Haematology Flashcards
What is the most common cause of anaemia in the world ?
Iron deficiency
Which Histological cells are characteristic of Hodgkin’s lymphoma ?
Reed-steinberg cells - mirror-image nuclei
What are the peak incidence of Hodgkin’s lymphoma ?
- 20-34 (young adults)
- >70 (elderly)
What signs may be found in Hodgkin’s lymphoma ?
- lymphadenopathy (usually cervical, axilliary)
- cachexia
- anaemia
- splenomegaly or hepatomegaly
Which virus is known to increase the risk of lymphoma ?
EBV
Symptoms of Hodgkin’s lymphoma ?
- enlarged, painless, rubbery superficial lymph nodes
- fever, night sweats
- weight loss
- lethargy
- pruritis
- if mediastinum involvement = bronchial, SVC obstruction
Tests for suspected lymphoma ?
- lymph node excision biopsy
- full bloods
What is the link with alcohol and Hodgkin’s lymphoma ?
After ingesting causes pain at site of lymph node involvement
What is the difference between Hodgkin’s and non Hodgkin’s lymphoma ?
Non Hodgkin’s originates in the WBC , T and B lymphocytes whereas Hodgkin’s originate in the lymph nodes
- non Hodgkin’s more likely to disseminate to extra nodal sites
Which type of lymphoma is H pylori associated with ?
Gastric mucosa-associated lymphoid tissue (MALT)
What are the common extra nodal sites of non Hodgkin’s lymphoma ?
Bone, gut, CNS or lung
What is burkitts lymphoma ?
Childhood disease with characteristic jaw lymphadenopathy
Example of high-grade non Hodgkin’s lymphoma
What are the causes of macrocytic anaemia ? (8)
- B12/folate
- Alcohol excess/liver disease
- Reticulocytosis
- cytotoxics (e.g. Hydroxycarbamide)
- myelodysplastic syndromes
- marrow infiltration
- hypothyroidism
- anti folate drugs e.g. Phenytoin, trimethoprim
What are the causes of iron deficiency anaemia ? (4)
- blood loss, e.g. Periods, GI bleed
- poor diet (usually in children)
- malabsorption e.g.coeliacs
- parasitic e.g.hookworm in the tropics
What is the treatment for iron deficiency anaemia ?
- treat underlying cause
- oral iron tablets
What else should be considered if microcytic anaemia not responding to iron replacement ?
Sideroblastic anaemia
Which vitamin enhances absorption of iron ?
Vitamin C
Which drugs may impair absorption of iron ?
antacids and PPIs - as increase pH
Which bacteria can impair uptake of iron ?
h pylori - also increases iron loss
What is the symptoms of iron Deficiency anaemia ?
- fatigue
- SOB
- palpitations
- pruritis
- Headache
- tinnitus
What signs may you find in someone with iron deficiency anaemia ?
- koilonychia
- atrophic Glossitis
- angular chelitis
- pallor in conjunctiva, palmar creases etc
Define anisocytosis ? When is it seen ?
= variation in RBC size
As in megaloblastic anaemia, thalassaemia etc
Define poikilocytosis, when does it occur ?
= variation in RBC shape
As in IDA, myelofibrosis, thalassaemia
What a Reticulocytes?
Young, larger RBCs - signify active erythropoiesis
What do neutrophils do ? When might they be increased ?
Ingest and kill bacteria, fungi and damages cells
Increased in:
- bacterial infections
- inflammation e.g. MI
- myeloproliferative disorders
- drugs e.g. Steroids
- stress e.g. Trauma, surgery, burns
When might neutrophil count be low ?
- viral infections
- drugs e.g. Chemo
- severe sepsis
- bone marrow failure
What do lymphocytes do ?
Cell mediated immunity and antibody production
When might lymphocyte count be increased ?
- acute viral infections
- chronic infections e.g. Hepatitis, syphilis
- leukaemias, lymphomas
Which virus typically causes large amounts of atypical lymphocytes ?
EBV
What may cause lympopenia
- steroid therapy
- SLE
- legionnaires
- HIV
- chemo
What do eosinophils do ?
Mediate allergic reactions and defend against parasites
What are monocytes ?
Precursors of tissue macrophages
What is the role of basophils ?
On binging IgE, release histamine
What drugs would you ask about in a history of suspected IDA ?
- NSAIDS
- SSRIs
- clopidogrel
- corticosteroids
What is a megaloblast?
A cell in which nuclear maturation is delayed compared to cytoplasm
What are the megaloblastic causes if macrocytic anaemia ?
B12 and Folate as these are required for DNA synthesis (and so causes maturation to be delayed due to impaired synthesis)
What are the non megaloblastic causes of macrocytic anaemia ?
- alcohol
- reticulocytosis (e.g. Haemolysis)
- liver disease
- hypothyroidism
- pregnancy
Why would you not treat folate deficiency alone without B12 treatment as well ?
As low B12 states may precipitate or worse subacute combined degeneration of the cord
Who is macrocytic anaemia most likely to present in ?
Women over 60 years old
What is the management of macrocytic anaemias?
- correct the deficiency that caused the macrocytosis
- treat the underlying condition that lead to the deficiency
What type of anaemia is iron deficiency ?
Macrocyctic, hypochromic
