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Year 3 Haem > Haematology > Flashcards

Haematology Flashcards

1
Q

What does APTT measure?

A

Time taken for a blood clot as a function of the intrinsic and common pathways

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2
Q

What causes Haemophilia A?

A

Factor VIII deficiency

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3
Q

What causes Haemophilia B?

A

Factor IX deficency

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4
Q

What factors deficiencies will prolong APTT?

A

I, II, V, VIII, IX, XII

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5
Q

What does PT measure?

A

Time taken for blood to clot as a function on the extrinsic and common pathways

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6
Q

What would PT and APTT results be for Haemophilia A and B?

A

APTT prolonged

Normal PT

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7
Q

Which lymphomas are associated with EBV?

A

Hodgkin
Burkitt
AIDS-associated

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8
Q

What is Lymhoma?

A

Tumour derived from lymphocytes
Can be Hodgkin or non-Hodgkin
NHL has many subtypes

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9
Q

What are symptoms of lymphoma?

A

FLAWS
Lymphadenopathy
Pruritus
Fatigue

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10
Q

What causes chronic myeloid leukaemia?

A

Chromosomal translocation

Produces a fusion protein

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11
Q

What is the main use of anti-coagulants?

A

Prevent thrombus formation
(thrombus comprising of fibrin web, platelets and RBCs)
Mainly venous

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12
Q

What class of drug is Warfarin?

A

Vitamin K antagonist

Affect reversible by giving Vit K (phytomenadione)

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13
Q

What drug is more appropriate for arterial occlusion?

A

Aspirin

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14
Q

What needs to be monitored in patients on warfarin?

A

INR

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15
Q

What is the main adverse effect of oral anticoagulants?

A

Haemorrhage

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16
Q

What are some DOACs?

A

Apixaban
Rivaroxiban
Used in prevention of strokes in AF and 2ry prevention of DVT/PE

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17
Q

What is the advantages of DOACs?

A

Do not need to be monitored

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18
Q

What can reverse apixaban/rivaroxiban?

A

Andexanet alfa

Used for uncontrolled/life threatening bleeding

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19
Q

When must a patient taking Warfarin inform their GP for possible dose adjustment?

A

symptoms of, or confirmed, COVID-19 infection

are otherwise unwell with sickness or diarrhoea, or have lost their appetite

changes to diet, smoking, or alcohol

taking any new medicines or supplements;
are unable to attend their next scheduled blood test

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20
Q

What does anti-platelet therapy do?

A

Decreased platelet aggregation and inhibits thrombus formation in the arterial circulation

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21
Q

What are some anti-platelet therapies?

A

Asprin

Clopidogrel

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22
Q

What are the main indications for anti-platelets?

A

Prevention of atherothrombotic events
Prevention of cardiovascular events for high risk
Prior to PCI

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23
Q

What is 1st line anti-platelet for ACS?

A

Lifelong Asprin and 12 months ticagrelor

Same for PCI

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24
Q

What is 1st line anti-platelet for TIA, Ischaemic stroke and PAD?

A

Clopidogrel

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25
Q

What score is used to calculate risk of bleeding?

A

HAS-BLED

26
Q

What score is used to AF stroke risk?

A

CHA2DS2VASc

CHF
HTN
>75 years 
DM
Stroke
Vascular 
Age 65-74
Sex (female)
27
Q

What CHA2DS2VASc score suggests oral anticoagulation?

A

> 2

28
Q

What HAS-BLED score suggests oral anticoagulation?

A

> 3

29
Q

What is disseminated intravascular coagulation?

A

Dysregulation of coagulation and fibrinolysis
Results in widespread clotting and resultant bleeding
Mediated by Tissue Factor

30
Q

What are causes of DIC?

A

sepsis
trauma
obstetric complications
malignancy

31
Q

What would blood look like in DIC?

A 
↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products
schistocytes (haemolytic anaemia)
32
Q

What would blood looks like on a patient taking warfarin?

A

PT prolonged
APTT normal
Platelet count normal

33
Q

What would blood looks like on a patient taking asprin?

A

PT normal
APTT normal
Bleeding time prolonged
Platelet count normal

34
Q

What are some presenting features of DIC?

A 
Petechiae 
Haematuria
Epistaxis
Gangrene
Mental disorientation
35
Q

What investigations should be done in DIC?

A 
Platelet count
PT
Fibrinogen
D-dimer
APTT
36
Q

What is the treatment for DIC?

A

Treat underlying cause
If high bleeding risk or active bleeding:
Platelet transfusion
FFP for coagulation factors
If chronic:
Heparin
Antifibrinolytic agents e.g. tranexeamic acid

37
Q

What can produce lower than expected HbA1c?

A

Sickle cell
GP6D deficiency
Hereditary spherocytosis
(decreased red cell lifespan)

38
Q

What can produce higher than expected HbA1c?

A

Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
(increased red cell lifespan)

39
Q

Why is CO poisoning dangerous?

A

High affinity for haemoglobin
Left-shit of O2 dissociation curve
Tissue hypoxia

Pulse Ox might be falsely high

40
Q

What is ferritin?

A

Intracellular protein that binds iron and stores it

41
Q

What are some myeloproliferative disorders?

A

CML
Polycythaemia vera
Essential Thrombocythaemia
Primary myelofibrosis

42
Q

What are myeloproliferative disorders?

A

Rare disorders of the bone marrow that cause an increase in the number of blood cells

43
Q

What are some symptoms of MPDs?

A 
asympto 
headaches
tiredness
bruising or unusual bleeding
blurred vision
ringing in your ears
getting more infections than usual
44
Q

What is essential thrombocytosis?

A

myeloproliferative disorder associated with an increase in number and size of circulating platelets

45
Q

What would investigations show in essential thrombocytosis?

A

Platelet count >450x10^9/L
Large platelets seen on peripheral blood smear
Howell-Jolly bodies

46
Q

What is the treatment for essential thrombocytosis if thrombosis or bleeding are evident?

A

Plateletpheresis

Removing blood, separating it, removing platelets before returning

47
Q

What is pancytopenia?

A

reduction in the number of red blood cells, white blood cells, and platelets

48
Q

What are some differentials for pancytopenia?

A 
Chemo
Radio
B12 def
Folic acid def
Non-hodgkins
49
Q

What are the three categories of polycythaemia?

A

Relative

  • dehydration
  • stress

Primary
- vera

Secondary

  • COPD
  • altitude
  • OSA
  • excess erythropoietin
50
Q

What is Polycythaemia vera?

A

myeloproliferative disorder caused by clonal proliferation of a marrow stem cell leading to an increase in red cell volume

51
Q

What re the presenting features of polycythaemia vera?

A 
hyperviscosity
pruritus, typically after a hot bath
splenomegaly
haemorrhage (secondary to abnormal platelet function)
plethoric appearance
hypertension in a third of patients
low ESR
52
Q

What investigations are done for polycythaemia vera?

A

full blood count/film (raised haematocrit; neutrophils, basophils, platelets raised in half of patients)
JAK2 mutation
serum ferritin
renal and liver function tests

53
Q

What is the diagnostic criteria for polycythaemia vera?

A 
If JAK2 mutation present: 
High haematocrit (>0.52 in men, >0.48 in women) OR raised red cell mass

No JAK2 mutation:
Raised red cell mass (>25% above predicted) OR haematocrit >0.60 in men, >0.56 in women

+ Splenomegaly/Thrombocytosis etc.

54
Q

How is polycythemia vera managed?

A

Asprin
Phlebotomy
Cytoreductive therapy (Chemo)

55
Q

What is ecchymosis?

A

Bruise

56
Q

What are some differentials for easy bruising?

A 
Anticoagulant use, NSAIDs, corticosteroids
Heavy alcohol use
Drug induced thrombocytopenia
Von Willebrand disease
Cushings
Abuse
Bone marrow malignancy
57
Q

What are some causes of splenomegaly?

A 
Myelofibrosis
CML
Malaria
Haemolytic anaemia
Infection e.g. hepatitis, EBV
Sickle cell but can also be atrophied
Infective endocarditis
RA
58
Q

What are common causes of hepatomegaly?

A

Cirrhosis
Malignancy
Right sided HF

59
Q

What is a petechial rash?

A

Red or purple non-blanching macules smaller than 2 mm in diameter

60
Q

What is a purpuric rash?

A

spots larger than 2 mm in diameter

non-blanching

61
Q

What might purpura indicate?

A

Meningococcal sepsis
Acute Leukaemia
Von Willebrand disease
Immune thrombocytopenic purpura

Year 3 Haem (7 decks)

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