Haematology Flashcards
what are rouleaux and why do they occur?
stacks of aggregated RBS, they occur when the plasma protein concentration is high like in paraproteinaemias, inflammatory disorders and malignancies
what is basophilic stippling?
The blue staining of ribosomal precipitates within the cytoplasm of red blood cells.
seen in megaloblastic anaemia, thalassaemias, sideroblastic anaemia and alcohol abuse
what are Howell-Jolly bodies?
Peripheral bodies within red cells representing DNA material, typically removed by the spleen. If they are on a blood film it suggests hyposplenism
what are shistocytes?
Schistocytes are fragments of red blood cells seen in microangiopathic haemolytic anaemia
what is the difference between a right and left shift in haematology?
Left shift describes the presence of maore immature neutrophils with unlobed, band shaped nuclei-seen in infection or haem malignancy if severe
Right shift describes increased presence of hypermature neutrophils with greater than five nucleus lobes
when are target cells seen?
They are seen in obstructive liver disease, haemoglobinopathies (thalassaemia and sickle cell disease), and post-splenectomy. small numbers may be seen in iron deficiency anaemia
what is leukoerythroblastosis?
combined presence of immature red blood cells and left shift (immature white cells).
It is suggestive of marrow fibrosis or invasion
what are myeloproliferative neoplasms?
disease of the bone marrow where excess cells are produced, arising from mutations in precursors of the myeloid lineage
what are causes of polycythaemia?
polycythaemia vera
increased EPO- high altitude, COPD, renal carcinoma, renal artery stenosis
relative- decrease in plasma volume
what are symptoms of polycythaemia?
thrombosis, haemorrhage, headache, plethora, erythromyalgia, pruritus, splenomegaly
what is the treatment of polycythaemia?
venesection, aspirin to reduce clot risk. hydroxycarbamide can reduce cell production
what kind of mutations are common causes of polycythaemia vera, myelofibrosis and essential thrombocythaemia?
JAK2 mutations
what are common symptoms of essential thrombocythaemia?
numbness in the extremeties, thrombosis, hearing and vision disturbances, headaches, erythromyalgia
how is essential thrombocythaemia treated?
low risk patients are given aspirin for clot risk
high risk patients given hydroxycarbamide to reduce platelet count
what is the mean survival for myelofibrosis?
5 years
what are some treatment options for myelofibrosis?
treatment is mostly supportive
hydroxycarbamide, JAK2 inhibitors, folic acid, allopurinol, bloodtransfusions. some may require splenectomy
What features can be seen on a blood film post-splenectomy?
Howell jolly bodies
Pappenheimer bodies
Target cells
Irregular contracted erythrocytes
what blood results are seen with antiphospholipid syndrome?
presence of lupus anticoagulant and anti cardiolipin antibodies in two separate tests twelve weeks apart
what is primary thromboprphylaxis in antiphospholipid syndrome?
low dose aspirin
what is secondary thromboprophylaxis for antiphospholipid syndrome?
warfarin, aiming for an INR between 2-3
if they develop a clot while on warfarin, increase INR to 3-4 target and consider adding in low dose aspirin
with what condition can acute haemolysis occur following eating fava beans?
G6PD deficiency
what is virchows triad for thrombosis?
endothelial damage, hypercoagulability, haemostasis
why increased risk of DVT in pregnancy?
hypercoaguable state, gravid uterus pressure on pelvic veins limiting venous return
treatment of DVT in pregnancy?
subcut therapeutic dose LMWH like enoxiparin- monitor with anti factor Xa levels
how to monitor effect of unfractionated heparin?
aptt
what test do we use to monitor effect of LMWH and DOACs?
anti factor Xa level
what baseline tests would you do for a patient before starting anticoagulant?
FBC, renal function and coagulation screen
risk factors for b12 deficiency?
nitrous oxide use, vegan diet, autoimmune disorders (increased risk of pernicious anaemia), malabsorption disorders like crohns
some factors to minimise peri-operative bleeding risk for patient on doac?
reversal of anticoagulant or hold DOAC for 48hr before surgery, assess platelets and anti factor Xa level, check and monitor U+Es
what are causes of renal impairment in myeloma?
renal stones, light chain deposits in kidney, nephrotoxic medications used to treat myeloma, dehydration, amyloidosis, increased risk of infection/sepsis
what stain is used to look for amyloid?
congo red
why increased risk of gout in myeloma?
increased protein, as broken down produce more urea
What is ITP treated with?
oral prednisolone
common short term side effects?
insomnia, weight gain, mood/behaviour changes, immunosupression/opportunistic infection
MSK complications of steroids?
osteoporosis, avascular necrosis and proximal myopathy
