Haematology Flashcards
1
Q
What type of transfusion is TRALI most common
A
FFP
2
Q
What is normal central venous pressure
A
0-6
3
Q
What is platelet target for before invasive procedure
A
50
4
Q
What is platelet target for before surgery or invasive procedure at critical site
A
100
5
Q
Pathophysiology of factor V leiden
A
Resistance of activated protein C due to conformational change in factor V
6
Q
What is the reversal agent for dabigatran
A
Idarucizumab
7
Q
Pentad for TTP
A
Fever
Neuro signs
Renal failure
Haemolytic anaemia
Thrombocytopenia
8
Q
What is point of irradiating blood products for immunosuppressed patient
A
Prevent graft versus host disease
9
Q
What are bite and blister cells alongside heinz bodies seen in
A
G6PD
10
Q
What is a sequestration crisis
A
When blood pools in an organ due to sickling
11
Q
How identify a sickling episode on bloodwork
A
Reticulocytes
12
Q
Where do sequestration crises occur
A
Spleen
Lungs
13
Q
What is management of PCV
A
Aspirin long term to prevent thrombotic events
Venesection
Chemo- hydroxycarbamide
14
Q
What are risks of PCV
A
Thrombotic events
Progression to myelofibrosis or AML
15
Q
Presentation of acute GVHD
A
Painful maculopapular rash
Jaundice
Diarrhoea
16
Q
Presenation of chronic GVHD
A
Skin- scleroderma, vitiligo, lichen planus
Eyes- keratoconjunctivitis, scleritis
Restrictive lung disease
GI- dysphagia, odonyphagia
17
Q
Difference between toxoplasmosis and CNS lymphoma on HIV CT scan
A
Toxoplasmosis
- multiple lesions
- ring enhancing
- thallium SPECT negative
CNS lymphoma
- single lesion
- homogenous
- thallium SPECT positive
18
Q
What causes CNS lymphoma in HIV
A
EBV
19
Q
Most common cause of cerebral lesion in HIV patient
A
Toxoplasmosis- 50%
Lymphoma- 30%
20
Q
Management of toxoplasmosis lesions in brain
A
Sulfazadine
Pyrimethamine
21
Q
Management of CNS lymphoma in HIV
A
Steroids
Chemo- methotrexate
Radiotherapy
22
Q
What is post operative anaemia
A
Where lose blood intraoperatively and then end up with anaemia as a result in following days
23
Q
What are mirror image nuclei
A
Reed steenberg cells
24
Q
In a non-urgent scenario, how long are transfusions given over
A
90-120 mins
24
What is the RBC threshold for requiring transfusions
70- no ACS
80- ACS present
25
What causes urethritis in a male that is negative for gram-neg diplococci
Cant be chlamydia or gonorrhoea so most likely is mycoplasma genitalum
26
Main constituent of cryoprecipitate
Factor 8
27
What is in cryoprecipitate
Factor VIII
Fibrinogen
Can be VWB and factor 13
28
Blood findings of anaemia of chronic disease
Normocytic anaemia
High ferritin
Low TIBC
29
What is mangement of TLS
Hyperhydrate
IV allopurinol or rasburicase
30
What would cause a stable CLL patient to become severely unwell suddenly with B symptoms
Richter transformation to high grade lymphoma
31
TRALI vs TACO
TRALI
- hypotension
TACO
- hypertension
- raised JVP
32
What is use of hydroxyurea in SCD
Chronic use to prevent further relapses if there are consistent relapses
33
When are platelet transfusions CI
Chronic bone marrow failure
ITP
Heparin induced thrombocytopenia
TTP
34
What is threshold for needing a platelet transfusion if actively bleeding
Below 30
35
What is threshold for needing platelet transfusion when not bleeding
Below 10
Provided not CI from
- Chronic bone marrow failure
- ITP
- Heparin induced thrombocytopenia
- TTP
36
What is rain drop skull seen in
Multiple myeloma
37
How is multiple myeloma initially investigated
Serum protein electrophoresis and urinalysis for bence jones protein
38
How is multiple myeloma confirmed
Bone marrow aspiration showing increased plasma cells
39
What imaging is used for multiple myeloma
Whole body MRI
40
Hodgkins lymphoma presentation
Bimodal presentation -20s and then 60-80
B symptoms
- weight loss
- night sweats
- fever
Pruritus
Pain on drinking
Lymphadenopathy most commonly in neck and supraclavicular
41
Reversal agent for rivaroxaban and apixaban
Andexanet alpha
42
Management of sickle cell crisis
Opiates
Fluids
Oxygen
43
What is t(9;22) translocation seen in
CML mainly
Also ALL
44
What is post thrombotic syndrome
A complication long term of DVT where can get chronic venous HTN. Post thrombotic syndrome incorporates
- painful heavy calves
- itching
- swelling
- varicose veins
- venous ulceration
45
Management of post thrombotic syndrome
Compression stockings
46
Causes of B12 defic
Vegan diet
Post gastrectomy
Coeliac
Pernicious anaemia
Crohns
47
How long are VTEs treated for in cancer
6 months as treat like unprovoked as ongoing risk factor
48
What is first line for DVT
Apixaban or rivaroxaban
49
What is anticoagulant choice for people with cancer
DOAC
50
What do if renal impairment and needs anticoagulant
LMWH
51
How long treat a provoked VTE for
3 months
52
How long treat an unprovoked VTE for
6 months
53
How does wells score influence investigations for DVT
1= DVT unlikely therefore do D-dimer within 4 hours
2 or more= DVT likely so do USS
54
What do if wells score 2 or more
Do USS within 4 hours
If not able to measure D-dimer and give interim anticoagulation
55
What do if wells score 1
Do D-dimer within 4 hours
If not possible then give interim anticoagulation
56
How interpret D-dimer when wells score is 1
If positive then do USS within 4 hours, if can't give interim anticoagulation
If negative consider other diagnoses
57
What do if USS is negative after wells score=2 or more
Do d-dimer
58
What do if USS negative but D-dimer positive
Stop anticoagulation
Repeat USS in a week
59
Definitive diagnosis of SCD
Haemoglobin electrophoresis
60
What happens to bleeding time and APTT in VWB
Both prolonged
61
What use to treat acute intermittent porphyria
IV haem arginate
62
What is a reduced leukocyte ALP seen in
CML
63
What is given long term to prevent acute sickle cell crises
Hydroxycarbamide (hydroxyurea) as it increases HbF
64
What blood transfusion complication does IgA deficiency put you at risk of
Anaphylaxis
65
Folate deficiency presentation
Anaemia
Glossitis
66
Blood film findings of megaloblastic anaemia
Hypersegmented neutrophils
Megaloblasts
Metamyelocytes
67
What is used to treat neutropenia in chemotherapy
Filgastrim- GCS-F
68
Which medications increase risk of VTE
HRT
3rd gen COCP
Tamoxifen
Antipsychotics
69
Which electrolyte abnormality are most likely to see after a transfusion
Hyperkalaemia
70
Causes of sideroblastic anaemia
MDS
TB medications
Alcoholism
Lead poisoning
71
What is sideroblastic anaemia
where fail to fully form heam leading to a ring of iron around the RBC
72
Blood findings of sideroblastic anaemia
High iron
High ferritin
High transferrin saturations
Blood film will show basophilic stippling
73
What is basophilic stippling seen in
Sideroblastic anaemia
74
Management of ITP
Oral prednisolone
If needs be can use IVIG
75
If give more than 1 unit of RBC what need to give in between
Furosemide
76
What can be used to treat VWB disease
If mild- tranexamic acid
If more severe then desmopressin or factor VIII concentrates
77
Differentiating IDA from ACD
IDA
- very low iron ie less than 8
- high TIBC
- low ferritin
- low transferrin sats
ACD
- low iron ie less than 15
- low TIBC
- high ferritin
- low transferrin sats
78
What are howell jolly bodies and pappenheimer bodies seen in
Post splenectomy
79
What are indications for exchange transfusion in SCD
Stroke
Splenic sequestration
Acute chest syndrome
Sickle crises
80
Which hodgkins lymphoma has best and worst prognosis
Best= lymphocyte predominant
Worst= lymphocyte depleted
81
Management of acute haemolytic anaemia
Stop transfusion
IV fluids
Haem review
82
If are deficient in folate and B12, how administer
B12 injections first as folate can precipitate subacute degeneration of spinal chord
Then once levels are normal can give folate
Alphabetical- B->F
83
Management of TRALI
Stop tranfusion
Fluids
Titrate oxygen
84
Abdo pain, fever and hypotension after transfusion
Acute haemolytic reaction
85
Management of allergic reaction to transfusion
Temporarily stop the transfusion
Give an antihistamine
86
Causes of cold AIHA
Mycoplasma
EBV
Lymphoma
87
Presentation of cold AIHA
Raynauds
Fatigue
88
MOA of dabigatran
Direct thrombin inhibitor
89
MOA of apixaban and rivaroxaban
Direct factor Xa inhibitor
90
What is a raised HbA2 seen in
Beta thalassaemia trait
91
Presentation of acute chest syndrome
SOB
Chest pain
Pulmonary infiltrates
92
Universal donor for FFP
AB rhd negative
93
Pancytopenia a few years post chemo/radiation
MDS
94
How can differentiate MDS and myelofibrosis on presentation
Myelofibrosis more likely to have B symptoms on top of pancytopenia
95
Presentation of lead poisoning
Abdominal pain
Motor peripheral neuropathy
Neuropsychiatric features
Constipation
Blue lines on gum margin
96
What are blue lines on gum margin seen in
Lead poisoning
97
Management of lead poisoning
Chelating agents
- DMSA
- penicillamine
98
B12 deficiency presentation
Anaemia
Glossitis
Subacute degeneration of the spinal chord
99
What do anisocytosis, macrocytosis and hyposegmentation of the neutrophils suggest
MDS
100
Presentation of AIP
abdominal: abdominal pain, vomiting
neurological: motor neuropathy
psychiatric: e.g. depression
hypertension and tachycardia common
101
Autoimmune haemolytic anaemia treatmetn
Steroids
Rituximab too
102
Who is benign familial neutropenia seen in
black African and Afro-Caribbean ethnicity
103
Which drugs cause aplastic anaemia
Phenytoin
Chloramphenicol
Sulphonamides
104
What give for VTE if allergic to DOAC
Warfarin
105
What are siderocytes seen in
Hyposplenism
106
When and how confirm diagnose of G6PD
Enzyme assay 3 months after
107
Mangement of TACO
Slow or stop
IV furosemide
108
Sickle cell lung presentation with infiltrates in the lung
Acute chest crisis
109
How manage IDA before surgery
Depends on time to surgery
Oral iron takes 2-4 weeks to work
If less than this or oral not tolerated then give IV
110
Management of INR 5-8 if on warfarin but no bleeding
Withhold 1-2 doses and reduce subsequent dose when restart
111
Management of INR 5-8 if on warfarin but minor bleeding
Stop warfarin
IV vitamin K
Restart when INR under 5
112
Management of INR>8 if on warfarin but no bleeding
Stop warfarin
Oral vitamin K
Remeasure in 24 hours and restart once INR under 5 if not regive IV vitamin K
113
Management of INR>8 if on warfarin but minor bleeding
Stop warfarin
IV vitamin K
Repeat INR in 24 hours and regive if INR over 5
Restart when under 5
114
Management of major bleeding if on warfarin
Stop warfarin
IV vitamin K
Give prothrombin complex concentrate
115
What is alternative prothrombin concentrate if bleeding on vitamin K
FFP
116
As a rule of thumb when do you restart warfarin when restarting after bleeding/high INR
Under 5
117
What counts as major bleeding on warfarin
Intracranial
Variceal
GI
118
What is target INR for surgery if on warfarin
Less than 1.5
119
When stop warfarin pre surgery
5 days
120
What is management if on INR drops below 2 on warfarin
Increase dose and start LMWH
121
What is lower INR threshold to be concerned by when on warfrain
If drops below 2 then be concerned and start LMWH
122
IDA on examination
Glossitis
Angular cheilitis
Soft ejection systolic murmur which doesnt radiate
Pallor
123
Potassium of 7.6 in context of AKI, what need to consider
Dialysis
124
What can a soft ejection systolic murmur which doesnt radiate suggest
Anaemia
125
What is score for assessing risk of pressure ulcers
Waterlow
126
What is koilonychia
Spooning of the nails
127
How replace B12
Loading regime of IM 3/week
Then 1mg IM every 3 months
128
Polycythaemia presentation
VTE and thrombosis
Gastric ulcer disease
Aquagenic itch
Gout
Ruddy appearance and plethoric conjunctiva
Splenomegaly
129
In an urgent scenario how fast can transfusion be given
STAT
130
How investigate acute heamolytic reaction
Check patient details
Redraw blood for G&S and X match
Coombs test will give definitive diagnosis
131
What use to stage lymphomas
PET
132
What can AML develop from
PCV
Myelofibrosis
MDS
133
Auer rods
AML
134
Philadelphia chromosome
CML and ALL
BCR ABL gene
9:22
Imatinib treatment
135
What investigation is done for suspected leukaemia
FBC witin 48 hours
136
What investigation done to confirm leukaemia
Bone marrow biopsy at iliac crest
137
What are 2 types of bone marrow biopsy
Aspiration- just fluid
Trephine- take solid lump
138
What are smudge and smear cells seen in
CLL
139
Blood findings of TLS
High uric acid, potassium and phosphate
Low calcium
140
Complications of TLS
Uric acid kidney stones
AKI from build up of uric acid
Systemic inflammation from cytokine release
Arrythmias from hyperkalaemia
141
What do before chemo for patients with high risk of TLS
Hyperhydrate
142
What chemo give for all myeloproliferative diseases
Hydroxycarbamide
143
Essential thrombocytosis management
Aspirin
Hydroxycarbamide
Anagrelide
144
What can cause myelofibrosis
Primary myelofibrosis- radiotherapy etc
PCV
Essential thrombocytosis
145
Management of myelofibrosis
Hydroxycarbamide
Ruloxitinib
Allogenic stem cell transplant is gold standard
146
What gives ruddy complexion and conjunctival plethora
PCV
( conjunctival plethora is opposite to pallor)
147
Main investigation results of myelofibrosis
Dacrocytes or tear drop cells on blood film
Fibrosis in BM on biopsy
148
Spleno and hepatomegaly in myeloproliferative conditions
Caused by extramedullary haematopoeisis
149
Causes of MDS
Chemo
Radiation
Old age
150
Blood findings of MDS
Pancytopenia
Macrocytic anaemia
151
How diagnose MDS
Hypercellular with lots of blasts on bone marrow
152
Management of MDS
Supportive- transfusions, EPO and G-CSF
Allogenic SCT is curative
153
Thrombophillias
Protein S and C deficiency
Factor V leiden
APL
Antithrombin deficiency
154
Haemophillia inheritance
X linked recessive
155
Haemophilia management
If bleed give IV respective factor or if mild A then desmopressin
In severe cases can give prophylactic infusions throughout year
156
VWB management
No daily management just give desmopressin, tranexamic acid or VWB if active bleed
157
Long term SCD management
Hydroxyurea
5 yearly pneumococcal vaccine
158
Complications of SCD
Thrombotic crises
Sequestration
Aplastic
Acute chest syndrome
159
Management of sickle cell sequestration
Fluids and transfusions
160
Acute chest syndrome management
Oxygen
Fluids
Pain relief
161
MGUS vs smouldering myeloma
Plasma cells under 10% in MGUS
162
Myeloma management
Drugs- steroids, bortezomib and thalidomide
Allogenic stem cell transplant acceptable
163
If suspect myeloma what do in GP
Serum electrophoresis and urinary bence jones within 48 hours
If any come back suggestive of myeloma do 2WW
164
Blood findings of myeloma
Hypercalcaemia
Kidney injury
Anaemia
Raised ESR
Hyperviscosity
165
Heparin induced thrombocytopenia pathophysiology
Occurs 5 days after starting typically UFH
Get antibodies which activate and reduce platelets
166
Heparin induced thrombocytopenia management
Stop heparin
Refer to haem to start alternate anticoag like fondaparinux
167
What do schistocytes indicate
Microangiopathic haemolytic anaemia
168
Investigation for AIP
Urine sample
169
Causes of microcytic anaemia
TAILS
Thalassaemia
Anaemia of chronic disease
IDA
Lead poisoning
Sideroblastic anaemia
170
Thalassaemia diagnosis
Hb electrophoresis
171
Causes of normocytic anaemia
3 As 2 Hs
ACD
Aplastic
Acute blood loss
Haemolytic anaemia
Hypothyroidism
172
Macrocytic anaemia causes
Megaloblastic
- b12
- folate
Non-megaloblastic
- alcohol
- liver disease
- reticulocytosis
- hypothyroidism
- drugs like azathioprine
173
Causes of haemolytic anaemia
Acquired
- AIHA
- prosethic valve
- MAHA
- malaria
Genetic
- hereditary elliptocytosis and spherocytosis
- G6PD
174
MAHA causes
HUS
DIC
TTP
Adenocarcinoma
175
What causes dark urine in morning with thrombosis risk
Paroxysmal nocturnal haemoglobinuria- loss of proteins on surface of RBC
176
Warm AIHA causes
Idiopathic- most common
SLE
CLL
Lymphoma
Drugs- methyldopa
