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Haematology Flashcards

1
Q

How is anaemia defined?

A
  • lower than normal concentration of haemoglobin/RBCs
  • Hb <130 in men
  • Hb <120 in women
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2
Q

What are the different types of anaemia?

A
  • haemolytic = increased breakdown of RBCs
  • aplastic = decreased RBC, WBC, platelets
  • microcytic = reduced MCV
  • macrocytic = raised MCV
  • normocytic = normal MCV
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3
Q

What is MCV?

A

mean corpuscular volume
- average size of RBCs

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4
Q

General symptoms of anaemia

A
  • fatigue
  • headache
  • dizziness
  • dyspnoea esp on exertion
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5
Q

General signs of anaemia

A
  • tachycardia
  • skin pallor
  • conjunctiva pallor
  • intermittent claudication
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6
Q

What are signs of iron deficiency?

A
  • koilonychia = spoon-shaped nails
  • angular stomatitis
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7
Q

What are signs of B12 deficiency?

A
  • angular stomatitis
  • lemon-yellow skin
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8
Q

What are signs of haemolytic anaemia?

A
  • jaundice
  • dark urine
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9
Q

What are the causes of microcytic anaemia?

A
  • iron deficiency
  • anaemia of chronic disease
  • sickle cell
  • thalassemia
  • sideroblastic anaemia
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10
Q

Investigations for iron deficiency microcytic anaemia

A

FBC → low Hb/MCV

Iron studies

blood film → small, hypochromic cells

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11
Q

Causes of iron deficiency microcytic anaemia

A

reduced absorption

  • low intake
  • malabsorption
  • drugs eg PPIs and tetracyclines

increased utilisation → pregnancy

blood loss

  • stools
  • urine
  • trauma
  • surgery
  • menorrhagia
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12
Q

Investigations for chronic disease microcytic anaemia

A

FBC

  • low Hb
  • low/normal MCV
  • high ESR

Iron studies

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13
Q

Causes of chronic disease microcytic anaemia

A
  • chronic infection
  • chronic inflammation → connective tissue diseases
  • neoplasia
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14
Q

What is thalassemia?

A
  • inherited alpha or beta globin mutations
  • varied presentation
  • generally microcytic, hypochromic cells
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15
Q

What is sideroblastic anaemia?

A
  • iron levels normal
  • body cannot insert iron into Hb
  • microcytic
  • increased iron, transferrin, ferratin
  • ringed sideroblasts on blood film
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16
Q

Causes of normocytic anaemia

A
  • acute blood loss
  • bone marrow failure
  • pregnancy
  • haemolytic anaemia
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17
Q

Presentation of haemolytic anaemia

A
  • jaundice
  • dark urine
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18
Q

Investigations for haemolytic anaemia

A
  • raised reticulocytes (chronic)
  • raised bilirubin
  • raised urobilinogen
  • schistocytes on blood film
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19
Q

Causes of haemolytic anaemia

A
  • autoimmune
  • sepsis
  • DIC
  • sickle cell
  • thalassemia
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20
Q

What is the main cause of macrocytic anaemia?

A

B12 deficiency

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21
Q

Causes of B12 deficiency in macrocytic anaemia

A
  • pernicious anaemia
  • malabsorption → coeliac, IBD, bowel resection, ileostomy
  • decreased dietary intake
  • chronic NO use
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22
Q

Investigations for B12 deficiency in macrocytic anaemia

A

bloods

  • raised MCV
  • low Hb, B12
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23
Q

Signs and symptoms of B12 deficiency in macrocytic anaemia

A
  • general anaemia presentation
  • range of neurological symptoms

presents as megaloblastic anaemia

  • cell changes on blood smear
  • oval shaped RBCs
  • hypersegmented neutrophils
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24
Q

Causes of macrocytic anaemia

A
  • B12 deficiency
  • diseases of the liver and spleen
  • haematological malignancy
  • alcohol → chronic consumption affects bone marrow
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25
What is neutrophilia?
too many neutrophils causes - infection - inflammation - CML
26
What is neutropenia?
not enough neutrophils causes - Abs - chemo - marrow failure - liver disease
27
What is thrombocytosis?
too many platelets causes - infection - inflammation - tissue injury - splenectomy - essential thrombocythemia
28
What is thrombocytopenia?
not enough platelets causes - production failure → marrow failure, congenital - increased removal → ITP, TTP, DIC
29
What is lymphocytosis?
too many lymphocytes causes - EBV - cytomegalovirus - hepatitis - malignancy → CLL, ALL, lymphoma - stress
30
What is lymphocytopenia?
not enough lymphocytes causes - steroids - HIV - post viral - marrow failure - chemo
31
What is haemostasis?
process that stops bleeding primary haemostasis - initiation and formation of platelet plug - platelet activation secondary haemostasis - formation of fibrin clot - intrinsic and extrinsic coagulation cascade
32
What are the effects of platelet activation?
- platelet shape change - dense granule release - alpha granule release
33
Inheritance of sickle cell
- autosomal recessive - gene on Cr11 → glutamic acid substitution with valine → B-globin polymerisation
34
What is sickle cell disease
- sickled cells - endothelial damage - reduced O2 carrying capacity
35
Acute presentation of sickle cell (7)
- bone and joint pain - infection - dyspnoea - cough - hypoxia - stroke - sequestrian crisis → blood outflow from spleen is blocked → blood accumulates → splenomegaly
36
Risk factors of sickle cell
- low O2 - cold weather - parvovirus B19 - exertion
37
Chronic complications of sickle cell
- avascular necrosis of joints - silent CNS infarcts - retinopathy - nephropathy - ED
38
Investigations for sickle cell
- FBC → low MCV, Hb - blood smear → sickled erythrocytes - sickle solubility test → detects HbS → does not distinguish trait from disease - Hb electrophoresis → band of Hbs
39
Management of sickle cell
acute - morphine - O2 - IV fluids - transfusion exchange chronic - hydroxycarbamide → decreases DNA synthesis
40
What is HIV?
- human immunodeficiency virus - leads to AIDS - RNA retrovirus - virus enters and destroys CD4 T helper cells
41
How is HIV transmitted?
- unprotected anal, vaginal, oral sex - mother to child during pregnancy or breastfeeding → vertical transmission - exposure to blood or bodily fluids
42
What are AIDS-defining illnesses?
occur when CD4 count drops to level that allows unusual infections and malignancies to appear - Kaposi's sarcoma - PCP - cytomegalovirus - candidasis - lymphomas - TB
43
Who should be screened for HIV
- everyone admitted to hospital with an infectious disease should be tested - patients with risk factors - test initially then 3 months after exposure
44
Investigations for HIV
- antibody test - p24 antigen → quicker - PCR testing for HIV RNA gives viral load
45
Monitoring HIV
- CD4 count - viral load
46
Treatment for HIV
- antiretroviral therapy ART - aim is normal CD4 count and undetectable viral load
47
Natural progression of HIV
1. acute primary infection → acute seroconversion illness 2. asymptomatic phase 3. early symptomatic HIV 4. AIDS
48
Additional management of HIV
- if AIDS, prophylactic septrin to protect against PCP - monitor and reduce CVD risk - annual cervical smears for women - up to date vaccines, but avoid live vaccines
49
What is HAART?
- highly active ART - 2 nucleotide reverse transcriptase inhibitors and 1 non-nucloetide reverse transcriptase inhibitor - 2 NRTIs and 1 protease inhibitor
50
What is PEP?
- post exposure prophylaxis - must be started within 72 hours - combination of ART therapy for 28 days
51
What is PrEP?
- pre exposure prophylaxis - Take ART before exposure as prevention - highly effective
52
What is leukaemia?
cancer of the bone marrow 1. immature blast cells uncontrollably proliferate 2. take up space in bone marrow 3. then infiltrate into other tissues lack of space in bone marrow → fewer healthy cells can mature and be released into blood
53
What are the 4 types of leukaemia
- acute lymphoblastic - acute myeloid - chronic lymphoblastic - chronic myeloid
54
Features of ALL
- most common leukaemia in children → 0-4 - proliferation of immature lymphoblasts
55
Presentation of ALL
- general anaemia symptoms - bleeding/bruising - infections - hepatosplenomegaly - lymphadenopathy - CNS infiltration → headaches, CN palsies
56
Diagnosis of ALL
- FBC → anaemia, thrombocytopenia, neutropenia - blood film - bone marrow biopsy - CT/chest xray → lymphadenopathy lumbar puncture in cases of CNS involvement
57
Management of ALL
- blood/platelet transfusions - chemo → methotrexate - steroids - stem cell/bone marrow transplant - Abs
58
Features of AML
- mostly elderly - proliferation of immature myeloblasts
59
Presentation of AML
- general anaemia symptoms - bleeding/bruising - infections - hepatosplenomegaly - gum hypertrophy
60
Diagnosis of AML
- FBC → anaemia, thrombocytopnenia - blood film - bone marrow biopsy → auer rods
61
Management of AML
- blood and platelet transfusions - chemo - stem cell/bone marrow transplant - Abs
62
Features of CLL
- mostly 60+ - most common type of leukaemia in adults - proliferation of B lymphocytes
63
Presentation of CLL
- often asymptomatic - lymphadenopathy - may have night sweats and weight loss
64
Diagnosis of CLL
- FBC → anaemia, thrombocytopenia, leukocytosis - blood film → smudge cells - bone marrow biopsy
65
Management of CLL
- watch and wait in early stages - chemo → rituximab - stem cell/bone marrow transplant
66
Features of CML
- most common in 40+ - proliferation of myeloid blood cells - associated with philadelphia chromosome
67
Presentation of CML
- general anaemia symptoms - bleeding/bruising - infections - hepatosplenomegaly - weight loss, night sweats - gout
68
Diagnosis of CML
- FBC → anaemia, thrombocytopenia, leukocytosis - bone marrow biopsy - blood film - genetic testing
69
Management of CML
- chemo - stem cell/bone marrow transplant - tyrosine kinase inhibitors → imatinib
70
Features of hodgkin lymphoma
- proliferation of lymphocytes in lymph nodes - associated with EBV, immunosuppression - bimodal distribution → early 20s then 70s
71
Presentation of hodgkin lymphoma
- lymphadenopathy → painful upon drinking alcohol - B symptoms → fever, night sweats, weight loss
72
Diagnosis of hodgkin lymphoma
- ESR raised - CT/chest xray for staging - lymph node biopsy → Reed Sternberg cells
73
Management of hodgkin lymphoma
- ABVD chemo - radiotherapy - steroids - stem cell/bone marrow transplant
74
What is ABVD chemo?
- adriamycin - belomycin - vinblastine - decarbazine
75
Features of non-hodgkin lymphoma
- predominantly adults 40+ - associated with EBV, immunosuppression
76
Presentation of non-hodgkin lymphoma
- painless lymphadenopathy - B symptoms - can get hepatosplenomegaly
77
Diagnosis of non-hodgkin lymphoma
- CT/chest xray for staging - lymph node biopsy → no Reed sternberg
78
Management of non-hodgkin lymphoma
- RCHOP chemo - radiotherapy
79
What is RCHOP chemo?
- rituximab - cyclophosphamide - hydroxy-danorubicin - oncovin - prednisolone
80
What staging is used for lymphoma staging?
Ann Arbor staging
81
What is Ann Arbor staging
1. disease in only one area 2. disease in 2 or more areas on same side of diaphragm 3. disease in 2 or more areas on both sides of diaphragm 4. disease spread beyond lymph nodes
82
Features of multiple myeloma
- predominantly 40+ - close link to MGUS
83
What is MGUS
- monoclonal gammopathy of undetermined significance - too much immunoglobulin released by abnormal plasma cells - 1% develop into myeloma
84
Presentation of multiple myeloma
CRAB - calcium elevation → polydipsia - renal impairment - anaemia - bone lesions → bone pain
85
Diagnosis of multiple myeloma
- FBC → anaemia - ESR raised - blood film → Rouleaux formation - serum and urine electrophoresis → Bence Jones protein in urine - bone marrow biopsy - CT/xray → bone lesions
86
Management of multiple myeloma
- chemo - stem cell transplant - analgesia - bisphosphonates → zoledronic acid - blood transfusions
87
Common chemo combinations for multiple myeloma
- VCD - VTD - MTP

Phase 2a Green Conditions (10 decks)

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