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Finals > Haematology > Flashcards

Haematology Flashcards

1
Q

What are the causes of microcytic anaemia?

A
  • Thalassaemia
  • Anaemia of chronic disease
  • Iron deficiency
  • Lead poisoning
  • Sideroblastic
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2
Q

What are the causes of normocytic anaemia?

A
  • Anaplastic anaemia
  • Anaemia of chronic disease
  • Acute blood loss
  • Haemolytic anaemia
  • Hypothyroidism
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3
Q

What are the causes of macrocytic anaemia?

A

Megaloblastic:
- B12 and folate deficiency

Normoblastic
- alcohol
- reticulocytosis
- hypothyroidism
- liver disease
- drugs e.g. azathioprine

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4
Q

What are the generic symptoms of anaemia?

A
  • dizziness
  • palpitation
  • fatigue
  • headaches
  • shortness of breath
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5
Q

What are the generic signs of anaemia?

A
  • Pale skin
  • conjunctival pallor
  • tachycardia
  • raised resp rate
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6
Q

What are the causes of iron deficiency anaemia?

A
  • dietary intake not sufficient
  • malabsorption e.g. cystic fibrosis
  • pregnancy
  • growth spurt
  • blood loss e.g. menorrhagia, GI loss
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7
Q

Bloods iron deficiency

A
  • microcytic
  • hypochromic
  • low iron
  • low ferritin (may be raised or normal if inflammation)
  • low transferrin
  • high total iron binding capacity
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8
Q

Bloods anaemia of chronic disease

A
  • normocytic normochromic or microcytic hypochromic
  • decreased iron
  • increased ferritin
  • normal or low total iron binding capacity
  • low transferrin
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9
Q

What is sideroblastic anaemia?

A

Deposition of iron in the mitochondria, forming a ring around the nucleus of the cell

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10
Q

What are the causes of sideroblastic anaemia?

A
  • congenital
  • myelodysplasia
  • alcohol
  • lead
  • anti TB drugs
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11
Q

bloods sideroblastic anaemia

A
  • hypochromic
  • microcytic
  • high ferritin, iron and transferrin
  • basophillic stipping
  • sideoblast prussian blue staining
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12
Q

What are the inherited types of hameolytic anaemia?

A
  • hereditary spherocytosis
  • G6PD deficiency
  • Hereditary Elliptocytosis
  • Sickle cell anaemia
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13
Q

What are the acquired forms of haemolytic anaemia?

A
  • warm type autoimmune
  • cold type autoimmune
  • prosthetic valve haemolysis
  • alloimmune: blood transfusion reaction or heamolytic disease of newborn
  • microangiopathic haemolytic anaemia
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14
Q

Presentation of hereditary spherocytosis

A
  • jaundice
  • gallstones
  • splenomegaly
  • aplastic crisis if parovirus
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15
Q

bloods hereditary spherocytosis

A
  • sphere shaped RBC
  • raised MCHC
  • raised reticulocytes
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16
Q

What is the management of hereditary spherocytosis?

A
  • folate supplements
  • splenectomy
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17
Q

What is the inheritance of hereditary spherocytosis?

A

Autosomal dominant

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18
Q

What is the inheritance of G6PD deficiency?

A

X linked recessive

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19
Q

What are the triggers for G6PD deficiency?

A
  • fava beans
  • infection
  • primaquine (anti-malarial)
  • ciprofloxacin
  • sulfonylurea
  • sulfasalazine
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20
Q

What is the management of warm type autoimmune haemolytic anaemia?

A

Steroids ± rituximab

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21
Q

immunoglobulin warm type AIHA?

A

IgG

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22
Q

immunoglobulin cold type AIHA

A

IgM

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23
Q

What are the causes of warm type AIHA?

A
  • Idiopathic
  • Autoimmune disease e.g. SLE
  • Neoplasia (lymphoma, leukaemia)
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24
Q

What are the causes of cold type AIHA?

A
  • neoplasia e.g. lymphoma
  • Infection: mycoplasma, EBV
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25
Q

What is the cause of haemolytic anaemia with prosthetic heart valves?

A

Turbulence around the valve causing collision of the red blood cells with the implanted valve

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26
Q

What is microangiopathic haemolytic anaemia?

A

Structural deformities of the blood vessels results in haemolysis

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27
Q

What are the causes of microangiopathic haemolytic anaemia

A
  • Haemolytic uraemic syndrome
  • disseminated intravascular dissemination
  • thrombotic thrombocytopenia purpura
  • SLE
  • cancer
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28
Q

What are the causes of vitamin B12 deficiency?

A
  • pernicious anaemia
  • post gastrectomy
  • vegan diet
  • disorders of the terminal ileum (Crohn’s or ileoceacal resection)
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29
Q

What is the management of vitamin B12 deficiency anaemia?

A
  • IM hydroxocobalamin 3 times a week for two weeks then once every 3 months
  • Must correct B12 before folate due to degeneration of the cord
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30
Q

What chromosome alpha thalassaemia?

A

16

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31
Q

What chromosome beta thalassaemia?

A

11

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32
Q

Describe alpha thalassaemia

A
  • if one or two alleles: hypochromic, microcytic and normal Hb
  • if 3: HbH disease: hypochromic, microcytic, splenomegaly
  • if 4: death in utero
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33
Q

Describe beta thalassaemia

A
  • trait/minor: hypochromic, microcytic, target cell, Hb normal
  • Major (both genes): severe anaemia, splenomegaly, hepatomegaly and bone expansion
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34
Q

Bone expansion beta thalassaemia major

A
  • hair on end appearance in skull
  • fragility fracture
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35
Q

What is the management of beta thalassaemia major?

A
  • regular red blood cell transfusions
  • consider splenectomy
  • monitor iron, iron chelation (desferrioxamine)
  • folic acid
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36
Q

Schistocytes

A

Microangiopathic haemolytic anaemia

37
Q

Why may the urine appear dark in haemolytic anaemia?

A

Haemoglobinuria in severe haemolysis, usually intravascular

38
Q

Differentials of petechiae

A
  • Leukaemia
  • Meningococcal septicaemia
  • Vasculitis
  • Henoch-Schonlein Purpura (HSP)
  • Idiopathic Thrombocytopenia Purpura (ITP)
  • Non-accidental injury
39
Q

What is the presentation of leukaemia?

A
  • fatigue
  • petechiae and abnormal bruising
  • fever
  • abnormal bleeding
  • hepatosplenomegaly
  • lymphadenopathy
40
Q

What are the types of leukaemia?

A
  • acute myeloid leukaemia
  • acute lymphoblastic leukaemia
  • chronic myeloid leukaemia
  • chronic lymphocytic leukaemia
41
Q

Blood acute myeloid leukaemia

A
  • blast cells
  • auer rods
42
Q

Blood acute lymphoblastic leukaemia

A
  • blast cells
  • no auer rods
43
Q

Blood chronic lymphocytic lymphoma

A
  • smear/smudge cells on blood film
44
Q

Which leukaemias are associated with the philadelphia chromosome?

A
  • acute lymphoblastic leukaemia
  • chronic myeloid leukaemia
45
Q

What is Richter’s transformation?

A

The transformation of chronic lymphocytic leukaemia into a high grade lymphoma

46
Q

What is the presentation of Hodgkin’s lymphoma?

A
  • lympadenopathy: rubbery, non tender
  • B symtpoms: fever, weight loss, night sweats
  • Fatigue
  • itch
  • cough
  • shortness of breath
  • abdominal pain
47
Q

What are the risk factors for Hodgkin’s lymphoma?

A
  • HIV
  • EBV
  • Family history
  • Autoimmune conditions e.g. rheumatoid arthritis
48
Q

Hodgkin’s lymphoma biopsy

A

Reed Sternberg cells

49
Q

Explain the staging of hodgkin’s lymphoma

A
  • I: confined to one region of lymph nodes
  • II: more than one region but one side of the diaphragm
  • III: lymph nodes above and below the diaphragm
  • IV: widespread involvement including non lymphatic organs
50
Q

What are the non-Hodgkin lymphomas?

A
  • Burkitt
  • MALT
  • Diffuse large B cell
51
Q

What is monoclonal gammopathy of undetermind significance?

A

Excess of a single type of antibody or antibody component without any other features of myeloma or cancer

52
Q

What is smouldering myeloma?

A

Progression of MGUS, high levels of antibodies or antibody components. Premalignant

53
Q

What is multiple myeloma?

A

Myeloma affecting multiple areas of the body

54
Q

Bloods myeloma

A
  • low WCC (neutropenia)
  • anaemia
  • thrombocytopenia
  • Rasied ESR
  • Raised calcium
  • Raised plasma viscosity
55
Q

Specific tests for myeloma

A
  • Bence jones proteins
  • serum free light chain assay
  • serum immunoglobulin
  • serum protein electrophoresis
  • bone marrow biopsy
56
Q

Investigation for spread of myeloma

A
  • MRI
  • CT if MRI not suitable, X ray if CT not suitable
57
Q

What are the signs of myeloma on X-Ray?

A
  • punched out lesions
  • lytic lesions
  • raindrop skull
58
Q

What is the presentation of myeloma?

A
  • Dehydration ( myeloma renal disease)
  • Easy bruising
  • reduced sight
  • Heart failure
  • Bone pain (pathological fracture, increased activity of osteoclasts)
59
Q

What are the myeloproliferative neoplasms?

A
  • Essential thrombocytopenia
  • Myelofibrosis
  • polycythaemia vera
60
Q

What is the presentation of essential thrombocytopenia?

A
  • anaemia
  • splenomegaly
  • portal hypertension
  • thrombosis
  • decreased WCC

RAISED PLATELETS

61
Q

What is the presentation of polycythaemia vera?

A
  • splenomegaly
  • portal hypertension
  • thrombosis
  • Low WCC

RAISED HAEMOGLOBIN

62
Q

What is the presentation of myelofibrosis?

A
  • anaemia
  • splenomegaly
  • portal HTN
  • low platelets and WCC
63
Q

blood film myelofibrosis

A
  • Teardrop RBCs
  • Poikilocytosis
  • blasts
64
Q

What is the management of essential thrombocytopenia?

A
  • Hydroxyurea
  • Aspirin
  • Chemotherapy
65
Q

What is the management of polycythaemia vera?

A
  • venesection
  • aspirin
  • chemotherapy
66
Q

What is the management of myelofibrosis

A
  • Allogenic stem cell transplant
  • chemotherapy
67
Q

What are the genetic mutations associated with myeloproliferative disorders?

A
  • JAK2
  • MPL
  • CALR
68
Q

What is Von Willebrand Disease?

A

Autosomal dominant bleeding disorder

69
Q

What are the types of von willebrand disease?

A
  • Type 1: decreased factor
  • Type 2: abnormal VWF
  • Type 3: total lack of VMF (type 3)
70
Q

What are the symptoms of von willebrand disease?

A
  • increased bleeding
  • monorrhagia
  • nose bleeds (epistaxis)
71
Q

What are the investigations for von willebrand disease?

A
  • Prolonged bleeding time
  • APTT may be prolonged
  • VWF function assay
72
Q

What is the management of von willebrand disease?

A
  • tranexamic acid
  • desmopression
  • factor VIII
73
Q

What is the deficiency in haemophilia A?

A

Factor VIII

74
Q

What is the deficiency in haemophilia B?

A

Factor IX

75
Q

What is the inheritance of haemophilia A and B?

A

Autosomal recessive

76
Q

What are the symptoms of haemophilia?

A
  • excessive bruising
  • fatigue
  • recurrent or severe bleeding
  • musculoskeletal bleeding - presents with the swelling of joints
  • cutaneous purpura in acquired
77
Q

What are the risk factors for acquired haemophilia?

A
  • Age >60
  • Autoimmune conditions
  • IBD
  • Diabetes
  • Malignancy
78
Q

Investigations haemophilia

A
  • Prolonged APTT
  • Plasma factor VIII and IX assay: decreased or absent
  • Mixing study: APTT corrected
  • FBC: Hb may be low
  • Prothrombin time, platelet aggregation studies should be normal
79
Q

What is the treatment of haemophilia?

A
  • Replace factor VIII or IX
  • If acquired: immunosuppression with prednisolone and cyclophosphamide
80
Q

What does a low haemoglobin with a high reticulocyte count suggest?

A

Haemolysis or bleeding

81
Q

Coagulation screen DIC

A
  • ↓ platelets
  • ↓ fibrinogen
  • ↑ PT & APTT
  • ↑ fibrinogen degradation products
82
Q

What is the diagnostic test for hereditary spherocytosis?

A

EMA binding test

83
Q

What is the empirical antibiotic of choice for neutropenic sepsis?

A

Piperacillin with tazobactam (Tazocin)

84
Q

Why are blood products irradiated?

A

To avoid transfusion related graft vs host disease

85
Q

What is the presentation of idiopathic Thrombocytopenic purpura?

A
  • petechiae, purpura
  • bleeding (e.g. epistaxis)
  • catastrophic bleed (uncommon)
86
Q

What is the first line treatment for ITP?

A

Oral prednisolone

87
Q

How long should the oral contraceptive pill be stopped before surgery?

A

4 weeks

88
Q

What is the reversal agent for dabigatran?

A

Idarucizumab

Finals (37 decks)

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