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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
Q

Acute Lymphoblastic Leukaemia (ALL)

A

neoplastic proliferation of immature lymphoid progenitor cells in the bone marrow, which leads to bone marrow failure and tissue infiltration.

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26
Q

Acute Lymphoblastic Leukaemia (ALL) Symptoms

A
  • Tired
  • Fever/Night sweats
  • Easy bruising/bleeding
  • Petechiae
  • Bone pain
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27
Q

Acute Lymphoblastic Leukaemia (ALL) Diagnosis

A

Bone marrow biopsy shows blast cells

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28
Q

Acute Lymphoblastic Leukaemia (ALL) Treatment

A

– Chemotherapy

– Bone marrow transplant

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29
Q

Acute Myeloid Leukaemia (AML)

A

proliferation of immature myeloid cells in the bone marrow.

Associations:
→ Downs Syndrome
→ Radiation

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30
Q

Acute Myeloid Leukaemia (AML) Symptoms

A
  • Fever, SOB
  • Easy bruising/ bleeding & gum hypertrophy
  • Petechiae
  • Weight loss
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31
Q

Acute Myeloid Leukaemia (AML) Diagnosis

A

– Bone marrow biopsy shows blast cells with Auer rods

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32
Q

Acute Myeloid Leukaemia (AML) Treatment

A
  • Blood transfusion
  • Allopurinol
  • IV antibiotics
  • Chemo
  • Bone marrow transplant
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33
Q

Chronic Lymphocytic Leukaemia (CLL) & Complication

A

neoplastic proliferation of malignant B cells which co-express CD5 and CD20.
accumulation of non-functional B cells

Complication: Richter’s syndrome

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34
Q

Chronic Lymphocytic Leukaemia (CLL) Symptom

A
  • Asymptomatic
  • Non- tender lymph node swelling
  • Sweating
  • Fever & Infection
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35
Q

Chronic Lymphocytic Leukaemia (CLL)

diagnosis

A

Blood film

– Shows smear/smudge cells

36
Q

Chronic Lymphocytic Leukaemia (CLL) Treatment

A

Chemo

Monoclonal Antibodies = Rituximab

Bruton kinase Inhibitors = Ibrutinib

37
Q

Chronic Myeloid Leukaemia (CML)

A

neoplastic proliferation of mature myeloid cells, such as basophils.
– Due to 9 ➔ 22 chromosome translocation (Philadelphia Chromosome)

38
Q

Chronic Myeloid Leukaemia (CML) Symptom

A

→ As ymptomatic

  • Tired
  • Weight loss
  • Night sweats
  • Fever
39
Q

Chronic Myeloid Leukaemia (CML) Diagnosis

A

Blood film
- Raised myeloid cells
– Shows many WBC at different stages of differentiation

40
Q

Chronic Myeloid Leukaemia (CML) Treatment

A

– 1st line is BCR-ABL tyrosine kinase inhibitor = Imatinib

– Bone marrow transplant

41
Q

Hodgkin Lymphoma (HL)

A

malignant proliferation of Reed-Sternberg (RS) cells.

42
Q

Hodgkin Lymphoma (HL) Symptoms

A
  • Painful lymph node swelling
  • Alcohol induced Pain
  • SOB, Pain
43
Q

Hodgkin Lymphoma (HL) Diagnosis

A

– Blood film with Reed Sternberg cells - diagnostic

– FBC = anaemia, high ESR

44
Q

Hodgkin Lymphoma (HL) Treatment

A

Chemotherapy : Adriamycin + Bleomycin + Vinblastine + Dacarbazine

Marrow transplant

45
Q

Hodgkin Lymphoma (HL) Staging

A

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
Q

Non-Hodgkin’s Lymphoma

A

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
Q

Non-Hodgkin’s Lymphoma Symptom

A

– Superficial lymphadenopathy

- fever, night sweats, weight loss

48
Q

Non-Hodgkin’s Lymphoma Diagnosis

A

Blood tests – FBC shows raised WCC, LDH, inflammatory markers
Biopsy of the lymph node

49
Q

Non-Hodgkin’s Lymphoma Treatment

A

– Chemotherapy and radiotherapy

– Surgery

50
Q

Polycythaemia

A

proliferation of RBCs

So increase in haematocrit, RBC count & Haemoglobin concen.

51
Q

Polycythaemia Symptoms

A
  • Headaches, blurry vision and dizziness + Hypertension
    – Itching after hot bath
    – Flushed face
    – Gum bleeds
52
Q

Polycythaemia Diagnosis

A

FBC shows increased hematocrit, raised cell mass + Mutation in JAK2

  • Low Serum Erythropoietin
53
Q

Polycythaemia Treatment

A

– 1st line is phlebotomy/ Plasmapheresis

– 2nd line is hydroxycarbamide

54
Q

Multiple Myeloma

A

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
Q

Multiple Myeloma Symptom

A

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
Q

Multiple Myeloma Diagnosis

A

– Blood –> FBC shows anaemia, Raised Urea/creatinine, Hypercalcaemia, Rouleaux

– Serum Protein Electrophoresis → Bence Jones Protein in urine

– Bone marrow biopsy –> raised plasma cells

57
Q

Multiple Myeloma treatment

A

Haematopoietic Stem Cell transplant

Non- chemo. meds = Thalidomide, Dexamethasone

Chemo. meds = Vincristine

58
Q

Haemophilia A

A

Genetic deficiency of Factor VIll

Inherited X- linked recessive

59
Q

Haemophilia A symptoms

A
  • Deep bruising, Swelling in Joints, Epistaxis
60
Q

Haemophilia A Diagnosis

A
  • Raised Activated Partial Thromboplastin Time & Low Factor VIll assay
  • Normal PT, thrombin time and platelet Count
61
Q

Haemophilia A Treatment

A
  • Desmopressin → raises Factor VIII levels

- Recombinant Factor VIll

62
Q

Haemophilia B

A

X- Linked recessive inherited bleeding disorder caused by mutation in Factor lX

63
Q

Haemophilia B Management

A

Recombinant Factor lX

64
Q

Von Willebrand Disease

A

Inherited cause of abnormal bleeding (haemophilia).

  • Autosomal dominant
  • Due to deficiency / absence of glycoprotein - Von Willebrand Factor
65
Q

Von Willebrand Presentation

A
  • Prolonged Bleeding gums when brushing
  • Nose bleeds (epistaxis)
  • Menorrhagia
  • Heavy bleeding during surgery
66
Q

Von Willebrand diagnosis

A
  • Bleeding assessment tools
  • lab investigations - VWF
  • history of abnormal bleeding
67
Q

Von Willebrand Treatment

A
  • 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
Q

HIV

A
  • RNA retrovirus
  • Virus enters & destroys CD4 T- helper cells
  • Spread through sexual activity, Pregnancy & blood/ body fluids
  • Presents with mouth sores & weight loss
69
Q

HIV testing

A
  • 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
Q

HIV Management

A
  • Antiretroviral Therapy
  • Nucleoside Reverse Transcriptase Inhibitor

Tenofovir & Emtricitabine

71
Q

Microcytic anaemia Causes

A

→ Iron Deficiency anaemia

→ Sideroblastic anaemia

→ Alpha & Beta Thalassaemia

72
Q

Macrocytic Anaemia causes

A

→ B12 / Folate deficiency

73
Q

Haemolytic Anaemia

A

Anaemia caused by destruction of red blood cells.

74
Q

Haemolytic Anaemia Causes

A

→ Glucose 6 Phosphate Deficiency

→ Sickle cell

75
Q

Glucose 6 Phosphate Deficiency Management

A

Blood transfusions

Oxygen therapy

76
Q

Pernicious Anaemia

A

Autoimmune condition caused by autoantibodies to Intrinsic Factors (made in parietal cells of stomach) → lack of Intrinsic Factor → B12 deficiency

77
Q

B12 deficiency Causes

A

→ Gastric causes - Pernicious anaemia

→ Zollinger - Ellison Syndrome

78
Q

Pernicious Anaemia Diagnosis

A

Blood tests:

  • Low Hb
  • High MCV
  • Large RBCs
  • Low B12
79
Q

Pernicious Anaemia Management

A
  • Cobalamin
80
Q

Aplastic Anaemia + Causes

A

Autosomal recessive, Pancytopenia with a hypocellular marrow.

Acquired Causes: Drugs (NSAIDs), Infection

Inherited Causes: Fanconi ‘s anaemia

81
Q

Aplastic Anaemia

A

Pancytopenia with a hypocellular marrow

82
Q

Aplastic Anaemia Diagnosis

A

Anaemia Hb <10 g/dL

Thrombocytopenia Platelets < 50

Neutropenia

83
Q

Aplastic Anaemia Symptoms

A
  • fatigue & Pallor
  • Infection
  • Easy bruising / bleeding
84
Q

Haemophilia B Symptoms & Diagnosis

A

Symptoms:
- Early life bleeding from soft tissues, joints & muscles.

Diagnosis:
Factor lX assay.

85
Q

Hodgekin Lymphoma Risk Factors

A
  • Epstein Barr Virus
  • HIV
  • Immunosuppression
  • Smoking
86
Q

Disseminated Intravascular Coagulation

Symptoms

Diagnosis

A

Inappropriate activation of Clotting cascade.

Sx = Excess bleeding, fever, Confusion

Ix = Thrombocytopenia, Increased Prothrombin time, Decreased Fibrinogen

87
Q

DIC Pathophysiology

A

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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