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Phase 2a > Haematology > Flashcards

Haematology Flashcards

1
Q

What is microcytic anaemia?

A

Reduced MCV (<80)

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2
Q

What causes microcytic anaemia?

A

TAILS

Thalassemia/haemoglobinopathies
Anaemia of chronic disease
Iron deficiency anaemia
Lead poisoning 
Sideroblastic anaemia

Hookworm infection (low/middle income countries)

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3
Q

What is the most common cause of anaemia?

A

Iron deficiency

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4
Q

What causes iron deficiency anaemia?

A

Low iron intake

Iron loss

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5
Q

Give examples of low iron intake that can cause iron deficiency anaemia.

A

Malabsorption and vegan diet

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6
Q

Give examples of iron loss that can cause iron deficiency anaema.

A

Menorrhagia, GI bleed, hookworm

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7
Q

Where is iron absorbed?

A

Duodenum

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8
Q

How is iron deficiency anaemia treated?

A

Treat cause

Iron supplements - ferrous sulfate/ferrous gluconate

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9
Q

What are the signs of iron deficiency anaemia?

A 
Pale skin & mucous membranes
Tachycardia
Systolic flow murmur
Brittle hair/nails
Atrophic glossitis
Angular stomatitis
Koilonychia
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10
Q

What are the symptoms of iron deficiency anaemia?

A 
Fatigue
Lethargy
Dyspnoea
Palpitations
Syncope
Headache
Tinnitus
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11
Q

What is normocytic anaemia?

A

Normal MCV

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12
Q

What causes normocytic anaemia?

A 
Anaemia of chronic disease
Acute blood loss
Increased plasma volume (pregnancy, fluid overload)
Haemoglobinopathies
Aplastic anaemia
Haemolysis
Hypersplenism (destruction of RBCs)
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13
Q

What is macrocytic anaemia?

A

Increased MCV

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14
Q

What causes macrocytic anaemia?

A 
B12/folate deficiency
Toxins (alcohol, chemo)
Liver disease
Reticulocytosis
Pregnancy
Myeloma
Hypothyroidism
Myelodysplastic syndrome
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15
Q

What causes folate deficiency?

A

Low intake
Malabsorption
Pregnancy
Drugs

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16
Q

Who is at risk of folate deficiency?

A

Elderly, poverty, alcohol excess

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17
Q

What drugs can cause folate deficiency?

A

Trimethoprim, phenytoin, methotrexate

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18
Q

How does folate deficiency anaemia present?

A

Same as other anaemias

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19
Q

How do you investigate folate deficiency?

A

FBC
Blood film
Red cell folate

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20
Q

What does a blood film show for folate deficiency anaemia?

A

Macrocytic megaloblastic anaemia

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21
Q

What does red cell folate show for folate anaemia?

A

<160ug/ml

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22
Q

How do you treat folate deficiency anaemia?

A

Treat underlying cause

Folic acid supplement if certain of cause

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23
Q

Why should you be cautious of prescribing folic acid supplements for folate deficiency?

A

Can aggravate neuropathy associated with B12 deficiency

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24
Q

What causes pernicious anaemia?

A

Lack of intrinsic factor usually produced by parietal cells in the stomach which allow B12 absorption in the terminal ileum

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25
Q

What is the pathology of pernicious anaemia?

A

B12 and folate needed for DNA synthesis - RBC development arrested - large immature megaloblastic cells

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26
Q

How does pernicious anaemia present?

A

Same as other anaemias + neuropathy, depression and psychosis

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27
Q

How do you investigate pernicious anaemia?

A

FBC
Blood film
Serum antibodies - IF/parietal cell antibodies
Serum B12 <50ng/L

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28
Q

How do you manage pernicious anaemia?

A

B12 IM/PO (hydroxocobalamin)

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29
Q

What is sickle cell anaemia?

A

Inherited mutation of HbS leading to sickling of RBCs

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30
Q

What is the epidemiology of sickle cell disease?

A

More common in Afro-Carribeans

31
Q

How is sickle cell disease inherited?

A

Autosomal recessive - 50% chance of being a carrier

32
Q

What is the pathology of sickle cell disease?

A

Mutation of B globin (HbS)
Under stress this polymerises
RBCs become rigid and sickle shaped
Leads to intravascular haemolysis - obstruction of microcirculation - infarction

33
Q

How does sickle cell anaemia present?

A 
Anaemia symptoms (lethargy, syncope)
Pain in hands and feet
Jaundice
Acute chest syndrome
Dactylitis
Stroke
Priapism
Nocturnal enuresis
Thrombosis - ulcers/vascular necrosis
34
Q

What are the key presentations of sickle cell anaemia?

A

Chest crisis
Sickle cell crisis
Splenic infarction/sequestration (main cause of death in children)

35
Q

What is chest crisis in sickle cell anaemia?

A

Pulmonary infiltrate/infarct/infection - main cause of death in adults = PHTN/chronic lung disease

36
Q

What is sickle cell crisis?

A

Acute bone pain

37
Q

How do you investigate sickle cell disease?

A

FBC
Blood film
Hb electrophoresis
Heel prick test

38
Q

What is the supportive management of sickle cell disease?

A

Folic acid
Analgesia (start with opiates)
Abx
Fluids

39
Q

What is the disease modifying therapy for sickle cell disease?

A

Hydroxycarbamide (increase HbF)
Transfusion
Stem cell transplant

40
Q

What is the hyposplenic treatment for sickle cell disease?

A

Prophylactic abx

Vaccinations

41
Q

What are complications of sickle cell disease?

A

Mesenteric ischaemia
Renal impairment
Pulmonary HTN
Joint damage

42
Q

What causes malaria?

A 
Protozoa
P. falcirum
P. vivax
P. ovale
P. malariae

Vector = female mosquito

43
Q

What are the risk factors for malaria?

A 
Poor
Young
Pregnant
Elderly
Recent travel abroad
44
Q

How does malaria present?

A 
Fever
Chills
Rigors
Cough
Myalgia
Splenomegaly
Hepatomegaly
Jaundice
45
Q

How is malaria investigated?

A 
Travel history - where, when, stopovers
Thick and thin blood film
Diagnostic tests for plasmodium antigens
Pregnancy test
Rule out meningitis
46
Q

How is falciparum malaria managed?

A

Quinine sulfate/IV quinine dihydrochloride

47
Q

How is non-falciparum malaria managed?

A

Chloroquine

48
Q

How is malaria prevented?

A

Chemoprophylaxis
Nets
Long clothes

49
Q

What is polycythaemia?

A

Increase in Hb, packed cell volume and RBCs

50
Q

What causes primary polycythaemia?

A

Increased sensitivity to EPO
JAK2 mutation
EPO receptor gene mutation

51
Q

What causes secondary polycythaemia?

A

Increased EPO
Chronic hypoxia
EPO producing tumour
High altitude

52
Q

What is the pathology of polycythaemia?

A

Impaired blood flow due to sludging

Haemostat mechanisms disrupted

53
Q

How does polycythaemia present?

A 
Red face
Hepatosplenomegaly (PRV only)
Easy bleeding/bruising
Fatigue
Dizziness
Headache
Sweating
Pruritus
Thrombosis
54
Q

How is polycythaemia investigated?

A

FBC - raised Hb
Secondary polycythaemia - low EPO
BM biopsy - hypercellularity
Testing for JAK2 gene

55
Q

How do you manage polycythaemia?

A 
Venesection (400-500ml removed)
Aspirin
Treat cause if secondary
Hydroxyurea
Splenectomy if required
Monitor haematocrit
56
Q

What are the complications of polycythaemia?

A

Thrombosis

Can transform into myelofibrosis or AML

57
Q

What do lymphoid stem cells become?

A

T and B cells

58
Q

What do myeloid stem cells become?

A 
Erythrocytes
Platelets
Mast cells
Eosinophils
Neutrophils
Basophils
etc.
59
Q

What is leukaemia?

A

Cancer of blood cells in bone marrow

60
Q

What are the symptoms of leukaemia?

A 
Fatigue
Night sweats
Weight loss
Bleeding/bruising
Pain or swelling in abdomen
61
Q

What are the features of chronic myeloid leukaemia?

A

Rare in children
Philadelphia chromosome
Blood smear resembles bone marrow aspirate
Affects one or all three of erythroid, platelet and myeloid cell lines
Chronic > accelerated > blast crisis
Tyrosine kinase inhibitors +/- stem cell transplant

62
Q

What are the features of acute myeloid leukaemia?

A 
Most common adult leukaemia
Exposure to chemo/benzene
Gum hypertrophy
Auer rods in blast cells
Chemo +/- stem cell transplant
63
Q

Who does chronic lymphocytic leukaemia typically affect?

A

Older people

64
Q

What are the symptoms of acute lymphoid leukaemia (ALL)?

A

Bruising, bleeding, fatigue, malaise

65
Q

What is myeloma?

A

Malignancy of plasma cells

66
Q

What causes myeloma?

A

Non-malignant > pre-malignant (smouldering) > malignant

67
Q

How does myeloma present?

A

CRAB

Calcium
Renal
Anaemia
Bone

68
Q

How does myeloma present (calcium)?

A

Hypercalcaemia - confusion

69
Q

How does myeloma present (renal)?

A

Nephrotic syndrome

Renal failure

70
Q

How does myeloma present (anaemia)?

A

Thrombocytopoenia - bleeding

Leukopenia - infections

71
Q

How does myeloma present (bone)?

A

Spinal cord compression

Osteolytic lesions - fractures and bone pain

72
Q

How is myeloma investigated?

A

FBC (low WBC, RBC, platelets)
U+Es (high Ca2+)
Serum protein electrophoresis - paraprotein
Urine protein electrophoresis - Bence Jones protein
X-ray
MRI

73
Q

What is the gold standard investigation for myeloma?

A

Bone marrow biopsy

Immunofixation of serum and urine - paraprotein

74
Q

How is myeloma managed in older patients?

A

Chemo

Phase 2a (25 decks)

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