Haematology Flashcards by Matthew Ashman

What cells do myeloblasts form?

Basophil
Eosinophil
Neutrophil

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What cells do lymphoblasts form?

Lymphocytes

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What part of the coagulation cascade does APTT measure

Intrinsic patheay (factor 12 onwards)

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What part of the coagulation cascade does prothrombin time measure

Extrinsic (tissue factor)

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What factors does wayfaring effect?

2,7,9,10

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Clotting results for haemophilia

APTT - increased
PT - normal
Bleeding time - normal

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Clotting results of von willebrands disease

APTT increased
PT normal
Bleeding time increased

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Iron results in iron deficient anaemia

Transferrin increased 
Saturation decreased 
TiBC - increased 
Serum iron decreased 
Ferritin decreased

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Blood film in folate and B12 deficiency

Hypersegmented neutrophils

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Is B12 ot foliate deficiency more common?

B12

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Tests for sickle cell anaemia

Newborn screening - heelprick test
Hb low
Increase in reticulocytes
Blood film - sickle cells 
Hb electrophoresis

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Complications of sickle cell disease

Vaso-occlusive painful crisis

microvascular occlusion causing distal ischaemia
commonly occurs when cold, infection, dehydration

Aplastic crisis

temporary loss of RBC production
due to parvovirus B19

Sequestration crisis

RBCs block blood flow within spleen
pooling of blood in spleen and liver

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Management of sickle cell anaemia

Avoid triggers of crisis 
Ensure vaccines up to date 
Abx prophylaxis 
Blood transfusions 
Bone marrow transplant 
Hydroxycaebamide- can be used to stimulate production of fetal haemoglobin 
Hydroxyurea

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The myeloproliferative disorders and the cells

Myelofibrosis - haematopoietic stem cell
Polycythaemia Vera - erythroid cells
Essential thrombocytothaemia - megakaryocyte

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What is myelofibrosis

Proliferation of stem cells leads to fibrosis and scarring of the bone marrow
Leads to haematopoeisis occurring in liver and spleen = massive hepatosplenomegaly

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Presentation of myelofibrosis

Anaemia
Leuocoytosis of leukaemia 
Massive hepatosplenomegaly 
B SYMPTOMS 
- Fevers
- night sweats 
- weight loss 
- abdominal discomfort 
- bone marrow failure- anaemia, infections, bleeding

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What Smisby showed on the film in myelofibrosis

Tear drop cells

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Presentation of polycythaemia vera

Insidious onset
Over 60 years old 
Tiredness 
Headache 
Visual disturbance 
Erythromelagia - red and hot peripheries, especially when getting in Bath 
Gout

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What mutation is associated with polycythaemia vera

JAK2 mutation

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Management of polycythaemia vera

Venesection
Aspirin
Hyrroxycarbamide
Chemotherapy

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Ages of leukaemia presentation

Under 5 of greater than 45 - ALL
Over 55 - CLL
Over 65 - CML
Over 75 - AML

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Which leukaemia is common in children

Acute leukoblastic leukaemia

Blood film of ALL

Blast cells

Blood film of CLL

Smear or smudge cells

What leukaemia is associated with the philedelphia chromosome?

CML

How is CML treatment?

Main treatment is a tyrosine kinase inhibitor

Age of presentation of hodgkins lymphoma

20 and 75 years

What are reed-sternberg cells associated with.

Hodgkins lymphoma

Clinical features of myeloma

CRABI ``` High calcium Renal impairment Anaemia Bony disease Infections - recurrent ```

Investigations for myeloma

BLIP B - BENCE Jones protein (request urine electrophoresis) L - light chain assay I - serum immunoglobulin P - serum protein electrophoresis Film - rouleaux Bone marrow biopsy - to confirm diagnosis X rays- punched out lesions

Investigations for DVT

Wells score If <2 - D-dimer within 4 hours >2 - proximal leg US should be carried out within 4 hours Therapeutic anticoagulation should be carried out in the meantime

Investigations for DVT

Wells score If <2 - D-dimer within 4 hours >2 - proximal leg US should be carried out within 4 hours Therapeutic anticoagulation should be carried out in the meantime

Length of treatment for DVT

Warfarin or DOAC Provoked - 3 months Unprovoked- 6 months

Autoimmune hemolytic anaemia classification

Coombs positive Warm and cold

Warm autoimmune hemolytic anaemia cause and management

IgG antibody Tends to occur in extravascular beds - spleen Causes - autoimmune- SLE, neoplasia - lymphoma, CLL, drugs- methyldopa Management - steroids, immunosuppression, splenectomy

Cold autoimmune hemolytic anaemia features and causes

Usually IgM Causes haemolysis at 4 degrees More common intravascular occurs Featues - Raynauds Cause- neoplasia - lymphoma Infection - mycoplasma, EBV

Causes of hemolytic anaemia

Hereditary - membrane - hereditary spherocytosis - metabolism - G6PD deficiency - haemoglobinopathies - sickle cell, thalassemia Acquired - immune causes - autoimmune (warm/cold( - - autoimmune- transfusion reaction - drugs - methyldopa - malaria

What is G6DP deficiency?

Metabolism deficit Chief RBC deficit Makes cells vulnerable to oxidative stress Cause of hereditory hemolytic anaemia Inherited in an X-linked recessive fashion

Features of G6DP deficiency

Most are asymptomatic Can present as crisis - after infection or certain drugs - rapid anaemia and jaundice Neonatal jaundice Gallstones common

Diagnosis of G6DP deficiency

Blood film - heinz bodies, bite and blister cells | G6DP enzyme assay - checked around 3 months after an acute episode of haemolysis

What can prosthetic heart valves cause?

Haemolytic anaemia

Management of neutropenic sepsis

Taz and piperacillin | Assessed by senior

Neck lump, severe pain on alcohol drinking, points to a diagnosis of what?

Hodgekins lymphoma

Tear drop poikilocytes are associated with what

Myleofibrosis

Smear cells are associated with what

CLL

Spherocytes are associated with what

Hereditary spherocytosis | Autoimmjne hemolytic anaemia

What is the most common form of non-hodgkins lymphoma in the UK?

Diffuse large B cell lymphoma

Type of anaemia in B-thalassaemia

Haemolytic | Hypochromic microcytic anaemia

What are Howell jolly bodies seen into?

Severe hemolytic anaemia Hereditary spherocutosis Sickle cell disease They suggest hyposplenism

Differences between G6DP deficiency and hereditary spherocytosis

G6 - male (X-linked recessive), HS - male and female (autosomal dominant) HS - northern European descent G6 - neonatal jaundice, infection/drugs precipitate hemolysis. HS - neonatal jaundice, chronic symptoms although hemolytic crisis may be precipitated by infection. Gallstones and splenomegsly is common G6 - heinz body HS - spherocytes

Inheritance pattern of hereditary spherocytosis

Autosomal dominant

Blood film of hereditary spherocytosis

Spherocytes

Conditions associated with polycythaemia vera

DVT Gout Gallstones

Treatment of hereditary spherocytosis

Folate Splenectomy Removal of gall bladder if gallstones