haematology Flashcards
Types of leukemia and how they look like on blood film
Lymphoid cells: NK cells, b lymphocytes, t lymphocytes, plasma cells
Myeloid cells: myelobasts –> neutrophils, basophils, eosinophils, monocytes/macrophages
ALL:
AML:
CML: mature and immature neutrophils
CLL:
translocation for burkitts lyphoma
t (8:14)
translocation for CML
t(9:22)
BCR-ABL
What is GVHD
Acute <6 months
Chronic >6 months
multi-system: skin, liver, gut
skin - rash on soles and palms
Liver - mildly derranged LFTS
gut - diarrhoea, abnormal colour
Management: good nutrition, weight maintenance and immunosuppression with methylprednisone and cyclosporin.
Tacrolim
What is transfusion GVHD
post BMT, host cannot mount an immune response
When lymphocytes in donor bood attack host tissues
Clinical features: identical to GVHD
typically occurs 14 days after transfusion
Management: avoid tranfusions, irradiated blood (kills lymphocytes)
CMV Infection post transplant
Diarrhoea
Derranged LFTs
Myelosuppression
transfusion hypersensitity reaction
erythema, urticario, bronchospasma (wheeze/crackles/chest tightness), fever
MX: adrenaline, hydrocortison, chlorphenamine
Signs of TTP
MAHA Thrombocytopenia Neuro dysfunction renal impairment fever
ADAMTS13 deficiency
Management of TTP
Plasmapharesis (exhange) and FFP
Whats is waldenstrom macroglobulinemia
lyphoplasmacytuc lymphoma - IgM paraprotein
COmplications: hyperviscosity syndrome
test and treatment of hyperviscosity syndrome
plasma viscosity
plasmapharesis to remov IgM
CVID
reduced IgG and IgA 1. Recurrent chest infections 2, Autoimmune disease 3. Lymphoid hyperplasia/granulomatous disease 4. Malignancy
leukoerythroblastic reactions
peripheral blood contains immature white cells and nucleated red cells irrespective of the total white cell count and circulating blasts may be seen.
Managwmwnt of bone pain
radiotherapy
what is PNH
Erthrocytes are sensitive to lysis by complement
Panyctopenia
Ptoyhrobotic
Dark urine in the morning
CLL and cytometry
Cytometry is gold standard
Picks up monolclonal B cells proliferation (CD19/5 co expressing, CD23 positive, light chain restricted B cell population) is diagnostic of CLL.
Neutropenic sepsis management
anti pseudomonal (piptaz) and gent
antifungal if no improvement
treatment for post splenectomy and chronic ITP with bleeding
immunosupression agent (not steroid)
management of iron overload in chronic anemia from multiple transufsions (secondary haemochromatosis)
oral iron chelation with deferasirox is the first line gold standard treatment for iron chelation in iron overload related to repeated transfusions in patients with chronic anaemias.
symptoms of hyperviscosity syndrome
dizziness tinnitus headaches blurred vision, and pruritus.
causes of Polycythemia ruvra vera
A classic symptom of polycythemia vera is pruritus or itching, particularly after exposure to warm water (such as when taking a bath), which may be due to abnormal histamine release1 or prostaglandin production2.
Signs include:
Various ophthalmological changes (for example, dilated retinal veins)
Neurological findings, and
Facial plethora ('ruddy' appearance).
Secondary causes of polycythaemia include erythropoietin-secreting tumours and causes of chronic hypoxia
Erythropoietin-secreting tumours:
Renal cell carcinoma Hepatocellular carcinoma Haemangioblastoma Uterine fibroids. Chronic hypoxia:
COPD Right-to-left cardiac shunts Sleep apnoea High altitude Chronic carbon monoxide poisoning (including heavy smoking).
TRALI
Fever
Hypoxia
von Willebrand’s disease
von Willebrand’s disease is associated with mucosal bleeding and abnormal bleeding time.
HHT
recent headaches, recurrent epistaxis, and an episode of haemoptysis with probable pulmonary haemorrhages on his chest XR. These findings are highly suggestive of hereditary haemorrhagic telangiectasia (HHT).
Other clues are punctiform oral lesions, a sister with a history of gastrointestinal bleeding in absence of abnormal clotting or thrombocytopenia.
There are two genetic types associated with mutations involving the endoglin gene on chromosome 9q and activin receptor-like kinase 1 located on 12q. HHT typically presents with epistaxis, and arteriovenous malformations of the brain and lung.
