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Medicine > Haematology > Flashcards

Haematology Flashcards

1
Q

What would you use to supplement B12?

A

Hydroxycobalamin

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2
Q

Which two drugs are used in AIHA?

A

Prednisolone
Rituximab

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3
Q

What is the MOA of Rituximab?

A

anti CD20

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4
Q

What is Eculizumab used for?

A

Paroxysmal nocturnal haemoglobinuria
HUS

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5
Q

In which anaemias might you offer folic acid?

A

Enzyme-defect haemolytic anaemias

(PK / G6PD deficiency)

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6
Q

Which 2 drugs do you offer to someone with Sickle Cell anaemia?

A

Hydroxyurea
Crizanlizumab

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7
Q

What is the MOA of hydroxyurea?

What does this tell us about its’ uses?

A

inhibits DNA synthesis (which is why it’s used in polycythaemia vera)

stimulates HbF (which is why it’s used in sickle cell)

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8
Q

Why is someone with sickle cell given crizanlizumab?

A

prevents vaso-oclusive crises

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9
Q

What is the MOA of desferrioxamine and when is it used?

A

It’s a chelating agent used to eliminate XS iron

Used in beta-thalassaemia major

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10
Q

What is Ascorbic acid, how does it work, and when is it used?

A

Vitamin C

Reduces methaemoglobin

Useful for NADH methaemoglobinaemia reductase deficiency - causing methaemoglobinuria

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11
Q

What is Methylthionium Chloride, how does it work, and when is it used?

A

Methylene blue

Reduces ferric iron in Hb to ferrous iron

Useful for methaemoglobinuria

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12
Q

What is the MOA of Imatinib and what is it used for

A

Tyrosine Kinase Inhibitor

CML

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13
Q

What are the management options for Myeloma?

A

Combination - Velcade, Thalidomide, Dexamethasone
Lenalidomide
Cyclophosphamide

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14
Q

What is Velcade used for?

A

Myeloma

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15
Q

How would you treat primary myelofibrosis?

A

Need blood transfusion really

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16
Q

What risk is associated with hydroxyurea use?

A

risks BM suppression

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17
Q

What is the MOA of Anagrelide?

A

Inhibits maturation of platelets from megakaryocytes

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18
Q

What is the MOA of Warfarin?

A

Inhibits synthesis of Vit K-dependent clotting factors
1972 - 10, 9, 7, 2

This affecs both the intrinsic, extrinsic, and common pathways

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19
Q

What is Warfarin used to treat?

A

Antiphospholipid syndrome
Metallic heart valves

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20
Q

What is the MOA of heparins?

A

activate antithrombin III, which inhibits thrombin

It hence thins the blood

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21
Q

What risks are associated with unfractionated heparins?

How can you reverse it?

A

Risks HiT

Reversal with protamine sulphate

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22
Q

Name 3 examples of LMWHs

A

Enoxaparin
Tinzaparin
Dalteparin

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23
Q

What are LMWHs used for?

A

Thromboprophylaxis
Antiphospholipid pts in pregnancy

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24
Q

Name 3 examples of DOACs

A

Dabigatran
Rivaroxaban
Apixaban

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25
Q

What are DOACs used for?

A

AF
DVT
PE

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26
Q

What is the MOA of Dabigatran? How is it reversed?

A

Direct thrombin inhibitor

Reversed with Idarucizumab

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27
Q

What is the MOA of Rivaroxaban? How is it reversed?

A

Direct factor Xa inhibitor

Reversed with Andexanet Alfa

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28
Q

What is the MOA of Apixaban? How is it reversed?

A

Direct factor Xa inhibitor

Reversed with Andexanet Alfa

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29
Q

In combined B12 and folate deficiency, which do you replace first and why?

A

Replace B12 first as you risk subacute combined degeneration of the spinal cord

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30
Q

What dose would you start someone with IDA on?

A

100-200mg elemental iron daily

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31
Q

How is pernicious anaemia treated?

A

IM hydroxycobalamin 1mg

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32
Q

How is antiphospholipid syndrome managed?

A

Low dose aspirin

Long term warfarin

pregnant? -> LMWH + aspirin (NO WARFARIN)

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33
Q

What is the MOA of Desmopressin?

A

stimulates the release of vWF from endothelial cells

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34
Q

What are the options for treating von Willebrand disease?

A

Desmopressin
Tranexamic acid
vWF infusion
Factor VII + vWF infusion

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35
Q

What are the 4 types of DIC?

A

Non-symptomatic DIC
Organ failure DIC
Bleeding DIC
Massive bleeding DIC (low fibrinogen)

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36
Q

How is non-symptomatic DIC managed?

A

Blood products
prophylactic heparin

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37
Q

How is organ failure DIC managed?

A

Heparin

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38
Q

How is bleeding/massive bleeding DIC managed?

A

blood products
antifibrinolytics

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39
Q

How is low fibrinogen DIC managed?

A

cryoprecipitate

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40
Q

How would you treat an acute episode of haemophilia?

A

Infusions
Desmopressin
Tranexamic acid
Emicizumab

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41
Q

How would you manage Essential Thrombocythaemia?

A

1st line - Hydroxyurea
2nd line - Anagrelide

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42
Q

How would you manage acute intermittent porphyria?

A

1st line - IV haematin / haem arginate

2nd line - IV glucose

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43
Q

How would you manage thrombocytopenia?

A

Prednisolone + rituximab

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44
Q

How would you rapidly reverse anticoagulant?

A

Prothrombin complex concentrate (PCC)

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45
Q

What is the relationship between MDS and AML?

A

MDS is the precursor to AML
It becomes AML when >20% of BM cells are blasts

Think about this in cases of pancytopenia 5 years post chemo

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46
Q

How would you treat MDS?

A

EpO
GCSF (stimulates neutrophils)

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47
Q

How would you treat Hereditary Haemochromatosis?

A

Venesection

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48
Q

How would you managed ITP in a haemodynamically stable patient?

A

Prednisolone (if plt < 30)

You don’t need to give them a platelet infusion as they’re stable, and they would jsut get wrecked by the autoAbs

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49
Q

What is the most common type of Hodgkin’s lymphoma?

A

Nodular sclerosing

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50
Q

What type of Hodgkin’s lymphoma carries the best prognosis?

A

Lymphocyte predominant

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51
Q

In a sickle cell patient, how would you differentiate an aplastic crisis from a haemolytic or splenic sequestration crisis?

A

An aplastic crisis will also show depleted reticulocytes in addition to reduced Hb and platelets

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52
Q

What respiratory disease is associated with Polycytaemia Rubra Vera?

A

COPD

low PaO2 > Epo^

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53
Q

What is the inheritance pattern of Beta thalassaemia intermedia and major?

A

AR

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54
Q

What finding on blood film is consistent with myelofibrosis?

A

Poikilocytes - tear drop cells

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55
Q

What characteristic of a bone marrow biopsy would suggest myelofibrosis?

A

‘Dry’ aspirate

cos it’s all fibrosed ennit

56
Q

What is nomally the first symptom of myelofibrosis?

A

fatigue

57
Q

What mutation is associated with essential thrombocythaemia?

A

JAK2

58
Q

How would the presentation of haemophilia and vWD differ?

A

vWD - menorrhagia, GI bleeding

Haemophilia - haemarthroses, muscle bleeding, XLR so DUDES

59
Q

Which haematological malignancy is particularly associated with massive splenomegaly?

A

CML

60
Q

What blood film findings are associated with B12 deficiency anaemia?

A

Hypersegmented neutrophils

Macrocytic RBCs

61
Q

In polycythaemia rubra vera, what happens to the viscosity of the blood?

How might this present?

A

Increased viscosity

Headaches, dizziness, and tinnitus

62
Q

How might you classify Macrocytic anaemias?

A

Megaloblastic
Non-megaloblastic

63
Q

What might cause a megaloblastic macrocytosis?

A

Impaired DNA synthesis in the bone marrow

Occurs in B12 and folate deficiency

64
Q

What 4 things might cause non-megaloblastic macrocytic anaemia?

A

Chronic alcoholism
Hypothyroidism
Myelodysplastic syndromes
Liver disease

65
Q

What causes pernicious anaemia?

A

AI condition as Abs bind intrinsic factor

Intrinsic factor would normally bind dietary B12 to cross the terminal ileum

66
Q

What is the function of allopurinol in the context of tumour lysis syndrome?

A

Hyperuricacemia associated with chemotherapy can be prevented by taking allopurinol

67
Q

What disease has a 30% chance of progressing to AML?

A

Myelodysplasia

68
Q

How do you manage a patient on warfarin, INR 5-8 with no bleeding?

A

Hold warfarin for a few days

69
Q

What is the mainstay drug for CML management?

A

Imatinib

70
Q

What needs to be co-prescribed with methotrexate?

Why?

A

Folate

Methotrextae inhibits dihydrofolate reductase and may cause folate deficiency

71
Q

What is the triad of acute chest crisis management?

What hould the patient be started on long term?

A

High flow O2
Abx
Exchange transfusion

Hydroxyurea

72
Q

What biopsy finding is characteristic of Hodgkin’s lymphoma?

A

Reed-Sternberg cells

(owls :P)

73
Q

Recreational use of what drug is known to deplete B12 reserves?

A

Nitrous oxide

74
Q

Which clotting factor is typically affected in those with vWD?

A

Factor 8

This is because vWF stabilises factor 8

75
Q

What organism should patients be immunised against post-splenectomy?

Why?

A

Streptococcus pneumoniae

Encapsulated organisms like strep pneumo are normally destroyed in the spleen

76
Q

How would you differentiate TACO and TRALI?

A

TRALI - hypotension
TACO - hypertension

77
Q

Name a good prognostic factor in ALL

A

Hyperdiploid blast cells

(the presence of extra chromosomes in blast cells compared to the normal 46 in somatic cells)

78
Q

What autoAb type is associated with cold AIHA?

A

IgM

79
Q

What autoAb type is associated with warm AIHA?

A

IgG

80
Q

How might prednisolone affect an FBC?

A

^neutrophils

81
Q

Name one similarity and one difference between aplastic anaemia and ALL

A

Similarity - pancytopenia

ALL - BM hypercellularity with lymphoblasts

Aplastic anaemia - BM hypocellularity

82
Q

How would you differentiate non-hodgkin lymphoma and ALL?

A

ALL - BM predominantly affected

lymphoma - more lymphoid

makes sense

83
Q

Which bodily system is typically affected in ALL and NOT in AML?

A

CNS

84
Q

How do you use stain to confirm Amyloidosis?

A

Congo red: apple-green birefringence

85
Q

How would you differentiate ACD and IDA?

A

ACD has higher ferritin levels and lower transferrin saturation

86
Q

How would you treat severe Aplastic Anaemia?

A

HSCT

87
Q

What sort of leukaemia is commonly accociated with DIC?

A

Acute promyelocytic leukaemia

(a rarer subtype of AML)

88
Q

What is the MOA of methotrexate?

A

Inhibits dihydrofolate reductase

89
Q

Name 2 medications which should not be co-administered with methotrexate

A

trimethoprim
co-trimoxazole

90
Q

What type of anaemia is associated with SLE?

A

Warm AIHA

91
Q

Which is more common, hameophilia A or B?

A

A

92
Q

What is the most common adverse effect of methotrexate?

A

BM suppression

93
Q

How might a DVT lead to a stroke and not a PE?

A

ASD

pretty neat! :D

94
Q

How might you differentiate variceal and non-variceal bleeding?

A

Portal HTN causes splenic enlargement and hyperfunction, and thus platelet sequestration

Therefore in variceal bleeding -> low patelets

95
Q

How would you manage an acute painful crisis of SCI?

A

O2
Morphine
IV fluids
Ceftriaxone (likely infective cause)
RBC transfusion

96
Q

Which antibiotic should you be wary of in pts on warfarin?

Why?

A

Cirpfloxacin

cytochrome p450 inhibitor, increasing levels of Warfarin, which may elevate INR

97
Q

When treating high-grade B cell lymphoma, what might you want to offer in addition to R-CHOP?

A

Rituximab

98
Q

How might smoking affect FBC?

A

neutrophilia

99
Q

What might trigger haemolytic anaemia in those with G6PD deficiency?

A

Malaria prophylaxis (e.g. primaquine)

Also sulph- drugs
Sulphonomides
Sulphasalazine
Sulfonylureas

100
Q

What are the bood film findings in coeliac disease?

Why?

A

Howell-Jolly bodies
Target cells

Hyposplenism

101
Q

How would you manage TACO?

A

Stop transfusion

IV loop diuretics

102
Q

In a non-urgent scenario, over how long would you transfuse a unit of RBCs?

A

90-120 minutes

103
Q

What should be done before commencing Epo in ACD over CKD?

A

Check iron levels

if deficient these need correcting

104
Q

What is the transfusion threshold or RBC’s?

A

ACS - 80
w/out ACS - 70

105
Q

A painful mass when drinking alcohol is pathognomic of what?

A

Hodgkin’s lymphoma

106
Q

How is Sickle Cell Anaemia inherited?

A

AR

107
Q

How might you differentiate CML in the accelerated and blast phases?

A

Accelerated - 10-20% blasts
Blast - 20% + blasts

108
Q

Which type of blood product has the highest risk of bacterial contamination?

Why?

A

Platelets

They’re stored at 22deg, 5-7 days

109
Q

Describe the targets for patelet transfusion for thrombocytopenia before surgery or an invasive procedure

A

> 50 - most pts
50-75 - high risk of bleeding
100 - surgery at critical site

110
Q

What other type of haemolytic aneamia may show spherocytes (barring hereditary spheocytosis?)

A

AIHA

111
Q

Which gene mutation is Burkitt’s lymphoma associated with?

A

C-myc translocation

112
Q

Which lymphatic areas do ovaries and testes drain to?

A

Para-aortic lymph nodes

113
Q

What sort of deficiency increases the risk of anaphylactic blood transfusion reactions?

A

IgA defiicency

114
Q

What does FDP stand for in clotting?

A

Fibrin degradation products

(think DIC, fibrinolytics, etc)

115
Q

Which antipsychotic is associated with an increased risk of VTE?

A

Olanzapine

116
Q

In cases of major haemorrhage, how should tranexamic acid be administered?

A

IV bolus 1g followed by 1g slow infusion over 8h

117
Q

What is the recommended treatment for post-thrombotic syndrome?

A

compression stockings

118
Q

What are those on 3rd generation COCPs at greater risk of?

A

VTE

119
Q

What are those with polycythaemia rubra vera at risk of morbidity from?

A

Stroke

120
Q

A patient with ^ESR and osteoporosis has what condition unless proven otherwise?

A

Multiple Myeloma

121
Q

What is the most common cause of neutropenic sepsis?

A

Staph epidermis

122
Q

What in the actual fuck is IgG4-related disease?

A

Pancreatic endocrine insuficiency (AI)

New onset DM

Sausage pancreas sign on CT

123
Q

How do anabolic steroids cause polycythaemia?

A

^Epo

124
Q

What should parents continue to monitor in children with HSP?

A

BP
Urine dip

125
Q

What are the features of TTP?

A

FAT RN

Fever
Anaemia
Thrombocytopenia
Renal failure
Neuro features

126
Q

What is unusual about the clotting profile seen in antiphospholipid syndrome?

A

paradoxical rise in APTT

don’t bother remembering exactly why this is, just remember that it happens. The patient will also have thrombocytopenia

127
Q

Describe Ann Arbor staging

A

1 - single node
2 - 2 nodes same side of diaphragm
3 - nodes both sides of diaphragm
4 - non lymphoid spread

128
Q

Which sites of GI absorption do you need to be aware of in cases of anaemia?

A

Duodenum - iron
Jejunum - folate
Ileum - B12

129
Q

What is the most common form of non-Hodgkin’s lymphoma?

A

Diffuse large B cell lymphoma

130
Q

How might EBV (glandular fever) affect an FBC?

A

neutropenia

131
Q

What is the 1st line imaging for suspected multiple myeloma?

A

Whole body MRI

132
Q

What mutation is associated with APML?

A

t(15:17) translocation, causing fusion of PML and RAR-alpha genes

133
Q

Why is APML a haematological emergency?

A

^coagulopathy

134
Q

Why do females fair better than males with ALL?

A

2 sanctuaries for lymphoblasts, the CNS, and testicles

135
Q

What additional test is important to perform in ALL?

A

TPMT

Often use Mercaptopurine (similar to azathioprine)

Medicine (22 decks)

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