Haematology Flashcards
1
Q
Name the complaint:
Rapid uncontrolled growth and accumulation of undifferentiated lymphoid cells
A
Acute lymphoblastic leukaemia
2
Q
What is the most common cancer of childhood?
A
Acute lymphoblastic leukaemia
3
Q
For how many months must maintenance therapy for haematological malignancy be carried out for?
A
18 months
4
Q
Name the complaint:
Bone marrow failure + bone pain + infection + fever
A
Acute lymphoblastic leukaemia
5
Q
Chronic lymphocytic leukaemia requires a white cell count of what to be diagnosed?
A
Over 5 x 10^9/L
6
Q
Which Binet stage of chronic lymphocytic leukaemia is described:
5 lymph node areas involved + thrombocytopenia
A
Stage 3
7
Q
What Binet stage of chronic lymphocytic leukaemia is described:
2 lymph node areas involved
A
Stage 1
8
Q
Describe the Richter transformation
A
Chronic lymphocytic leukaemia transforming to diffuse large B cell lymphoma a
9
Q
Thrombocytopenia is most likely to cause which type of bleeding?
A
Mucosal membrane bleeding - petechiae, nose bleeds, gum bleeds
10
Q
Bone marrow aspirate blast cell percentage of how much is diagnostic of acute myeloid leukaemia?
A
More than 20%
11
Q
Which haematological malignancy is associate with the Philadelphia 9;22 gene translocation?
A
Chronic myeloid leukaemia
12
Q
Which gene mutation is associated with polycythaemia vera?
A
JAK2
13
Q
Name the complaint:
Increased haematocrit + blurred vision + iron deficiency anaemia
A
Polycythaemia vera
14
Q
Which anaemia is associated with polycythaemia vera?
A
Iron deficiency
15
Q
EPO levels will be what in polycythaemia vera?
A
Low
16
Q
What is the mode of action of ruxolitinib?
A
JAK2 inhibitor
17
Q
When is ruxolitinib therapy indicated?
A
Polycythaemia vera, essential thrombocythaemia
18
Q
Name the complaint:
Digital ischaemia + gout + headache
A
Essential thrombocythaemia
19
Q
Anagrelide can be given in what haematological malignancy?
A
Essential thrombocythaemia - directly inhibits platelets
20
Q
Which medication can be given in essential thrombocythaemia to decrease risk of thrombosis?
A
Aspirin
21
Q
Name the complaint:
Back pain + hypercalcaemia + anaemia
A
Myeloma
22
Q
Which immunoglobulin type of myeloma does not exist?
A
IgM
23
Q
Name the clinical features of myeloma
A
CRAB:
C - hyperCalcaemia
R - Renal failure
A - Anaemia
B - Bone disease
24
Q
Myeloma is a cancerous disorder of which cells?
A
Plasma cells (type of B cell)
25
The presence of IgM suggests what?
Lymphoma
26
What percentage of plasma cells must there be in bone marrow aspirate to diagnosis myeloma?
10%
27
A 6% plasma cell concentration on bone marrow aspirate warrants a diagnosis of what?
Monoclonal gammopathy of uncertain significant (MGUS)
28
Which bone cell does myeloma stimulate?
Osteoclasts
29
Zoledronic acid inhibits activity of what cells?
Osteoclasts
30
What is the key difference in presentation between lymphoma and leukaemia?
Lymphoma presents with B symptoms (fever, night sweats, weight loss, fatigue)
31
Hodgkin lymphoma is associated with what virus?
Epstein Barr virus
32
Alcohol induced painful lymphadenopathy indicates presence of what haematological malignancy?
Hodgkin lymphoma
33
Where are red blood cells made?
Bone marrow
34
Where is erythropoietin made, and in response to what?
Made in the kidneys in response to hypoxia
35
What is a red blood cells lifespan?
120 days
36
Haemolytic anaemia leads to what type of jaundice?
Pre hepatic unconjugated
37
Severe anaemia in spherocytosis can be treated by what?
Splenectomy
- spleen is main site of destruction of RBC, removal allows them to survive in circulation a bit longer
38
G6PD deficiency confers resistance against what disease?
Malaria
39
Name the complaint:
Anaemia + jaundice + history of DKA
G6PD deficiency
40
Sickle cell disease has what pattern of inheritance?
Autosomal recessive
41
Under what circumstances do red blood cells polymerise in sickle cell disease?
Hypoxia
42
Name the complaint:
Painful bones via vaso-occlusion + anaemia + PMH UTI
Sickle cell crisis
43
What effect does sickle cell disease have on the spleen?
Hyposplenism via splenic infarcts
44
What type of analgesia should be given in sickle cell crisis?
Opiate
45
Which disease modifying drug can be given sickle cell disease?
Hydroxycarbamide
46
Thalassaemia has what pattern of inheritance?
Autosomal recessive
47
G6PD deficiency has what pattern of inheritance?
X linked
48
At what age does beta thalassaemia major present at?
3-6 months
- due to foetal haemoglobin not having beta chains and so beta chain deficiency is unnoticeable until later
49
Name the complaint:
Anaemia + bony deformities + growth retardation
Beta thalassaemia major
50
How often should we give transfusions in beta thalassaemia major patients?
4-6 weekly
51
How can we treat iron overload in beta thalassaemia major?
SC desferrioxamine and/or oral desferasirox
52
What MCV value must cells have in order to be classed as microcytic?
Under 80fl
53
Iron deficiency anaemia presents with what levels of iron binding capacity and ferritin?
High iron binding capacity
Low ferritin
54
Which molecule produced by the liver is involved in absorption of iron?
Hepcidin
55
In what disease state is Hepcidin produced? What may this lead to?
Released in inflammatory state, may lead to anaemia of disease e.g. in rheumatoid arthritis
56
New iron deficiency in patietns over 60 raises concerns of what?
Colorectal cancer
57
What blood parameter should be measured in a normocytic normochromic anaemia?
Reticulocyte count
58
Normochromic normocytic anaemia with high reticulocyte count can be caused by what?
Haemolysis, acute blood loss
59
Name the complaint:
Unconjugated hyperbilirubinaemia + anaemia + increased reticulocytes + high LDH
Haemolytic anaemia
60
High LDH indicates what?
Increased cell turnover
61
Macrocytic megaloblastic anaemia can be caused by lack of what 2 substances?
Vitamin B12 or folate
62
What drugs can cause non-megaloblastic macrocytic anaemia?
Methotrexate, hydroxycarbamide
63
Pernicious anaemia is characterised by presence of what?
Antibodies against intrinsic factor
64
How can we treat pernicious anaemia?
IM B12 injections
65
Hypothyroidism, liver disease and alcoholism can lead to what type of anaemia?
Non megaloblastic macrocytic anaemia
66
Arterial thrombosis is made up of what 2 constituents?
Platelets + fibrin (white clot)
67
Arterial thrombosis is most commonly secondary to what?
Atherosclerosis
68
Thrombolysis can be given within how many hours of arterial thrombosis presentation?
4.5 hours
69
Venous thrombosis is made up of what 2 constituents?
Red cells + fibrin (red clot)
70
The Wells score is used to assess risk for what?
DVT
71
D-dimer negative can be used to rule out what?
Venous thrombosis
72
Factor V Leiden increases the risk of what?
Venous thrombosis
73
Microvascular thrombosis is most commonly due to what?
DIC
74
What is the unifying diagnosis for presentation of arterial and venous thrombosis together?
Atrial septal defect
75
Wells score of 2 or more indicates the need for what investigation?
USS Doppler within 4 hours
76
Wells score of less than 2 indicates the need for what investigation?
D-dimer within 4 hours
77
What is the first line treatment for DVT?
Direct oral anticoagulant (apixaban, rivaroxaban) for 3 months in provoked DVT and 6 months in unprovoked DVT
78
What assessment score can be used for bleeding significance?
ISTH tool
79
Haemophilia has what pattern of inheritance?
X linked
80
Name the complaint:
X linked condition + haemarthrosis
Haemophilia
81
Which factors are deficient in haemophilia A and B?
A - factor VIII (8)
B - factor IX (9)
82
Haemophilia will present with what blood finding?
Isolated prolonged APTT
- PT is normal
83
Desmopressin (DDAVP) helps release of what from the endothelium?
Factor VIII and vWF
84
Von Willebrand disease has what pattern of inheritance?
Autosomal dominant
85
Von Willebrand disease causes what type of bleeding?
Platelet type
86
Clinical presentation with bleeding and microvascular thrombosis indicates what?
DIC
87
DIC causes depletion of what?
Clotting factors and platelets
88
DIC can have what affect on blood pressure?
Hypotension
- due to bleeding
89
ITP is most associated with what infectious agents?
EBV, HIV
90
Isolated thrombocytopenia is suggestive of what?
ITP
91
Which vitamin cannot be absorbed in cholestasis?
Vitamin K
92
Haemorrhagic disease of the newborn can be prevented by administering what at birth?
Vitamin K
93
Name the complaint:
Pancytopenia + hypo cellular bone marrow + no abnormal cells
Aplastic anaemia
94
Name the complaint:
Bronze skin + liver cirrhosis + T2DM + adrenal insufficiency
Haemochromatosis
95
Haemachromatosis results in excessive what?
Iron accumulation
96
Which factor does vWF stabilise?
Factor 8
97
What should be checked and corrected before starting folate?
B12
98
Thalassaemia will present with what type of anaemia?
Hypochromic microcytic
99
Patients with SLE and APS should be commenced on what 2 medications for DVT prophylaxis?
Low dose aspirin + LMWH
100
Which metabolic disturbance is common with heparin?
Hyperkalaemia
101
Lymphadenopathy and splenomegaly together are most associated with which haematological malignancy?
CLL
102
Reed-Sternberg cells are indicative of which haematological malignancy?
Hodgkin’s lymphoma
103
Imatinib can be used in which haematological malignancy?
Chronic myeloid leukaemia
104
Which drug can reduce the amount of sickle cell crises experienced by a patient?
Hydroxycarbamide
- increases foetal haemoglobin
105
Presence of schistocytes on blood film indicates what type of haemolysis?
Intravascular
106
Peptic ulcer disease most commonly causes which type of anaemia?
Iron deficiency
- microcytic hypochromic
107
Presence of the CD20 antigen identifies the presence of what type of cells?
Mature B lymphocytes
- consider CLL in presence of CD20
108
Malignancy increases the risk of what haematological complication?
Venous thromboembolism
109
Thrombocytopenia and raised fibrin degradation products indicates what?
DIC
110
Subacute combined degeneration of the cord is a complication of what?
Vitamin B12 deficiency
111
The presence of Bence-Jones proteins is suggestive of what diagnosis?
Multiple myeloma
112
EPO use in athletes can lead to what?
Polycythaemia
113
Which coagulation factors are affected in liver disease?
1, 2, 5, 7, 9, 10, 11
114
Abdominal pain in chronic myeloid leukaemia is most commonly caused by what?
Massive splenomegaly
115
Factor V Leiden results in what?
Activated protein C resistance
116
Definitive diagnosis of sickle cell disease is by what?
Haemoglobin electrophoresis
117
What is the most common adult leukaemia?
CLL
118
Where are the majority of red blood cells broken down?
Spleen
- splenectomy can be beneficial in medication refractory anaemia or very severe anaemia
119
Hydroxyurea is beneficial in the prophylaxis of what condition?
Sickle cell disease
120
Cytokines released by myeloma cells increase activity of what cells?
Osteoclasts
- leads to hypercalcaemia
121
How long do body stores of vitamin B12 last?
2-4 years
122
Haemolysis results in what levels of haptoglobin?
Low levels
123
Methotrexate leads to a megaloblastic anaemia via lack of what?
Folate
124
Which haematological malignancy presents with no bone marrow failure?
Chronic myeloid leukaemia
125
Joint pain + hyperpigmentation on palmar creases are indicative of what complication of beta thalassaemia?
Iron overload
126
What is the first line treatment for von-Willebrand disease?
Desmopressin
127
Desmopressin increases circulating levels of what?
Factor 8 and von Willebrand factor
128
Deficiency in protein S causes increased risk of what?
Blood clotting
129
Protein C inhibits what factors?
5 & 8
130
To which patient group must Anti-D prophylaxis be given?
Rhesus negative
131
What is the current mainstay for ALL treatment?
Chemotherapy
132
Pernicious anaemia occurs due to the autoimmune destruction of what?
The stomach lining
133
What is the first line treatment for ITP?
Oral prednisolone
134
What is the antigen in blood group A?
N-acetyl-galactosamine
135
What is the antigen in blood group B?
Galactose
136
Which blood type should be given in an emergency?
O negative
137
Which blood group is the universal donor?
O negative
138
How long after the start of a transfusion do we check obs?
15 minutes
139
Acute transfusion reactions can occur up to how long after transfusion?
24 hours
140
DHTR can occur up to how long after transfusion?
14 days
141
What is the most common reaction in RBC transfusions?
Febrile
142
Which cell is involved in parasitic infection?
Eosinophils
143
Which cells are involved in fungal infection?
Monocytes
144
What blood finding is common after chemotherapy?Neutropenia
