Haematology Flashcards
Clinical fts of non-haemolytic febrile reaction (to blood products)
fever, chills
Mx of non-haemolytic febrile reaction (to blood products)
slow/stop transfusion
paracetamol
monitor
Pathophys of non-haemolytic febrile reaction (to blood products)
(thought to be)
antibodies reacting with white cell fragments (HLA antibodies) of the blood product and cytokines leaked from the blood cell during storage
prev sensitization (pregnancy/transfusion)
Pathophys minor allergic reaction (transfusion)
(thought to be)
foreign plasma proteins
Clinical fts of minor allergic reaction (transfusion)
pruritis, urticaria
Mx of minor allergic reaction (transfusion)
temporarily stop transfusion - resume once reaction resolves
antihistamine
monitor
Pathophys of anaphylaxis (to blood transfusion)
pts with IgA deficiency who have anti-IgA antibodies
Clinical fts of anaphylaxis (to blood transfusion)
hypotension
dyspnoea, wheezing
angiodoema
Mx of anaphylaxis (to blood transfusion)
Stop transfusion
IM adrenaline
ABC support (oxygen, fluids)
Pathophys of acute haemolytic reaction (to blood products)
ABO- incompatible blood (2ry to human error)
red blood cell destructio by IgM-type antibodies
Clinical fts of acute haemolytic reaction (to blood products) - incl time of onset
Onset - minutes from start
fever
abdominal pain
hypotension
agitation
Mx of acute haemolytic reaction (to blood products)
Stop transfusion
Confirm diagnosis (pt identity on pt and product; send bloods for direct coombs test, repeat typign and cross-matching)
Supportive (fluid resus)
Pathophys of transfusion-associated circulatory overload (TACO)
excessive rate of transfuion
pre-existing heart failrue
Clinical fts of transfusion-associated circulatory overload (TACO)
pulmonary oedema
hypertension
Mx of transfusion-associated circulatory overload (TACO)
slow/stop transfusion
consider IV loop diuretic (furosemide) + oxygen
Pathophys of transfusion-related acute lung injury (TRALI)
non-cardiogenic pulmonary oedema
thought to be 2ry to incr vascular permeability caused by host neutrophils activated by substanced in donated blood
Clinical fts of transfusion-related acute lung injury (TRALI) - incl time of onset
Onset - 6hrs of transfusion
Hypoxia
Hypotension
Fever
Pulmonary infiltrates of CXR
Mx of transfusion-related acute lung injury (TRALI)
Stop transfusion
O2 and supportive care
Complications of acute haemolytic transfusion reaction
disseminated itntravascular coagulation
renal failure
Mx fpr Well’s score DVT 2 or more
= DVT ‘likely’
- prox leg vein USS within 4hrs
- OR interim anticoag while awaiting USS within 24hrs
If USS positive - start/cont anticoag
if USS negative - do D-dimer
- if positive - stop/no anticoag + rpt USS in 6-8 days
- if negative stop/no anticoag + consider other dx
anticaog in DVT
- 1st line
- c/o to first line + second option
- length of tx
- 1st line DOAC (apixaban/rivaroxaban)
- is c/o then LMWH when suspected followed by dabigatran or edoxaban (or warfarin id renal impairment eGFR <15 or antiphospholipid syndrome)
length: 3mo for provoked; 3-6 mo of active ca; 6 mo if unprovoked
Causes of macrocytic, megaloblastic anaemia
- vit B12 deficiency
- folate deficiency
- 2ry to methotrexate
Causes of marcocytic, normoblastic anaemia
- alcohol
- liver disease
- hypothyroidism
- pregnancy
- reticolcystosis
- myelodysplasia
- drugs: cytotoxics
Mx of pneumocystis jiroveci pneymonia
co-trimaxazole abx (IV pentamidine in severe cases)
steroids if hypoxic
causes of normocytic anaemia
- anaemia of chronic disease
- chronic kidney disease
- aplastic anaemia
- haemolytic anaemia
- acute blood loss
causes of microcystic anaemia
- iron-deficiency
- thalassaema (beta-thalassaemia minor — microcytosis disproportionate to the anaemia)
- congenital sideroblastic anaemia
- anaemia of chronic disease (usually more normocytic)
- lead poisoning
Fts of polycythamiea rubra vera
- 60s
- hyperviscosity of blood
- pruritis
- splenomegally
tx of poycythaemia rubra vera
- aspirin - prophylaxis for VTE
- venesection - 1st line to keep Hb down
- chemotherapy - hydroxyurea (risk of 2ry leukaemia) or phosphorus-32
Typical presentation of multiple myeloma (acronym) + pathophys
CRABBI
Calcium - hypercalcaemia (bone resorption from cytokines released by myeloma cells) –> consipation/nausea/anorexia/confusion
Renal - light chain deposits in renal tubules –> dehydration and incr thirst
Anaemia - bonw marrow crowding suppresses erythripoesis –> fatigue + pallor
Bleeding - bone marrow crowding results in thrombocytopenia
Bones – bone marrow infiltration by plasma cells and cyokine-mediated osteoclast overactivity = lytic bone lesions = pain (back) + pathological fractures
Infection = reduction in normal immunoglobulins
Other clinical fts of multiple myeloma
- amyloidosis (i.e: macroglossia)
- carpal tunnel syndrome
- neuropathy
- hyperviscosity
Investigation findings in multiple myeloma
Bloods - anaemia, renal failure, hypercalcaemia
Peripheral blood film - rouleaux formation
Protein electrophoresis - raised conc monoclonal IgA/IgG in serum; Bence Jones proteins in urine
Imaging - XR ‘rain-drop skull (dark spots of lytic lesions); full body MRI shows bone lesions
Bone marrow aspiration - confirms dx with incr number of plasma cells
Blood film in hyposplenism
- target cells
- Howell-Jolly bodies
- Pappenheimer bodies
- siderotic granules
- acanthocyts
Main causes of hyposplenism
post-splenectomy
coeliac disease (30%)
blood film in iron-deficiency anaemia
- target cells
- ‘pencil’ poikilocytes
- if B12/folate as well = ‘dimorphic’ film with mixed microcytic and macrocytic cells
blood film in myelofibrosis
- tear-drop poikilocytes
intravascular haemolysis findings in blood film
schistocytes
blood film in megaloblastic anaemia
hypersegmented neutrophils
Target cells in blood film - associated conditions
- sickle cell/thalassaemia
- iron-deficiency anaemia
- hyposplenism
- liver disease
Heinz bodies in blood film associated conditions
- G6PD deficiency
- alpha-thalassaemia
Fts of H6PD deficiency
- neonatal jaundice
- intravascular haemolysis
- gallstones
- splenomegaly
- haeinz bodies on films
Ann-Arbor staging of Hodgkin’s lymphoma
I - single lymph node
II - 2 or more lymph nodes/regions on the same side of diaphragm
III: nodes on both sides of diaphragm
IV: spread beyond lymph nodes
A: no sx symptoms (other than pruritis)
B: weight loss >10% in 6mo, fever >38C, night sweats
post-thrombotic syndrome fts
- painful, heavy calves
- pruritis
- swelling of legs
- varicose veins in leg
- venous ulceration in leg
what is post-thrombotic syndrome?
complication following DVT
venous outflow obstruction + venous insuffiency = chronic venous hypertension
Mx of post-thrombotic syndrome
compression stockings + elevate legs
compression stockings used to be recommeded as prophylaxis after DVT, but not anymore
