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Phase 2a Revision > Haematology > Flashcards

Haematology Flashcards

1
Q

Anaemia

A 
low haemoglobin (Hb) concentration, which can be either due to a reduced RBC mass or increased plasma volume 
 It is 130 - 180g/L for men and 120 - 160g/L for women
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2
Q

Microcytic + Normocytic + Macrocytic MCV Anaemia

A

microcytic (MCV < 83 microns)

normocytic (MCV 80-100 microns)

macrocytic (MCV > 100 microns).

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3
Q

Anaemia Symptoms

A

– Weakness, fatigue and dyspnea
– Pale conjunctiva
– Headaches + light headedness

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4
Q

Anaemia Diagnosis

A

– If microcytic –> do iron studies
– If macrocytic –> check blood film to distinguish megaloblastic and normoblastic anaemia.
– If normocytic –> look at the reticulocyte count.

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5
Q

Iron deficiency anaemia

A

microcytic anaemia which occurs due to increased loss of iron, reduced intake or malabsorption.

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6
Q

Iron deficiency anaemia causes

A

– Blood loss –> GI bleeding or menstruation

– Poor diet

– Malabsorption –> coeliac disease & IBD

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7
Q

Iron deficiency anaemia symptoms

A

– Subconjunctival Pallor

– Koilonychia (spoon-shaped nails) & Brittle nails

– Pica (disorder where you eat random stuff e.g. dirt)

-

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8
Q

Iron deficiency anaemia diagnosis

A

– Blood film shows microcytic, hypochromic RBCs

– Iron studies –> Low ferritin, high Total Binding Capacity

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9
Q

Iron deficiency anaemia Treatment

A
  • iron supplements, (ferrous sulphate)

- treat underlying cause

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10
Q

Glucose-6-phosphate dehydrogenase deficiency

A

X-linked recessive disorder which may present in babies with jaundice, or haemolysis following exposure to oxidative stressors

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11
Q

Glucose-6-phosphate dehydrogenase deficiency Cause

A

Sulphur-drugs/ NSAIDs

Deficiency of G6PD enzyme -> Less Glutathione -> no protection of RBCs in Oxidative stress -> makes Heinz bodies into bite cells

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12
Q

Glucose-6-phosphate dehydrogenase deficiency Symptom

A
  • Fatigue
  • Palpitations
  • SOB
  • Pallor

Made worse by fava beans

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13
Q

Glucose-6-phosphate dehydrogenase deficiency Diagnosis

A
  • G6PD enzyme assay

- Blood film shows Heinz bodies & Bite cells & Reticulocytes

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14
Q

Sickle Cell Anaemia

A

autosomal recessive mutation in the b-chain where a glutamate is replaced with valine.
– This leads to production of HbS rather than HbA

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15
Q

Sickle Cell Anaemia Symptoms

A
  • Sequestration
  • Acute chest syndrome - Tachypnoea, Wheeze with hypoxia
  • Vaso - occlusive crisis
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16
Q

Sickle Cell Anaemia Diagnosis

A

Hb electrophoresis
Blood Film - sickle cells
Sickle solubility test

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17
Q

Sickle Cell Anaemia Treatment

A
  • Oxygen
  • IV fluids
  • Analgesia
  • hydroxycarbamide
  • Prophylactic antibiotics
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18
Q

Immune Thrombocytopenic Purpura (ITP)

A

autoimmune production of antibodies directed against platelet antigens → less platelet’s

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19
Q

Immune Thrombocytopenic Purpura (ITP) Symptoms

A

– Purpura and Gum bleeding

– easy bruising

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20
Q

Immune Thrombocytopenic Purpura (ITP) Diagnosis

A

– Low platelet count + increased megakaryocytes on bone marrow biopsy

– Platelet autoantibodies

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21
Q

Immune Thrombocytopenic Purpura (ITP) Treatment

A

– 1st line corticosteroids - Prednisolone
- IV immunoglobin to raise platelet count

  • IV Azathioprine (immunosuppression)
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22
Q

Thrombotic Thrombocytopenic purpura (TTP)

A

condition which occurs due to a deficiency of the enzyme which usually cleaves vWF into monomers
– This leads to large, uncleaved vWF giving abnormal platelet adhesion, schistocytes

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23
Q

Thrombotic Thrombocytopenic purpura (TTP) Symptoms

A

– Haemolytic Anaemia
– Thrombocytopenia
– AKI
– Fever

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24
Q

Thrombotic Thrombocytopenic purpura (TTP) Treatment

A

Plasma exchange (removes antibodies) + Steroids

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25
Acute Lymphoblastic Leukaemia (ALL)
neoplastic proliferation of immature lymphoid progenitor cells in the bone marrow, which leads to bone marrow failure and tissue infiltration.
26
Acute Lymphoblastic Leukaemia (ALL) Symptoms
- Tired - Fever/Night sweats - Easy bruising/bleeding - Petechiae - Bone pain
27
Acute Lymphoblastic Leukaemia (ALL) Diagnosis
Bone marrow biopsy shows blast cells
28
Acute Lymphoblastic Leukaemia (ALL) Treatment
– Chemotherapy | – Bone marrow transplant
29
Acute Myeloid Leukaemia (AML)
proliferation of immature myeloid cells in the bone marrow. Associations: → Downs Syndrome → Radiation
30
Acute Myeloid Leukaemia (AML) Symptoms
- Fever, SOB - Easy bruising/ bleeding & gum hypertrophy - Petechiae - Weight loss
31
Acute Myeloid Leukaemia (AML) Diagnosis
– Bone marrow biopsy shows blast cells with Auer rods
32
Acute Myeloid Leukaemia (AML) Treatment
- Blood transfusion - Allopurinol - IV antibiotics - Chemo - Bone marrow transplant
33
Chronic Lymphocytic Leukaemia (CLL) & Complication
neoplastic proliferation of malignant B cells which co-express CD5 and CD20. accumulation of non-functional B cells Complication: Richter's syndrome
34
Chronic Lymphocytic Leukaemia (CLL) Symptom
- Asymptomatic - Non- tender lymph node swelling - Sweating - Fever & Infection
35
Chronic Lymphocytic Leukaemia (CLL) | diagnosis
Blood film | – Shows smear/smudge cells
36
Chronic Lymphocytic Leukaemia (CLL) Treatment
Chemo Monoclonal Antibodies = Rituximab Bruton kinase Inhibitors = Ibrutinib
37
Chronic Myeloid Leukaemia (CML)
neoplastic proliferation of mature myeloid cells, such as basophils. – Due to 9 ➔ 22 chromosome translocation (Philadelphia Chromosome)
38
Chronic Myeloid Leukaemia (CML) Symptom
→ As ymptomatic - Tired - Weight loss - Night sweats - Fever
39
Chronic Myeloid Leukaemia (CML) Diagnosis
Blood film - Raised myeloid cells – Shows many WBC at different stages of differentiation
40
Chronic Myeloid Leukaemia (CML) Treatment
– 1st line is BCR-ABL tyrosine kinase inhibitor = Imatinib | – Bone marrow transplant
41
Hodgkin Lymphoma (HL)
malignant proliferation of Reed-Sternberg (RS) cells.
42
Hodgkin Lymphoma (HL) Symptoms
- Painful lymph node swelling - Alcohol induced Pain - SOB, Pain
43
Hodgkin Lymphoma (HL) Diagnosis
– Blood film with Reed Sternberg cells - diagnostic – FBC = anaemia, high ESR
44
Hodgkin Lymphoma (HL) Treatment
Chemotherapy : Adriamycin + Bleomycin + Vinblastine + Dacarbazine Marrow transplant
45
Hodgkin Lymphoma (HL) Staging
Staging: 1 = singly lymph node 2 = >1 node on same side diaphragm 3 = nodes on both sides of diaphragm 4 = extra nodal site involvement
46
Non-Hodgkin’s Lymphoma
group of lymphomas without Reed-Sternberg cells Associated with viral or Bacterial infection: → Epstein Barr Virus with Burkitt's Lymphoma → Helicobacter Pylori → Hep.C
47
Non-Hodgkin’s Lymphoma Symptom
– Superficial lymphadenopathy | - fever, night sweats, weight loss
48
Non-Hodgkin’s Lymphoma Diagnosis
Blood tests – FBC shows raised WCC, LDH, inflammatory markers Biopsy of the lymph node
49
Non-Hodgkin’s Lymphoma Treatment
– Chemotherapy and radiotherapy | – Surgery
50
Polycythaemia
proliferation of RBCs So increase in haematocrit, RBC count & Haemoglobin concen.
51
Polycythaemia Symptoms
- Headaches, blurry vision and dizziness + Hypertension – Itching after hot bath – Flushed face – Gum bleeds
52
Polycythaemia Diagnosis
FBC shows increased hematocrit, raised cell mass + Mutation in JAK2 - Low Serum Erythropoietin
53
Polycythaemia Treatment
– 1st line is phlebotomy/ Plasmapheresis | – 2nd line is hydroxycarbamide
54
Multiple Myeloma
Plasma cell dyscrasia ``` due to abnormal clonal proliferation of plasma cells in the bone marrow Criteria: → Monoclonal Protein in serum/ urine → Lytic bone lesions → Excess plasma cells in bone marrow ```
55
Multiple Myeloma Symptom
C = (Hyper) Calcaemia - due to increased osteoclast - mediated bone resorption R = Renal impairment A = Anaemia - due to marrow infiltration by tumour B = Bone - Osteolytic lesions H = Hyperviscosity - headaches & thrombosis A = Amyloidosis I = Infections - (low lgG)
56
Multiple Myeloma Diagnosis
– Blood –> FBC shows anaemia, Raised Urea/creatinine, Hypercalcaemia, Rouleaux – Serum Protein Electrophoresis → Bence Jones Protein in urine – Bone marrow biopsy –> raised plasma cells
57
Multiple Myeloma treatment
Haematopoietic Stem Cell transplant Non- chemo. meds = Thalidomide, Dexamethasone Chemo. meds = Vincristine
58
Haemophilia A
Genetic deficiency of Factor VIll | Inherited X- linked recessive
59
Haemophilia A symptoms
- Deep bruising, Swelling in Joints, Epistaxis
60
Haemophilia A Diagnosis
- Raised Activated Partial Thromboplastin Time & Low Factor VIll assay - Normal PT, thrombin time and platelet Count
61
Haemophilia A Treatment
- Desmopressin → raises Factor VIII levels | - Recombinant Factor VIll
62
Haemophilia B
X- Linked recessive inherited bleeding disorder caused by mutation in Factor lX
63
Haemophilia B Management
Recombinant Factor lX
64
Von Willebrand Disease
Inherited cause of abnormal bleeding (haemophilia). - Autosomal dominant - Due to deficiency / absence of glycoprotein - Von Willebrand Factor
65
Von Willebrand Presentation
- Prolonged Bleeding gums when brushing - Nose bleeds (epistaxis) - Menorrhagia - Heavy bleeding during surgery
66
Von Willebrand diagnosis
- Bleeding assessment tools - lab investigations - VWF - history of abnormal bleeding
67
Von Willebrand Treatment
- Desmopressin → stimulates release of vWF - vWF infusion - Factor VIII → infused with plasma- derived vWF women with heavy periods can be managed by: → Tranexamic acid → Combined oral Contraceptive pill
68
HIV
- RNA retrovirus - Virus enters & destroys CD4 T- helper cells - Spread through sexual activity, Pregnancy & blood/ body fluids - Presents with mouth sores & weight loss
69
HIV testing
- Antibody testing → Screening for p24 antigen - PCR testing →test for no. of viral copies → viral load - CD4 count → lower the count = higher risk of infection
70
HIV Management
- Antiretroviral Therapy - Nucleoside Reverse Transcriptase Inhibitor Tenofovir & Emtricitabine
71
Microcytic anaemia Causes
→ Iron Deficiency anaemia → Sideroblastic anaemia → Alpha & Beta Thalassaemia
72
Macrocytic Anaemia causes
→ B12 / Folate deficiency
73
Haemolytic Anaemia
Anaemia caused by destruction of red blood cells.
74
Haemolytic Anaemia Causes
→ Glucose 6 Phosphate Deficiency → Sickle cell
75
Glucose 6 Phosphate Deficiency Management
Blood transfusions Oxygen therapy
76
Pernicious Anaemia
Autoimmune condition caused by autoantibodies to Intrinsic Factors (made in parietal cells of stomach) → lack of Intrinsic Factor → B12 deficiency
77
B12 deficiency Causes
→ Gastric causes - Pernicious anaemia → Zollinger - Ellison Syndrome
78
Pernicious Anaemia Diagnosis
Blood tests: - Low Hb - High MCV - Large RBCs - Low B12
79
Pernicious Anaemia Management
- Cobalamin
80
Aplastic Anaemia + Causes
Autosomal recessive, Pancytopenia with a hypocellular marrow. Acquired Causes: Drugs (NSAIDs), Infection Inherited Causes: Fanconi 's anaemia
81
Aplastic Anaemia
Pancytopenia with a hypocellular marrow
82
Aplastic Anaemia Diagnosis
Anaemia Hb <10 g/dL Thrombocytopenia Platelets < 50 Neutropenia
83
Aplastic Anaemia Symptoms
- fatigue & Pallor - Infection - Easy bruising / bleeding
84
Haemophilia B Symptoms & Diagnosis
Symptoms: - Early life bleeding from soft tissues, joints & muscles. Diagnosis: Factor lX assay.
85
Hodgekin Lymphoma Risk Factors
- Epstein Barr Virus - HIV - Immunosuppression - Smoking
86
Disseminated Intravascular Coagulation Symptoms Diagnosis
Inappropriate activation of Clotting cascade. Sx = Excess bleeding, fever, Confusion Ix = Thrombocytopenia, Increased Prothrombin time, Decreased Fibrinogen
87
DIC Pathophysiology
Tissue damage → Release of Tissue Factor → Clot form. & Consumption of Platelets & Coag. Factors → Tissue plasminogen Activator → Increased fibrinolysis → Increased bleeding

Phase 2a Revision (9 decks)

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