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XUAN MSRA > Haematology > Flashcards

Haematology Flashcards

1
Q

What is the most commonly inherited clotting disorder and its mode of inheritance?

A

Von Willebrand’s factor
Mostly autosomal dominant

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2
Q

What would coag results look like in haemophilia?

A

1) Prolonged APTT
2) BT, TT and PT all normal

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3
Q

What do blood parameters look like in DIC?

A

↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products
High D-dimer

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4
Q

What would coag results look like in Von Willebrand’s disease?

A

1) Prolonged bleeding time
2) APTT may be prolonged
Normal platelets

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5
Q

What is the most common inherited thrombophilia?

A

Factor V Leiden

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6
Q

What would blood tests show in tumour lysis syndrome? Prophylaxis?

A

High potassium
High phosphate
Low calcium

Management: allopurinol or rasburicase

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7
Q

Why use irradiated blood?

A

To avoid transfusion-associated graft versus host disease

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7
Q

FBC results in sickle cell anaemia?

A

Low Hb
Normal MCV
Raised reticulocytes

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8
Q

What is the single most important factor in determining whether cryoprecipitate should be given?

A

A low fibrinogen level

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9
Q

What are signs of hyposplenism on a blood film?

A

Hyposplenism (post-splenectomy, coeliac disease)
target cells
Howell-Jolly bodies
Pappenheimer bodies
siderotic granules
acanthocytes

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10
Q

What are the signs of IDA on blood film?

A

target cells
‘pencil’ poikilocytes
if combined with B12/folate deficiency a ‘dimorphic’ film occurs with mixed microcytic and macrocytic cells

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11
Q

What is the sign of myelofibrosis on blood film?

A

‘tear-drop’ poikilocytes

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12
Q

What is the sign of intravascular haemolysis on blood film?

A

Schistocytes

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13
Q

What is the sign of megaloblastic anaemia on blood film?

A

hypersegmented neutrophils

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14
Q

What is the blood film feature for multiple myeloma?

A

Rouleaux formation

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15
Q

What are blood film signs of APML?

A

Auer rods

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16
Q

What is in cryoprecipitate?

A

Factor VIII
Factor XIII
VWF
Fibrinogen

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17
Q

What is the blood film sign associated with AML?

A

Acute promyelocytic leukaemia- Auer rods (seen with myeloperoxidase stain)

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18
Q

What is the management of antiphospholipid syndrome fpr pregnancy?

A

1) Low-dose aspirin once urine pregnancy test confirmed
2) LMWH once fetal heart rate on ultrasound

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19
Q

What are the causes of warm AIHA?

A

1) idiopathic
2) autoimmune disease: e.g. systemic lupus erythematosus*
3) neoplasia (lymphoma,
chronic lymphocytic leukaemia)
4) drugs: e.g. methyldopa

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20
Q

What is the management of warm AIHA?

A

1) treatment of any underlying disorder
2) steroids (+/- rituximab) are generally used first-line

21
Q

What are the causes of cold AIHA?

A

1) neoplasia: e.g. lymphoma
2) infections: e.g. mycoplasma, EBV

22
Q

What are the blood test features of haemolytic anaemia?

A

1) Anaemia
2) reticulocytosis
3) Low haptoglobin
4) raised LDH
5) Blood film: spherocytes and reticulocytes
Specific feature to autoimmune: positive direct antiglobulin test (Coombs’ test).

23
Q

What is the management of Beta-Thalassaemia major?

A

repeated transfusion

(note can lead to Fe overload so iron chelation therapy important e.g. desferrioxamine)

24
Q

What is the sign on blood film for megaloblastic anaemia?

A

hypersegmented neutrophils

25
Q

What is the management of a Non-haemolytic febrile reaction?

A

Slow or stop the transfusion

Paracetamol

Monitor

26
Q

What is the management of a Minor allergic reaction?

A

Temporarily stop the transfusion

Antihistamine

Monitor

27
Q

What is the management of anaphylaxis during blood transfusion?

A

Stop the transfusion

IM adrenaline

ABC support
oxygen
fluids

28
Q

What is the management of an Acute haemolytic reaction?

A

1)Stop transfusion

2)Confirm diagnosis
- check the identity of patient/name on blood product
- send blood for direct Coombs test, repeat typing and cross-matching

3)Supportive care
- fluid resuscitation

29
Q

What is the management of Transfusion-associated circulatory overload (TACO)?

A

Slow or stop transfusion

Consider intravenous loop diuretic (e.g. furosemide) and oxygen

30
Q

What is the management of Transfusion-related acute lung injury (TRALI)?

A

Stop the transfusion

Oxygen and supportive care

31
Q

What virus is associated with Burkitt’s lymphoma?

A

Epstein-Barr virus (EBV) is strongly implicated in the development of the African form

32
Q

What are microscopy findings for Burkitt’s lymphoma?

A

‘starry sky’ appearance: lymphocyte sheets interspersed with macrophages containing dead apoptotic tumour cells

33
Q

What are the complications fo tumour lysis syndrome?

A

hyperkalaemia
hyperphosphataemia
hypocalcaemia
hyperuricaemia
acute renal failure

34
Q

What is Richter’s transformation?

A

Ritcher’s transformation occurs when leukaemia cells enter the lymph node and change into a high-grade, fast-growing non-Hodgkin’s lymphoma.

E.g. CLL-> non-hodgkin’s

35
Q

What are the blood test features for chronic lymphocytic anaemia?

A

1) lymphocytosis
2) anaemia: due to bone marrow replacement or
AIHA
3) thrombocytopenia
4) Blood film: smudge cells

36
Q

What is the management of chronic myeloid leukaemia?

A

1st line: imatinib

Also:
hydroxyurea
interferon-alpha
allogenic bone marrow transplant

37
Q

What is the management of hereditary spherocytosis?

A

1) acute haemolytic crisis:
- treatment is generally supportive
- transfusion if necessary

2) longer term treatment:
- folate replacement
- splenectomy

38
Q

What is the staging system used for patients with Hodgkin’s lymphoma?

A

Ann-Arbor staging

39
Q

What is the management of Hodgkin’s lymphoma?

A

1st line: chemotherapy

Also:
- Radiotherapy
- Combined modality therapy
- Hematopoietic cell transplantation

40
Q

What is the management of ITP?

A

Oral prednisolone

41
Q

What are the causes of macrocytic anaemia?

A

Megaloblastic:
1) vitamin B12 deficiency
2) folate deficiency
3) e.g. secondary to methotrexate

Normoblastic:
alcohol
liver disease
hypothyroidism
pregnancy
reticulocytosis
myelodysplasia
drugs: cytotoxics

42
Q

What are the causes of microcytic anaemia?

A

1) iron-deficiency anaemia
2) thalassaemia*
3) congenital sideroblastic anaemia
4) anaemia of chronic disease (more commonly a normocytic, normochromic picture)
5)lead poisoning

43
Q

What are the features of myeloma?

A

Calcium (HIGH)
Renal (impairment)
Anaemia (fatigue and pallor)
Bleeding (and bruising)
Bones (pain)
Infection (susceptibility to infections)

44
Q

What are the investigations for myeloma?

A

Bloods
1) Anaemia
2) rouleaux formation on blood film
3) renal failure
4) hypercalcaemia

Protein electrophoresis
1) serum: raised concentrations of monoclonal IgA/IgG proteins
2) urine: Bence Jones proteins

Bone marrow aspiration (confirms diagnosis)

Imaging
1) whole body MRI
2) X-Ray: ‘rain-drop skull’
- raised no of plasma cells

45
Q

What are the causes of normocytic anaemia?

A

1) anaemia of chronic disease
2) chronic kidney disease
3) aplastic anaemia
4) haemolytic anaemia
5) acute blood loss

46
Q

How is Paroxysmal nocturnal haemoglobinuria diagnosesd?

A

flow cytometry of blood to detect low levels of CD59 and CD55

47
Q

What is the management of Paroxysmal nocturnal haemoglobinuria?

A

1) blood product replacement
2) anticoagulation
3) stem cell transplantation

48
Q

What is the management of Polycythaemia vera?

A

1) Aspirin
2) Venesacion (1st line- keep Hb in range)
3) Chemotherapy

49
Q

What is the long-term management of sickle cell anaemia?

A

1) Hydroxyurea (increases HbF so is prophylactic)
2) pneumococcal polysaccharide vaccine every 5 years

50
Q

What are the types of sickle cell crises?

A

1) Thrombotic crises
2) Acute chest syndrome
3) Aplastic crises
4) Sequestration crises

51
Q

What is the management of Von Willebrand’s disease?

A

1) tranexamic acid for mild bleeding
2) desmopressin (DDAVP)
3) factor VIII concentrate

XUAN MSRA (20 decks)

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