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Y4 Medicine > Haematology > Flashcards

Haematology Flashcards

1
Q

Transmission of which type of infection is most common following platelet transfusion?

A

Bacterial

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2
Q

Which drugs can reduce the risk of tumour lysis syndrome

A

Allopurinol or Rasburicase

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3
Q

Which haematological malignancy is most strongly associated with the mutation (t(9:22))

A

CML
(Philadelphia chromosome)
- Also found in 30% of ALL cases

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4
Q

How often should sickle cell patients receive the pneumococcal vaccine?

A

every 5 years

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5
Q

When does heparin induced thrombocytopenia typically occur

A

5-14 days after heparin exposure

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6
Q

Blood findings in DIC

A

Decreased Hb
Decreased Platelets
Decreased Fibrinogen
Increased APTT
Increased FDP

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7
Q

Which blood products have the highest risk of bacterial infection

A

Platelets

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8
Q

Transfusion of platelets is contraindicated in which conditions?

A

Chronic bone marrow failure
TTP
Autoimmune thrombocytopenia
Heparin induced thrombocytopenia

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9
Q

MOA of aspirin

A

irreversibly inhibits COX to reduce the production of thromboxane from arachidonic acid, therefore reducing platelet aggregation

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10
Q

MOA of Apixaban

A

Directly inhibits factor Xa preventing the formation of thrombin from prothrombin

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11
Q

Complications of polycythemia vera

A

AML
Myelofibrosis
Thrombotic events:
Stroke
Splenic infarct –> Ruptured spleen (rare)
Kidney stones (due to high uric acid)

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12
Q

Metabolic abnormalities in tumor lysis syndrome

A

Hyperkalemia
Hypophosphatemia
Hypocalcemia

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13
Q

Labatory findings in beta thalassemis major

A

Increased HbA2
Increased HbF
Absent HbA

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14
Q

Classic skull Xray findings in myeloma and difference from hyperparathyroidism and pagers disease

A

Patchy bone reabsorption
Rain-drop skull - random pattern of dark spots.
Hyperparathyroidism gives ‘Pepperpot skull’ (random dark and light spots)
Pagets disease gives a thickened vault + osteoporosis circumscripta.

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15
Q

Tear drop poikilocytes are seen in which condition

A

Myelofibrosis

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16
Q

First line treatment for ITP

A

Oral prednisolone

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17
Q

Metabolic differences between Myeloma, Bony metastasis, Pagets disease, Osteomalacia + Hyperparathyroidism

A

Myeloma = Normal ALP, Raised Calcium & Raised phosphate
Bony mets = Raised ALP, Calcium & Phosphate
Osteomalacia = Normal ALP, Decreased calcium, phosphate & Vit D.
Pagets disease = Isolated ALP rise
hyperparathyroid = Raised ALP, Raised calcium, Decreased phosphate

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18
Q

Management of non-haemolytic febrile transfusion reaction

A

Paracetamol

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19
Q

Treatment of neutropenic sepsis

A

Tazocin

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20
Q

Sideroblastic anemia investigation findings

A

Hypochromic microcytic anemia
Bloods = High ferritin, High Transferrin, normal iron
Basophilic stippling of RBCs

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21
Q

Causes of sideroblastic anaemia

A

Anti-TB meds
Myelodysplasia
Alcohol
Lead

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22
Q

Which type of Hodgkins lymphoma carries the best prognosis

A

Lymphocyte predominant

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23
Q

What type of transfusion reaction is more common in patients with IgA deficiency

A

Anaphylaxis

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24
Q

Which drugs need to be avoided in G6PD deficiency (due to risk of hemolysis)

A

Sulph drugs
Sulphonamide, Sulphonylureas (E.g Glipizide) + Sulfalazine

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25
Q

Causes of Microcytic anaemia

A

Thalassemia
Anemia of chronic disease
Iron deficiency anemia
Lead poisoning
Sideroblastic anemia

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26
Q

Causes of normocytic anemia

A

Acute blood loss
Aplastic anemia
Anemia of chronic disease
Haemolytic anemia
Hypothyroidism

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27
Q

Causes of microcytic anemia

A

Normoblastic = Reticulocytosis + Alcohol + Liver disease + Azathioprine
Megaloblastic = Pernicious or Folate deficiency

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28
Q

Which medication can cause Megaloblastic microcytic anemia

A

Methotrexate as it causes a folate deficiency

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29
Q

Causes of iron deficiency

A

Pregnancy
Iron losses - GI bleed, Cancer, Menorrhagia
Malabsorption - PPIs, Coeliac, Crohns

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30
Q

Blood findings in iron deficiency anemia

A

High TIBC + Low transferrin

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31
Q

Management of IDA

A

Refer for investigations if high risk (OGD/Colonoscopy).
Oral ferrous sulfate 200mg TDS
IV cosmofer if malabsorption (anaphylaxis risk)

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32
Q

Investigations for pernicious anemia

A

Bloods: Megaloblastic microcytic anemia
IF antibody
Gastric parietal cell antibody

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33
Q

Hereditary causes of haemolytic anemia

A

Hereditary spherocytosis
Hereditary elliptocytosis
G6PD deficiency
Thalassemia
Sickle cell

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34
Q

Acquired causes of haemolytic anemia

A

Warm/cold AHA
Alloimmune
Paroxysmal nocturnal haemoglobinuria
Microangiopathic haemolytic anemia
Prosthetic heart valves

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35
Q

Sx and Invx for spherocytosis

A

Sx = Jaundice + Gallstones + Splenomegaly + Aplastic crisis (during parvovirus) + Fhx
Invx;
- blood films shows spherocytes
- Diagnosis = EMA binding test

36
Q

G6PD deficiency

A

X linked recessive mutation resulting in a defect in the G6PD enzyme. Makes RBCs more prone to oxidative stress.

37
Q

Triggers of haemolysis in G6PD deficiency

A

Infection
Drugs - sulph drugs + antimalarials
Flava beans

38
Q

Blood film findings in G6PD Deficiency

A

Heinz bodies, Bite cells + blister cells

39
Q

Diagnosis of G6PD Deficiency

A

G6PD enzyme assay at presentation + 3 months after

40
Q

Warm AHA

A

More common. Occurs at body temperature. Can be secondary too CLL.
Caused by IgG antibody
Features = extravascular haemolysis (splenomegaly)

41
Q

Treatment of AHA

A

Steroids +/- Rituximab

42
Q

Cold AHA

A

Occurs at cold temperatures (<10 degrees). Usually secondary to SLE/EBV/CMV/HIV/Lymphoma/Leukemia
Caused by IgM antibodies
Features = intravascular haemolysis + Raynaud’s

43
Q

Paroxysmal nocturnal haemoglobinuria

A

Complement driven destruction of RBCs
Sx = red urine in the morning
Tx = Eculizumab (Inhibits C5)
Bone marrow transplant is curative

44
Q

Causes of Microangiopathic haemolytic anemia

A

DIC
HUS
TTP
SLE
Cancer

45
Q

A mutation on which chromosome causes sickle cell

A

Chromosome 11

46
Q

What medication can be given to prevent the occurrence of sickle-cell crises

A

Hydroxycarbamide - increases production of HbF

47
Q

Complications of sickle cell

A

Increased risk of infection
Stroke
Avascular necrosis of large joints
pulmonary HTN
Priapism
Acute chest syndrome
Sickle-cell crises
CKD

48
Q

Splenic sequestration crisis presentation

A

Acutely enlarged + painful spleen
Severe anemia
Hypovolemia

49
Q

Presentation of Aplastic crises (sickle cell)

A

Aplastic anemia
Commonly following slapped cheek/parvovirus

50
Q

Beta-thalassemia cause

A

Recessive mutation on chromosome 11

51
Q

Alpha thalassemia cause

A

Recessive mutation on chromosome 16

52
Q

Thalassemia diagnosis

A

Hb Electrophoresis

53
Q

Invx for sideroblastic anemia

A

FBC = microcytic hypo chromic anemia
Iron = raised ferritin + iron + transferrin
Blood film = basophilic stippling of RBCs

54
Q

Causes of aplastic anemia

A

Idiopathic
Fanconis anemia
Cytotoxics, chloramphenicol, sulphur drugs, gold
Benzene
Parvovirus B19 & Hepatitis

55
Q

Acute myeloid leukaemia

A

Most common adult acute leukemia
Raised WCC + Thrombocytopenia + reduced reticulocytes
Blood film shows Auer rods + blast cells

56
Q

Acute Lymphoid leukaemia

A

Most common paediatric leukaemia (age 2-4yrs)
RF = Downs syndrome / Philadelphia chromosome

57
Q

Chronic myeloid leukaemia

A

Massive splenomegaly!
RF = philadelphia chromosome
Increase in granulocytes at different stages + occasionally thrombocytosis
(likely to have raised everything)
% Blasts in blood/marrow >30%.
Tx = imatinib

58
Q

CLL

A

Common in adults >55yrs
RF = TP53 Mutations / Trisomy 12
Lymphadenopathy main feature
Blood film = smudge/smear cells

59
Q

Complications of CLL

A

Richter’s transformation / Warm AHA / Hypoglobulinemia (recurrent infections)

60
Q

Hodgkins lymphoma

A

Characterised by presence of Reed-Sternberg cells
Classically presents with painful lymphadenopathy after drinking

61
Q

Most common type of Hodgkins lymphoma

A

Nodular sclerosing

62
Q

Types of non-hodgkins lymphoma

A

Diffuse large B cell - most common. Rapidly growing mass in pt >65yrs
Burkitts lymphoma = starry sky appearance. associated with EBV. Tumor lysis syndrome
MALT lymphoma - in stomach. associated with H.pylori
T cell lymphoma in intestines - Coeliac disease

63
Q

Staging system for lymphoma

A

Ann Arbor

64
Q

Features of myeloma

A

Calcium high
Renal failure
Anemia
Bone disease
Hyperviscosity / Infections

65
Q

Blood film findings in myeloma

A

Rouleux formation

66
Q

Urinary marker of myeloma

A

Bence jones proteins

67
Q

Chemotherapy for myeloma

A

Bortezomib + thalidomide + dexamethasone

68
Q

Features of polycythemia vera

A

Conjunctival plethora
Facial plethora (ruddy complex)
Splenomegaly
Raised Hb
Intense itch after hot water
JAK 2 mutation

69
Q

Features of essential thrombocythemia

A

Raised platelets
Characteristic burning sensation in hands

70
Q

Investigations for myeloproliferative disorder

A

Blood film = Tear drop poikilocytes
Bone marrow aspiration = Dry tap
JAK2, MPL & CALR gene testing

71
Q

Immune Thrombocytopenia purpura (ITP)

A

Thrombocytopenia + normal bone marrow
Cause = autoantibodies against Glycoprotein Ib-V-IX complex

72
Q

Treatment of ITP

A

Can observe in children
Prednisolone +/- IV immunoglobulin if acute

73
Q

Presentation of TTP

A

Pentad: Microangiopathic haemolytic anemia + Purpura + Renal insufficiency + Neurological symptoms + Fever

74
Q

Von Willebrand disease

A

Most common inherited bleeding disorder
Caused by autosomal dominant mutation resulting in vwf deficiency

75
Q

Difference in presentation between Von-willebrand and haemophilia

A

VWD behaves like a platelet disorder so causes epistaxis + menorrhagia whereas haemophilia causes spontaneous bleeding such as hemarthrosis or intracerebral bleeds.
Also VWD can occur in females whereas haemophilia is X linked

76
Q

Haemophilia A

A

Deficiency of factor VIII
90% of haemophilia

77
Q

Haemophilia B

A

Deficiency of factor IX

78
Q

Types of Thrombophilia

A

Inherited;
- prothrombin gene mutation
- Factor V leiden (most common)
- Protein C deficiency
- Protein S deficiency
- Antithrombin III deficiency
Acquired;
- Antiphospholipid syndrome
- COCP

79
Q

Which type of inherited thrombophilia causes the greatest increased risk of VTE

A

Antithrombin III deficiency

80
Q

Features or Antiphospholipid syndrome

A

Recurrent thrombosis + miscarriage

81
Q

Bleomycin

A

MOA = Cytotoxic antibiotic. Works on G2 phase + mitosis

SE = Pulmonary fibrosis (lower zone)

82
Q

Methotrexate

A

Antimetabolite - Folic acid antagonist.
Works by inhibiting dihydrofolate reductase.
SE = Myelosupression, Lung fibrosis, Liver damage.

Requires monitoring of LFTs, U&Es, FBC etc

83
Q

Doxarubicin

A

Anthracycline
MOA = Inhibits topoisomerase II therefore preventing transcription

SE = Cardiomyopathy

84
Q

Cisplatin

A

Platinum compound.
MOA = Creates cross-links between guanine molecules which blocks replication + transcription
Uses = mainly ovarian / lung cancer / colon cancer

SE = Ototoxicity + Nephrotoxicity

85
Q

Cyclophosphamide

A

Aklylating agent
moa = prevents DNA replication + blocks DNA repair
Use = Leukemia / lymphoma

SE = Haemorrhagic cystitis

86
Q

Vincristine / Vinblastine

A

Vinca alkaloids
MOA = binds to tubulin + inhibits microtubule formation during mitosis thus preventing cell division. (M phase arrest of mitosis)
SE = Peripheral neuropathy + myelosuppression

Y4 Medicine (22 decks)

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