- What are reticulocytes? - What do they indicate is happening? - What conditions might this be associated with?

- Immature red blood cells - They indicate active production of red blood cells to replace lost cells - indicates anaemia due to blood loss / haemolysis

Haematology Flashcards by Callum McCabe

Low ferritin vs high ferritin

Low ferritin = iron deficiency anaemia

High ferritin = inflammatory marker

Normal ferritin can still have iron deficiency, especially in the context of inflammation e.g. infection

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High TIBC (total iron binding capacity) =

iron deficiency

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Transferrin saturation =

Good indication of total iron in the body, normally around 30%.

decreased transferrin saturation = less iron

Goes up after meals so try to measure a fasting sample.

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What pathology can increase all iron test values (apart from decreased TIBC) ?

Acute liver damage

lots of iron is stored in the liver

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Best iron supplements?

Ferrous sulphate or ferrous fumarate

slowly corrects the iron deficiency.
(Oral iron causes constipation and black coloured stools. It is unsuitable where malabsorption is the cause of the anaemia).

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2nd most common leukaemia in children ?

AML - acute myeloid leukaemia

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When do the commonest childhood leukaemias present ?

ALL 2-3 years
AML under 2 years

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The excessive production of a single type of blood cell causes …

Pancytopaenia:
Red blood cells (anaemia),
White blood cells (leukopenia)
Platelets (thrombocytopenia)

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Risk factors for leukaemia ?

Radiation exposure, e.g. abdominal x-ray during pregnancy, is the main environmental risk factor for leukaemia.

Conditions that predispose to a higher risk of developing leukaemia:
- Down’s syndrome
- Kleinfelter syndrome
- Noonan syndrome
- Fanconi’s anaemia

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Presentation of leukaemia =

Persistent fatigue
Unexplained fever
Failure to thrive
Weight loss
Night sweats
Pallor (anaemia)
Petechiae and abnormal bruising (thrombocytopenia)
Unexplained bleeding (thrombocytopenia)
Abdominal pain
Generalised lymphadenopathy
Unexplained or persistent bone or joint pain
Hepatosplenomegaly

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any child with unexplained petechiae or hepatomegaly?

immediate specialist assessment

urgent FBC (pancytopenia + high number of the abnormal WBCs)
blood film shows blast cells
bone marrow biopsy
-lymph node biopsy

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Further tests for staging of leukaemia

Chest x-ray
CT scan
Lumbar puncture
Genetic analysis and immunophenotyping of the abnormal cells

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Helminth infection (with roundworms, hookworms, or whipworms) - treatment?

Single dose of albendazole or mebendazole

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Microcytic anaemia causes

TAILS

T – Thalassaemia
A – Anaemia of chronic disease
I – Iron deficiency anaemia
L – Lead poisoning
S – Sideroblastic anaemia

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Normocytic anaemia causes

3 As, 2 Hs

A – Acute blood loss
A – Anaemia of Chronic Disease
A – Aplastic Anaemia
H – Haemolytic Anaemia
H – Hypothyroidism

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2 types of macrocytic anaemia

Megaloblastic (B12/folate deficiency)

Normoblastic (H-LARD)

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Causes of normoblastic macrocytic anaemia ?

H-LARD

Hypothyroidism
Liver disease
Alcohol
Reticulocytosis
Drugs such as azathioprine

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Symptoms of anaemia + symptoms that are specific to iron deficiency anaemia ?

Tiredness
Shortness of breath
Headaches
Dizziness
Palpitations
Worsening of other conditions

Specific to iron deficiency anaemia:
Pica
Hair loss

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Generic signs of anaemia

Pale skin
Conjunctival pallor
Tachycardia
Raised respiratory rate

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Koilonychia (spoon nails)
Angular chelitis (cracked corners of mouth)
Atrophic glossitis (smooth tongue)
Brittle hair and nails

= what type of anaemia ?

Iron deficiency anaemia

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Bone deformities occur in what type of anaemia ?

Thalassaemia

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What are reticulocytes?
What do they indicate is happening?
What conditions might this be associated with?

Immature red blood cells
They indicate active production of red blood cells to replace lost cells
indicates anaemia due to blood loss / haemolysis

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Medications which reduce B12 absorption ?

PPIs, metformin, chloramphenicol, colchicine

Which cells produce intrinsic factor and where?
What is the role of intrinsic factor?

Parietal cells in the stomach
Aids B12 absorption in the distal ileum

Explain what pernicious anaemia is.

- Autoantibodies attack parietal cells - Parietal cells can't produce intrinsic factor - Reduced B12 absorption in the distal ileum

Which autoantibodies are associated with pernicious anaemia?

- Intrinsic factor antibodies - Gastric parietal cell antibodies

Treatment for B12 deficiency:

Intramuscular hydroxocobalamin No neurological symptoms - 3 times weekly for 2 weeks Neurological symptoms - every other day until symptoms stop improving

B12 and folate deficiency - which to treat first and why?

Treat B12 first - giving patients folic acid when they have a B12 deficiency can lead to subacute combined degeneration of the cord, with demyelination in the spinal cord and severe neurological problems.

Maintenance B12 replacement for pernicious anaemia =

2-3 monthly injections for life

Maintenance B12 replacement for dietary deficiency =

oral cyanocobalamin or twice-yearly injections

Multiple myeloma features

CRAB: - hyperCalcaemia - Renal failure - Anaemia (and thrombocytopenia) - Bone fractures/lytic lesions

For how long should anticoagulation therapy be continued?

Provoked = 3 months Unprovoked = 6 months

Differentiate between CML and CLL

cML - Massive splenomegaly cLL - Lymphadenopathy

Differentiate between acute and chronic leukaemia

If there are only blasts (babies) --> acute If they managed to develop and mature --> chronic

Which blood component is at highest risk of bacterial contamination?

Platelet concentrates (stored at ambient temperatures, which increases the risk of bacterial proliferation. Common contaminants include Staphylococcus epidermidis and Bacillus cereus)

Imaging for staging of Hodgkin's lymphoma

PET/CT scan

Staging system for Hodgkin's lymphoma

Lugano classification (replacing Ann Arbor staging)

Headaches, dizziness, and pruritus, especially after bathing. Ruddy complexion and mild splenomegaly. Diagnosis?

Polycythaemia vera - leads to increased red blood cells, white blood cells, and platelets - prescribe aspirin to reduce risk of thrombotic events

Sickle cell disease - presents with dyspnoea, chest pain, cough, hypoxia and new pulmonary infiltrates seen on chest x-ray

Acute chest syndrome (complication of sickle cell)

Dabigatran reversal agent?

Idarucizumab (Dab gets the mab)

Recent chemo + fever Management?

Immediate IV antibiotics

Sites of absorption in the small intestine

Dude I Just Feel Ill Bro Duodenum (Iron) Jejunum (Folate) Ileum (B12)

Test for autoimmune haemolytic anaemia

Positive direct antiglobulin test (Coombs' test)

Sore hip in sickle cell disease

Salmonella infection? "sickla cella salmonella" (vaso-occlusive crises normally affect the long bones)

Polycythaemia vera can lead to which two more serious conditions?

AML / myelofibrosis

Tumour lysis syndrome: 1. What is it? 2. Management?

1. Rapid lysis of tumour cells following chemotherapy (or rapid onset of haematological malignancy) - causes massive release of intracellular contents - this causes AKI and electrolyte disturbance. 2. Managed by correcting/managing electrolyte disturbances (e.g. calcium gluconate for hyperkalaemia) + IV fluids & Rasburicase - metabolises uric acid to allantoin

Patient on methotrexate contracts UTI - which antibiotic should be avoided and why?

Trimethoprim Both methotrexate and trimethoprim are folate antagonists therefore, they should not be prescribed together to mitigate the risk of BONE MARROW SUPPRESSION.

Sickle cell disease + acute RUQ pain

Acute cholecystitis due to sickling and sludging of red blood cells in the microvasculature of the gallbladder, leading to ischaemia and infarction of the gallbladder wall.

A hypocellular marrow with no abnormal cell population, fibrosis or other infiltrate = ?

Aplastic anaemia - bone marrow stops producing sufficient blood cells which can lead to pancytopenia - tends to affect children, young adults and the elderly

Metabolic vs respiratory alkalosis ABG results

Respiratory = low CO2, low HCO3 (due to blowing off CO2) Metabolic = opposite Raised CO2, raised HCO3

Why does hypocalcaemia?

Phosphate binds with calcium to form calcium phosphate. This deposits in the renal tubules, causing AKI.

Which marker to assess renal function in children post-transplantation?

Serum creatinine

Hyperkalaemia - which medication should be stopped?

Ramipril

Electrolyte abnormalities in refeeding syndrome?

Big Massive PP: low B1 (thiamine) low Magnesium low Potassium low Phosphate

Refeeding syndrome - hyper or hypoglycaemic? And why?

Hyperglycaemic because cells/tissues become insulin-resistant in starvation then, when feeding is reintroduced, insulin spikes.