Haematology Flashcards
AML poor prognostic factors (2)
> 60yo
20% blasts after first chemo
Translocation 15;17
Average age 25yo
Auer rods
Presents with thrombocytopenia/ DIC
=
Acute promyelocytic leukaemia
Antiphospholipid syndrome
Features (3)
Could be secondary to which condition?
Predisposition to:
1. Venous and arterial thrombus
2. Recurrent fetal aloss
3. Thrombocytopenia
SLE
Antiphospholipid syndrome
In pregnancy which complications may occur? (6)
Recurrent miscarriage
IUGR
PET
Abruption
Pre-term labour
VTE
Mx antiphospholipid syndrome in pregnancy (3)
Low dose aspirin once pregnancy confirmed
LMWH once FHR on US
Discontinue at K34
- Pancytopenia
- Hypoplastic bone marrow
- Could be the presenting feature of AML/ALL
- Normochromic, normocytic anaemia
- Lekopenia with lymphocytes spared
30yo
aplastic anaemia
Auto immune haemolytic anaemia classification
Which is more common?
Which antibody?
Extra/intravascular?
Warm - most common, IgG, extravascular e.g spleen
Cold - less common, IgM, intravascular
Features Raynaud’s, acrocyanosis
Causes of warm (3) and cold autoimmune haemolytic anaemia (2)
Which one response well to steroids?
Warm - underlying autoimmune condition e.g SLE, lymphoma, CLL
Steroids
Cold - lymphoma, EBV
Beta thalassemia trait
What type of anaemia?
What may be raised?
Hypochromic, microcytic anaemia
HbA2 raised
‘starry sky’ appearance: lymphocyte sheets interspersed with macrophages containing dead apoptotic tumour cells
Classification (2)
Burkitt’s lymphoma
1. Endemic (African) form - involves maxilla or mandible
2. Sporadic (most common) - common in pts with HIV
What is strongly implicated in the development of the endemic Burkitt’s lymphoma?
EBV
Tumour lysis syndrome signs (5)
AKI
Low calcium
High potassium, phosphate, uric acid
CLL complications (3)
Hypogammaglobulinaemia leading to recurrent infections
Warm autoimmune haemolytic anaemia
High grade lymphoma
What is Richter’s transformation?
Features (5)
Leukaemia turning into high grade Hodgkin’s lymphoma
- Lymph node swelling
- Fever without infection
- Weight loss
- Night sweats
- AP
CLL
Blood film
What will you seen on FBC?
Smudge cells
Anaemia
Lymphocytosis
Raynaud’s
Ulceration
Arthralgia
Glomerulonephritis
=
Can be caused by? (3)
C4 high or low
ESR high or low
Cryoglobulinaemia
HIV/ hep C/ lymphoma
C4 low
High ESR
Where would you see Howell Jolly bodies?
Asplenia
How to diagnose DVT
Wells score
If =>2 US within 4 hours
If +ve - DOAC
If -ve do a d-dimer
If scan -ve but d-dimer +ve stop DOAC and repeat scan in 1 week
If <2
D-dimer within 4 hours
If negative then likely alternative diagnosis
If positive then US within 4 hours
DVT length of anticoag
Provoked 3 months
Unprovoked 6 months total
Three DOACs direct factor Xa inhibitor
x1 direct thrombin inhibitor
Reversal drugs
Rivarox
Apix
Edox
Reversal: Andexanet
Dabigatran
Reversal: Idarucizumab
What is Fanconi anaemia? (5)
Aplastic anaemia
Increased risk of AML
Pancytopenia
Short stature
Cafe au lai spots
G6PD deficiency is most common in which patient group?
Inheritance?
X linked recessive
Mediterranean & AFrica
Features G6PD deficiency (4)
Blood film (2)
Neonatal jaundice
Intravascular haemolysis
Gall stones
Splenomegaly
Heinz bodies
Bite and blister cells
G6PD deficiency
Diagnosis
G6PD enzyme assay three months after an acute episode of haemolysis
Which drugs can precipitate haemolysis in G6PD defiency?
Primarquine
Cipro
Sulphonamides
Hereditary spherocytosis
Inheritance
Patient group
Features that make it different from G6PD deficiency(1)
AD
Northern European
Extravascular haemolysis
Primary immunodeficiency
Recurrent bacterial infections
Eczema
Thrombocytopenia
Low IgM levels
X linked recessive
Wiskott-Aldrich syndrome
Weight loss
Visual disturbance
Hepatosplenomegaly
Lymphadenopathy
Cryoglobulinameia e.g Raynaud’s
Waldenstrom’s macroglobulinaemia
Most common inherited bleeding disorder
Inheritance
Features (2)
Von Willebrand’s disease
AD
Epistaxis
Menorrhagia
Von Willebrand’s Ix (2)
Mx (3)
APTT prolonged
Factor VIII reduced
TXA
Desmopressin
Factor VIII concentrate
Rx essential thrombocytopenia (3)
Hydroxyurea
Interferon a
Low dose aspirin
Essential thrombocytosis features (3)
Burning sensation in the hands
Thrombosis and haemorrhage
Platelet count >600
Causes of splenomegaly (4)
Myelofibrosis
CML
Malaria
Visceral leishmaniasis
How often should sickle cell patients receive the pneumococcal vaccine?
Every 5 years
Secondary causes of polycythaemia (4)
COPD
Altitude
Obstructive sleep anoea
Excessive EPO
Secondary causes of polycythaemia (4)
COPD
Altitude
Obstructive sleep anoea
Excessive EPO
What is polycythaemia?
Mutation of what gene?
Overproduction of red blood cells
JAK2
Fatigue
Dizziness
Increased sweating
Redness in the face
Blurred vision
Itchiness after a hot shower
=
Polycythaemia rubra vera
Polycythaemia features (7)
Hyperviscosity
Pruritus
Splenomegaly
Haemorrhage
Plethoric appearance
HTN
Low ESR
Polycythaemia
Age
Mx (3)
60yo
Aspirin, venesection, chemo (hydroxyurea)
Polycythaemia can go on to develop which two diseases?
Myleofibrosis
Acute leukaemia
Haemophillia
Inheritance
A deficiency in factor?
B deficiency in factor?
Ix
X linked recessive
A - factor 8
B factor 9 deficiency
Prolonged APTT, all the rest normal
Reed-Steenberg cell
Age?
Hodgkin’s lymphoma
30yo and 70yo
Hodgkin’s lymphoma features (5)
Lymphadenopathy
Weight loss
Alcohol pain
Eosinophilia
LDH raised
Mx immune thrombocytopenia
PO prednisolone
IVIG
What is Evan’s syndrome?
ITP in association with autoimmune haemolytic anaemia
In IDA a
High TIBC/ transferrin =
Low iron stores
abdominal pain
peripheral neuropathy (mainly motor)
neuropsychiatric features
fatigue
constipation
blue lines on gum margin (only 20% of adult patients, very rare in children)
=
Lead poisoning
Lead poisoning investigations (3)
Blood film (2)
Lead levels >10
Microcytic anaemia
Raised serum and urine levels of aminolaevulinic acid
Blood film: basophillic stippling, clover leaf morphology
Mx lead poisoning (2)
Dimercaptosuccinic acid (DMSA)
D penicillamine
Causes of megaloblastic macrocytic anaemia (2)
B12 and folate
usually asymptomatic
no bone pain or increased risk of infections
around 10-30% of patients have a demyelinating neuropathy
paraprotinaemia
normal immune function
=
Monoclonal gammopathy of undetermined significance
Myeloma features (5)
Ix (3)
Bone pain
Hypercalcaemia
Renal failure
Lethargy
Infection
Monoclonal antibodies (bence jones proteins)
Whole body MR
XR rain drop skull
What is paroxysmal nocturnal haemoglobinuria?
Features (4)
Acquired disorder leading to haemolysis
More prone to venous thrombosis
Haemolytic anaemia
Pancytopenia
Haemoglobinuria (dark coloured urine in the morning)
Thrombosis (Budd Chiari syndrome)
