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Revision > Haematology > Flashcards

Haematology Flashcards

1
Q

Febrile non haemolytic transfusion reaction

A

Fever > 38
Raise in body temp 1-2 C during/after transfusion (up to 4 hrs)
Chills/rigours or asymptomatic
Other vitals normal

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2
Q

Treatment FNHTR

A

Tx : paracetamol & monitoring
Stop transfusion, give normal saline
Resume transfusion when symptoms and fever subside
Observe for 15-30 mins

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3
Q

Acute hemolytic transfusion reaction (AHTR)

Features (5)

A 
Can be fatal 
Starts w/in minutes** of transfusion 
Fever + hypotension/shock
Pain @ transfusion site
\+/- DIC
\+/- haemoglobinuria 
\+/- feeling of impending doom
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4
Q

Types of leukaemia

A

CLL CML

ALL AML

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5
Q

CML features (6)

  • age
  • examination findings
  • labs/smear
  • genetics
A

40-50 yrs old
Massive splenomegaly - does not always have it
“Crazy massive large spleen)
WBC > 100x10^9
Granulocytes*** @ all stages w/o blast cells!
Neutrophilia - myelocytes, basophils, eosinophils
Ph chromosome - Philadelphia chromosome

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6
Q

CLL features(4)

  • age
  • presentation
  • labs/smear
A
  • > 60 years old
  • asymptomatic / anemia + recurrent infection , lymphadenopathy
    Usually no splenomegaly
  • raised dysfunctional WBCS with B lymphocyte predominance
  • smear = mature lymphocyte with smudge cells
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7
Q

ALL features

  • age group
  • presentation
  • labs
  • aspiration/biopsy findings
A 
Children - up to 15 yrs 
Pancytopenia
- hb - anemia, fatigue
-wbc - recurrent infections ( wbc can be normal/hi/low)
-plts - thrombocytopenia - bleeding

Bone morrow aspiration = numerous blasts

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8
Q

AML features

  • age group
  • blood film
  • clinical features
  • aspiration/biopsy
A

Adults - 20-30 yrs
Auer rods on blood film
Gingivitis , gum bleeding
Numerous blast calls * on biopsy

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9
Q

Think of lymphoma if

A

Painless cervical lymphadenopathy + B symptoms
+- splenomegaly
B = unintended weight loss, unexplained fever, drenching night sweats

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10
Q

TB vs Lymphoma

A

TB: Hx of travel - South Asia, sub Saharan Africa
Tender * firm LNs
Usually chronic productive cough +- bloody sputum
+- erythema nodosum

Lymphoma - painless lymphadenopathy

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11
Q

RFs for TB

A

Homeless
Drug abuse
Smoking
Low socio-economic class

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12
Q

Most common HIV related lymphoma

Dx test

A

Non Hodgkin lymphoma
Burkitt lymphoma

Diagnostic test - LN biopsy

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13
Q

DIC

Features

A

Sepsis + bleeding
- purpurin, petechia, ecchymosis , bleeding e.g. GIT,ENT

Sx - blood clots blocking blood vessels = chest pain SOB leg pain etc

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14
Q

Common causes DIC (5)

A 
Sepsis 
surgery 
Major trauma 
Cancer
Complications of pregnancy
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15
Q

Dx of DIC

A

Low platelets & fibrinogen
Raised PT PTT INR D-dimer
High bleeding time

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16
Q

Treatment DIC

A

Treat underlying condition

Platelet/FFP transfusion

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17
Q

Raised PTT + bleeding into muscles

Suspect

A

Haemophilia

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18
Q

Raised PTT & bleeding time + mucosal bleeding

Think ___

A

VWD

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19
Q

Raised PT PTT & bleeding time
+ bleeding at any site
Suspect

A

DIC

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20
Q

Isolated low platelets + bleeding +- hx of URTI

A

Idiopathic thrombocytopenic purpura

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21
Q

Polycythemia rubra Vera (4)

A

Primary polycythemia - malignancy
JAK2 mutation
RBC WBC platelets raised , HCT >55%
Hyperviscosity of the blood

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22
Q

Presentation of PRV (5)

A 
Fatigue, lethargy
Pruritic - esp after hot shower
Splenomegaly 
Burning sensation in fingers toes
Gout - due to increased cell turnover

Headache,hepatomegaly, low or normal erythropoietin

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23
Q

PRV vs 2ry polycythemia

A

PRV - low or normal erythropoietin , RBC WBC Plt raised

2ry - high erythropoietin , only hgb raised

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24
Q

Treatment PRV

A

1.Venesection (phlebotomy)
- reduces the elevated Hct + blood viscosity
2. Aspirin - low dose
75md OD for fear of thrombosis
3.Chemotherapy
= <40 - interferon ; >40 - hydroxyurea

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25
Q

Important cause of 2ry polycythemia

Other causes

A

Chronic hypoxia - stimulates kidneys to produce more erythropoietin - stimulates bone marrow to produces RBCs so they can carry more O2
e.g chronic smokers , COPD

Other : high altitude, cyanosis congenital heart disease

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26
Q

G6PD deficiency

A

G6PD enzyme def - decreased glutathione - RBCs vulnerable to oxidative damage - hemolysis
X-linked recessive = male
African/Mediterranean
Hx of neonatal jaundice
Jaundice , red/dark urine , back abdominal pain

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27
Q

G6PD triggers

A
  • primaquine, fava beans , infection- severe hemolysis
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28
Q

DX

Treatment G6PD def

A

Avoid triggers
IV fluids
If severe hemolysis - blood transfusion

Definitive Dx - G6PD enzyme activity 6 weeks after hemolytic attack
G6PD = hemolytic anemia

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29
Q

Test used in cross-matching blood transfusion

A

Indirect Coomb test
= detects antibodies in serum (unbound)

Used in cross match , antenatal antibody screening (igG that can cross placenta and cause hemolysis)

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30
Q

Direct vs indirect Coombs test

A

Direct - detects antibodies or complement on SURFACE of RBC
- autoimmune, drug induced, hemolytic disease of newborn

Indirect - antibodies in SERUM (unbound, floating)
Can’t detect complement

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31
Q

Osmotic fragility test detects

A

Hereditary spherocytosis

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32
Q

Multiple myeloma

Main symptoms

A

Cancer of plasma cells
- plasma cell overgrowth +overproduction of non functioning Igs

Bone pain + hypercalcemia + anemia
- back + ribs

Renal failure*, recurrent infections

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33
Q

Investigations for multiple myeloma

  • diagnostic
  • blood film
  • imaging
  • labs
A

D - bone marrow biopsy = abdundant plasma cells
Serum protein electrophoresis - monoclonal immunoglobulin spike
Urgent protein “ - Bence jones protein
Film - Rouleaux formation
Xray - lytic lesion
Hypercalcemia + normal ALP + anemia + high ESR
Impaired renal fn - low GFR , high U&C - in 50%

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34
Q

Most common lab finding in Multiple myeloma

A

Anemia

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35
Q

ALL vs Aplastic anemia

A

Pancytopenia in both
Blast cells in ALL
AA - hypoplastic bone marrow

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36
Q

Hypercalcemia differentials

A

Bone mets
SCC of lung
MM - ALp normal
1ry hyperparathyroidism

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37
Q

ECG finding hypercalcemia

A

Short QT. Interval

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38
Q

Low hb low MCP low ferritin

High TIBC , High RDW

A

IDA

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39
Q

Features of IDA

A

Angular stomatitis - also seen in B12 def
Red sore tongue
Koilonychia

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40
Q

Most common cause of IDA

A

GI blood loss

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41
Q

Indications for blood transfusion

A

hb <7 - regardless of whether they are symptomatic
<8 + symptoms of anemia
<9+ known CVD

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42
Q

What deficiency can methotrexate cause?

A

Folate deficiency (macrocytic anemia)

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43
Q

Anaemia of chronic disease

A

Normocytic normochromic
However,
Can be micro cystic hypochromic in rheumatoid A, and chronic disease

44
Q

HSP features

A

Non blanching purpura - buttocks, LL
Precipitated by URTI
All bloods - normal

Arthralgia, raised ESR IgA
Rarely - impaired renal function

45
Q

Treatment HSP

A

Self limiting
Aspirin for arthralgia unless renal impaired

HSP- PAAN *= purpura arthralgia , abd pain , nephropathy (hematuria/proteinuria)

46
Q

Dx of aplastic anemia

A

2/3 must be present
1. Hb <10
Plt s<50
Neutrophils<1.5

47
Q

Irregular folded or ridges white patches on sides of tongue
What is this?
How do you treat?

A

Hairy leukoplakia
- supportive of HIV disease

EBV * invades was immense system in HIV - can’t be scraped off

Benign - no treatment needed

48
Q

Target INR

A

Mostly - 2-3 (incl warfarin intake)

Mechanical valve replacement (metallic valve) = 3-4

49
Q

ITP features

A

Children > adults
Usually preceded by infection in children
Isolated thrombocytopenia
Bleeding, epistaxis, petechia, menorrhagia , sometimes asymptomatic

50
Q

Treatment ITP

A

Prednisolone
IV Ig
Life threatening hemorrhage (<20 platelets = emergency platelet transfusion

51
Q

What is the normal
PT
PTT
Bleeding time

A 
PT - 10-14 s
- extrinsic pathway
PTT - 35-45 s
-instrinsic pathway 
Bleeding - 3-9 mins
52
Q

Hemophilia A vs B

A

A: 90% of cases
Factor 8 deficiency
Tx - desmopressin , if major bleeding give recombinant factor 8

B: factor 9 deficiency , tx - give recombinant factor 9
(No role of desmopressin)

53
Q

Christmas disease

A

Hemophilia B

54
Q

Genetic inheritance of hemophilia

A

X- linked recessive

Affects males

55
Q

Anemia + high bilirubin

A

Hemolysis

56
Q

Markers of hemolysis

Appropriate investigation

A

Raised LDH, indirect bilirubin
+ reticulocytosis

Direct coomb test

57
Q

Polychrome said + spherocytosis seen on peripheral blood smear
Dx?

A

Spherocytosis - seen in heriditary spherocytosis + autoimmune hemolytic anemia

Differentiate by direct Coombs test
HS - -ve ; AHH +ve

Osmotic fragility test +ve in HS

58
Q

HELLP vs AFLP vs DIC

A

HELLP - low hb + elevated liver, low platelet
AFLP = ELLP ^ +low glucose +- high ammonia
DIC - high PT, PTT, bleeding time , low plts + fibrinogen

59
Q

Von Willebrand disease mode of inheritance

A

Autosomal dominant - mostly

60
Q

Cytochrome p450 inducers

Effect on warfarin

A

CRAP GPs
Decrease warfarin effect - decrease INR
Can’t use w/ COCPS
Carbamazepine, rifampin, chronic alcohol , phenytoin , phenobarbital , sulphonylureas

61
Q

P450 inhibitors

Effect on warfarin

A

SICK FACES . COM
Increase effect of warfarin, raise INR
Sodium valproate, isoniazid, cimetidine, ketoconazole, fluconazole, acute alcohol, erythromycin (macrolides), sulfonamides, cipro, omeprazole, metronidazole

62
Q 
Management of high INR in patients of INR 
Major bleeding (intracranial bleed, GI bleed)
A

Stop warfarin
IV vitamin K (phytomenadione) 5mg
Prothrombin complex concentrate
^if not available - FFP

63
Q 
Management of high INR in patients of INR 
INR >8 
INR 5-8 
INR <5 
\+- Minor bleeding (epistaxis, hematuria)
A

INR > 8
Stop warfarin + IV/oral vitamin K

5-8
Stop warfarin, check INR next day
Restart when INR <5

<5 (by higher than target )
Reduce/or omit a dose of warfarin
Measure INR in 2-3 days

64
Q

B12 deficiency
Features
Treatment

A

Macrocytic anemia - oval macrocytic RBCs
Hypersegmented neutrophils
Peripheral paresthesia
Features of anemia

Tx - hydroxycobalmin

65
Q

RFS for DVT

A

Smoking
Immobility
Long sitting
Major surgery

66
Q

JAK mutation screen requested in

A

1ry polycythemia

67
Q

What test requested in 2ry polycythemia

A

Erythropoietin

68
Q

TTP

Features (5)

A 
Haemolytic anemia
Uraemia ( acute renal failure)
Thrombocytopenia (low platelets)
Neuro manifestations 
Fever
69
Q

HUS

Features (3)

A

Haemolytic anemia
Uraemia (acute renal failure)
Thrombocytopenia

hematuria proteinuria raised U&Cs

*CHILDREN

70
Q

Cause of HUS

A

Eating contaminated/ undercooked food
E.coli O157 - produces verotoxin- profuse diarrhoea > bloody diarrhoea- uremia
= hematuria proteinuria raised U&Cs

71
Q

Cause of TTP

A

ADAMTS 13 factor deficiency or inhibition

72
Q

Treatmentt of HUS

A

Supportive - IV fluids +- transfusion , dialysis if required
If severe - plasma exchange

NO ABX - more toxins released if e.coli dies

73
Q

Most common cause of AKI in children

A

HUS

74
Q

Ddx for opacity/ mass in superior mediastinumt

A 
5 T’s 
Terrible lymphoma
Thymoma
Thoracic aortic aneurysm 
Thyroid goitre/neoplasm
Teratoma
75
Q

Troisier’s sign

A

Virchows node

- left supraclavicular mass indicative of gastric carcinoma

76
Q

Right supraclavicular mass seen in

A

Oesophageal ca
Lung ca
Hodgkin’s lymphoma

77
Q

Pancoast tumour

A

Tumour @ apex of lung
Spreads to nearby tissue - ribs , vertebrae
Most tumours - non small cell lung ca

78
Q

Pernicious anemia

A

Autoimmune gastric atrophy - loss of intrinsic factors - impaired B12 absorption = B12 deficiency

High MCV (macrocytic) + associated autoimmune disease
= hypothyroidism, vitiligo, T1DM
79
Q

Treatment of pernicious anemia

A

IM hydroxycobalmin

80
Q

Treatment of megaloblastic anemia - with B12 + folic acid are both deficient

A 
IM B12 (hydroxycobalmin)
Then give oral folic acid once B12 normal

B before F

81
Q

Tumour lysis syndrome

Features

A 
UK Pc
Hyper:
Uricemia
Kalemia
Phosphatemia

Hypocalcemia

82
Q

Cause of tumour lysis syndrome

A

Occurs mainly in ALL & lymphoma (burkitts especially)after start of chemo

Chemo/radio/surgery - rapid lysis of tumour cell- excessive UKP released in blood

83
Q

Complications & Management of tumour lysis syndrome

A

Hemato-ontological emergency = leads to retail failure, cardiac and neuro complications
M= IV fluid , rest is complicated

84
Q

Single best investigation in tumour lysis syndrome

A

Serum urate

Urticaria acid + urate

85
Q

Hereditary spherocytosis

Features

A

High MCHC
Hemolytic anemia - jaundice, reticulocytosis, high bilirubin
Gallstones
Spherocytes & reticulocytosis on blood film

86
Q

Important complication of h.spherocytosis

A

Aplastic crises - due to PVB19 infection

^ it causes aplastic crises in SCA ,

87
Q

Management of h.spherocytosis

A

Steroids
Folic acid
Splenectomy ‘

88
Q

How does hemolysis cause gallstone

A

Bro if hemolysis causes increased bilirubin excretion and pigment gallstones

89
Q

How long do you stop warfarin before surgery

A

3-5 days before
Heparin started instead = heparin bridging
Surgery when INR <1.5

90
Q

Heparin bridging - why?

When do yo resume warfarin?

A

More easily and rapidly reversed than warfarin

On evening of operation when INR @ therapeutic levels (not always)

91
Q

PVB19 aplastic crises vs splenic sequestration crises

In SCA

A

PVB19 - severely low Hb + LOW reticulocytes

SScrises- severely low Hb + HIGH reticulocytes

92
Q

Crises in SCA

A

Vasopressin-occlusive

  • most common
  • mesenteric ischemia, avascular necrosis

Splenic sequestration - sudden enlargement of splee, pooling of RBCs
= low hb , high reticulocytes
If recurrent - splenectomy

Aplastic crises
PVB19 commonly
Low hb + low reticulocytes

Haemolytic - rare

93
Q

Beta thalassemia major

Features

A

Autosomal recessive
Regular blood transfusion
Hepatosplenomegaly
Frontal bossing

Frequent transfusion > iron overload > endocrinopathy - DM

94
Q

Treatment of beta thalassemia major

A

Life long transfusion - maintain hb >9.5

Iron chelation - deferoxamine (Desferal) = SC x2/week

95
Q

Score used to determine need for anticoagulants in patients who have Atrial fib

A 
CHAD2DS2-VASCULAR score
CHF (LVEF <40%) = 1
HTN =1
Age >=75 = 2
DM = 1
Stroke/TIA or sys embolism = 2
Vascular disease = 1
Age 65-74 = 1
Female = 1

All patients Score >/= 2 —- warfarin/ DOAC
Men w/ score >= 1 — consider DOAC or warfarin

96
Q

DOAC meds + advantage

Disadvantages

A

Apixaban
Rivaroxaban
Edoxaban
Dabigatran

No INR monitoring , faster onset of action (2-4 hrs), reduce risk of ICH

Dis - no antidote , requires strict compliance

97
Q

Venous thrombosis above and below inguinal ligament - sites

A

Above - iliac vein thrombosis

Below - femoral vein thrombosis

98
Q

Heinz bodies and Bute cells seen in

A

G6PD

99
Q

Treatment of superficial thrombophlebitis

A

NSAIDs to relive pain/soreness

100
Q

Well’s criteria

A 
Active cancer/in last 6 mo = 1
Paralysis/immobilisation = 1
Bedridden >3 days / major surgery in last 12 weeks = 1
Localised tenderness in venous system = 1
Entire leg swollen = 1
Calf swelling >3cm  of asymptomatic leg =1
Pitting oedema of symptomatic leg= 1
Non varicose veins = 1
Previous Dave = 1
Alt dx is at least as likely as DVT = -2
Score 2 or more = DVT like 
1 or less - unlikely
101
Q

Preferred time for US in DVT

A

In 4 hours

- however usually not possibl esp start treatment dose of DOAC and arrange US with in 24 hrs

102
Q

B12 vs folic acid deficiency

A

B12 - peripheral paresthesia
Folate - does not eat vegetables but eats meat

No veggies or meat - B12

Microwaveable canned food w/ no veggies - folate

B12 - fish meat dairy / folate - vegetables
B12 store may last up to 4 years

103
Q

Milk decreases absorption of ____

A

Iron

104
Q

Hodgkins lymphome
Age group
Diagnostic feature

A

<25 or >55

Binucleated cells with prominent nucleoli - Reed Sternberg cells

105
Q

Non Hodgkin’s lymphoma

What is seen on LN biopsy

A

Monomorphic small irregular b lymphocytes

Revision (31 decks)

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