Haematology Flashcards

Question

What are major features of multiple myeloma?

Answer 1

``` CRAB2 Calcium raised Renal impairment Amyloidosis Bone lesions Bence Jones protein ```

Answer 2

Hodgkin's lymphoma Mirror image nuclei = reed sternberg cells Incidence high in young adults and elderly

Answer 3

Haemolytic uraemic syndrome Initial gastroenteritis and subsequent haemolysis Can resolve of own accord but may need plasmapheresis in severe cases

Answer 4

Prevent radical formation: transferrin and lactoferrin | Remove/inactivate ROS: SOD, vit C and E, glutathione

Answer 5

``` Lipid and protein peroxidation Damage to cell membranes Increased capillary permeability Impaired mitochrondrial respiration DNA strand breaks Apoptosis ```

Answer 6

Immunoglobulin light chain found in urine | Suggestive of multiple myeloma

Answer 7

Iron - duodenum Folate - jejunum B12 - terminal ileum

Answer 8

Impaired production: myelodysplastic syndromes, myeloma, tumour infiltration, aplastic anaemia, HIV Excessive destruction/increased consumption: ITP, DIC, TTP Sequestration: splenomegaly, hypersplenism Dilutional: massive transfusion

Answer 9

``` Myeloproliferative disorders Renal disease Liver disease Paraproteinaemias Drug induced: NSAIDs ```

Answer 10

Platelet function impaired by urea and other metabolites which accumulate in renal disease

Answer 11

Develop antibodies to factor VIII Deep internal bleeding Joint damage Infection secondary to transfusion

Answer 12

Vit K deficiency: cholestasis Reduced synthesis of coag factors Thrombocytopenia: hypersplenism secondary to portal hypertension or folic acid deficiency Functional abnormalities of platelets and fibrinogen DIC in acute liver failure

Answer 13

``` Malignant disease Septicaemia - gram neg Haemolytic transfusion reaction Obstetric: placental abruption, amniotic fluid embolism, pre eclampsia Trauma Burns Surgery Infections: falciparum malaria Liver disease Snake bite ```

Answer 14

``` Hx of unprovoked VTE Increasing age Pregnancy/post partum Malignancy Acute inflammatory state Antiphospholipid antibodies Myeloproliferative disorders Nephrotic syndrome Behçet's disease DIC Paroxysmal nocturnal haemoglobinuria Heparin induced thrombocytopenia COCP, HRT, SERM Chemotherapy Surgery Antithrombin deficiency Protein c/s deficiency Plasminogen deficiency Obesity Smoking HIV Long haul flight Factor V Leiden mutation ```

Answer 15

FBC Peripheral blood smear: red cell fragmentation, spherocytes, thrombocytopenia, sickle shaped cells APTT: reduced or prolonged Fibrinogen: elevated if prothrombotic, reduced if DIC PT: prolonged D dimer Serum albumin: low in nephrotic syndrome Serum creatinine: high in nephrotic syndrome Serum triglycerides: high in nephrotic syndrome

Answer 16

``` Active cancer or treatment Age over 60 Dehydration Known thrombophilia Obesity BMI over 30 One or more significant medical comorbidities Personal Hx first degree relative with VTE Hx Use of HRT Used of COCP Varicose veins with phlebitis Pregnancy or ```

Answer 17

Significantly reduced mobility for 3 days or more Hip or knee replacement Hip fracture Total anaesthetic and surgery time over 90 mins Surgery involving pelvis or lower limb with total time over 60 mins Acute surgical admission with inflam or intra abdo condition Critical care admission Surgery with significant reduction in mobility

Answer 18

Patients presenting with first VTE age under 50 Unprovoked or recurrent VTE Thrombosis in unusual site Neonatal purpura fulminans Warfarin induced skin necrosis Family Hx in first degree relative at young age

Answer 19

``` Protein c level Free protein s level Activated protein c resistance Antithrombin level Prothrombin gene mutation ```

Answer 20

Low molecular weight heparin, unfractioned heparin or fondaparinux Mechanical thromboprophylaxis: graduated compression stockings, intermittent pneumatic compression device

Answer 21

Blue black inclusions of red blood cells which represent nuclear fragments commonly seen in asplenic patients

Answer 22

Fragmented red blood cells seen in intravascular haemolysis

Answer 23

Iron deficiency Thalassaemia Anaemia of chronic disease Sideroblastic anaemia

Answer 24

``` Alcohol Haemolysis Haemorrhage Liver disease Hypothyroidism Azathioprine ```

Answer 25

``` Acute blood loss Anaemia of chronic disease CKD Autoimmune rheumatic disease Marrow infiltration/fibrosis Endocrine disease Aplastic anaemia ```