HAEMATOLOGY Flashcards
hypersegemented neutrophils
macrocytic anaemia - vitB12 or folate deficiency
management of vitB12 def anaemia
1g IM hydroxycobalamin 3 times a week for 2 weeks
then every 3 months
if dietary can give oral oxocobalamin daily
management for folate def anaemia
oral folic acid daily for 4 months
anaemia symptoms
neuro symptoms
lemon tinge/mild jaundice
typically middle-old age female
pernicious anaemia
pancytopenia normocytic normochromic anaemia thrombocytopenia leukopenia (anaemia symptoms, infections and bleeding)
aplastic anaemia
definitive investigation for aplastic anaemia
biopsy - empty marrow or dry tap
management of aplastic anemia
remove any toxinx/meds/cause
if under 50 = stem cell transplant
if over 50 = immunosuppression with cyclosporine and glucocorticoids
severe cases = blood transfusion and GCS factor
angina dyspnoea tachycardia jaundice splenomegaly gallbladder involvement \ ulcers
haemolytic anaemia
investigation for haemolytic anaemia
coombs test - positive
spherocytes on blood film
IgM = cold HA
IgG = warm HA
management of haemolytic anaemia
warm = steroid, immunosuppression and then splenectomy cold = no tx
if severe = plasmapheresis
anaemia, neonatal jaundice/dark urine, splenomegaly, gallstones, intravascular haemolysis/haemoglobinuria
triggered by broad bean consumption
G6PD deficiency
Investigations of G6PD def anaemia
diagnostic = G6PD enzyme assay
also heinz bodies and bite/blister cells on blood film
management of G6PD def anaemia
avoid triggers
crisis = rehydrate and blood transfusion
25yrs anaemia neutropenia thrombocytopenia splenomegaly bone pain
AML
management for AML
chemo
allogenic SCT
philadelphia chromosome 60-70yrs marked splenomegaly = abdo pain B symptoms and WBC at different stages of maturation
CML
management of CML
imatinib
(hydroxyurea, a-interferon and allogenic BM transplant)§
child, boy anaemia thrombocytopenia = brusing, bleeding or petechiae bone pain hepatosplenomegaly
ALL
management of ALL
chemotherapy +/- immunotherapy
adult with marked lymphadenopathy, B symptoms, bleeding and infections, anaemia
CLL
investigations for CLL
Immunophenotyping
smudge/smear cells on blood film
management of CLL
watchful waiting if caught early
immunochemotherapy
usually after injection/infection
can be in older females
bleeding
petechiae/purpura
ITP
management of ITP
prednisolone and IVIG
sometimes splenectomy
fever, raised creatinine, anaemia, neurological symptoms and thrombocytopenia
usually linked to ADAMTS13 deficiency
TTP
Investigations for TTP
ADAMTS13 IgG
management of TTP
daily plasma exchange
corticosteroids/rituximab
hypercalcemia, renal stones, anaemia, lytic lesions (on MRI)/ bence jones proteins (urine electrophoresis)
Multiple myeloma
management of multiple myeloma
induction therapy
dexamethasona and rituximab - SCT
associated with EBV or c-myc translocation
either presents with jaw swelling/pain
OR
abdo pain, distension or ascites
burkitt’s lymphoma
investigations for burkitt’s lymphoma
starry sky appearance - apoptotic cells in macrophages
management of burkitt’s lymphoma
chemotherapy
painless lymphadenopathy B symptoms alcohol consumption pain pruritus normocytic anaemia
hodgkin’s lymphoma
reed sternberg/owl shaped/multinucleate
hodgkin’s lymphoma
management of hodgkin’s lymphoma
immunochemotherapy
diagnostic Ix for hodgkin’s lymphoma
biopsy
prolonged bleeding time lowered factor 8 epistaxis menorrhagia prolonged PT/APTT
von willebrand’s disease
management of VWD
mild bleeding = tranexamic acid
desmopressin
factor 8
hemophilia A
factor 8 deficiency
hemophilia B
factor 9 deficiency
haemophilia C
factor 11 deficiency
haemarthrosis
haematomas
prolonged bleeding after surgery or trauma
haemophilia
management of haemophilia
IV infusion of desmopressin
and blood transfusion/correct coagulation factor deficiency
failure to thrive in first year of life
hepatoplenomegaly - swollen abdomen
microcytic anaemia
jaundice
thalassemia
target cells on blood film
high iron/ferritin/TIBC
thalassemia
management of thalassemia
repeated transfusion
SC infusion of deferoxamine
management of thrombocytopenia
stop anticoagulation with heparin
only transfuse if pt is haemorrhaging
hyperviscosity pruritus, typically after a hot bath splenomegaly haemorrhage (secondary to abnormal platelet function) plethoric appearance hypertension in a third of patients associated with JAK mutation
polycythemia vera
management of polycythemia vera
venesection first line
aspirin
chemotherapy - hydroxyurea
