Haematology Flashcards by Belle Storey

4 symptoms of lymphoma

B-symptoms:
Fever
Night sweats
Weight loss

Painful nodes when drinking alcohol
Pruritis

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Name 2 signs you will look for on examination in lymphoma

Lymphadenopathy (non-tender and rubbery)
Splenomegaly
Hepatomegaly

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Classical cell name that suggests Hodgkin’s lymphoma

Reed-sternberg cell

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State 2 staging investigations for Hodgkins

CT
PET
Bone marrow biopsy

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What staging system is used for Hodgkins?

Lugano classification

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Hodgkins pt with dyspnoea, swelling of face and congested veins in neck and chest - what has happened

SVCO

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Name 3 signs of anaemia

Tachypnoea
Tachycardia
Pale conjunctiva
Ejection systolic murmur

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Other than menorrhagia, name one other cause of iron-deficiency anaemia

Inadequate dietary intake
Internal bleeding e.g. malignancy

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Name 2 specific signs of chronic iron-deficiency anaemia

Koilionychia (spoon-shaped nails)
Atrophic glossitis
Angular cheilitis

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Name 2 common side effects of ferrous sulphate

Dark sticky stools
Nausea
Constipation
Diarrhoea

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Name 2 drugs used in the long term treatment of sickle cell anaemia

Hydroxyurea
Penicillin V

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Other than infection, name 2 factors that can bring on a sickle-cell crisis

Dehydration
Exposure to cold
Exhaustion
Hypoxia
Acidosis

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State 3 general points in managing a vaso-occlusive sickle cell crisis

Oxygen therapy
Analgesia (e.g. morphine)
IV fluids (e.g. 0.9%)
Keep warm
Contact haemotology
Empirical abx (local guidelines)

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Pattern of inheritence of sickle-cell disease?

Likelihood of children carrying sickle cell if person with the disease + partner with normal chromosomes?

Autosomal recessive

100%

(to have the disease, you have to have homozygous recessive (ss) + SS = 100% carrier / Ss Ss Ss Ss)

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Why does sickle cell not clinically manifest until roughly 6 months of age

Fetal Hb mask the effect of the disease

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What is multiple myeloma

Malignant clonal proliferation of B-lympholympcytic plasma cell

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What is the commonest immunoglobulin expressed as part of multiple myeloma

IgG

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Other than bone pain, name 2 other symptoms of multiple myeloma

CRABBI
Hypercalcaemia (stones, thrones, groans, moans)
Renal damage (light chain deposition; dehydration, polydipsia)
Anaemia (tiredness)
Bruise easily (thrombocytopenia)
Bone pain
Infections (low Ig)

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Except an X-ray, name 3 investigations you would perform for multiple myeloma

Diagnostic: Bone marrow sampling (>60% plasma cells)

CRAB (end organ damage):
U&E (hypercalcaemia, renal failure)
FBC (anaemia)
Whole body MRI for bone lesions

Biomarkers:
Protein electrophoresis (IgG in serum, Bence Jones in urine)
Peripheral blood film (rouleaux formation)

X-ray raindrop skull

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Why are multiple myeloma patients prone to infections

Bone marrow infiltration (low WCC)
Immunoparesis secondary to overexpression of IgG

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State 4 acute complications of myeloma

i.e. severe CRAB

Hypercalcaemia
Acute renal failure
Hyperviscosity
Spinal cord compression

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Name 2 causes for splenomegaly other than leukaemia

Increased workload:
Haemolytic anaemia

Congestion:
Liver cirrhosis with portal hypertension

Infiltration:
Leukaemia and lymphoma

What would you expect the WCC to be on chronic leukaemia FBC

High

How could you differentiate on a blood film between acute leukaemia and chronic leukaemia?

AL: immature WBC (blast cells)
CL: mature WBC

What leukaemia has the characteristic philadelphia chromosome and what is the genetic mutation?

CML Translocation of chromosomes 9 and 22

Bone marrow aspirate with 95% cancer cells after medical treatment - management?

Bone marrow transplant

3 FBC findings in bone marrow failure

Thrombocytopenia Anaemia Leucopenia/neutropenia

Why do you get bone pain in bone marrow failure

Marrow infiltration from abnormal cells causing expansion of the bone

Immediate investigation in possible haematological malignancy

Blood film

Bone marrow biopsy shows dominant presence of blast cells of myeloid lineage - diagnosis

AML

Supportive treatment during stem cell transplantation

Blood transfusions (anaemia) Platelet transfusions (thrombocytopenia) Prophylactic abx

Below what value of Hb should a blood transfusion take place, regardless of symptoms

Name 2 signs of severe anaemia

Tachycardia Tachypnoea Flow murmur Pallor

Fever and hypotension after blood transfusion - type of transfusion reaction and what else could have occurred?

Acute haemolytic Bacterial contamination

First management step in adverse transfusion reaction

stop the transfusion!

Oozing from cannula site after transfusion reaction - what haematological state has occurred?

DIC

Name 1 type of early (24h) transfusion complication and 1 management option you can do for any

TRALI (acute lung injury) TACO (circulatory overload) Acute haemolytic reaction Anaphylaxis (IgA deficiency) Stop the transfusion! ## Footnote TACO is the only one that presents with HTN

What is the definition of a massive blood transfusion

Entire pts blood volume / 10 units within 24h

Name 2 causes of each category of macrocytic anaemia

Megaloblastic - folate and B12 Normoblastic - thyroid, liver, alcohol

What test distinguishes between the 2 categories of macrocytic anaemia

blood film

Patient with 'addisons disease and vitiligo' has macrocytic anaemia - likely cause? Name a test that could help confirm your diagnosis

Pernicious anaemia Intrinsic factor antibody serology

First line treatment for B12 deficiency

IM hydroxycobalamin

Signs of thalassaemia major on examination (2)

Hepatosplenomegaly Frontal bossing Jaw enlargement Dental malocclusion Flow murmur Generalised pallor

Common name given to beta-thalassaemia major

Cooley's anaemia

2 main treatments for beta-thalassaemia major

Blood transfusion Iron chelation therapy

Why does thalassaemia major never usually present in the first 6 months of life

fetal Hb

How can haemophilia lead to compartment syndrome and joint deformities

Bleeding into joints

How is haemophilia A inherited

X-linked recessive

Which clotting factor is deficient in haemophilia A

INR and APTT in haemophilia A

normal INR, prolonged APTT

Name a treatment for haemophilia A to improve clotting factor deficiency

Purified factor 8 FFP containing factor 8 Desmopressin

How would you account for a lady being diagnosed with haemophilia A at the age of 70

acquired haemophilia A

3 investigations to confirm leukaemia

FBC Peripheral blood film Bone marrow biopsy

What electrolyte abnormality can allopurinol help prevent in tumour lysis syndrome

Hyperuricaemia