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FINALS: PASSMED/QUESMED > Haematology > Flashcards

Haematology Flashcards

1
Q

What would be blood results of anaemia of chronic disease?

A

low/normal ferritin and wide distribution of red blood cell volume

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2
Q

What are side effects of ferrous sulphate?

A

Black stools, constipation, diarrhoea, nausea

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3
Q

What are triggers for sickle cell crisis?

A

Infection, dehydration, hypoxia, acidosis, exposure to cold

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4
Q

Why does sickle cell not present till 6 months?

A

High levels of HbF mask the effect of this until they start to fall at 6 months

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5
Q

What are some complications of myeloma?

A

Hypercalcaemia, spinal cord compression, hyperviscosity, acute renal failure.

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6
Q

Why are people with myeloma susceptible to other infections?

A

Possible bone marrow infiltration; immunoparesis secondary to overexpression of one immunoglobulin and underexpression of any other immunoglobulins.

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7
Q

What is the treatment for CLL and how is it given?

A

Imatinib - tyrosine kinase inhibitor, oral

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8
Q

CML vs CLL

A

CLL - usually an incidental finding with no symptoms
CML - will have symptoms, usually massive splenomegaly (described as sense of fullness sometimes)

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9
Q

AML vs CML

A

AML - low neutrophils and platelets
CML - anaemia, raised neutrophils and platelets

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10
Q

ALL blood findings

A
  • Raised lymphocytes
  • Low neutrophils
  • Low platelets
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11
Q

What is raised with beta thalassaemia major?

A

HbA2

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12
Q

PT vs APTT

A

PT - extrinsic - Factors 3 and 7 (play tennis outside)
APTT - intrinsic - Factors 9,11,13 (play table tennis inside)

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13
Q

New B symptoms in someone with CLL?

A

Richters transformation -> CLL transforms into aggressive large cell lymphoma

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14
Q

Patients over the age of 60 who present with iron deficiency anaemia

A

Investigate for colorectal cancer -> colonoscopy

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15
Q

Causes of the renal impairment in myeloma?

A

AL type amyloidosis, Bence Jones nephropathy, nephrocalcinosis, nephrolithiasis

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16
Q

Isolated rise in GGT in the context of a macrocytic anaemia

A

Alcohol excess

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17
Q

‘starry sky’ appearance on lymph node biopsy

A

Burkitt lymphoma - associated with EBV/HIV

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18
Q

Complications of blood transfusions

A

Non-haemolytic febrile reaction: Fever and chills -> slow/stop transfusion + paracetamol
Minor allergic reaction: urticaria and pruritic -> stop transfusion and give antihistamine
Acute haemolytic reaction: fever, abdominal pain, hypotension -> stop transfusion, recheck patient identity, send blood for repeat testing
Transfusion-associated circulatory overload: hypertension, pulmonary oedema -> slow/stop transfusion + loop diuretic and oxygen
Transfusion-related acute lung injury: hypoxia, hypotension, fever -> stop transfusion, oxygen

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19
Q

What is the most common clotting abnormality?

A

Von-Wilebrand disease

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20
Q

What is the treatment for beta thalassaemia major?

A

Lifelong blood transfusions

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21
Q

low platelets, increased clotting time and raised fibrin degradation products (FDPs)

A

DIC

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22
Q

When does heparin-induced thrombocytopenia present?

A

5-14 days post op with low platelets, nothing else

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23
Q

Which drugs can cause haemolytic in patients with G6PD?

A
  • Ciprofloxacin
  • Sulphasalazine
  • Sulfonylureas
  • Sulphonamides
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24
Q

Hereditary spherocytosis vs G6PD?

A

HS - extra vascular haemolysis -> causes splenomegaly
G6PD - intravascular haemolysis -> normal spleen

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25
Q

Inheritance of G6PD vs HS?

A

G6PD - X linked recessive -> transmitted from mother
HS - Autosomal dominant

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26
Q

What can precipitate renal failure in patients with myeloma?

A

NSAIDs

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27
Q

unexplained nosebleeds and menorrhagia + an immune condition

A

Think ITP

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28
Q

IgA deficiency increases the risk of what?

A

Anaphylactic reactions to blood transfusions

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29
Q

Which leukaemia is associated with polycythaemia?

A

AML

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30
Q

Blood test findings for leukaemia?

A

AML: increased myeloblasts + anaemia and thrombocytopenia
ALL: increased lymphoblasts + anaemia and thrombocytopenia
CML: increased granulocytes + anaemia
CLL: increased lymphocytes (usually B cells) + anaemia

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31
Q

What are negative prognostic factors for lymphoma?

A
  • The presence of B symptoms
  • Male gender
  • Being aged >45 years old at diagnosis
  • High WCC, low Hb, high ESR or low blood albumin
  • Lymphocyte depleted subtype
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32
Q

What infection can trigger an aplastic crisis in patients with hereditary spherocytosis?

A

Parvovirus

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33
Q

Which subtype of Hodgkins has the best prognosis?

A

Lymphocyte predominant

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34
Q

Malaria prophylaxis can trigger what?

A

Haemolytic anaemia in those with G6PD deficiency

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35
Q

hyper-segmented neutrophil polymorphs

A

Megaloblastic anaemia

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36
Q

Abdominal pain, constipation, neuropsychiatric features, basophilic stippling

A

Lead poisoning

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37
Q

What are irradiated blood products used for?

A

Reduce the risk of graft vs host disease by destroying T cells

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38
Q

What are the adverse effects of tamoxifen?

A

Increased risk of VTE and endometrial cancer

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39
Q

Most common organism which causes neutropenic sepsis?

A

Staph epidermis

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40
Q

Which drugs can cause aplastic anaemia?

A
  • Phenytoin
  • Chloramphenicol
  • Cytotoxics
  • Sulphonamides
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41
Q

IgM paraprotein

A

Waldenstrom’s macroglobulinaemia

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42
Q

pain, oedema, dermatitis, ulceration, abnormal skin pigmentation, hyperpigmentation, gangrene, lipodermatosclerosis

A

post-thrombotic syndrome

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43
Q

When should G6PD enzyme assays be done?

A

At presentation and 3 months after to avoid false negatives

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44
Q

Mycoplasma infection can cause what?

A

Cold Autoimmune haemolytic anaemia

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45
Q

What ITU treatment could be considered for someone with sickle cell crisis

A

Exchange transfusion -> reduce number of sickle cells and increase normal RBC to improve oxygenation

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46
Q

What is a common complication of Burkitts lymphoma?

A

Tumour lysis syndrome

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47
Q

What electrolyte imbalances are seen in tumour lysis?

A

hyperkalaemia
hyperphosphataemia
hypocalcaemia
hyperuricaemia
acute renal failure

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48
Q

‘tear drop’ poikilocytes

A

Myelofibrosis

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49
Q

intense itching which usually occurs after exposure to hot water or hot and humid weather

A

Polycythaemia vera

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50
Q

What can be given prior to chemo to prevent tumour lysis syndrome?

A

Allopurinol or rasburicase

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51
Q

Beta thalasaaemia major vs trait?

A

Major would have profound anaemia usually Hb <60

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52
Q

Sickle cell + abdominal pain + anaemia

A

Sequestration crisis

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53
Q

Transfusion thresholds?

A

Normal patients <70
Patients with ACS <80

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54
Q

What is the treatment for ITP?

A

Oral steroids / IVIG if signs of major bleeding

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55
Q

Rouleaux formation

A

Multiple myeloma

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56
Q

Target cells and Howell-Jolly bodies

A

Coeliac disease -> hyposplenism

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57
Q

decrease in haptoglobin levels

A

Haemolysis

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58
Q

large multinucleate cells with eosinophilic nucleoli

A

Reed-Sternberg

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59
Q

What are complications of CLL?

A
  • Anaemia
  • Recurrent infections due to hypogammaglobulinaemia
  • Warm AIHA
  • Transformation into non-Hodgkins
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60
Q

High HBA2?

A

Beta thalassaemia

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61
Q

What is the treatment for post thrombotic syndrome?

A

Compression stockings

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62
Q

Complications of polycythaemia?

A
  • Thrombotic events (patients given aspirin as prophylaxis)
  • Myelofibrosis
  • Acute leukaemia
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63
Q

normocytic anaemia with low serum iron, low TIBC but raised ferritin

A

Think anaemia of chronic disease

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64
Q

Aplastic crisis vs sequestration crisis in sickle cell?

A

Aplastic - reduced reticulocytes
Sequestration - increased reticulocytes

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65
Q

Thalassaemias will cause what?

A

Haemolysis -> raised bilirubin

66
Q

Management of anti-phospholipid in pregnancy?

A

Aspirin + LMWH

67
Q

What is the reversal agent for dabigatran?

A

Idarucizumab

68
Q

Myeloma Investigations

A

Bloods - anaemia
Blood film - rouleaux formation
Urine protein electrophoresis - Bence Jones (IgA/IgG)
Bone marrow - Raised plasma cells
CXR/MRI - osteolytic lesions

69
Q

What mutation would be seen in polycythaemia?

70
Q

How does heparin work?

A

Activate antithrombin III - measure APTT

71
Q

Elderly patient with fatigue, splenomegaly, weight loss/night sweats?

A

Think myelofibrosis

72
Q

‘myeloid blast’ cells are suggestive of what?

73
Q

What are signs of low Hb on examination?

A

Pallor, tachycardia, tachypnoea, flow murmur

74
Q

What are causes of late transfusion complications?

A

Iron overload, graft versus host disease, post transfusion purpura, infection

75
Q

What is a massive blood transfusion?

A

Transfusion of 10 units/a patients entire blood volume within 24 hours

76
Q

How to test for pernicious anaemia?

A

Intrinsic factor - most useful
gastric parietal cell antibodies

77
Q

Pernicious anaemia predisposes to what?

A

Gastric cancer

78
Q

How is haemophilia inherited?

A

X linked recessive

79
Q

What is the most common inherited thrombophilia?

A

Factor V Leiden deficiency

80
Q

small, single, peripherally-located, rounded inclusion in 50-60% of the erythrocytes.

A

Howell-Jolly body -> Hyposplenism

81
Q

Metallic aortic valves can cause what?

A

Non-immune haemolytic anaemia

82
Q

What can be given to reduce the frequency of sickle cell crises?

A

Hydroxycarbamide (hydroxyurea)

83
Q

How to manage high INR in patients needing emergency surgery?

A

Give IV Vit K and recheck INR in 6-12 hours
If surgery cannot be postponed give 4 factor prothrombin + IV Vit K to reverse warfarin

84
Q

What is a safe INR for surgery?

85
Q

What organisms are people with sickle cell susceptible to?

A

Strep pneumoniae

86
Q

TACO vs TRALI

A

TACO - SOB and hypertension
TRALI - hypotension

87
Q

What is the management of ITP?

A

Emergency: Platelet transfusion/IV Methylpred/IVIG
Platelet > 30 - Observe
Platelet <30 - Oral pred

88
Q

What are features of blood film post splenectomy?

A

Howell- Jolly bodies
Pappenheimer bodies
Target cells
Irregular contracted erythrocytes

89
Q

finger abduction weakness

A

Lesion at T1

90
Q

TPP Symptoms?

A
  1. Fever
  2. Neuro symptoms
  3. Renal failure
  4. Anaemia
  5. Low platelets
91
Q

ITP VS TTP VS DIC

A

DIC will have raised PT/INR/APTT + low platelets whereas for ITP and TTP this will be normal

92
Q

How can tumour lysis syndrome be diagnosed?

A
  • Increased serum creatinine
  • Cardiac arrhythmia
  • Seizure
93
Q

Aplastic crisis vs sequestration

A

Aplastic - sudden fall in Hb after parvovirus infection
Sequestration - sickling within organs such as spleen/lungs causing pooling of blood

94
Q

Polycythaemia + sudden drop in Hb?

95
Q

Isolated rise in Hb?

A

Polycythaemia

96
Q

Bite and blister cells

A

G6PD deficiency

97
Q

What is the main management of sickle cell crises?

A
  • IV analgesia, fluids + oxygen
  • Consider Abx if infection and blood transfusion if Hb is low
98
Q

ITP vs VWD?

A

ITP - destruction of platelets so platelet count is low with normal PT and APTT
VWD - platelets are fine but they take longer to stop bleeding so platelet count is normal, PT and APTT are prolonged

99
Q

Hand foot mouth syndrome - sudden swelling, pain and erythema?

A

Think Sickle cell disease

100
Q

How is tranexamic acid given followng major haemorrhage?

A

IV bolus followed by slow infusion

101
Q

anisocytosis, macrocytosis and hyposegmentation of the neutrophils.

A

Myelodyplastic syndrome -> can progress to AML

102
Q

Over how long are RBC transfused?

A

90-120 minutes in non urgent cases

103
Q

Microcytic anaemia with high ferritin + transferrin saturation?

A

Think sideroblastic anaemia - basophilic stippling

104
Q

Warm vs Cold AIHA?

A

Warm - IgG - associated with CLL
Cold - IgM (M for Mountains - cold) - associated with lyMphoma / Mycoplasma / EBV

105
Q

What is the pathological process behind myeloma?

A

Clonal proliferation of plasma cells with paraprotein production

106
Q

What is the treatment for myeloma?

A
  • Chemo
  • Bisphosphonates often given for bone protection
107
Q

What translocation causes Philadelphia?

A

t(9:22) - gene BCR/ABL

108
Q

What blood test will be raised with Hodgkins?

109
Q

Why does sickle cell often present in >1ys?

A

Fetal Hb protects against sickling therefore by 1 transformation to adult haemoglobin is completed

110
Q

What is the action of LMWH?

A

Anti-thrombin and anti-Xa

111
Q

What are the best blood tests to examine synthetic liver function?

A

INR and albumin

112
Q

What does cryoprecipitate contain?

A

Factor 8, VWF, fibrinogen and factor 13

113
Q

What does plasma contain?

A

All clotting factors

114
Q

What is the pathophysiology of DIC?

A
  • Diffuse thrombin activation by a trigger which activates coag cascade
  • This leads to platelet consumption and clotting factor consumption
115
Q

What are triggers for DIC?

A
  • Sepsis
  • Trauma
  • Malignancy
  • Vasculitis
  • Toxins
  • Pancreatitis
116
Q

Beta thalassaemia major vs trait?

A

Major - homozygous mutation, Trait - heterozygous mutation

117
Q

What may be seen on blood film in beta thalassaemia?

A
  • Basophilic stippling
  • Microcytosis
  • Hypochromic red cells
118
Q

What should be given to patients with beta thalassaemia major with blood transfusion?

A

Desferrioxamine

119
Q

What blood abnormality does warfarin cause?

A

Prolonged PT, normal APTT

120
Q

Which organisms cause post splenectomy sepsis?

A
  • Strep pneumoniae
  • H influenzae
  • Meningococci
121
Q

All patients with IHD should take what?

122
Q

Warfarin can rarely cause what?

A

Skin necrosis

123
Q

Ileocecal resection can result in what?

A

Vit B12 deficiency

124
Q

How can painful vaso-occulsive crises be diagnosed?

A

Clinically

125
Q

DIC is associated with what?

A

Schistocytes

126
Q

Men of any age with a Hb below 110g/L should what?

A

Refer for upper and lower GI endoscopy as 2 week wait

127
Q

What is the reversal agent for heparin overdose?

A

Protamine sulphate

128
Q

What is the management of heparin induced thrombocytopenia?

A

If anticoag needed, switch to direct thrombin inhibitors e.g. argatroban

129
Q

Prosthetic heart valves can cause what?

A

Haemolytic anaemia

130
Q

pain when exposed to cold, jaundice, anaemia?

A

Sickle cell

131
Q

platelet count < 30 x 109 and clinically significant bleeding

A

Platelet transfusion needed

132
Q

Raised haemoglobin, plethoric appearance, pruritus, splenomegaly, hypertension

A

Polycythaemia

133
Q

Haemoarthroses (bleeding in joints) are a sign of what?

A

Haemophilia

134
Q

Transfusions can cause what?

A

Hyperkalaemia and hypocalcaemia

135
Q

Investigations for polycythaemia?

A
  • FBC/Blood film
  • JAK2 mutation
136
Q

How often should sickle cell patients receive the PCV vaccine?

A

Every 5 years

137
Q

Reversal for rivaroxaban and apixaban

A

andexanet alfa

138
Q

Macrolides can cause what?

A

Drug induced neutropenia

139
Q

Sideroblastic anaemia vs iron deficiency?

A

Sideroblastic - high ferritin and serum iron levels

140
Q

What is the definitive investigation for sickle cell?

A

Haemoglobin electrophoresis

141
Q

Dry tap bone marrow aspirate?

A

Think primary myelofibrosis

142
Q

How is sideroblastic anaemia inherited?

143
Q

What does rituximab target?

144
Q

ADAMTS-13 deficiency is associated with what?

145
Q

Blood film showing Schistocytes?

146
Q

Target cells with asymptomatic anaemia?

A

Beta thalassaemia trait

147
Q

Non Hodgkins vs CLL

A

CLL - significant lymphocytosis

148
Q

Anaemia with raised bilirubin + LDH?

A

Haemolytic anaemia

149
Q

What is permissive hypotension?

A

A strategy in bleeding of trauma patients where you use less fluids and maintain lower BP to prevent clots

150
Q

What are electrolyte imbalances following large blood transfusion?

A
  • Hyperkalaemia
  • Hypocalcaemia
  • Iron overload
151
Q

Blood film changes

A

Target cells - Iron deficiency anaemia, sickle cell, hyposplenism, liver disease
Spherocytes - spherocytosis, AIHA
Basophilic stippling - lead poisoning, thalassaemia, sideroblastic anaemia
Heinz bodies - G6PD
Schistocytes - G6PD, DIC
Pencil poilkilocytes - Iron deficiency

152
Q

Management of AIHA

A
  • Supportive care
  • Steroids to suppress immune system
  • Splenectomy in severe cases
153
Q

What happens to EPO in polycythaemia?

154
Q

Schistocytes will be seen in what?

A

Haemolysis

155
Q

Raised red cell distribution width?

A

Think mixed deficiency e.g iron and folate

156
Q

Recurrent DVTs in someone already on a DOAC?

A

Increase dose, check adherence or switch to another anticoagulant e.g. warfarin

157
Q

Increased concentration of haemltocrit is what?

A

Polycythaemia

158
Q

Major haemorrhage protocol involves providing what?

A

Packed red cells, platelets and FFP

159
Q

Blood oozing from a cannula site is a classic sign of what?

160
Q

<40 year old with raised platelets but no raised Hb?

A

Essential thrombocytopenia

FINALS: PASSMED/QUESMED (22 decks)

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