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Finals > Haematology > Flashcards

Haematology Flashcards

1
Q

What type of transfusion is TRALI most common

A

FFP

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2
Q

What is normal central venous pressure

A

0-6

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3
Q

What is platelet target for before invasive procedure

A

50

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4
Q

What is platelet target for before surgery or invasive procedure at critical site

A

100

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5
Q

Pathophysiology of factor V leiden

A

Resistance of activated protein C due to conformational change in factor V

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6
Q

What is the reversal agent for dabigatran

A

Idarucizumab

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7
Q

Pentad for TTP

A

Fever
Neuro signs
Renal failure
Haemolytic anaemia
Thrombocytopenia

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8
Q

What is point of irradiating blood products for immunosuppressed patient

A

Prevent graft versus host disease

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9
Q

What are bite and blister cells alongside heinz bodies seen in

A

G6PD

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10
Q

What is a sequestration crisis

A

When blood pools in an organ due to sickling

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11
Q

How identify a sickling episode on bloodwork

A

Reticulocytes

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12
Q

Where do sequestration crises occur

A

Spleen
Lungs

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13
Q

What is management of PCV

A

Aspirin long term to prevent thrombotic events
Venesection
Chemo- hydroxycarbamide

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14
Q

What are risks of PCV

A

Thrombotic events
Progression to myelofibrosis or AML

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15
Q

Presentation of acute GVHD

A

Painful maculopapular rash
Jaundice
Diarrhoea

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16
Q

Presenation of chronic GVHD

A

Skin- scleroderma, vitiligo, lichen planus
Eyes- keratoconjunctivitis, scleritis
Restrictive lung disease
GI- dysphagia, odonyphagia

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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

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18
Q

What causes CNS lymphoma in HIV

A

EBV

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19
Q

Most common cause of cerebral lesion in HIV patient

A

Toxoplasmosis- 50%
Lymphoma- 30%

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20
Q

Management of toxoplasmosis lesions in brain

A

Sulfazadine
Pyrimethamine

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21
Q

Management of CNS lymphoma in HIV

A

Steroids
Chemo- methotrexate
Radiotherapy

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22
Q

What is post operative anaemia

A

Where lose blood intraoperatively and then end up with anaemia as a result in following days

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23
Q

What are mirror image nuclei

A

Reed steenberg cells

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24
Q

In a non-urgent scenario, how long are transfusions given over

A

90-120 mins

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24
Q

What is the RBC threshold for requiring transfusions

A

70- no ACS
80- ACS present

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25
Q

What causes urethritis in a male that is negative for gram-neg diplococci

A

Cant be chlamydia or gonorrhoea so most likely is mycoplasma genitalum

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26
Q

Main constituent of cryoprecipitate

A

Factor 8

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27
Q

What is in cryoprecipitate

A

Factor VIII
Fibrinogen
Can be VWB and factor 13

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28
Q

Blood findings of anaemia of chronic disease

A

Normocytic anaemia
High ferritin
Low TIBC

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29
Q

What is mangement of TLS

A

Hyperhydrate
IV allopurinol or rasburicase

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30
Q

What would cause a stable CLL patient to become severely unwell suddenly with B symptoms

A

Richter transformation to high grade lymphoma

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31
Q

TRALI vs TACO

A

TRALI
- hypotension
TACO
- hypertension
- raised JVP

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32
Q

What is use of hydroxyurea in SCD

A

Chronic use to prevent further relapses if there are consistent relapses

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33
Q

When are platelet transfusions CI

A

Chronic bone marrow failure
ITP
Heparin induced thrombocytopenia
TTP

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34
Q

What is threshold for needing a platelet transfusion if actively bleeding

A

Below 30

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35
Q

What is threshold for needing platelet transfusion when not bleeding

A

Below 10
Provided not CI from
- Chronic bone marrow failure
- ITP
- Heparin induced thrombocytopenia
- TTP

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36
Q

What is rain drop skull seen in

A

Multiple myeloma

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37
Q

How is multiple myeloma initially investigated

A

Serum protein electrophoresis and urinalysis for bence jones protein

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38
Q

How is multiple myeloma confirmed

A

Bone marrow aspiration showing increased plasma cells

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39
Q

What imaging is used for multiple myeloma

A

Whole body MRI

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40
Q

Hodgkins lymphoma presentation

A

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

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41
Q

Reversal agent for rivaroxaban and apixaban

A

Andexanet alpha

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42
Q

Management of sickle cell crisis

A

Opiates
Fluids
Oxygen

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43
Q

What is t(9;22) translocation seen in

A

CML mainly
Also ALL

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44
Q

What is post thrombotic syndrome

A

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

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45
Q

Management of post thrombotic syndrome

A

Compression stockings

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46
Q

Causes of B12 defic

A

Vegan diet
Post gastrectomy
Coeliac
Pernicious anaemia
Crohns

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47
Q

How long are VTEs treated for in cancer

A

6 months as treat like unprovoked as ongoing risk factor

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48
Q

What is first line for DVT

A

Apixaban or rivaroxaban

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49
Q

What is anticoagulant choice for people with cancer

A

DOAC

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50
Q

What do if renal impairment and needs anticoagulant

A

LMWH

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51
Q

How long treat a provoked VTE for

A

3 months

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52
Q

How long treat an unprovoked VTE for

A

6 months

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53
Q

How does wells score influence investigations for DVT

A

1= DVT unlikely therefore do D-dimer within 4 hours
2 or more= DVT likely so do USS

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54
Q

What do if wells score 2 or more

A

Do USS within 4 hours
If not able to measure D-dimer and give interim anticoagulation

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55
Q

What do if wells score 1

A

Do D-dimer within 4 hours
If not possible then give interim anticoagulation

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56
Q

How interpret D-dimer when wells score is 1

A

If positive then do USS within 4 hours, if can’t give interim anticoagulation
If negative consider other diagnoses

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57
Q

What do if USS is negative after wells score=2 or more

A

Do d-dimer

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58
Q

What do if USS negative but D-dimer positive

A

Stop anticoagulation
Repeat USS in a week

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59
Q

Definitive diagnosis of SCD

A

Haemoglobin electrophoresis

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60
Q

What happens to bleeding time and APTT in VWB

A

Both prolonged

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61
Q

What use to treat acute intermittent porphyria

A

IV haem arginate

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62
Q

What is a reduced leukocyte ALP seen in

A

CML

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63
Q

What is given long term to prevent acute sickle cell crises

A

Hydroxycarbamide (hydroxyurea) as it increases HbF

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64
Q

What blood transfusion complication does IgA deficiency put you at risk of

A

Anaphylaxis

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65
Q

Folate deficiency presentation

A

Anaemia
Glossitis

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66
Q

Blood film findings of megaloblastic anaemia

A

Hypersegmented neutrophils
Megaloblasts
Metamyelocytes

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67
Q

What is used to treat neutropenia in chemotherapy

A

Filgastrim- GCS-F

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68
Q

Which medications increase risk of VTE

A

HRT
3rd gen COCP
Tamoxifen
Antipsychotics

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69
Q

Which electrolyte abnormality are most likely to see after a transfusion

A

Hyperkalaemia

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70
Q

Causes of sideroblastic anaemia

A

MDS
TB medications
Alcoholism
Lead poisoning

71
Q

What is sideroblastic anaemia

A

where fail to fully form heam leading to a ring of iron around the RBC

72
Q

Blood findings of sideroblastic anaemia

A

High iron
High ferritin
High transferrin saturations
Blood film will show basophilic stippling

73
Q

What is basophilic stippling seen in

A

Sideroblastic anaemia

74
Q

Management of ITP

A

Oral prednisolone
If needs be can use IVIG

75
Q

If give more than 1 unit of RBC what need to give in between

A

Furosemide

76
Q

What can be used to treat VWB disease

A

If mild- tranexamic acid
If more severe then desmopressin or factor VIII concentrates

77
Q

Differentiating IDA from ACD

A

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
Q

What are howell jolly bodies and pappenheimer bodies seen in

A

Post splenectomy

79
Q

What are indications for exchange transfusion in SCD

A

Stroke
Splenic sequestration
Acute chest syndrome
Sickle crises

80
Q

Which hodgkins lymphoma has best and worst prognosis

A

Best= lymphocyte predominant
Worst= lymphocyte depleted

81
Q

Management of acute haemolytic anaemia

A

Stop transfusion
IV fluids
Haem review

82
Q

If are deficient in folate and B12, how administer

A

B12 injections first as folate can precipitate subacute degeneration of spinal chord
Then once levels are normal can give folate
Alphabetical- B->F

83
Q

Management of TRALI

A

Stop tranfusion
Fluids
Titrate oxygen

84
Q

Abdo pain, fever and hypotension after transfusion

A

Acute haemolytic reaction

85
Q

Management of allergic reaction to transfusion

A

Temporarily stop the transfusion
Give an antihistamine

86
Q

Causes of cold AIHA

A

Mycoplasma
EBV
Lymphoma

87
Q

Presentation of cold AIHA

A

Raynauds
Fatigue

88
Q

MOA of dabigatran

A

Direct thrombin inhibitor

89
Q

MOA of apixaban and rivaroxaban

A

Direct factor Xa inhibitor

90
Q

What is a raised HbA2 seen in

A

Beta thalassaemia trait

91
Q

Presentation of acute chest syndrome

A

SOB
Chest pain
Pulmonary infiltrates

92
Q

Universal donor for FFP

A

AB rhd negative

93
Q

Pancytopenia a few years post chemo/radiation

A

MDS

94
Q

How can differentiate MDS and myelofibrosis on presentation

A

Myelofibrosis more likely to have B symptoms on top of pancytopenia

95
Q

Presentation of lead poisoning

A

Abdominal pain
Motor peripheral neuropathy
Neuropsychiatric features
Constipation
Blue lines on gum margin

96
Q

What are blue lines on gum margin seen in

A

Lead poisoning

97
Q

Management of lead poisoning

A

Chelating agents
- DMSA
- penicillamine

98
Q

B12 deficiency presentation

A

Anaemia
Glossitis
Subacute degeneration of the spinal chord

99
Q

What do anisocytosis, macrocytosis and hyposegmentation of the neutrophils suggest

A

MDS

100
Q

Presentation of AIP

A

abdominal: abdominal pain, vomiting
neurological: motor neuropathy
psychiatric: e.g. depression
hypertension and tachycardia common

101
Q

Autoimmune haemolytic anaemia treatmetn

A

Steroids
Rituximab too

102
Q

Who is benign familial neutropenia seen in

A

black African and Afro-Caribbean ethnicity

103
Q

Which drugs cause aplastic anaemia

A

Phenytoin
Chloramphenicol
Sulphonamides

104
Q

What give for VTE if allergic to DOAC

A

Warfarin

105
Q

What are siderocytes seen in

A

Hyposplenism

106
Q

When and how confirm diagnose of G6PD

A

Enzyme assay 3 months after

107
Q

Mangement of TACO

A

Slow or stop
IV furosemide

108
Q

Sickle cell lung presentation with infiltrates in the lung

A

Acute chest crisis

109
Q

How manage IDA before surgery

A

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
Q

Management of INR 5-8 if on warfarin but no bleeding

A

Withhold 1-2 doses and reduce subsequent dose when restart

111
Q

Management of INR 5-8 if on warfarin but minor bleeding

A

Stop warfarin
IV vitamin K
Restart when INR under 5

112
Q

Management of INR>8 if on warfarin but no bleeding

A

Stop warfarin
Oral vitamin K
Remeasure in 24 hours and restart once INR under 5 if not regive IV vitamin K

113
Q

Management of INR>8 if on warfarin but minor bleeding

A

Stop warfarin
IV vitamin K
Repeat INR in 24 hours and regive if INR over 5
Restart when under 5

114
Q

Management of major bleeding if on warfarin

A

Stop warfarin
IV vitamin K
Give prothrombin complex concentrate

115
Q

What is alternative prothrombin concentrate if bleeding on vitamin K

A

FFP

116
Q

As a rule of thumb when do you restart warfarin when restarting after bleeding/high INR

A

Under 5

117
Q

What counts as major bleeding on warfarin

A

Intracranial
Variceal
GI

118
Q

What is target INR for surgery if on warfarin

A

Less than 1.5

119
Q

When stop warfarin pre surgery

A

5 days

120
Q

What is management if on INR drops below 2 on warfarin

A

Increase dose and start LMWH

121
Q

What is lower INR threshold to be concerned by when on warfrain

A

If drops below 2 then be concerned and start LMWH

122
Q

IDA on examination

A

Glossitis
Angular cheilitis
Soft ejection systolic murmur which doesnt radiate
Pallor

123
Q

Potassium of 7.6 in context of AKI, what need to consider

A

Dialysis

124
Q

What can a soft ejection systolic murmur which doesnt radiate suggest

A

Anaemia

125
Q

What is score for assessing risk of pressure ulcers

A

Waterlow

126
Q

What is koilonychia

A

Spooning of the nails

127
Q

How replace B12

A

Loading regime of IM 3/week
Then 1mg IM every 3 months

128
Q

Polycythaemia presentation

A

VTE and thrombosis
Gastric ulcer disease
Aquagenic itch
Gout
Ruddy appearance and plethoric conjunctiva
Splenomegaly

129
Q

In an urgent scenario how fast can transfusion be given

A

STAT

130
Q

How investigate acute heamolytic reaction

A

Check patient details
Redraw blood for G&S and X match
Coombs test will give definitive diagnosis

131
Q

What use to stage lymphomas

A

PET

132
Q

What can AML develop from

A

PCV
Myelofibrosis
MDS

133
Q

Auer rods

A

AML

134
Q

Philadelphia chromosome

A

CML and ALL
BCR ABL gene
9:22
Imatinib treatment

135
Q

What investigation is done for suspected leukaemia

A

FBC witin 48 hours

136
Q

What investigation done to confirm leukaemia

A

Bone marrow biopsy at iliac crest

137
Q

What are 2 types of bone marrow biopsy

A

Aspiration- just fluid
Trephine- take solid lump

138
Q

What are smudge and smear cells seen in

A

CLL

139
Q

Blood findings of TLS

A

High uric acid, potassium and phosphate
Low calcium

140
Q

Complications of TLS

A

Uric acid kidney stones
AKI from build up of uric acid
Systemic inflammation from cytokine release
Arrythmias from hyperkalaemia

141
Q

What do before chemo for patients with high risk of TLS

A

Hyperhydrate

142
Q

What chemo give for all myeloproliferative diseases

A

Hydroxycarbamide

143
Q

Essential thrombocytosis management

A

Aspirin
Hydroxycarbamide
Anagrelide

144
Q

What can cause myelofibrosis

A

Primary myelofibrosis- radiotherapy etc
PCV
Essential thrombocytosis

145
Q

Management of myelofibrosis

A

Hydroxycarbamide
Ruloxitinib
Allogenic stem cell transplant is gold standard

146
Q

What gives ruddy complexion and conjunctival plethora

A

PCV
( conjunctival plethora is opposite to pallor)

147
Q

Main investigation results of myelofibrosis

A

Dacrocytes or tear drop cells on blood film
Fibrosis in BM on biopsy

148
Q

Spleno and hepatomegaly in myeloproliferative conditions

A

Caused by extramedullary haematopoeisis

149
Q

Causes of MDS

A

Chemo
Radiation
Old age

150
Q

Blood findings of MDS

A

Pancytopenia
Macrocytic anaemia

151
Q

How diagnose MDS

A

Hypercellular with lots of blasts on bone marrow

152
Q

Management of MDS

A

Supportive- transfusions, EPO and G-CSF
Allogenic SCT is curative

153
Q

Thrombophillias

A

Protein S and C deficiency
Factor V leiden
APL
Antithrombin deficiency

154
Q

Haemophillia inheritance

A

X linked recessive

155
Q

Haemophilia management

A

If bleed give IV respective factor or if mild A then desmopressin
In severe cases can give prophylactic infusions throughout year

156
Q

VWB management

A

No daily management just give desmopressin, tranexamic acid or VWB if active bleed

157
Q

Long term SCD management

A

Hydroxyurea
5 yearly pneumococcal vaccine

158
Q

Complications of SCD

A

Thrombotic crises
Sequestration
Aplastic
Acute chest syndrome

159
Q

Management of sickle cell sequestration

A

Fluids and transfusions

160
Q

Acute chest syndrome management

A

Oxygen
Fluids
Pain relief

161
Q

MGUS vs smouldering myeloma

A

Plasma cells under 10% in MGUS

162
Q

Myeloma management

A

Drugs- steroids, bortezomib and thalidomide
Allogenic stem cell transplant acceptable

163
Q

If suspect myeloma what do in GP

A

Serum electrophoresis and urinary bence jones within 48 hours
If any come back suggestive of myeloma do 2WW

164
Q

Blood findings of myeloma

A

Hypercalcaemia
Kidney injury
Anaemia
Raised ESR
Hyperviscosity

165
Q

Heparin induced thrombocytopenia pathophysiology

A

Occurs 5 days after starting typically UFH
Get antibodies which activate and reduce platelets

166
Q

Heparin induced thrombocytopenia management

A

Stop heparin
Refer to haem to start alternate anticoag like fondaparinux

167
Q

What do schistocytes indicate

A

Microangiopathic haemolytic anaemia

168
Q

Investigation for AIP

A

Urine sample

169
Q

Causes of microcytic anaemia

A

TAILS
Thalassaemia
Anaemia of chronic disease
IDA
Lead poisoning
Sideroblastic anaemia

170
Q

Thalassaemia diagnosis

A

Hb electrophoresis

171
Q

Causes of normocytic anaemia

A

3 As 2 Hs
ACD
Aplastic
Acute blood loss
Haemolytic anaemia
Hypothyroidism

172
Q

Macrocytic anaemia causes

A

Megaloblastic
- b12
- folate
Non-megaloblastic
- alcohol
- liver disease
- reticulocytosis
- hypothyroidism
- drugs like azathioprine

173
Q

Causes of haemolytic anaemia

A

Acquired
- AIHA
- prosethic valve
- MAHA
- malaria
Genetic
- hereditary elliptocytosis and spherocytosis
- G6PD

174
Q

MAHA causes

A

HUS
DIC
TTP
Adenocarcinoma

175
Q

What causes dark urine in morning with thrombosis risk

A

Paroxysmal nocturnal haemoglobinuria- loss of proteins on surface of RBC

176
Q

Warm AIHA causes

A

Idiopathic- most common
SLE
CLL
Lymphoma
Drugs- methyldopa

Finals (29 decks)

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