Haematology Flashcards
Causes of warm haemolytic Anaemia
> 37 degrees
Ig G mediated
Lymphoma
SLE
Drugs: Penicillin, methyl dopa
Hep B / C
- Presence of spherocytes on blood film
Management:
- Steroids
- Rituximab
- Splenectomy if refractory
Cold Haemolytic Anaemia
<37 Degrees
IgM mediated
Red cell agglutination
Aetiology:
- Mycoplasma
- Idiopathic
Management:
- Not steroids
- Cold avoidance
- Rituximab if severe
Paroxysmal Nocturnal Haemoglobinuria
Triad:
1) Normocytic Anaemia
2) Pancytopaenia
3) Coagulopathy (Clots)
Test:
- Flow cytometry for GPI (CD55/59)
Management:
- Ecalizumab
-
G6PD management
Generally mild anaemia
- Avoid broad beans
- Avoid antimalarials
- Avoid sulphonamides
Management post splenectomy
Vaccination prior for pneumococcal, meningococcus, heamophilus
Vaccination after for pneumococcus and influenza
Prophylactic penicillin 2 years post
Early antibiotics in infection
Risk of thrombosis with coagulopathies
Warfarin management
Dose
How frequent INR checks
INR Target
Knowledge about food and drug interactions
- Dark leafy greens
- Alcohol
- Grapefruit juice
Factors that increase clot risk
-OCP
-Smoking
-Surgery
-Malignancy
-Pregnancy
-Long haul flights
*Ask about multiple unexplained miscarriages ie. anti-phospholipid syndrome
Indications for thrombophilia testing
Recurrent thrombosis
Thrombosis in unusual places ie.
- Cavernous sinus
- Portal vein
- Hepatic vein
Venous thrombosis prior to 45yoa
Thrombophilia tests
Factor V leiden
Antithrombin III, Protein C, Protein S
Lupus anticoagulant, B2Micro, anti-cardiolipin
CD55/59
Prothrombin gene mutation
Diagnosis of polycythaemia
Confirm diagnosis Hct >60%
JAK 2 mutation ~90%
Exclude secondary causes: Hypoxia, APCKD, smoking, RC C
Examine for splenomegaly
Check EPO level (Should be low or normal)
Treatment polycythaemia rubra vera
Phlebotomy
Hydroxyurea
Aspirin
Ruxolitinib
Secondary causes of myelofibrosis
Lymphoma
Leukaemia
SLE
Myeloma
Treatment myelofibrosis
hydroxyurea
Ruxolitinib
Curative -> Allogenic bone marrow transplant
Essential thrombocytosis
Typically doesn’t require treatment unless symptomatic
Low risk transformation
Treatment:
- Aspirin
- Hydroxurea
ECOG
0 - Normal Human
1 - Able to perform light or sedentary work
2 - <50% day in bed
3 - >50% day In bed
4 - Moribund
Investigations Lymphoma
CT CAP or PET scan
LFT
Bone marrow ? BM involvement
Flow cytometry if concern for peripheral leukaemia component
Prognosis Non-Hodgkins lymphoma
60-90% 10 year disease free survival depending on stage
Complications of lymphoma treatment (alkylating agents + radiotherapy)
Secondary malignancies
- Solid organ (particularly breast)
- Leukaemia
Screening for NHL Survivors
- Breast Cancer screening annual mammogram
- Lung cancer -> smoking cessation
- Skin cancer -> Annual skin check
- Cardiovascular health with risk factor control and stress test depending on risk factors
- Annual TFT due to risk of hypothyroidism
Risk of progression of MGUS
1% per yer
*MGUS present in ~10% of 80yo
Investigations Suspected Multiple Myeloma
-SPEP
-Serum Free light chain
-Bone marrow biopsy
-Skeletal Survey
- B2 Microglobulin
-FBC,UEC,CMP
Myeloma Treatment
Fit for transplant:
- Bortez/lenalidomide
- Autograft
Unfit:
- Bortez –> lenalidomide
POEMS
-Polyneuropathy
-Organomegaly (Liver spleen)
-Endocrinopathy (hyperthyroid and T2DM)
-Monoclonal gammopathy
-Skind changes
*Rare form off myeloma. Unlike myeloma has hepatomegaly and lymphadenopathy.
