Haematology Flashcards
What is amyloid?
A degradation resistant protein
Aetiology of ALL?
Radiation
Smoking
Down’s syndrome
Immunodeficiency
Benzene
Unknown
Define the following types of anaemia
- Macrocytic
- Microcytic
- Normocytic
Macrocytic = cells larger than normal
Microcytic = cells smaller than normal
Normocyctic = cell size within normal range
Causes of iron deficiency
***always assume blood loss until proved otherwise*** - GI? Menstrual?
Pregnancy
Impaired absorption - coeliac or gastrectomy
2 main types of stem cell transplants?
Autologous & allogenic
Define autologous stem cell transplant
Stem cells obtained from the patient
Define allogenic stem cell transplant
Stem cells from a suitable donor
3 differentials to anaemia & how to differentiate between them.
Trauma
- History of trauma or use of NSAIDs
- Evidence of injury
Acute GI bleed
- History or GI bleeding, PUD, gastritis etc
- NSAID use
- Upper GI endoscopy & colonoscopy
Rupture of vascular aneurysm
- Sudden tearing pain, affecting the back, abdo or chest.
- History of hypertension, collagen disorders, trauma, cocaine or amphetamine use.
A 65-year-old woman presents with unilateral leg pain and swelling of 5 days’ duration. She has a history of hypertension, congestive heart failure, and recent hospitalisation for a total knee replacement. She had been recuperating at home but on beginning to walk, her right leg became painful, tender, and swollen. On examination there is pitting oedema on the right and the right calf is 4 cm greater in circumference than the left when measured 10 cm below the tibial tuberosity. Superficial veins on the right foot are more dilated than on the left and easily visible. The right leg is slightly redder than the left. There is tenderness on palpation in the popliteal fossa behind the right knee.
What diagnosis do you suspect?
What tests would you do?
DVT
D-dimer & ultrasound of the leg
A 65-year-old woman presents with unilateral leg pain and swelling of 5 days’ duration. She has a history of hypertension, congestive heart failure, and recent hospitalisation for a total knee replacement. She had been recuperating at home but on beginning to walk, her right leg became painful, tender, and swollen. On examination there is pitting oedema on the right and the right calf is 4 cm greater in circumference than the left when measured 10 cm below the tibial tuberosity. Superficial veins on the right foot are more dilated than on the left and easily visible. The right leg is slightly redder than the left. There is tenderness on palpation in the popliteal fossa behind the right knee.
You suspect DVT.
How can you rule out any differential diagnosis?
Rule out cellulitis with an ultrasound.
Also fever & prior history of cellulitis indicates cellulitis.
A 38-year-old man presents to his primary care physician complaining of generalised weakness, epistaxis, mouth ulcers, and weight loss. He has unremarkable past medical history and takes no medications. Physical examination reveals mild pallor and petechial haemorrhages over his lower limbs. He has multiple widespread small lymph nodes that are palpable, and mild splenomegaly.
What diagnoses do you suspect?
How can you narrow down your suspicions?
Suspect ALL & AML
Bone marrow aspirate - in ALL shows at least 20% lymphoblasts present in bone marrow
Aetiology of Non-Hodgkins lymphoma
Associated with viruses & bacteria
- EBV
- HCV
- Helicobacter pylori
How to differentiate between Non-Hodgkin’s & Hodgkin’s lymphoma
Lymph node biopsy
Reed-sternberd cells in Hodgkin’s
A 25-year-old man presents to his general practitioner with a slowly enlarging, painless right neck mass. He denies recent upper respiratory tract infections, fevers, night sweats, or unintentional weight loss. He is otherwise healthy. Social history and family history are unremarkable. On examination he is afebrile with normal vital signs. Pertinent findings include a 3-cm, firm, round, non-tender, mobile mass in the mid-right neck. There is no other peripheral lymphadenopathy. Liver and spleen are not enlarged.
What diagnosis do you suspect?
How can you confirm/refute this?
Hodgkin’s lymphoma
Lymph node biopsy will show Reed-Sternberg cells.
A 60-year-old previously healthy man presents with 2 to 3 months of back pain. Over the last 3 weeks, he has developed a cough and increasing fatigue. On examination he has evidence of pneumonia and osteolytic lesions on radiography. Laboratory data reveals anaemia associated with the presence of a monoclonal protein.
What diagnosis do you suspect?
What tests can you do to confirm this?
Multiple myeloma
Symptoms of bone pain & anaemia = most common presenting features.
Key diagnostic test:
- Serum & or urine electrophoresis - shows monoclonal component
- Bone marrow biopsy - shows verify monoclonal plasma cell presence. Differentiates from MGUS
