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Phase 2 > Haematology > Flashcards

Haematology Flashcards

1
Q

What is the normal range for Hb in females?

A

11.5 - 14.5 g/dl

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2
Q

What is the normal range for MCV?

A

77-95 fl

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3
Q

What is the normal range for haematocrit?

A

0.37 - 0.47

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4
Q

What is the normal range for WCC?

A

4 - 11 x 10(9)/L

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5
Q

What is the normal range for platelets?

A

140-400 x 10(9)/L

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6
Q

Why is reticulocyte count relevant in anaemia?

A

Absence of an appropriate reticulocytosis in the setting of anaemia suggests impaired RBC production

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7
Q

What is APTT?

A

Activated Partial Thromboplastin Time

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8
Q

What does APTT measure?

A

Intrinsic pathway - factors XII, XI, IX, VIII

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9
Q

What causes a prolonged APTT?

A

Factor deficiency

Heparin treatment

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10
Q

What does prothrombin time measure?

A

Extrinsic pathway

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11
Q

What else is a long prothrombin time called?

A

High INR

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12
Q

What are the causes of prolonged prothrombin time?

A

Vitamin K deficiency
Anticoagulation with warfarin
Factor deficiency

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13
Q

What are D dimers?

A

Fibrinogen-fibrin degradation products

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14
Q

What is polycythaemia?

A

Increase in total mass of red blood cells in body

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15
Q

What is erythrocytosis?

A

Increase in concentration of red blood cells

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16
Q

What is primary polycythaemia?

A

Polycythaemia rubra vera - myeloproliferative

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17
Q

What causes secondary polycythaemia?

A

Driven by erythropoietin production

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18
Q

When is secondary polycythaemia physiologically appropriate?

A 
High altitude
Chronic cor pulmonale
Cyanotic congenital heart disease
Hypo ventilation
Abnormal Hbs
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19
Q

When is secondary polycythaemia physiologically inappropriate?

A

Renal: RCC, haemangioma, post-transplant, polycystic
Hepatocellular carcinoma
Others - cerebellar haemangioma, uterine tumours, Cushing’s syndrome, EPO abuse, androgen abuse

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20
Q

What are the causes of microcytic anaemia?

A 
Iron deficiency
Anaemia of chronic disease
Haemoglobinopathy
Vit A or B6 deficiency
Sideroblastic anaemia
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21
Q

What are the causes of folate deficiency?

A

Poor diet
Increased needs
Malabsorption - coeliac disease, jejunal resection

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22
Q

What type of anaemia do vit B12 and folate deficiency cause?

A

Macrocytic

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23
Q

What drugs cause increased MCV?

A 
Sulfasalazine
Alcohol
Methotrexate
Valproate
Cholestyramine
Some cytotoxic drugs
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24
Q

What are the different types of haemolysis?

A

Hereditary or acquired
Immune or non-immune
Extravascular or intravascular

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25
Q

What are the causes of AIHA (autoimmune haemolytic anaemia)?

A 
Primary
CLL
Drugs
SLE
EBV
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26
Q

What are the causes of non-immune haemolytic anaemia?

A

Hypersplenism
Prosthetic heart valves
Sepsis
Malaria

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27
Q

What are the causes of mechanical haemolysis?

A

Cardiac haemolysis
AV malformations
Microangiopathic haemolytic anaemia eg TTP, DIC, malignancy, vasculitis, pre-eclampsia, renal vascular disorders

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28
Q

What are the causes of normocytic anaemia?

A

All of previous causes
Blood loss
Anaemia of chronic disease
Starvation or anorexia nervosa

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29
Q

What is the normal range for Hb in males?

A

12.5 - 15.5 g/dl

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30
Q

What does a raised reticulocyte count in anaemia suggest?

.

A

Active marrow response … Not necessarily haemolysis

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31
Q

What should you do if a platelet count comes back low?

A

Repeat and send full clotting screen

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32
Q

What drugs should be avoided in thrombocytopenia?

A

Aspirin

NSAIDs

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33
Q

What drugs can cause neutropenia?

A 
Antipsychotics
Antidepressants
Anti-inflammatory
Antithyroid
Chemotherapy
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34
Q

What is the treatment for ITP?

A

Steroids

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35
Q

How do you reverse warfarin?

A

5mg IV vitamin K

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36
Q

How do you immediately reverse warfarin?

A

Prothrombin complex and vitamin K

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37
Q

What is the dose of FFP?

A

10 - 15ml/kg

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38
Q

What is virchow’s triad?

A

Hypercoagulability
Vascular damage
Stasis

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39
Q

What factors contribute to the Wells score?

A 
Active cancer
Immobilisation > 3 days
Localised tenderness along DV
Entire leg swollen
Calf swelling > 3cm
Pitting oedema
Collateral superficial veins
Likely alternative diagnosis
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40
Q

What wells score indicates the need for imaging?

A

Moderate or high (>1) in patients with other inter current illness

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41
Q

What score is a high wells score?

A

3 or more

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42
Q

When is testing D dimers a sensitive test?

A

To exclude DVT in non-hospitalised patients with a low risk score

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43
Q

Why are D dimers not used for patients in hospital?

A

They are raised in any inter current ilness and so not recommended - not specific

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44
Q

When is the probability of PE high?

A

A + B…
A) clinical features (SOB, tachypnoea, pleuritic chest pain, haemoptysis, syncope)
B) absence of another reasonable clinical explanation or presence of a major risk factor

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45
Q

What types of malignancy are major risk factors for PE?

A

Abdominal or pelvic

Advanced or metastatic

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46
Q

What is the first line imaging technique for suspected PE?

A

CTPA

Including intermediate or high probability in pregnancy

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47
Q

What other imaging techniques are used for suspected PE?

A

VQ scan
Echo
Leg USS
Pulmonary angiogram

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48
Q

When is thrombolysis indicated for PE?

A

Massive life-threatening PE
Haemodynamic compromise
Significant right ventricular dysfunction

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49
Q

How do you use heparin when commencing warfarin?

A

Continue heparin for minimum of 4 days until INR>2 for 2 consecutive days

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50
Q

What is the target INR for PE and DVT?

A
  1. 5

3. 5 if recurrent VTE whilst on warfarin

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51
Q

What is the relationship of proximal DVT and PE?

A

50% of patients with proximal DVT have asymptomatic pulmonary embolism at the time of diagnosis

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52
Q

What proportion of patients with PE have a DVT at the time of diagnosis?

A

40-50%

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53
Q

How long should warfarin be continued after proximal DVT or PE?

A

At least 3 months

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54
Q

When should dalteparin be used in medical patients?

A 
Reduce mobility with one of:
A) severe cardiac failure
B) acute respiratory failur
C) active cancer or inflammatory disease
D) acute infection/inflammation plus >75y, chronic heart or resp failure, previous VTE, obesity, COCP, varicose veins
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55
Q

What are the contraindications to Dalteparin?

A

Known bleeding disorder or platelets

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56
Q

What are the contraindications to TED stockings?

A 
Dermatitis
Gangrene, leg ulcers
Symptomatic PVD
Cellulitis
Peripheral neuropathy
Massive oedema of legs or pulmonary oedema from CCF
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57
Q

Over how long should red cells be transfused?

A

Within 4 hr of removal from fridge

Ideally over 2-3 hours

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58
Q

How is the use by date of blood products relevant in practice?

A

Transfusion must be STARTED by midnight on day of use by

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59
Q

How are red cells stored?

A

Fridge

2-6 degrees

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60
Q

How are platelets stored?

A

Room temperature

61
Q

What antigens are found on red cells of a patient with blood group A?

62
Q

What antibodies are found in the plasma of a patient with blood group B?

63
Q

What antibodies are found in the plasma of a patient with blood group O?

A

Anti-A and Anti-B

64
Q

Why does blood have to be ABO compatible?

A

Transfusion of only a few mls of incompatible blood can trigger a massive immune response leading to shock and DIC
Patients may die from circulatory collapse, severe bleeding or renal failure within a few hours

65
Q

When can RhD positive cells be given to a RhD negative patient?

A

In an emergency situation

If female older than 50 or male older than 16

66
Q

What are the Hb levels that indicate the need for red cell transfusion?

A

No CVS disease maintain at 70-90g/L

Known/likely CVS disease maintain at 90-100g/L

67
Q

How are platelets for transfusion collected?

A

Pooled platelets - from whole blood that has been centrifuged
Apheresis - specially collected from a donor

68
Q

When are platelet transfusions contraindicated?

69
Q

When is FFP given?

A

Coagulation deficiencies / DIC

TTP

70
Q

What is cryoprecipitate?

A

Contains cryoproteins (clotting factors)

71
Q

When do blood giving sets need to be changed?

A

After 8 hours or 2 units

If the blood component being transfused changes, so should the giving set

72
Q

How long does blood traceability need to be maintained?

A

Minimum 30 years

73
Q

What are SABREs and what is their significance?

A

Serious adverse blood related events

Must be reported to the MHRA within 7 days of their occurrence

74
Q

What is SHOT?

A

Serious Hazards Of Transfusion

Anonymous national scheme for reporting adverse blood incidents or near miss events

75
Q

What is positive identification for transfusion?

A

Full name + DOB + hospital number

Ask the patient and ALWAYS check the ID band

76
Q

When should the massive haemorrhage protocol be activated?

A

50% total blood volume loss in 3 hours
Total blood volume loss in less than 24 hours
Rate of loss 150ml/min
If 4 units of red cells have been transfused in an hour and similar further need is anticipated

77
Q

What does activating the massive haemorrhage protocol mean?

A

Blood components will be prepared at regular intervals of 15mins until the MH is stood down by the clinical team

78
Q

What is autologous transfusion?

A

Donor and recipient are the same person

79
Q

How can transfusion requirements be reduced perioperatively?

A

Pre-op diagnosis and treatment of anaemia
Plan for intra-op cell salvage
Maintain normothermia
Careful positioning of patient during surgery

80
Q

What is intra-operative cell salvage?

A

Collection and re-infusion of blood aspirated from the operative field during surgery

81
Q

What is post-operative cell salvage?

A

Collection of blood from surgical drains followed by re-infusion

82
Q

What are the potential early transfusion reactions?

A 
Acute haemolytic reactions
Anaphylaxis
Bacterial contamination
Febrile reactions
Allergic reactions
Fluid overload
TRALI
83
Q

What are the potential delayed transfusion reactions?

A

Infections
Iron overload
Graft versus host disease
Post-transfusion purpura

84
Q

What should you do if a complication occurs during transfusion?

A

Stop the transfusion

85
Q

How much does 1 unit of red cells increase Hb?

86
Q

How much does 1 adult dose of platelets increase platelet count by?

87
Q

What is the threshold for transfusion in a chemo patient?

88
Q

What is the lowest platelet count can be for most procedures?

89
Q

What is a Hickman line?

A

Incision in jugular vein and chest wall

Done under sedation/GA

90
Q

What prophylaxis needs to be given to chemo patients?

A

Allopurinol
Antifungals - itraconazole
Co-trimoxazole
Antiviral - aciclovir

91
Q

What is leukaemia?

A

Increase in number of white blood cells

92
Q

Which leukaemia is more common in children?

A

Acute lymphoid leukaemia (ALL)

93
Q

How does acute leukaemia present?

A

Rapid onset of symptoms

Tiredness, fever, sweats

94
Q

What are the signs of marrow failure?

A

Normal cells are lost:
RBC - tired, pale, short of breath
WBC - infection
Platelets - bleeding and bruising

95
Q

What does the bone marrow look like in acute leukaemia?

A

Hyper cellular
Often packed with blasts
Auer rods = AML

96
Q

What does the FBC show in acute leukaemia?

A

Normocytic normochromic anaemia
Low platelet count
WCC may by low, normal or high

97
Q

What is the Philadelphia chromosome?

A

Translocation 9 to 22

Characteristic of ALL

98
Q

When is bone marrow transplant used in acute leukaemia?

A

During 1st remission in disease with poor prognosis

99
Q

How is bone marrow transplantation done?

A

Destroy leukaemic cells and the immune system by total body irradiation
Repopulate marrow by transplantation from a matched donor, infused IV

100
Q

What is ALL?

A

Acute lymphoblastic leukaemia
Malignancy of lymphoid cells, affecting B or T lymphocyte lines
Uncontrolled proliferation of immature blast cells leading to marrow failure and tissue infiltration

101
Q

In which type of leukaemia is the Philadelphia chromosome identified?

A

ALL

And

CML

102
Q

How does the Philadelphia chromosome affect prognosis?

A

If present in ALL, means worse prognosis

If present in CML (80% patients) indicates better prognosis

103
Q

How does CML present?

A 
Weight loss
Tiredness
Fever
Sweats
Gout
104
Q

What do investigations show in CML?

A

Normochromic normocytic anaemia
BM hyper cellular
Cytogenetics: t(9;22)

105
Q

What is the treatment for CML?

A

Imatinib - tyrosine kinase inhibitor

106
Q

What is the median survival rate for CML?

107
Q

What is the most common form of leukaemia?

108
Q

How does CLL present?

A 
Often asymptomatic, incidental finding on FBC
Anaemia
Infection-prone
Weight loss, sweats, anorexia
Enlarged, nontender rubbery nodes
Soleno or hepatomegaly
109
Q

What are the potential complications of CLL?

A

Autoimmune haemolysis
Marrow infiltration - low Hb, neutrophils and platelets
Increased infection rate

110
Q

What are the common causes of death from CLL?

A

Infection

Transformation to aggressive lymphoma

111
Q

What is the prognosis for CLL?

A

One third never progress
One third progress slowly
One third progress actively

112
Q

What is lymphoma?

A

Malignant proliferation of lymphocytes (B and T cell neoplasms)
Accumulate in lymph nodes and can also be found in peripheral blood or infiltrate organs = extra-nodal areas

113
Q

What is the difference between lymphoma and leukaemia?

A

Affecting mainly bone marrow = leukaemia

Predominantly nodal/organ based = lymphoma

114
Q

What type of cells do you get in Hodgkin’s lymphoma?

A

Reed-Sternberg cells

115
Q

How does Hodgkin’s lymphoma present?

A

Enlarged, painless, non-tender, rubbery nodes

Systemic (B) symptoms: fever, weight loss, night sweats, pruritis, lethargy

116
Q

What are the signs of Hodgkin’s lymphoma?

A

Lymph node enlargement
Cachexia
Anaemia
Spleno-/hepatomegaly

117
Q

How might Hodgkin’s lymphoma present as an acute emergency?

A

SVCO due to mediastinal node involvement

118
Q

How do you diagnose Hodgkin’s lymphoma?

A

Lymph node excision biopsy if possible

FBC, blood film, ESR, LFT, LDH, urate, calcium

119
Q

What staging system is used for lymphoma?

120
Q

What investigations are required for staging of lymphoma?

A

CXR
CT thorax, abdo, pelvis
Marrow biopsy if B symptoms

121
Q

Describe Ann Arbor staging

A

1- single lymph node region
2- 2 or more nodal areas, but same side of diaphragm
3- nodes on both sides of diaphragm
4- spread beyond lymph nodes e.g. Liver or marrow
A or B - systemic symptoms

122
Q

What are the B symptoms in Ann Arbor staging?

A

Weight loss >10% in last 6 months
Unexplained fever >38
Night sweats needing change of clothes

123
Q

What is the treatment for Hodgkin’s lymphoma?

A

Chemoradiotherapy
Longer courses of chemo for higher stages
Relapsed disease - high-dose chemo with peripheral stem cell transplantation

124
Q

What is the prognosis for Hodgkin’s lymphoma?

A

5y survival 95% in I-A

125
Q

What is non-Hodgkin’s lymphoma?

A

All lymphomas without R-S cells

126
Q

What is the most common NHL?

A

Diffuse large B cell lymphoma

127
Q

What are the extra-nodal presentations of NHL?

A

Gastric MALT
Non-MALT gastric lymphoma
Small bowel lymphoma

128
Q

How do low grade and high grade lymphomas differ?

A

Low grade often incurable and widely disseminated, but may not require treatment if asymptomatic
High grade more aggressive but often curable

129
Q

How does high grade lymphoma present?

A

Rapidly-enlarging lymphadenopathy and systemic symptoms

130
Q

Give some examples of high grade lymphomas

A

Burkitt’s lymphoma
Lymphoblastic lymphomas
Diffuse large B cell lymphoma

131
Q

What factors indicate worse prognosis in NHL?

A 
Age>60
Systemic symptoms
Bulky disease
Raised LDH
Disseminated disease
132
Q

What is myeloma?

A

Abnormal proliferation of a single clone of plasma or lymphoplasmacytic cells
Leading to the secretion of Ig causing the dysfunction of many organs

133
Q

How is Ig detected in myeloma?

A

Seen as a monoclonal band (paraprotein) on serum/urine electrophoresis

134
Q

Why are myeloma patients susceptible to infection?

A

Other Ig levels are low

135
Q

What is Bence Jones protein?

A

Free Ig light chains filtered by the kidneys

Detected in urine in 2/3 cases

136
Q

What is the peak age for diagnosis of myeloma?

137
Q

What are the manifestations of myeloma?

A

Osteolytic bone lesions - back pain, fractures, hypercalcaemia
Anaemia, neutropenia, thrombocytopenia
Recurrent bacterial infections
Renal impairment

138
Q

Why do patients get renal impairment in myeloma?

A

Light chain deposition

139
Q

Why may myeloma patients get pancytopenia?

A

Marrow infiltration by plasma cells

140
Q

What does CRAB stand for in relation to myeloma?

A

Calcium (high)
Renal impairment
Anaemia
Bone/Back pain

141
Q

What do X-rays show in myeloma?

A

Lytic ‘punched out’ lesions

Eg pepper pot skull, vertebral collapse, fractures or osteoporosis

142
Q

How do you diagnose myeloma?

A
  1. Monoclonal protein band on serum or urine electrophoresis
  2. Plasma cells increased on marrow biopsy
  3. Evidence of end-organ damage eg renal, anaemia, hypercalcaemia
  4. Bone lesions - skeletal survey
143
Q

What supportive treatment is used for myeloma?

A 
Analgesia (avoid NSAIDs as renal failure)
Bisphosphonate
Local radiotherapy
Transfusion/EPO for anaemia
Fluid intake
Antibiotics for infection
144
Q

What are the common causes of death in myeloma?

A

Infection

Renal failure

145
Q

What factors indicate worse prognosis in myeloma?

A

> 2 osteopathic lesions

Hb

146
Q

What are the complications of myeloma?

A

Hypercalcaemia
Spinal cord compression
Hyperviscosity
AKI

147
Q

What are the symptoms of hyperviscosity?

A

Reduced cognition
Blurred vision
Bleeding

148
Q

What is MGUS?

A

Monoclonal gammopathy of uncertain significance
Paraprotein present in serum, but there is no myeloma
Some develop myeloma or lymphoma

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