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Internal Medicine > Haematology > Flashcards

Haematology Flashcards

1
Q

Describe MCV, ferritin, serum iron, transferrin; transferrin saturation in iron deficiency anaemia

A

All low except transferrin high

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2
Q

Describe MCV, ferritin, serum iron, transferrin; transferrin saturation in anaemia of chronic disease

A
  • MCV, low or normal
  • ferritin, high or normal
  • serum iron, low
  • transferrin; low
  • transferrin saturation, low or normal
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3
Q

Name 4 causes microcytic hypochromic anaemia

A

MCV <80
TICS

  • Thalassaemia
  • iron deficiency
  • Chronic disease anaemia
  • Sideroblastic anaemia
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4
Q

Name 9 causes macrocytic hyperchromic anaemia

A

Megaloblastic

  • folate deficiency
  • vit B12 deficiency
  • Bactrim

Non-megaloblastic ALARMS

  • Aplastic anaemia, AZT
  • Liver disease
  • Alcohol
  • Reticulocytosis
  • Myxoedema, multiple myeloma
  • Smoking
    Also hypothyroid
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5
Q

Name normal haemoglobin in females and males

A

Male: 14-18 g/dL
Female: 11.5- 15.5

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6
Q

How investigate for thalassaemia?

A

Hb electrophoresis

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7
Q

How test for pernicious anaemia (3)

A
  • Anti-parietal cell antibodies
  • anti-intrinsic factor antibodies
  • gastroscope with biopsy: atrophic gastritis with significant reduction in parietal cells
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8
Q

Where is b 12 absorbed

A

Distal ileum
Must first combine with intrinsic factor (secreted by parietal cells) stomach in order to be absorbed

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9
Q

How diagnose anaemia caused by parvovirus B 19

A

Bone marrow aspirate: giant pronormoblasts
(Pathomnemonic)

Will cause normocytic anaemia with low reticulocyte count

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10
Q

Name 4 risk factors Hodgkin’s lymphoma

A
  • HIV
  • EBV
  • autoimmune conditions eg ra, sarcoidosis
  • family history
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11
Q

Name 3 types non-hodgkin lymphoma

A
  • Diffuse large B cell lymphoma (rapidly growing painless mass in elderly)
  • Burkitt lymphoma (ass with EBV, HIV)
  • malt lymphoma (around stomach)
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12
Q

Histologic cell found in Hodgkin lymphoma?

A

Reed-sternberg cell (2 nuclei)

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13
Q

Pentad of TTP

A

Thrombotic thrombocytopenia purpUra

Fat Cats Make Terrible Ropes

  • fever
  • fluctuating CNS signs: fits, hemiparesis, decrease consciousness, loss vision
  • maha ( microangiopathic hemolytic anaemia) (severe, often with jaundice ).
  • thrombocytopenia (severe, often mucosal bleed)
  • renal failure.
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14
Q

Name 4 causes target cells on blood smear

A

Central area of haemoglobinisation.

  • liver disease
  • thalassaema
  • post splenectomy
  • haemoglobin c disease
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15
Q

Name 3 causes spherocytes on blood smear

A

Dense cells, no area of central pallor

  • autoimmune haemolytic anemia
  • post-splenectomy
  • hereditary spherocytosis
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16
Q

Name 2 causes howell-jolly bodies on blood smear

A

Small round nuclear remnants

  • hyposplenism, post-splenectomy
  • dyshaematopoeisis
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17
Q

Name 2 causes polychromAsia on blood smear

A

Young red cells- reticulocytes present

  • haemolysis, acute haemorrhage
  • increased red cell turnover
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18
Q

Name 2 causes basophilic stippling on blood smear

A

Abnormal ribosomal RNA appears as blue dots

  • lead poisoning
  • dyshaematopoeisis
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19
Q

Normal platelets?

A

150 - 400 x 10^9/l

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20
Q

Normal prothrombin time?

A

9-12 seconds

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21
Q

Absolute vs relative erythrocytosis?

A

Aka polycythaemia.

  • Haematocrit high both
  • Red cell mass high vs normal
  • plasma volume normal vs low
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22
Q

Name 4 broad causes absolute polycythaemia with examples

A

Primary

  • myeloproliferative disorder: polycythaemia rubra Vera

Secondary

  • high erythropoietin due to tissue hypoxia: high altitude, cardiorespiratory disease
  • inappropriately high erythropoietin: renal disease (hydronephrosis, cysts, carcinoma), other tumours ( hepatoma, phaeochromocytoma, bronchogenic carcinoma), exogenous testosterone
  • exogenous erythropoietin: performance enhancing drugs in athletes
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23
Q

Name 5 causes relative (low -volume) polycythaemia

A
  • Diuretics
  • smoking
  • obesity
  • alcohol
  • Gaisbock’s syndrome
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24
Q

Define polycythaemia

A

Persistent raised haematocrit about > 0,5

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25
Q

Name 6 broad causes with examples of lymphadenopathy

A

Miami

  • malignancy: primary ( lymphoma, leukemia), secondary ( lung, breast, thyroid, melanoma)
  • Infective: bac (strep, tb, brucellosis), viral (ebv, HIV), parasite (toxoplasmosis), fungal (histoplasmosis, coccidiodomycosis )
  • autoimmune: connective tissue disorders: ra, SLE
  • miscellaneous: sarcoidosis, amyloidosis
  • iatrogenic: drugs: phenytoin (antiepileptic)
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26
Q

How differentiate cause of bleeding by site? (2)

A
  • Bleed into muscles, joints, retroperitoreal+ intracranial haemorrhage = coagulation factor defect
  • purpurA, prolonged bleed from superficial cut, epistaxis, git haemorrhage, menorrhagia = thrombocytopenia / platelet dysfunction / Von willebrand disease.
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27
Q

Name 5 causes purpura

A
  • Most common = thrombocytopenia /platelet dysfuction / Von willebrand disease!
  • Henoch schonlein purpura (autoimmune)
  • vasculitis
  • purpura fulminanS eg in DIC 2° to sepsis
  • senile purpura (sun exposure)
  • factitious (inflicted by patients )
  • paraproteinaemias
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28
Q

Name 4 causes pancytopenia with examples

A
  • Bone marrow failure: hypoplastic/aplastic anaemia inherited/viral/ drugs / idiopathic
  • Bone marrow infiltration: acute leukemia, lymphoma, myelodysplastic syndromes
  • ineffective haematopaeisis: megaloblastic anaemia, AIDS
  • peripheral pooling/destruction: SLE, hypersplenism (pht, felty, malaria, myelofibrosis)
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29
Q

Name 5 indications heparin/lmwh/ fondaparinux

A
  • Prevent + treat VTE
  • post thrombolysis for mi
  • percutaneous coronary intervention
  • unstable angina pectoris
  • acute peripheral arterial occlusion
  • cardiopulmonary bypass
  • haemodialysis + haemofiltration
  • non q-wave mi
30
Q

Name 5 indications warfarin (coumarin)

A
  • Prevent + treat VTE
  • arterial embolism
  • dilated cardiomyopathy
  • afib with specific risk factors for stroke
  • mechanical prosthetic cardiac valve
  • mobile mural thrombus post mi; extensive anterior mi,
  • Cardioversion
  • ischaemic stroke in antiphospholipid syndrome
  • mitral stenosis + mitral regurgitation with afib
31
Q

Name 2 indications rivaroxaban/ dabigatran/ apixaban/ edoxaban

A
  • Prevent VTE ( except edoxaban)
  • treat VTE (except dabigatran, apixaban)
  • afib with risk factors for stroke
32
Q

Name 4 antiplatelet drugs and their moa

A
  • Cox inhibition: aspirin
  • ADP receptor inhibition: clopidogrel
  • glycoprotein 2b/3a inhibition: abciximab, tirofiban
  • phosphodiesterase inhibition: dipyridamole
33
Q

Name 3 oral anticoagulant drugs and their moa

A
  • Vitamin K antagonist: warfarin (coumarin)
  • direct thrombin inhibition: dabigatran
  • direct 10a inhibition: rivaroxaban, apixaban, edoxaban
34
Q

Name 3 injectable anticoagulant drugs and their moa

A
  • Antithrombin -dependent inhibition of thrombin and 10a: heparin, lmwh
  • antithrombin dependent inhibition of 10a: fondaparinux
  • direct thrombin inhibition: argatraban
35
Q

Antidote to warfarin

A

Prothrombin complex concentrate + iv vitamin K

36
Q

Target INR for patients on warfarin?

A

2-3

37
Q

Target INR for patients on warfarin and recurrent VTE on warfarin or mechanical prosthetic heart valve?

A

2,5 - 3,5

38
Q

Name 3 causes iron deficiency anaemia with examples

A
  • Blood loss, esp git : From malignancy, gastritis, peptic ulcer, IBD, diverticulitis, polyps, hookworm, schistosomiasis, angiodysplastic lesions, aspirin, NSAID. Also menstruation, pregnancy
  • malabsorption: deficient intake; lack gastric acid (need to release fe from food + keep iron in soluble ferrous state) eg PPI, achlorhydria in elderly, gastric surgery; Coeliac disease (absorbed in upper small intestine)
  • physiological demands: infancy, puberty, pregnancy, breadfeeding
39
Q

Dose iron for fe deficiency anaemia?

A

Ferrous sulphate 200 mg 3x daily for 3-6 months.

40
Q

Pathogenesis anaemia of chronic disease?

A

Hepcidin protein excess due to inflammation → keeps iron trapped in ferritin.

41
Q

Name 5 clinical signs megaloblastic anaemia

A

Proliferating cells exhibit megaloblastosis causing clinical changes:

  • smooth tongue
  • angular cheilosis
  • vitiligo
  • skin pigmentation
  • heart failure
  • pyrexia
42
Q

Lab results megaloblastic anaemia? (6)

A
  • Hb low
  • MCv high
  • erythrocyte, reticulocyte, leukocyte, platelet count low
  • ferritin high
  • LDH high! (High proliferation rate in marrow → ineffective erythropoiesis → haemolysis)
  • blood film: neutrophil hypersegmentation!, oval macrocytosis, poikilocytosis, red cell fragmentation
  • bone marrow: high Iron stores!, pathological non-ring sideroblasts, giant metamyelocytes…
43
Q

Name 4 causes b12 deficiency

A
  • Dietary deficiency: vegan
  • gastric pathology: hypochlorydia in elderly, gastric surgery
  • pernicious anaemia: atrophy gastric mucosa → loss parietal cells → IF deficiency
  • small bowel pathology: mobility disorders/ hypogammaglobulinaemia → bacterial overgrowth; Chron’s disease
44
Q

Name 4 causes folate deficiency

A
  • Diet: poor vegetable intake
  • malabsorption: coeliac disease, small bowel surgery
  • increased demand: pregnancy!, cell proliferation eg haemolysis
  • drugs: methotrexate, phenytoin, contraceptive pill
45
Q

Diagnosis folate deficiency anaemia

A

Low red cell folate levels (not plasma folate)

46
Q

Treatment b12 deficiency?

A

Hydroxycobalamin 1000 micrograms IM for 6 doses 2 or 3 days apart, then
Maintenance 1000 micrograms every 3 days for life

47
Q

Describe and name 3 indications for direct Coombs test

A

Detect presence of antibody bound to red cell surface

  • autoimmune haemolytic anaemia
  • haemolytic disease of the newborn
  • transfusion reactions
48
Q

Describe and name 2 indications for indirect Coombs test

A

Detect antibodies in plasma

  • antibody screen in pre-transfusion testing
  • screening in pregnancy for antibodies that may cause haemolytic disease of the new born
49
Q

Classic precipitant of haemolysis in patients with G6PD deficiency

A

Consumption of Fava beans causing favism

50
Q

Blood film features of G6PD deficiency haemolysis? (3)

A
  • Bite cellS
  • blister cells
  • polychromasia reflecting the reticulocytosis
  • denatured hb visible as Heinz bodies within red cell cytoplasm with methyl violet stain
  • irregularly shaped small cells
51
Q

Blood film of pyruvate kinase deficiency?

A

Prickle cells (resemble holly leaves)

(Red cell enzyme defect)

52
Q

Name 4 precipitating factors of sickle cell crisis

A
  • Hypoxia
  • acidosis
  • dehydration
  • infection
53
Q

Name 5 clinical features of sickle cell crisis

A
  • Painful vasO- occlusive crisis: acute severe bone pain (most common)
  • stroke
  • sickle chest syndrome: follows vaso-occlusive crisis → bone marrow infarction → fat emboli to lungs → ventilatory failure (most common cause death)
  • sequestration crisis: thrombosis of venous outflow from organ → loss function + painful enlargement eg spleen, liver, priapism
  • aplastic crisis: infection with parvo B19 → severe red cell aplasia → anemia → Hf
54
Q

Define thalassaemia

A

Inherited Impairment of hb production with partial/complete failure to synthesise a specific type of globin chain eg beta or alpha chains

55
Q

Define leukemia

A

Malignant disorders of haematopoeitic stem cell compartment, characteristically associated with increased no of while cells in bone marrow andor peripheral blood.

56
Q

Name 5 risk factors leukaemia

A
  • Ionising radiation: radiotherapy, diagnostic xr of foetus in pregnancy
  • cytotoxic drugs
  • retroviruses
  • genetic: Down’s syndrome
  • immunological deficiency eg hypogammaglobulinaema
57
Q

Name 4 types leukemia

A

Acute: failure of cell maturation → accumulation primitive cells → take up marrow space at expense of normal cells.

  • Acute lymphoblastic leukemia (all) (b and t cells)
  • acute myeloid leukemia (AML) (other lineages: red cells, granulocytes, monocytes,platelets) (more common in adults)

Chronic

  • chronic lymphocytic leukemia (Cll) (most common leukemia, B lymphocytes)
  • chronic myeloid leukemia (CML) (predominantly granulocytes )
58
Q

Name 5 complications of acute leukaemia

A
  • Anaemia (give rcc)
  • thrombocytopenia Bleeding (give platelets)
  • infection due to neutropenia eg S aureus, staph epidermis, E. coli, pseudomonas, klebsiella, pneumocystis jirovecii in ALL, candida, HsV + hzv reactivation
  • metabolic: diarrhoea → anorexia + electrolyte loss,
  • psychological
59
Q

Defining genetic characteristic of CML?

A

Philadelphia chromosome ( shortened chromosome 22)

60
Q

Name 3 phases CML

A
  • Chronic phase: responsive to treatment, easily controlled (give imatinib)
  • accelerated phase
  • blast crisis: transform to acute leukaemia relatively refractory to treatment. Main cause of death.
61
Q

What chemo is given for lymphoma

A

ABVD regimen

  • doxorubicin
  • bleomycin
  • vinblastine
  • dacarbazine
62
Q

What is multiple myeloma (3)

A

Malignant proliferation of plasma cells (from B cells)→ produce paraprotein
Appears in urine as Bence Jones proteinuria

Need 2 out of 3:

  • Increased malignant plasma cells on bone marrow aspiration
  • serum and/or urine m-protein on electrophoresis
  • skeletal lytic lesions on bane scan
63
Q

Name 7 broad clinical and lab features of multiple myeloma with examples

A

Neoplasm of plasma cells in bone marrow

  • Amyloid: “panda” eyes, nephrotic syndrome, carpal tunnel, bone pain/#, lytic lesions skull
  • hyper viscosity: retinal bleeds, bruising, cerebral ischaemia, Hf
  • Renal failure due to paraprotein deposition, hyper Ca, infection, NSAIDs, amyloid
  • abnormal blood tests: macrocytic anaemia, pancytopenia, high ESR, hyper ca, renal impair, paraproteinaemia
  • Bence Jones proteinuria
  • bone marrow: plAsmacytosis > 10%
  • spinal cord compression: bony collapse, extradural mass

CRAB = Calcium elevated, Renal disease, Anemia, Bone lesions

64
Q

Define aplastic anaemia

A

Bone marrow failure with pancytopenia, low reticulocyles, macrocytosis

65
Q

Name 6 causes secondary aplastic anaemia

A
  • Drugs: cytotoxicS, sulphonamides, indomethacin, carbimazole, anticonvulsants, azathioprine
  • chemicals: glue sniffing, insecticides
  • radiation
  • pregnancy
  • viral hepatitis
  • paroxysmal nocturnal haemoglobinaria
66
Q

How classify bleeding disorders (8)

A

Disorders of primary haemostasis (forming initial platelet plug)

  • thrombocytopenia
  • Von willebrand disease
  • platelet function disorders
    > acquired: iatrogenic ( aspirin, clopidrogel),
  • vessel wall abnormalities
    > congenital: hereditary haemorrhagic telangiectasia, ehlers Danlos disease
    > acquired: vasculitis, scurvy ( vit C deficiency)

Coagulation disorders

  • congenital
    > haemophilia a+b
    > Von willebrand disease
  • acquired
    > under production: liver failure, vitamin K deficiency
    > increased consumption: DIC
    > inhibition of function of coagulation factors: heparin
67
Q

Define ITP

A

Immune-mediated (autoantibodies) against platelet membrane glycoprotein 2b/3a → sensitise platelet → premature removal from circulation by cells of reticulo-endothelial system. → thrombocytopenia

68
Q

Name 4 clinical manifestations of antiphospholipid syndrome

A
  • Adverse pregnancy outcome: 3 or more first trimester abortion, unexplained death of normal foetus after 10 weeks gestation, severe early pre-eclampsia
  • Vte
  • ate
  • livedo reticularis, catastrophic APS, transverse myelitis, shin necrosis, chorea
69
Q

Name 4 conditions associated with secondary antiphospholipid syndrome

A
  • SLE
  • ra
  • temporal arteritis
  • Sjögren’s syndrome
  • systemic sclerosis (scleroderma)
  • BehCet’s disease
70
Q

What is DIC

A

Systemic activation of pathways involved in coagulations + its regulation

  • Intra vascular fibrin clots → multi-organ failure
  • simultaneous coagulation factor + platelet consumption → bleeding
71
Q

Name 8 causes DIC

A
  • Infection/sepsis !
  • obstetric eg amniotic fluid embolism, placental abruption, pre-eclampsia
  • Trauma
  • severe liver failure
  • malignancy eg solid tumours, leukaemias
  • tissue destruction eg pancreatitis, burns
  • toxic/immunological eg Abo incompatibility, snake bites, drugs
  • vascular abnormalities eg vascular aneurysms, liver haemangiomas
72
Q

Diagnosis DIC? (6)

A

Isth scoring system

  • must have associated disorder eg sepsis
  • platelets X10^9/ L
    > > 100 = o
    > <100 = 1
    > <50 = 2
  • Elevated fibrin degeneration products
    > no increase = o
    > moderate = 2
    > strong =3
  • prolonged prothrombin time
    > <3 sec = O
    > >3 - <6 sec =1
    > >6 sec = 2
  • fibrinogen
    > > 1=0
    > <1 = 1

Score 5 or more = overt DIC
<5 = repeat monitoring over 1-2 days

Internal Medicine (20 decks)

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