Haematology Flashcards
How does polycythaemia vera present?
Itchyness, increased HB, and platelets, splenomegaly and HTN
What does liver failure show in terms of coagulation study bloods?
Prolonged PT/APTT. All the clotting factors are low apart from Factor 8 which will be super high!
Rouleaux formation is seen in which condition?
Myeloma
What is the classical presentation for hereditary spherocytosis?
Neonatal jaundice, splenomegaly, failure to thrive
Hereditary spherocytosis - what are the biochemical findings?
Haemolytic anaemia, increase unconjugated bilirubin, increased LDH, increased reticulocytes. raised mean haemoglobin concentration MCHC.
What is the reference range for MCV ?
82-100
Thalaessmia presents in childhood how? What are the biochemical findings?
Beta thalaessmia MAJOR- Anaemia, failure to thrive, frontal bossing of head
Microcytic anaemia with good iron stores.
How does haemophilia present?
Bleeding
Early in life
Haemarthorses - bleeding into joints !
What are the bloods for haemophilia?
Raised APTT (isolated)
Low factor 8/9 assay
What are the INR ranges for stopping/ continuing warfarin in the context of no bleeding?
If over 8 and no bleeding- stop and give vit k
If 5-8 and no bleeding- withhold a couple of doses.
Auer rods indicate?
Acute myeloid leukaemia
How does acute lymphoblastic leukaemia present (biochemically)
Anaemia, Thromboyctopaenia, neutropenia. PANCYTOPAENIA
Features of ALL
Most common malignancy in children
Hepatosplenomegaly
Fever
Recurrent infections
Antiphospholid syndrome- what is seen on bloods and what is the biochemical picture?
Recurrent miscarriage
Anticardiolipin
Levido reticularis
On bloods
Thrombocytopenia
Prolonged APTT
First line management is Aspirin
Smear cells are seen in?
CLL
Myelofibrosis has which characteristic cell?
Tear drop cell
Philadelphia chromosome is associated with which condition?
CML
Reed stenberg cells are a/w which condition?
Hodgkins lymphoma
What are the features of G6PD deficiency?
Precipitated by drugs/ fava beans
Intravascular haemolysis
Males
Mediterranean descent
What is seen on a blood film for G6PD deficiency?
Heinz bodies
Howell Jolley bodies are seen in?
Post splenectomy
Coeliac disease.
Causes of a microcytic anaemia?
Iron deficiency
Thalasseamia
B12 deficiency present with ?
Macrocytic (megaloblastic) anaemia and peripheral neuropathy
How does Idiopathic Thomboyctopenia purpura commonly present?
Children
Purpuric/ petechial rash following a viral illness
Epistaxis!
Low platelets is the only blood abnormality
Is Haemophilia more common in males or females?
Males because X linked recessive
Haemophilia A is reduction in which clotting factor?
Factor 8
What are the features of aplastic anaemia?
Normocytic anaemia
Pancytopenia (leukopenia and thrombocytopenia)
Hypoplastic bone marrow.
What is found during biopsy when diagnosing amyloidosis?
apple green birefringence when using the Congo red stain.
DVT management- what are the provoking factors?
Surgery, trauma, pregnancy. HRT AND COCP are considered provoking factors!
Management of confirmed DVT in a patient with antiphopholipid syndrome?
LMWH and WARFARIN for 5 days then just warfarin
Ann Arbour staging used for?
Hodgkins and Non- Hodgkins lymphoma
What is the management of Hodgkins lymphoma?
Chemotherapy (ABVD) and Radiotherapy in combination
What does PT (prothrombin time) look at?
As you Play Tennis outside
Extrinsic
Overall clotting factor synthesis and consumption
What does APTT look at?
As you Play Table Tennis inside
Intrinsic pathway
When switching from warfarin to DOAC what INR can you start the DOAC?
Start the DOAC when the INR is less 2.5.
Apixiban start when the INR is less than 2.
What factors potentiate Warfarin?
Orlistat
NSAIDS
Inhbitors of the PY40 enzyme system (Ciprofloxacin)
Cranberry Juice
Liver disease
Management of sickle cell crisis (principles) ?
Analgesia
Strong opioid if moderate or severe pain
(Also add in NSAIDS/ paracetamol)
Non Hodgkins lymphoma is treated with?
RCHOP regime of chemotherapy for AGGRESSIVE disease
R-CHOP = Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone
What sort of anaemia do you get with Beta Thalessemia?
Microcytic anaemia
How would beta thalassemia major present?
Microcytic anaemia
Heptasplenomegaly
Recurrent infections
CML
- Which age group?
- Which chromosome
- First line treatment?
Age group: 60s
Philadelphia chromosome
First Line: Imatinib
CLL management?
Chemotherapy with FCR Fludarabine, cyclophosphamide and rituximab (FCR)
Curative: allogenic stem cell transplant
What type of anaemia does sickle cell give you?
Normocytic anaemia
Infection with a parasite increases which white blood cell?
Eosionphils
How does thrombotic thromboyctopenia purpura present?
haemolytic anaemia, thrombocytopenia and neurological symptoms.
Non blanching petechial rash
Fever
Renal failure
How does acute haemolytic reaction present (following blood transfusion)?
Fever, abdominal pain, hypotension
Anaphyaxis is a differential but would have wheeze/angiooedema
What are some examples of myeloproliferative disorders?
Primary myelofibrosis
PCV (Polycythaemia Rubera)
Essential thrombocytopenia
How does essential thrombocytopenia present?
High platelets
JAK 2
Burning in hands
Inheritance of sickle cell?
Autosomal recessive
Most common crisis in sickle cell?
Vasocculsive- presents with pain and ischaemia.
eg strokes, acute limb ischaemia.
Reed Sternberg Cells indicate…
HODGKINS lymphoma
Von willebrand- what do the clotting studies show?
Prolonged APTT
PT Normal
*Most common inherited bleeding disorder**
Hodgkins lymphoma- management?
Chemo + Radiotherapy!
Non Hodgkins lymphoma- management
Wide spectrum of disease
Follicular (mild form)- local radiotherapy
Aggressive disease= RCHOP or Bone marrow transplant
What is the triad for paroxysmal nocturnal haemoglobinuria? And classic presentation?
Aplastic anaemia
Haemolytic anaemia (Raised LDH and Reduced Hb)
Thrombosis
Man presents with dark urine in the morning that clears by afternoon
Sickle cell presents how? and what is seen on bloods?
Normocytic anaemia
Jaundice
Low ESR
Might present with their first crises eg pain
Congenital spherocytosis presents how?
Anaemia, failure to thrive
Autosomal dominant
Splenomegaly
What are some of the causes of a unprovoked DVT/PE
Active ca.
Thrombophillia
EG: Risk factors that are not easily modifiable!
6 months anticoagulation
What disorders increase your risk of thrombosis?
Factor V leiden
Antiphospholipid
Haemochromotosis - what are the features and which are reversible?
Problem with Iron
Features: Bronze diabetes
Skin pigmentation (reversible)
Cardiomyopathy (reversible)
Cirrhosis
DM
Erectile dysfunction
Treatment is venesection
What is a complication of CML?
Blast crisis! Acute illness- ++progenitor cells/ blast cells. Present with fever/ splenomegaly
Target cells are seen in which pathological conditions?
B Thalasemia
IDA
Hyposplenism
Liver disease
Heinz bodies are seen in?
G6DPH defiency
Features of ALL
Children
A/W Downs syndrome
Neutropenia
Thrombocytopenia
Anaemia, bleeding and infections
Major bleeding in the context of warfarin?
Stop warfarin/ Vit K and OCTAPLEX if
INR >8 and bleeding!
Characteristic features of PCV (Polycythaemia vera )
Tingling
INCREASED HB!
Itching after a hot bath
JAK 2
What is seen on clotting studies of haemophilia?
PROLONGED APTT
