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Finals (HV) > Haematology > Flashcards

Haematology Flashcards

1
Q

What is leukaemia?

A

Cancer of WBCs in bone marrow

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2
Q

What is AML?

A

Clonal expansion of myeloid blasts in bone marrow, peripheral blood or extramedullary tissues.

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3
Q

List 3 RF for AML?

A

Previous haem disorder
Pre radiation or chemo exposure
Exposure to Benzenes (Paint, petrol, rubber)

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4
Q

What may be seen on Blood film in someone with AML?

A

Auer Rods

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5
Q

What are the Sx of AML?

A

*Anaemia: pallor, lethargy, weakness
*Neutropenia + freq infxns
- although WBC counts
* Thrombocytopenia: bleeding
* Splenomegaly
* Bone pain

GUM HYPERTROPHY
Leukaemia skin cuts

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6
Q

What is the mx of AML?

A

Blood and platelet transfusion
Chemo (> drugs- Cytarabine, Daunorubicin)
Bone marrow transplant
Stem cell transplant

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7
Q

What is CML?

A

Malignant clonal disorder of myeloid stem cells arising due to the t9;22
mutation (Philadelphia chromosome) resulting in the BCR-ABL fusion gene (Activates Tyrosine Kinase)

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8
Q

What results may be present on a blood film in CML?

A

Elevated granulocytes (Basophils, and eosinophils)

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9
Q

What is the Tx of CML?

A

Imatinib- Tyrosine Kinase Inhibitor

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10
Q

What other tx options are available for CML other than the 1st line?

A

Hydroxy urea
Interferon alpha

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11
Q

What is the epidemiology of CML?

A

Male aged 65-74

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12
Q

What is CLL?

A

A lymphoproliferative disorder in which monoclonal B lymphocytes are predominantly found in peripheral blood

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13
Q

What are the sx of CLL?

A

Often asymptomatic
Enlarged non tender rubbery lymph nodes
Systemic sx
Bleeding

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14
Q

What will be present on the blood film of pt with CLL?

A

Smudge/smear cells

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15
Q

What staging system is used for CLL staging?

A

Binet staging

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16
Q

What is the mx of CLL?

A

Watch and wait
Chemo (Rituximab)
BM transplant

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17
Q

What is Richter Transformation?

A

A serious complication of CLL and is often fatal. It is characterised by the sudden transformation of the CLL into a significantly more aggressive form of large cell lymphoma.

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18
Q

What is the sx of Richter transformation?

A

Sudden and dramatic increase in the size of lymph nodes characterised by usually painless areas of swelling in the neck, axilla, abdomen (spleen) or groin.
Patients also often experience a dramatic unexplained weight loss, fevers and night sweats

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19
Q

What is ALL?

A

clonal expansion of lymphoblasts

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20
Q

What other conditions is ALL associated with?

A

Down’s syndrome
Klinefelter’s syndrome
Fanconi Anaemia

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21
Q

What are the sx of ALL?

A

Hepatosplenomegaly
Fever
Lymphadenopathy
Bleeding/petechial rash
Anaemia
Bone pain
Meningeal infiltration
Mediastinal mass- svc obstruction

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22
Q

What is the histology appearance of Burkitt’s lymphoma?

A

‘starry sky’ appearance of highly proliferative cells with basophilic cytoplasm.

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23
Q

What metabolic abnormalities are seen in Tumour lysis syndrome?

A

Hyperkalaemia, Hyperphosphataemia, Hyperuricaemia, Hypocalcaemia

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24
Q

What is the most common childhood malignancy?

A

ALL

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25
Q

What is Hodgkin’s lymphoma

A

Uncontrolled proliferation of B-lymphocytes characterised by the presence of Reed Sternberg cells

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26
Q

What is Hodgkin’s lymphoma associated with?

A

EBV and HIV

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27
Q

What sx are present in Hodgkins?

A

Asymmetrical painless lymph nodes (cervical>mediastinal)- painful when drinking alcohol

B sx: Fever, Night sweats, WL
Hepatosplenomegaly

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28
Q

What Ix findings are common in Hodgkin’s Lymphoma?

A

Reed-Sternberg cells (owl eyes)
Eosinophilia
High LDH
Normocytic anaemia

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29
Q

Which subtype of Hodgkin’s carries the best prognosis?

A

Lymphocyte predominant

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30
Q

Which subtype of Hodgkin’s carries the worst prognosis?

A

Lymphocyte depleted

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31
Q

List 5 RF of non-Hodgkin’s lymphoma?

A

Hx of viral illness (EBV)
FHx
Elderly and White
Hx of chemo or radiation
Immunodeficient

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32
Q

What is the mx of Hodgkin’s Lymphoma?

A

Chemotherapy (ABVD regimine)

Adriamycin (Doxorubicin)
Bleomycin
Vinblastine
Dacarbazine

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33
Q

List the sx present in non-Hodgkin’s?

A

Painless lymphadenopathy (non-tender, rubbery, asymmetrical)
B symptoms
Extranodal sx - Gastric, Bone marrow, Skin, CNS

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34
Q

What is the GS Ix for Hodgkin’s and non-Hodgkin’s lymphoma?

A

Excisional node biopsy

35
Q

What is the mx for non-Hodgkin’s lymphoma?

A

Chemotherapy (R-CHOP regimine)

Rituximab – a monoclonal antibody that targets CD20 on B-cells.
Cyclophosphamide
Hydroxydaunorubicin (Doxorubicin)
Oncovin (Vincristine) –
Prednisone

36
Q

What model is used for in the staging of lymphoma?

A

Lugano staging (modified Ann Arbour w/ PET)

37
Q

What is the most common inherited thrombophilia?

A

Factor V Leiden deficiency (Activated Protein C resistance)

38
Q

List the causes of microcytic anaemia?

A

TAILS
Thalassaemia
Anaemia of chronic disease
IDA
Lead poisoning
Sideroblastic anaemia

39
Q

List the causes of normocytic anaemia?

A

(AAAHH)
Acute blood loss
Anaemia of chronic disease
Aplastic anaemia
Haemolytic anaemia
Hypothyroidism

40
Q

List the causes of megaloblastic anaemia?

A

Vit B12 deficiency
Folate deficiency

41
Q

List the causes of normoblastic anaemia?

A

Alcohol
Reticulocytes
Hypothyroidism
Liver disease
Drugs- e.g. azathioprine

42
Q

What is sideroblastic anaemia?

A

In which RBC cannot from haem in the mitochondria > deposits of iron in mitochondria > ring sideroblasts

43
Q

What is the Ix for sideroblastic anaemia?

A

FBC- hypochromic microcytic anaemia
Iron studies-Raised iron, ferritin and transferrin
Blood film- Basophillic stippling of RBC

44
Q

What would the result of iron studies be in sideroblastic anaemia?

A

Raised iron, ferritin and transferrin

45
Q

What may be seen on a blood film in sideroblastic anaemia?

A

Basophillic stippling of RBC

46
Q

What is the mx of sideroblastic anaemia?

A

Supportive- treat cause
+/- Pyridoxine (B6)

47
Q

What are the sx for lead poisoning?

A

Abdo pain
Peripheral neuropathy (mainly motor)
Neuropsychiatric sx
Fatigue
Constipation
Blue line in gum margins

48
Q

What may be seen on blood film in lead poisoning?

A

Basophillic stippling of RBC

49
Q

What is the lifespan of RBCs?

A

110-120 days

50
Q

What is the lifespan of platelets?

A

7-10 days

51
Q

List 3 causes of IDA?

A

Inadequate intake of dietary iron
Impaired absorption
Increased iron requirements
Idiopathic
Blood loss

52
Q

List the sx of IDA?

A

Dyspnoea
Pallor
Fatigue
Palpitations
Hair loss
Pica- abnormal craving of non-food substances

53
Q

List the signs of IDA?

A

Koilonychia (spooning of nails)
Atrophic glossitis
Angular stomatis

54
Q

List the result of iron studies in IDA?

A

Ferritin- low
TIBC- high
Transferrin- High

55
Q

What will be seen on bloodfilm in IDA?

A

Hypochromic microcytic RBC
Target cells
Poikilocytes

56
Q

What is the 1t line mx of IDA?

A

Oral ferrous sulphate + lifestyle advice

57
Q

What antibody is associated with cold autoimmune haemolytic anaemia

A

IgM

58
Q

What antibody is associated with warm autoimmune haemolytic anaemia

A

IgG

59
Q

List the 3 broad categories of hereditary haemolytic anaemia?

A

Inherited RBC defects-hereditary spherocytosis, elliptocytosis

Enzyme deficiencies- G6PD

Abnormal Hb production-Sickle cell anaemia, Thalassemia

60
Q

What is aplastic anaemia?

A

Defined by pancytopenia (low RBC, WBC, Platelets) with hypocellular marrow with no abnormal cells

61
Q

List the causes of aplastic anaemia?

A

Idiopathic
Congenital- Fanconis anaemia
Parvovirus B19
Drugs-gold, NSAIDs, Phenytoin, chloramphenicol

62
Q

What is the GS ix for aplastic anaemia?

A

Bone marrow biopsy

63
Q

What is pernicious anaemia?

A

autoimmune disorder affecting the gastric mucosa that results in vitamin B12 deficiency

64
Q

List the causes of b12 deficiency?

A

Pernicious anaemia
Decreased in take of vitb12- vegans
Diminished gastric breakdown of B12- Medicines, PPIs, H2 antagonists
Malabsorption from G1 tract- crohns, coeliacs

65
Q

Where is B12 absorbed?

A

terminal ileum

66
Q

How is vit b12 absorbed?

A

Ingested> vitb12 binds to intrinsic factor secreted by parietal cells from gastric fundus > vitb12 complex travels through small intestine where it is absorbed in terminal ileum

67
Q

Which cells release intrinsic factor?

A

Parietal cells in gastric fundus

68
Q

List the sx of B12 deficiency?

A

Anaemia-pallor, fatigue

Neurological- paraesthesia, numbness, ataxia, peripheral neuropathy, memory loss, poor concentration

Mild jaundice
Glossitis

69
Q

What is the Ix of choice in pernicious anaemia?

A

Intrinsic factor antibody

70
Q

What is sickle cell disease?

A

An autosomal recessive single gene defect in the beta chain of Hb which results in production of sickle cell Hb (HbS)

71
Q

What amino acid change is seen in sickle cell disease?

A

Valine replaces glutamic acid on Chr 11

72
Q

What is the gold standard investigation for sickle cell anaemia?

A

Hb electrophoresis

73
Q

What is the treatment for acute sickle crisis?

A

Oxygen
Iv morphine
IV fluids
+/- penicillin

74
Q

List 3 chronic complications of sickle cell disease?

A

Renal impairment
Pulmonary hypertension
Joint damage

75
Q

List 3 acute complications of sickle cell disease?

A

Vaso-occlusive crisis
Aplastic crisis
Stroke

76
Q

What drug may you give someone to prevent painful sickle crises?

A

Hydroxycarbamide

77
Q

What can precipitate sickling?

A

Trauma
Stress
Cold
Exercise

78
Q

What is the general mx of sickle cell disease?

A

Avoid triggers- dehydrations, stress etc
Ensure vaccinated
Hydroxycarbamide

79
Q
A
80
Q

What is the mode of inheritance of G6PD?

A

X linked recessive

81
Q

What haematological disease are Mediterranean people most likely to have?

A

G6PD

Thallesemia

82
Q

What histological feature is seen in G6PD?

A

Heinz bodies and bite cells

83
Q

What are the triggers for G6PD?

A 
Fava beans 
Red wine 
Soy products 
Henna 
Drugs (NSAIDs, primaquine, notrofurantoin)
84
Q

What is the pathophysiology behind G6PD deficiency?

A

Low G6PD — low amounts of reduced gluthathione — therefore oxidative damage to RBC

Finals (HV) (15 decks)

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