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Progress test packs > Haematology > Flashcards

Haematology Flashcards

1
Q

heparin

full vs lmwh

A

affects intrinsic pathway
activate antithrombin iii
se bleeding, HIT, osteo, hyperkal

FULL
monitor aptt
given IV

LMWH
monitor anti factor X (not routine)
subcut inject long lasting fewer side effects

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2
Q

Hep Induced Thrombocytopaenia

HIT

A

actually pro thrombotic state

5-10 days post treatment

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2
Q

low vit c

A

bleeding gums

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3
Q

low niacin

syndorme called pellagra

A

dermatitis
dementia
diarrhoea

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4
Q

warfarin

A

vit k antag
affects extrinsic pathway
monitor prothrombin time - INR

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5
Q

low vit d

A

osteo rickets

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6
Q

low thiamin

A

from starvation - ie in alcoholics

Beriberi

  • wet - heart failure
  • dry - affects cns

affects brain: wernicke korskoff

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7
Q

low b12

A 
megaloblastic anaemia
mouth tongue (glossitis)
dementia
neuropathy
eyes and gut
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8
Q

low vit a

A

blindness

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9
Q

low folate

A

anaemia

ntd in pregnancy

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10
Q

anti CCP

A

RA

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11
Q

ANA

A

SLE (anti ds-dna, anti smith)

autoimmune hep

SSc

  • cutaneous: anti centromere
  • diffuse: anti-topoisom, scl-70
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12
Q

AMA

A

primary biliary cirrhosis

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13
Q

SMA

A

autoimmune hep

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14
Q

TTG, endomysial antibodies

A

coeliac

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15
Q

anti GBM

A

goodpastures

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16
Q

C-ANCA

A

wegeners

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17
Q

acute laeukaemias

A
  • present unwell - fever, sweat, wl, malaise
  • splenomeg, lymphadenop
  • signs of marrow failure

1) resus - abx, transfuse
2) chemo (+ allopurinol vs tls)
- - BM transplant

ALL - kids, treat for years
AML - inc w age, AUER RODS, treat for months

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18
Q

acute leakaemia diagnostics

A

blood

  • pancytopenia
  • wcc normal or raised
  • blasts present

BM

  • hypercellular
  • > 30% blasts

in AML
- auer rods, myeloid enzymes

in ALL
- lymphoid cells eg b/t cells

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19
Q

hyponatraemia <137

A

hypovol

  • diuretics (thiazide), addisons
  • vom, diarhh, burns

euvol
- SIADH

hypervol
- liver, kidney, heart fail

drugs- SSRI, TCA, carbamez, cyclophosp

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20
Q

CLL

A

malig of B cell prolif - functionally immature
most common leuk - age, male, fh

massively raised wbc - may be chance finding

  • may be >15000
  • many lymphocytes
b symptoms (sweat, fever, wl)
lymphadenopathy /organomeg
can get autoimmune haemolysis (coombes)
marrow faliure
- anaemia
- infection (low neutrophils)
- platelet

anaemia - may be haemolytic or normocytic
may see monoclonal gammopathy
*peripheral blood flow cytometry more useful than BM

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22
Q

iron deficiency

A

microcytic
low iron, ferritin, high tibc
? gi bleed
also - coeliac, pregnancy, menorrhagia

koilonychia
angular stomatitis
tongue atrophy

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22
Q

CLL prognosis

A

thirds: no progress, slow, active

transformation to aggressive lymphoma = richters

treatment chemo (fludarabine, chlorambucil, rituximab)
bm transplant if young
23
Q

CML

A

middle age (rarely affects kids)

b symptoms, splenomeg, anaemia
platelets less affected
get ‘blast’ transformation (aml or all)

PHILADELPHIA CHROMOSOME t9:22

wcc raised >30 often >100
- esp neutrophils
normocytic anaemia

BM

  • hypercellular
  • granulocytic hyperplasia
  • megakaryocytes

t: imatininb v effective

24
Q

thalassaemia

A

trait - mild microcytic anaemia

disease = serious

  • beta-globulin (alpha disease die inutero)
  • anaemia in baby
  • affects growth, infections, ulcers, skull bossing (hair on end)
  • SPLENOMEGALY

tx: transfusio dependant, iron chelators (Vs overload)
bm transplant
survival 40’s

25
Q

normocytic anaemia

A

chronic disease
EPO deficiency (renal fail)
haemolytic

26
Q

macrocytic anaemia

A

megaloblastic

hypothyroid (mild)

27
Q

megaloblastic anaemia

A

macrocytic

commonest cause: ALCOHOL

  • low folate (can deplete quickly)
  • diet, coeliac, methotrexate
  • low b12 (chronic) ie pernicious anaemia
  • neurology - periph, sc degen, –> IM B12 5 days, then every 3 m for life
  • glossitis

hyper segmented neutrophils

28
Q

pernicious anaemia

A

autoimmune destruc of parietal cells and intrinisc factor
anti GPC, anti IF

no IF –> no B12 abs

inc risk gastric ca

29
Q

haemolytic anaemia

A

hereditary
- sphero, G6PD, pyruvate kinase def, sickle, thalass

acquired

  • TTP, HUS, autoimmune, Cll
  • cardiac, drugs, infection

tests - inc uncong bilirubin, inc urinary urobilinogen
inc LDH
reticulocytes
polychromasia

30
Q

autoimmune haemolysis

A

coombes +ve
fatigue
splenomegaly
red cell agglutination on blood film

warm or cold

warm IgG
splenic phagocytosis
can be idio or assoc w sle, lymphoprolif, ibd, drugs
T: pred -> blood transfusion -> splenectomy

cold IgM, purple colour to extremeties
idio or post infection (1-2 weeks)
can be precip by cold
may be assoc w lymphoprolif, chlorambucil

31
Q

spherocytosis

A

autosomal dominant cause of anaemia
abnormal membrane

SPLENOMEGALY

often no need for treat
if severe - splenectomy

32
Q

G6PD defic

A 
Inherited cause of anaemia
X linked - affects males
common in tropics
usually asympto until trigger (infect etc)
usually self limiting, supportive tx
33
Q

HUS haemolytic uraemic syndrome

A

acquired cause of anaemia

assoc w diarrhoea e coli 0157

see degree of renal failure –> uraemia
low platelets

34
Q

TTP thrombotic thrombocyto pupura

A

pentad

  • haem anaem
  • thrombocyto
  • neuro signs (ie stroke)
  • renal imp (occlusion)
  • fever

fatal w/out treat
- plasmaphoresis, FFP

35
Q

sickle

A

beta globin
electrophoresis shows HbS band (with normal HbA band if trait)
sickle solubility test - +ve in train and disease

trait - one sickle and one normal beta Hb
- asympto, normal blood film

disease - both sickle beta Hb’s

  • change shape when deox
  • prone to occlusions, mild anaemia
  • HYPOSLENISM due to infarct - need penicillin, folic acid
  • prone to crises
36
Q

sickle crises

T; transfuse

A

THROMBOTIC
painful vascular occlusion - often to bone
maybe post infec/dehydration/stress

APLASTIC
post PAROVIRUS
sudden drop Hb

SEQUESTRATION

  • acute chest syndrome - cough, cp
  • splenic

HAEMOLYTIC
rare sudden drop hb, raised reticulocytes

37
Q

bone marrow failure

A

anaemia, infection, rash/bleeding

malignancy
radiotherapy, cytotoxic drugs
aplastic anaemia (idiopathic, hep c) 
- hypocellular bm
myelodisplasia/fibrosis
sepsis, alcohol, b12 def
38
Q

complications/features of aplastic anaemia

A

See hypocellular blood film

treatment of aa
support (transfuse, abx) -> bm transplant -> immunosupp

paroxysmal noctunal haemaglobinuria
- may cause budd chiari

fanconi’s
- early onset aa, with skeletal, growth, pigment probs

39
Q

hodgkin lymphoma

A

REED STERNBERG - large, eosinophilic, multinucleated or bilobed nucleus
** Ann Arbor Staging
good cure rate w chemo

lymphadenopathy in neck
b sympotms: wl, fever, night sweats

EBV link

lymphocyte predominant - best progn but rare
lymphocy depleted - worst prog

‘nodular sclerosing’
-most common

40
Q

non hodgkin lympyhoma types

A

80% B cell 20% T cell
high grade or low grade
- B symptoms and lymphadenopathy (rubbery non tender)

low grade - slow incurable

  • follicular
  • waldenstroms macroglobulinaemia

high grade - fast, 30% curable w chemo

    • Ann Arbor Staging
  • DLBCL
  • Burkitts t(8:14)
  • 1) african endemic, EBV, mandibular
  • 2) non endemic, HIV
41
Q

burkitts lymphoma

A

high grade b cell lymphoma
endemic in africa - jaw lymphadenopathy

may see tumour lysis syndrome post chemo - confsion, muscle pain, renal probs

42
Q

low grade NHL

A

elderly

T: chemo - chlorambucil or FCR

1) follicular - t(14:18)

2) waldestroms - IgM paraprotein - hyperviscosity
- headache, visual dist, lethargy
- - plasmaphoresis

43
Q

Myeloproliferative disorders

A

CML

PRV

essential thrombocythaemia

myelofibrosis

44
Q

myelofibrosis

A

proliferation and release of cytokines -> fibrosis
affects rbc –> anaemia
massive splenomegaly
also fever wl

nb wcc and plt may be norm, high or low

blood film - immature wbc and rbc
- tear drop rbc

t difficult, includes tranfuse, splenect, thalid/pred, hydroxyurea
4 yr survival

45
Q

essential thrombocythaemia

A

plt may be over 1000
type of myeloprolif disorder
asympto or thombotic event

aspirin vs thrombosis
? hydroxylurea

46
Q

polycythaemia rubra vera

A

inc red cells, 50% also rasied wcb and plt
risk thromboembolic events
treat venesection -> hydroxyureea
- ?aspirin

JAK2

pruritis, bruing, red/blue discol
splenomegaly
flushed

may convert -> myelofib, or aml

47
Q

myeloma

A

malig prolif of plasma cells
monocal Ig paraproteinaemia

back pain in elderly
infection
anaemia
renal fail

anaemia from marrow infiltrate, renal imp, chronic disease
hypercalcaemia in 25%

excess light chains - levels can be monitored
bence jone in urine
–> renal failure in 50%

48
Q

myeloma treat

A

often start w thalidomide and prednis
bisphosphonates vs bone lesions
plasmaphoresis vs viscosity

49
Q

MGUS

A

monocloneal gammopathy of uncertain significance

aka benegn paraproteinaemia

paraprotein but no path symtpoms

1% devel myeloma

50
Q

myelodysplasia

A

elderly
bm produces abnormal cells

anaemia common
- macrocytic but folate/b12 normal

? infection
? low plt

support: transfuse, plt, abx
?bm transplant

51
Q

rasie wbc - leukocytosis

A

neutrophils - bacterial infec
also
- steroids, tissue necrosis (MI), maignancy, inflamm disord, dka

lymphocyte - viral

eosinophil

  • allergy, atopy, asthma
  • parasitic
  • vasculitis - esp PAN
  • hodgkin lymphoma
52
Q

thrombocytopenia

A

ITP

  • autoimmune
  • acute, self limitng in kids post viral
  • also middle aged women (other autoimmue)
  • exclude bm problems
  • give stroid only if plt less than 30
  • IgG in emergency

post transfusion
heparin induced

HUS and TTP (see sep cards)

53
Q

coag disorders

A

Haemophilia - inherited

  • bleed into muscles and large joints
  • haemophilia A - defic factor 8 (affects APTT) - x linked
  • haemophilia B - defic factro 9
  • von Willebrand’s disease

Acquired - DIC, liver disease, vit K defic (in malnut and obstruc jaundice)

DIC - both microvascular thromobisis with bleeding due to consumption
- give ffp, blood to buy time, address underlying cause

54
Q

von Willebrands disease

A

Most common inherited bleeding disorder
vW factor either deficient or defective
- its usual job is to help platelet clot formation

Type 1 - partial deficiency
2 - total deficiency
3 - defective

Bruising, bleeding - menorrhagia, epistaxis

Not affect PT or APTT

Treat: desmopressin

55
Q

thrombophilia

A
  • mainly venous thrombosis
  • may see dvt/pe, budd chiari

inherited

  • include defic of prot c,s, antithrombin
  • also factor V leiden (resistant to activated protein c) - defect in factor 5

acquired

    • antiphospholipid syndrome
  • smoking, malig, cocp, polycythaemia,
56
Q

antiphospholipid

A

either primary or assoc w sle etc

thrombosis and misacrriages
arterial (cva, ihd, renal) and venous (dvt/pe)

anti cardiolipin
anti phospholipid binding protein

platelets may be low (TTP)
may see anaemia

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