Haematology Flashcards
What investigation should you do next for macrocytic anaemia?
Blood film - do see if megaloblastic anaemia
What are the possible causes of megaloblastic and non-megaloblastic anaemia?
Megaloblastic - B12 deficiency, folate deficiency, drug-induced eg.methotrexate
Non-megaloblastic - Alcohol abuse, hypothyroidism, pregnancy
What are the possible causes of vitamin B12 deficiency?
Most common: Pernicious anaemia (autoimmune antibodies against intrinsic factor or parietal cells)
Other causes: atrophic gastritis, gastrectomy, malnutrition
What are the blood features of someone with hypospenism?
Howell-Jolly bodies
siderocytes
What causes multiple myeloma?
Uncontrolled plasma cell proliferation
What are the features of multiple myeloma?
CRABBI
hyperCalcaemia
Renal dysfunction (due to light chain deposition)
Anaemia
Bleeding (thrombocytopenia)
Bone lesions
Infection (reduced normal antibodies)
What will bloods and urine show in multiple myeloma?
Anaemia, ROUEAUX formation, deranged U&E’s and hyper calcaemia
Urine: BENCE JONES proteins
What is the first line investigations for multiple myeloma?
FBC, U&E & peripheral blood film
1st line imaging: whole body MRI
What is the classical finding on blood film in CLL?
Smear cells (also called smudge cells)
What X-ray finding may be found in multiple myeloma?
rain-drop skull’
What causes alpha-thalassaemia?
2 genes for ⍺ globin are located on chromosome 16
Occurs if 1-4 of the genes are deleted
What are the different types of alpha-thalassaemia?
1-2 alleles affected = carrier, may be asymptomatic or have Normal haemoglobin but hypo chromic microcytic cells
3 alleles affected = haemoglobin H disease
4 alleles deleted = hydrops fetalis & death in utero
What treatment should be given for those with a suspected/confirmed DVT and for how long?
DOAC (apixaban or rivaroxaban)
For 3 months if provoked or 6 months if unprovoked
What earns a point in the Wells score?
COP PASSED
Cancer
Oedema (pitting)
Paralysis/plaster
Pain (localised to vein)
Asymmetrical swelling
Surgery (major)
Superficial veins (non-varicose)
Entire leg swollen
DVT previously
What should you do if a Wells score <2?
Order D-dimer (done within 4 hrs)
+ = vein ultrasound within 4 hrs
What should you doit a Wells score ≥2?
Vein ultrasound within 4hrs
What Neutrophil count is consistent with neutropenic sepsis?
neutrophil count of < 0.5 * 10^9
What is associated the Philadelphia chromosome associated with?
Present >95% of CML patients
Poor prognosis in ALL
What is Acute promyelocytic leukaemia ?
Subtype of AML, t(15;17) translocation which causes mutation of retinoic acid receptor - results in lots of Auer rods which increase risk DIC!!!
What are the features of CML?
Long history & age 60-70
Anaemia/lethargy
weight loss & sweating
splenomegaly
On film granulocytes at different stages maturation + high platelets
What is the first-line treatment for CML?
imatinib (inhibitor of the tyrosine kinase)
What is the platelet count cut off for a platelet transfusion?
10 x 109 for patients not bleeding
30 x 109/L for bleeding patients or patients having invasive procedure
What is the typical blood test results in DIC?
↓ platlets & fibrinogen
↑ PT & APTT
Schistocytes
What is the most common causative agent of neutropenic sepsis?
Coagulase-negative, Gram-positive bacteria such as Staphylococcus epidermidis
What is the reversal agent for rivaroxaban and apixaban?
Andexanet alfa
What are the five key features of TTP?
Fever
Altered mental state (headache, confusion, excess tiredness, seizure)
Thrombocytopenia
Haemolytic anaemia
Reduced renal function
What are irradiated blood products and why are they sometimes required?
Irradiated blood products are depleted of T-lymphocytes
Used to avoid transfusion-associated graft versus host disease (TA-GVHD)
What are the clinical marks on blood test that indicate G6PD deficiency?
Heinz bodies
Bite and blister cells
Which system is used for staging lymphoma?
Ann-Arbor
What are the different stages of the Ann-Arbor staging?
I = single lymph node
II = 2 or more on the same side of diaphragm
III = Nodes on both sides diaphragm
IV = beyond lymph nodes
What are the features of lymphoma?
Lymphadenopathy
Alcohol induced lymph pain = Hodgkins
B syptoms
Mediastinal mass
What are the features of tumour lysis syndrome?
High potassium and phosphate
Low calcium
Increase in uric acid and creatinine
What prophylaxis should be given to those at high risk of tumour lysis syndrome?
IV allopurinol or IV rasburicase
What is Factor V Leiden?
Inherited thrombophilia
Mutation in factor V (clotting factor) means it is inactivated slower by activated protein C
↑ risk blood clots
