Haematology Flashcards
B symptoms are a sign of…
what cancer? (1)
what prognosis? (1)
lymphoma
poor prognosis
What are the B symptoms in Hodgkins lymphoma? (3)
weight loss > 10% in last 6 months
fever > 38ºC
night sweats
Afro-carribeans have worse prognosis of what haematological cancer
ALL
Hodgkins lymhpoma:
what cells
malignant proliferation of lymphocytes characterised by the presence of the Reed-Sternberg cell.
Vitamin B12 and folate deficiency together - what is important to do in treatment?
treat B12 first otherwise –> subacute combined degeneration of spinal cord
where is B12 absorbed? (1)
what condition should you consider this in? (1)
terminal ileum (impacted in Crohns/ following resection)
most common INHERITED thrombophilia
factor 5 leiden (–> clotting!/ VTE)
most common ACQUIRED thrombophilia
antiphospholipid syndrome
Antiphospholipid syndrome in pregnancy:
how to manage? (2)
aspirin + LMWH
(low-dose aspirin should be commenced once the pregnancy is confirmed on urine testing,
low molecular weight heparin once a fetal heart is seen on ultrasound. This is usually discontinued at 34 weeks gestation)
a reversal agent for dabigatran (used to treat AF)
idarucizumab (monoclonal antibody)
vWD:
management if bleeding (1)
other possibles (2)
tranexamic acid for mild bleeding
desmopressin (DDAVP): raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells
factor VIII concentrate (F8 can be low)
vWD:
types (3)
type 1: partial reduction in vWF (80% of patients)
type 2*: abnormal form of vWF
type 3**: total lack of vWF (autosomal recessive)
ITP (Immune (or idiopathic) thrombocytopenic purpura (ITP)):
trigger (1)
investigations (2)
management (2)
immune reaction –> low platelets post infection/ vaccination
FBC
blood film (bone marrow no longer needed)
1st line= prednisolone
2nd= pooled normal human immunoglobulin (IVIF) to raise count if urgent or active bleeding
Evan’s syndrome
ITP in association with autoimmune haemolytic anaemia (AIHA)
major criteria determining the use of cryoprecipitate in bleeding (1)
what does it contain? (3)
fibrinogen level
Contains: fibrinogen, factor VIII, and von Willebrand factor
when to give Fresh frozen plasma (FFP) (specific ratio)
prothrombin time (PT) ratio or activated partial thromboplastin time (APTT) ratio > 1.5
When to use prothrombin complex concentrate
A REVERSAL
emergency reversal of anticoagulation in severe bleeding or a head injury with suspected intracerebral haemorrhage
Can be prophlyactic if emergancy surgery
Fever, abdominal pain, hypotension during a blood transfusion → what should you be concerned about? (1)
acute haemolytic reaction
Blood transfusion complications
immunological: acute haemolytic, non-haemolytic febrile, allergic/anaphylaxis
infective
transfusion-related acute lung injury (TRALI)
transfusion-associated circulatory overload (TACO)
other: hyperkalaemia, iron overload, clotting
Non-haemolytic febrile reaction:
main features (2)
what to do (1)
fever+ chills
stop/ slow transfusion and paracetamol
Thought to be caused by antibodies reacting with white cell fragments in the blood product and cytokines that have leaked from the blood cell during storage
Minor allergic reaction
features
management
itch urticaria
stop+ histamine + monitor
Anaphylaxis:
features (4)
management (1)
hypotension, SOB, wheeze, angioedeam
stop+ adrenaline+ABC
Acute haemolytic reaction
what is it? (1)
Sx? (3)
test to confirm? (1)
management? (1)
ABO incompatable
abdo pain+ hypotension+ fever
STOP
confirm with Coombs test
fluid resuscitation (supportive care)
Transfusion-associated circulatory overload (TACO)
PO due to overload
diuretics
Transfusion-related acute lung injury (TRALI)
Non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood
Hypoxia, pulmonary infiltrates on chest x-ray, fever, hypotension
complications acute haemolytic reaction (2)
renal failure and DIC
Post thrombotic syndrome:
what is it? (1)
management (1)
venous problems post DVT
compression stockings
(only offered if post thrombotic not for DVT routienly)
do you rescan patients post DVT
no!
DIC typical picture
plaetles
fibrinogen
APTT and PT
D Dimer
↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products
schistocytes due to microangiopathic haemolytic anaemia
causes of DIC (4)
sepsis
trauma
obstetric complications e.g. aminiotic fluid embolism or hemolysis, elevated liver function tests, and low platelets (HELLP syndrome)
malignancy
Prothromibin time, APTT, bleeding time and platelet count of:
warfarin
aspirin
heparin
DIC
Warfarin- prolonged PT but rest normal
Aspirin- prolonged bleeding time but rest normal
Hepatin prolonged APTT but rest normal
DIC: prolonged everything and low platelets
Tonsilitis and neutropenia
Epstein-Barr virus may result in neutropaenia
(infectious mononucleosis)
An increase in the number of circulating activated T and B lymphocytes seen in the virus causes lymphocytosis.
Neutropenia:
what classes mild/ moderate/severe? (3)
mild= 1-1.5
moderate= 0.5-1
severe= <0.5
neutropenia causes:
viral (3)
drugs (3)
ethnic (1)
haematological (1)
other (4)
viral
HIV
Epstein-Barr virus
hepatitis
drugs
cytotoxics
carbimazole
clozapine
benign ethnic neutropaenia
common in people of black African and Afro-Caribbean ethnicity
requires no treatment
haematological malignancy
myelodysplastic malignancies
aplastic anemia
rheumatological conditions
systemic lupus erythematosus: mechanisms include circulating antineutrophil antibodies
rheumatoid arthritis: e.g. hypersplenism as in Felty’s syndrome
severe sepsis
haemodialysis
Hodgkins: High potassium, high phosphate, and low calcium - what causes this (1)
prophylaxis for this? (1)
who to suspect in? (1)
timor lysis syndrome (post chemo) due to the cancer cells breaking down
ALLOPURINOL
suspect in any patient with AKI and high phopshate/ uric acid level
Tumor lysis syndrome:
how to treat
IVF
rasburicase (higher risk)
alluring (lower risk)
rasburicase and allopurinol should not be given together in the management of tumour lysis syndrome as this reduces the effect of rasburicase
Definition tumor lysis syndrome
laboratory tumour lysis syndrome plus one or more of the following:
increased serum creatinine (1.5 times upper limit of normal)
cardiac arrhythmia or sudden death
seizure
‘tear drop’ poikilocytes on blood film causes (3)
thalassaemia, megaloblastic anaemia and myelofibrosis.
(the bone is all fibrosed so the blood cells have to squeeze out - making them tear drop shaped)
tear drop’ poikilocytes + weight loss/ fatigue + large spleen
myelofibrosis
reduces the ability of the bone marrow to produce normal cells, thus causing thrombocytopenia, anaemia and extramedullary haematopoiesis in the spleen.
Cryoprecipitation contains
factor VIII, fibrinogen, von Willebrand factor and factor XIII
Indications include massive haemorrhage and uncontrolled bleeding due to haemophilia
When to do exchange transfusion in sickle cell
if neurological complications
Long term management sickle cell (2)
Hydroxyurea (prophylaxis)
Pneumococcal polysaccharide vaccine every 5 years
A grossly elevated APTT (3)
may be caused by heparin therapy, haemophilia (bleeding) or antiphospholipid syndrome (clotting)
Haemophilia A and B factors
A= Factor VIII
B= Factor IX
blood tests haemophilia - what is elevated? (1)
prolonged APTT, rest normal
Lymphoma: why special irradiated blood products?
Irradiated blood products are often treated with gamma or x-ray radiation to deplete T-lymphocytes in order to prevent transfusion-associated graft versus host disease
Blood film in hyposplenism
target cells
Howell-Jolly bodies
Pappenheimer bodies
siderotic granules
acanthocytes
common cause of hyposplenism
Coeliac disease
Iron def anaemia:
what do the cells look like? (2 items)
if combined with B12/folate def? (1)
target cells
‘pencil’ poikilocytes
if combined with B12/folate deficiency a ‘dimorphic’ film occurs with mixed microcytic and macrocytic cells
Sickle cell crisis:
Thrombotic crisis what is it?
also known as painful crises or vaso-occlusive crises
precipitated by infection, dehydration, deoxygenation (e.g. high altitude)
painful vaso-occlusive crises should be diagnosed clinically - there isn’t one test that can confirm them although tests may be done to exclude other complications
infarcts occur in various organs including the bones (e.g. avascular necrosis of hip, hand-foot syndrome in children, lungs, spleen and brain