytosis: > 50% increase over 2 months or lymphocyte doubling time < 6 months
systemic symptoms: weight loss > 10% in previous 6 months, fever >38ºC for > 2 weeks, extreme fatigue, night sweats
autoimmune cytopaenias e.g. ITP
Therefore if asymptomatic + incidental - don’t treat
First line treatment CML?
Imatinib (tyrosine kinase inhibitor)
What is the best screening marker for hereditary angioedema between attacks? What about during an attack?
between: C4 (low)
during attack: C1-INH level (low)
MoA of texanes (E.g. docetaxel)?
prevents microtubule depolymerisation & disassembly
To remember: microtubules are responsible for transport in the cell, just like a TAXI ( TAXEL)
What is seen on blood film in DIC?
Schistocytes
Diagnosis of CLL
Immunophenotyping
what causes CLL?
monoclonal proliferation of B-cell lymphocytes
Hodgkin’s lymphoma staging
Ann arbor
I: single lymph node
II: 2 or more lymph nodes/regions on same side of diaphragm
III: nodes on both sides of diaphragm
IV: spread beyond lymph nodes
A: if no symptoms
B: if symptoms
How to prevent tumour lysis syndrome acutely?
Rasburicase
Microscopy of burkitt’s lymphoma
‘starry sky’ appearance
What causes burkitt’s lymphoma + what translocation
EBV
T(8;14)
What translocation in AML suggests a good prognosis?
15;17
In unprovoked DVT what investigation must you do?
Clotting screen
In haemolytic anaemias, what happens to haptoglobin?
Low (as binds to free Hb [more of this in haemolytic anaemia])
If very high wcc but raised leucocyte alkaline phsophatase what is the diagnosis?
Leukamoid reaction
How can you differentiate CML from leukamoid reaction?
Leukamoid reaction - raised leukocyte alkaline phosphatase
Why is factor VIII decreased in vWd?
Because vW factor carries factor VIII
What factor is reduced in vom willebrand disease and why?
Factor 8 as vw factor carries it
What is the clotting results in vWd?
APTT increased as drop in factor 8
PT normal
Bleeding time increased as platelets can’t aggregate to endothelium
What are the clotting results in haemophilias?
Bleeding time normal (as platelets unaffected)
PT normal
APTT increased
