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Medicine Specialities > Haematology > Flashcards

Haematology Flashcards

1
Q

B lymphocytes can become

A

plasma cells or memory B cells

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2
Q

T lymphocytes can become

A

CD4 (T helper cells)
CD8 (cytotoxic T cells)
natural killer cells

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3
Q

define anisocytosis and when it is seen

A

variation in size of red blood cells
…myelodysplastic syndrome

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4
Q

when are target cellls seen on a blood film?

A

iron defiency anaemia
post splenectomy

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5
Q

what are heinz bodies and when are they seen?

A

individual blobs seen inside red blood cells caused by denatured globin
in G6PD and alpha thalassaemia

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6
Q

what are howell jolly bodies and when are they seen?

A

individual blobs of DNA inside red cells which is normally removed by spleen
in post splenectomy and severe anaemia

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7
Q

what are reticulocytes and when are they seen?

A

immatured red cells, slightly larger than standard erythrocytes and still have RNA material
seen in haemolytic anaemia

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8
Q

what are schistocytes and when are they seen?

A

fragments of red cells
caused by haemolytic uraemic syndrome, DIC

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9
Q

what are sideroblasts and when are they seen?

A

red cells that contain blobs of iron, in myelodysplastic syndrome

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10
Q

what are smudge cells and when are they seen?

A

ruptured white cells
in chronic lymphocytic leukaemia

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11
Q

what are spherocytes and when are they seen?

A

spherical red cells
autoimmune haemolytic anaemia

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12
Q

what are the causes of microcytic anaemias?

A

T – Thalassaemia
A – Anaemia of chronic disease
I – Iron deficiency anaemia
L – Lead poisoning
S – Sideroblastic anaemia

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13
Q

what are the causes of normocytic anaemia?

A

A – Acute blood loss
A – Anaemia of Chronic Disease
A – Aplastic Anaemia
H – Haemolytic Anaemia
H – Hypothyroidism

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14
Q

what are the causes of macrocytic anaemias?

A

megaloblastic (impaired DNA synthesis) - B12 defiency, folate deficiency
normoblastic macrocytic - alcohol, reticulocytosis, hypothyroidism, liver disease, azathioprine

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15
Q

what are the sx and signs of anaemia?

A

Tiredness
Shortness of breath
Headaches
Dizziness
Palpitations
Worsening of other conditions such as angina, heart failure or peripheral vascular disease

Pale skin
Conjunctival pallor
Tachycardia
Raised respiratory rate

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16
Q

what are two specific signs of iron def anaemia?

A

Pica describes dietary cravings for abnormal things such as dirt and can signify iron deficiency
Hair loss can indicate iron deficiency anaemia
koilonychia
angular chelitis
atrophic glossitis

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17
Q

what is a specific sign seen in haemolytic anaemia?

A

jaundice

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18
Q

what is a specific sign seen in thalassaemia?

A

bone deformities

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19
Q

how is anaemia investigated?

A

Haemoglobin
Mean Cell Volume (MCV)
B12
Folate
Ferritin
Blood film
OGD
bone marrow biopsy

20
Q

what is the physiology behind iron absorption?

A

iron is mainly absorbed in duodenum and jerjenum in soluble form, Fe2+ (this requires acid to keep in this form - so PPI can interfere)

21
Q

what are some causes of iron deficiency anaemia?

A

Blood loss is the most common cause in adults - menorrhagia, GI cancer, oesophagitis, gastritis, IBD
Dietary Insufficiency is the most common cause in growing children
Poor iron absorption
Increased requirements during pregnancy

22
Q

how do blood results change in iron def anaemia?

A

Total iron binding capacity can be used as a marker for how much transferrin is in the blood. It is an easier test to perform than measuring transferrin. Both TIBC and transferrin levels increase in iron deficiency and decrease in iron overload

23
Q

how is iron def anaemia treated?

A

Blood transfusion. This will immediately correct the anaemia but not the underlying iron deficiency and also carries risks.
Iron infusion e.g. “cosmofer”. There is a very small risk of anaphylaxis but it quickly corrects the iron deficiency. It should be avoided during sepsis as iron “feeds” bacteria.
Oral iron e.g. ferrous sulfate 200mg three times daily. This slowly corrects the iron deficiency. Oral iron causes constipation and black coloured stools. It is unsuitable where malabsorption is the cause of the anaemia.

24
Q

B12 defiency can be caused by

A

insufficient dietary intake of vit B12
pernicious anaemia

25
Q

what is the pathology behind pernicious anaemia?

A

Paritetal cells of stomach produce intrinsic factor - essential for absorption of vit B12 il ileum. Pernicious anaemia is an autoimmune condition where antibodies form against the parietal cells or intrinsic factor. A lack of intrinsic factor prevents the absorption of vitamin B12

26
Q

what are the sx of pernicious anaemia?

A

vit b 12 defiency causes neurological sx - numbness, paraesthesia
loss of vibration sense or proprioception
visual changes
mood changes

27
Q

how is pernicious anaemia diagnsoed?

A

test for intrinsic factor antibody

28
Q

how is pernicious anaemia managed?

A

dietary (lack of b12) - oral cyanocobalamin
if severe (pernicious anaemia is cause)- IM hydroxycobalamin

29
Q

what are the inherited haemolytic anaemias?

A

Hereditary Spherocytosis
Hereditary Elliptocytosis
Thalassaemia
Sickle Cell Anaemia
G6PD Deficiency

30
Q

what are the acquired haemolytic anaemias?

A

Autoimmune haemolytic anaemia
Alloimmune haemolytic anaemia (transfusions reactions and haemolytic disease of newborn)
Paroxysmal nocturnal haemoglobinuria
Microangiopathic haemolytic anaemia
Prosthetic valve related haemolysis

31
Q

what are some clincial fx of sickle cell anaemia?

A

good periods, and crisis
crisis include thrombotic, ‘painful crises’ (vaso occlusive)
sequestration
acute chest syndrome
aplastic
haemolytic
…provide supportive treatment

32
Q

what are the clinical fx of polycythaemia vera?

A

The presence of increased haemoglobin, a plethoric appearance (red appearance), splenomegaly, and pruritus suggest a diagnosis of PV, a myeloproliferative disorder.

33
Q

how is suspected haemotological malignancy managed in young people?

A

Any of the following features in a person aged 0-24 years should prompt a very urgent full blood count (within 48 hours) to investigate for leukaemia:
Pallor
Persistent fatigue
Unexplained fever
Unexplained persistent infections
Generalised lymphadenopathy
Persistent or unexplained bone pain
Unexplained bruising
Unexplained bleeding

34
Q

what type of hodgkin lymphomas had the best prognosis?

A

Hodgkin’s lymphoma - best prognosis = lymphocyte predominant

35
Q

haemolysis blood results

A

Anaemia with reticulocytosis is suggestive of haemolysis or bleeding. The markedly raised bilirubin with otherwise normal LFTs is more in keeping with haemolysis, however, it is important to remember that haemorrhage can also result in increased bilirubin levels. Haemolysis results in the release of free haemoglobin. Haptoglobin is produced in the liver, and its primary function is to bind to free haemoglobin. Therefore low haptoglobins is a key feature of haemolysis

36
Q

chronic myeloid leukaemia

A

This patient has chronic myeloid leukaemia (CML), a haematological malignancy that affects older adults (60-70 years) and presents with progressive anaemia, weight loss and night sweats. Splenomegaly is common on examination and laboratory tests demonstrate an increase in granulocyte levels at different stages of maturation. Leucocyte alkaline phosphatase is decreased in CML. This patient is presenting with similar symptoms of lethargy, weight loss, night sweats and splenomegaly. His blood tests also demonstrate a leucocytosis that is predominantly of the myeloid lineage. The treatment of choice for CML is imatinib, a tyrosine kinase inhibitor, preventing further downstream cell division.

37
Q

hyposplenism

A

Target cells and Howell-Jolly bodies may be seen in coeliac disease → hyposplenism

38
Q

haemophilia

A

Haemophilia is an X-linked recessive disorder of coagulation. Up to 30% of patients have no family history of the condition. Haemophilia A is due to a deficiency of factor VIII whilst in haemophilia B (Christmas disease) there is a lack of factor IX
- prolonged APTT

39
Q

define myelodysplastic syndrome

A

acquired neoplastic disorder of hematopoietic stem cells
pre-leukaemia, may progress to AML

more common with age
presents with bone marrow failure (low Hb, neutropaenia, thrombocytopenia)

40
Q

define myelofibrosis

A

a myeloproliferative disorder
- hyperplasia of abnormal megakaryocytes

Features
e.g. elderly person with symptoms of anaemia e.g. fatigue (the most common presenting symptom)
massive splenomegaly
hypermetabolic symptoms: weight loss, night sweats etc

Laboratory findings-
anaemia
high WBC and platelet count early in the disease

41
Q

define polcythaemia vera

A

myeloproliferative disorder caused by clonal proliferation of a marrow stem cell leading to an increase in red cell volume, often accompanied by overproduction of neutrophils and platelets.
related to mutation in JAK2 is present in approximately 95% of patients

Features-
pruritus, typically after a hot bath
splenomegaly
hypertension
hyperviscosity
arterial thrombosis
venous thrombosis
haemorrhage (secondary to abnormal platelet function)
low ESR

42
Q

what is the management for a chest crisis experienced by a sickle cell patient?

A

Exchange transfusions are a way of reducing the number of sickle red cells and increasing the number of normal red cells, in order to improve oxygenation

43
Q

what are the clinical fx of chronic myeloid leukaemia and the tx?

A

chronic myeloid leukaemia (CML), indicated by the high white cell count which is due to high numbers of myeloid cells and the chronic nature of the presentation. The absence of blast cells indicates this is not acute leukaemia. The presence of anaemia and thrombocytopenia is due to bone marrow dysfunction, usually caused by myelofibrosis, indicating a need to start treatment. The first-line treatment for CML is the tyrosine kinase inhibitor imatinib. It is taken as a daily tablet and has excellent results in CML.

44
Q

how are lymphomas staged?

A

ann arbor

45
Q

thalassaemia trait

A

The key finding here is a severe microcytosis that is disproportionately lower than the haemoglobin level; this is suggestive of either beta- or alpha thalassaemia trait

46
Q

how do you manage a sickle cell crisis?

A

managing sickle cell crisis should be analgesia, oxygen, and IV fluids. You can also consider antibiotics if you suspect an infection, and transfusion if the Hb is low

47
Q

hodgkin lymphoma

A

Reed-Sternberg cells are diagnostic of Hodgkin’s lymphoma

Medicine Specialities (11 decks)

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