Haematology Flashcards
1
Q
Philadelphia +ve
A
CML
2
Q
Tear drop poikilocyte
Nucleated RBC
Myelocyte
A
Leucoerythroblastic Anaemia
immature WBC and RBC in anaemia
3
Q
Stain for reticulocytes
A
Methylene Blue
4
Q
Hereditary Spherocytosis caused by defect in…
A
Spectrin
5
Q
Increased LDH and haptoglobins
A
Haemolysis
6
Q
Which cancer causes MAHA?
A
Adenocarcinoma (prostate)
7
Q
Haemolytic Uraemic Syndrome caused by which bug?
A
E. coli
8
Q
Auer Rods
A
AML
9
Q
Which virus causes Adult T Cell Lymphoma
A
Human T-Lymphotrophic Virus 1 (HTLV1)
10
Q
Adult T Cell Lymphoma in which ethnicities?
A
Caribbean and Japan carriers
11
Q
Alcohol-induced pain
A
Hodgkin Lymphoma
12
Q
L&H Cells (“popcorn cells”)
A
Nodular Lymphocyte Predominant Hodgkin = “non-classical Hodgkin)
L = lymphocytic and histiocytic cells
13
Q
t(14;18) –> overexpression of bcl2 by cancerous B cells
A
Follicular Non-Hodgkin
14
Q
H. pylori causes which NHL?
A
Gastric MALToma
15
Q
Coeliac Disease associated with which NHL?
A
Enteropathy Associated T Cell Lymphoma (EATL)
16
Q
Reed-Sternberg Cells
A
Hodgkin Lymphoma
17
Q
t(11;14) –> over-express cyclin D1
A
Mantle Cell Lymphoma
18
Q
Starry-sky appearance on lymph node biopsy
A
Burkitt’s Lymphoma
19
Q
Burkitt’s Lymphoma caused by which virus?
A
EBV
20
Q
Large “epitheloid” lymphocytes on lymph node biopsy
A
Anaplastic Large Cell Lymphoma
21
Q
t(2;5) –> Alk-1 protein expression
A
Anaplastic Large Cell Lymphoma
22
Q
Smear/Smudge Cells (fragile cells which open up = purple splodges)
A
Autoimmune Haemolytic Anaemia (including CLL!)
23
Q
Pelger-Huet: bilobed neutrophils
A
Myelodysplasia
24
Q
Infection causing bone marrow failure
A
Parvovirus
25
Ringed Sideroblasts: iron accumulation in ring around nucleus
Myelodysplasia (and AML)
26
Anaemia with abnormal thumbs and Cafe au lait spots
Fanconi Anaemia
27
DKC1 and TERC mutations
Dyskeratosis Congenita = reduced tolemere length
28
Itchy after warm water on skin
Polycythaemia Vera
29
Massive splenomegaly, causing Budd-Chiari Syndrome (hepatic veins draining liver are blocked)
Myelofibrosis
30
Skin pigmentation, nail dystrophy and leukoplakia
Dyskeratosis Congenita
31
JAK2 V617F mutation
Polycythaemia Vera
32
Myelocytes
CML
33
Leukaemia which is emergency as die from rapid haemorrhage/DIC
Acute Promyelocytic Leukaemia
34
t(9;22) in Philadelphia chromosome
Chronic Myeloid Leukaemia
35
Philadelphia-positive cases treated with...
Imatinib
36
Tear drop cell and macrocytes
Pernicious Anaemia (vit B12 and folate deficiency)
37
Antibodies in Pernicious Anaemia
Parietal Cell and Intrinsic Factor antibodies
38
Leading cause of mortality in pregnancy
VTE
39
Antiphospholipid Syndrome antibodies
Lupus Anticoagulant (LA) and Anti-Cardiolipin (ACL) antibodies
40
Test to differentiate IDA from Thalassaemia Trait
Hb Electrophoresis
- IDA: normal
- Thalassaemia: increased HbA2 in beta-thalssaemia, normal in alpha
41
Megakaryocytes in neonate
Neonatal Leukaemia (develops in utero and remits spontaneously)
42
Howell-Jolly Body
Sickle Cell Anaemia
| infarction of spleen --> hyposplenism
43
What animal causes hyposplenism in sickle cell?
Dog bites = capnocytophaga canimorsus
44
Hyperplasia of facial bones
Beta-Thalassaemia
| increased EPO --> bone expansion
45
Irregularly contracted cells
G6PD deficiency
46
Schistocytes
MAHA (fragmented red cells)
47
Coagulation disorder with NORMAL bleeding time
Haemophilia A
48
Universal donor
Group O, RhD –ve
49
Universal recipient
Group AB, RhD+ve
50
Maculopapular rash/desquamation after blood transfusion
Transfusion-Associated Graft Vs Host Disease
51
Patients affected by Post-Transfusion Purpura
HPA-1a negative patients
52
Polychromatic macrocytes
G6PD deficiency
53
100 days after bone marrow transplant, develop widespread illness that looks autoimmune.
Chronic Graft vs Host Disease
54
Drug which reverses heparin
Protamine
55
"Toxic granulation and vacuolation”
Sepsis
56
Koilonychia and Angular Cheilitis
Iron Deficiency Anaemia
57
Glossitis ("beefy tongue")
B12 Deficiency
58
Target and pencil cells
Iron Deficiency Anaemia
59
Thrombotic Thrombocytopaenia Purpura (TTP) caused by what deficiency?
von Willebrand Factor Cleaving Protease (ADAMTS13)
60
Common infections in splenectomy patients
Encapsulated (pneumococcus, meningococcus)
61
Low platelets in post-surgical/septic patient
DIC
62
Osmotic Fragility Test
Hereditary Spherocytosis
63
Glucose-6-Phosphate Dehydrogenase Deficiency have deficiency in what?
Glutathione
| G6PD helps make NADPH, which makes glutathione, which protects RBCs against oxidative stress...
64
Echinocytes
Pyruvate Kinase Deficiency
| red cells have projections
65
Di-Binding Test
Hereditary Spherocytosis
66
Middle Eastern baby with sudden pallor and jaundice
G6PD deficient who ate fava beans
67
Heinz-Bodies
G6PD Deficiency
68
Stain for Heinz-Bodies
Methyl violet stain
69
Pectus excavatum, lax joints and a high-arched palate.
Ehlers-Danlos syndrome
70
The commonest adult leukaemia
Chronic lymphocytic leukaemia
71
Tan-to-grey hyperpigmented patches on his upper trunk, neck and face, nail ridges
Leukoplakia
Dyskeratosis congenita
72
Ham's Test positive
| also abdo pain and pancytopaenia
Paroxysmal nocturnal haemoglobinuria
73
19 year old Jewish male presenting with multiple pathological fractures and hypersplenism
Gaucher's disease (glucosylceramide lipidosis)
74
Donath-Landsteiner positive
Paroxysmal cold haemoglobinuria
75
Bone marrow red cell aplasia and a positive Paul-Bunnell test
B19 parvovirus infection
76
Anti-leucocyte antibodies with similar specificity to the patient’s white blood cell antigens
TRALI – Transfusion related acute lung injury
77
Deficiency of which immunoglobulin causes anaphylaxis after blood transfusions?
IgA Deficiency
78
Haemolytic Uraemic Syndrome is triad of what?
1. MAHA
2. AKI
3. Thrombocytopaenia
79
Low Factor VIII and low ristocetin cofactor activity
Von Willebrand Disease
80
Tumour cells express tartrate-resistant phosphatase (TRAP)
Hairy Cell Leukaemia
- Cancer of B cells (subset of CLL)
- Middle-aged men
81
Japanese person with lymphocytosis and hypercalcaemia
| Tumour cells have cloverleaf appearance
Adult T-cell Leukaemia
- Caused by Human T-Lymphotrophic Virus 1
- Common in Japs and Carribeans
82
t(11;14) --> over-expression of BCL-2 and cyclin-D1
Mantle Cell Lymphoma
| -Aggressive B cell lymphoma in old men
83
Tumour cells contain centrocytes and centroblasts
Follicular Lymphoma
- Centrocytes = small B cells with irregular nuclei
- Centroblasts = large B cells with many nuclei
Presents with painless "waxing and waning" lymphadenopathy
84
When would you give irradiated blood?
Very immunosuppressed — prevents Graft vs Host Disease (donor WBCs attack host)
85
Old man with vision disturbances (looks like looking out of windscreen). Protein electrophoresis shows an IgM paraprotein
Waldenstrom's macroglobulinaemia
86
Sudden jaundice and haemaglobinuria after cold exposure
Paroxysmal cold haemoglobinuria
| -Donath-Landsteiner antibodies
87
What does warfarin inhibit?
Vitamin K epoxide reductase
88
Which haematological cancer is increased in first 3 years in Down Syndrome?
AML --> get Auer Rods!
89
BCR-ABL fusion gene
CML -- arises from Philadelphia Chromosome = t(9;22)
90
t(15;17) --> PML-RARA fusion gene
Acute Promyelocytic Leukaemia
91
What medical emergency is Acute Promyelocytic Leukaemia associated with?
DIC
92
Desmopression treats this clotting disease
Von Willebrand Disease
93
Bite cells
G6PD Deficiency
94
Basophilic stippling
Beta-Thalassaemia trait (and lead poisoning)
95
Acanthocytes (spiculated blood cells/spur cells)
Hyposplenism
96
"Turkish patient"
Turkish (G6P)Delight!
97
Mechanism of Factor V Leiden
Resistance to protein C
98
Sudden anaemia and low reticulocytes
Parvovirus
99
When would you give Fresh Frozen Plasma?
Person with coagulopathy is bleeding, and cannot give them the relevant factor
100
IgA deficient need what type of blood product?
Washed red blood cells
101
Lack of HPA-1a antigen causes this transfusion reaction
Post-transfusion purpura
102
Definition of accelerated phase in CML (in terms of % blasts)
10-19% blasts
103
Definition of blast crisis in CML (in terms of % blasts)
>20% blasts
104
Treatment of blast crisis in CML
Allogeneic Stem Cell Transplant
105
3 components of Virchow's Triad
1. Hypercoagulability
2. Vessel wall injury
3. Stasis of blood
106
What measures Intrinsic and Common pathways?
APTT
107
Which clotting factors are in Intrinsic and Common pathways?
Factors 8 and 9 (= Haemophilia!)
108
What measures Extrinsic pathway?
PT
109
Which clotting factors are in Extrinsic pathway?
Factors 2, 7 and 10 (= INR)
110
Difference between Von Willebrand and Haemophilia (in terms of PT, APTT and Bleeding Time)
Von Willebrand has increased bleeding time
| Both have increased APTT (involves Factors 8 and 9)
111
Slight anaemia with hyperchromic cells lacking central pallor
Hereditary Spherocytosis
112
Warm vs Cold AIHA
Warm = IgG, which bind to RBCs at 37degrees
- Lymphoproliferative disorders
- Penicillin
- Autoimmune
Cold = IgM, which binds to RBCs at 4degrees
-Mycoplasma or EBV
113
Virus which causes Hodgkin's
EBV
114
Causes primary effusion lymphoma
HHV8 (effusion in a tumour mass)
115
Neonate with thumb abnormalities and macrocytic anaemia (WBC and platelets normal)
Diamond-Blackfan Anaemia (affect RBC progenitors)
116
Condition increasing risk of thrombosis when on COCP
Factor V Leiden = activated Protein C resistance
117
When would you use cryoprecipitate?
Replace fibrinogen
| -cryoprecipitate contains clotting factors and fibrinogen
118
What can CLL rapidly transform into?
Diffuse Large B cell non-Hodgkin's lymphoma (=Richter's transformation)
119
"Rain-drop skull" on X-Ray
Multiple Myeloma (multiple osteolytic lesions)
120
Clotting disorders associated with haemarthroses
Haemophilia A and B
121
Polycythaemia vera can transform to which leukaemia?
AML (>20% blasts on blood film)
122
Primary Myelofibrosis is associated with this genetic mutation
JAK2
123
Sickle Solubility Test is used to diagnose this
Sickle Cell Trait
124
Gene affected in Burkitt's
c-myc
125
What is HbA?
a2b2 = 95% adult Hb
126
What is HbA2?
a2d2 = increased in beta thalassaemia as can't make HbA
127
What is HbF?
a2g2 = foetal Hb
128
What is HbH?
b4 = in HbH Disease in alpha thalassaemia (3 alpha genes deleted)
129
What is Hb Barts?
g4 = alpha-thalassaemia major (4 alpha genes deleted)
130
What is HbS?
Hb found in sickle cell anaemia
131
Most common inherited bleeding disorder
Von Willebrand Disease
132
Pattern of inheritance in Von Willebrand
Autosomal dominant
133
How long should warfarin be used after DVT/PE?
3 months if provoked; 6 months if unprovoked
134
Rouleaux formation
Myeloma (stacking of RBCs)
135
Lymphoma which produces IgM
Waldenström's macroglobulinemia
136
Proliferation of megakaryocytes --> bone marrow fibrosis
Myelofibrosis = tear drop poikilocytes, dry tap
137
Mechanism of febrile transfusion reaction
Recipient anti-HLA antibodies react against donor WBCs
138
Common lymphoid progenitor gives which 3 cells?
T, B and NK Cell (rest are from common myeloid)
139
Pneumonia bug causing autoimmune haemolytic anaemia
Mycoplasma (acute cold haemagluttinin)
140
IDA vs Anaemia of Chronic Disease
ACD: increased ferritin, reduced TIBC
141
VTE -- how long warfarin and what INR target?
Warfarin for 3 months (6 if cancer)
| INR 2.5-3.5
142
VTE while on warfarin - how long warfarin and what INR target?
Warfarin lifelong
| INR 3.5
143
Emergency treatment in Haemophilia A vs B
```
A = cryoprecipitate (contains VIII)
B = FFP
```
144
Hepatomegaly and chondrocalcinosis
Haemachromatosis
145
Vit B12 deficiency - loss of touch and proprioception, UMN signs, but pain and temperature spared
Subacute Combined Degeneration of Cord
146
Most sensitive antibody in pernicious anaemia
Anti-parietal cell
147
PML-PARA fusion gene
Acute Promyelocytic Leukaemia (t15;17)
148
Microcytic anaemia -- reduced iron but increased ferritin
Anaemia of Chronic Disease (ferritin = acute phase protein)
149
Anaemia of Chronic Disease - what does liver produce which mediates the reduced iron?
Hepcidin (retains iron in macrophages and reduces export from enterocytes)
150
Immunoglobulin which binds to platelets in ITP
IgG
151
Apart from low VIII, what else is low in Von Willebrand?
Ristocetin
152
Hairy cell leukaemia express
Tartrate-resistant acid phosphatase
153
This degrades factor V
Protein C
154
Impaired degradation of factor Va and VIIIa
Protein S deficiency
155
Nuclei of cancer cells have cloverleaf apperance
Adult T-cell leukaemia
156
WBCs with filamentous projections/finger-like projections of cytoplasm
Hairy Cell Leukaemia
157
Blood film shows lots of RBCs stacked
Rouleaux = Multiple Myeloma
158
Hodgkin type that spreads contiguously
Hodgkin
159
Most common Hodgkin type
Nodular sclerosing (peaks in young women)
160
Treatment of Hodgkin relapse
High-dose salvage chemo --> autologous stem cell transplant
161
Waxing and waning lymphadenopathy but NO B symptoms
Follicular non-Hodgkin
162
First-line in myelodysplasia
Allogeneic Stem Cell Transplant
163
Which cells targeted in Aplastic Anaemia?
CD34 haematopoietic stem cells
164
Treatment of Aplastic Anaemia in
< 50yrs
> 50yrs
<50yrs: stem cell transplant
| >50yrs: horse anti-thymocyte globulin and ciclosporin
165
Mode of inheritance of most common form of Dyskeratosis Congenita
X-linked (mutated DKC1)
166
Haematocrit target in polycythaemia vera
<45% (via venesection and hydroxycarbamide)
167
Most common cause of high platelets
Essential Thrombocythaemia = platelets > 600
168
Neutrophil precursor found in CML
Myelocytes
169
Targeted treatment for Philadelphia +ve leukaemia
Imatinib
170
Reverses warfarin in emergency
Prothrombin Complex Concentrate
171
Cause of Transfusion-Related Acute Lung Injury (TRALI)
Anti-WBC antibodies in donor --> clump with recipient's WBCs
172
Jewish male presenting with multiple pathological fractures and hypersplenism
Gaucher's disease
173
Which paraprotein is most commonly raised multiple myeloma?
IgG
