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Toni's Pathology > Haematology > Flashcards

Haematology Flashcards

1
Q

IDA

A

Microcytic
Incr TIBC + transferrin
Decr ferritin
Anisocytosis/raised RDW/ poikilocytosis

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2
Q

Vit B 12 deficiency

A

Macrocytic megaloblastic anaemia

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3
Q

Aplastic anaemia

A

Low: Hb, reticulocytes, neutrophils, platelets, BM cellularity
High MCV due to HbF release

CD8 destruction of BM -> fatty changes
80% idiopathic
10% dyskeratosis Congenita + fanconi anaemia
10% secondary: SLE, drugs: carbamazepine, chloramphenicol, anticonvulsants, radiation

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4
Q

Anaemia of chronic disease

A

Microcytic hypochromic anaemia + rouleax
Decr TIBC + serum iron
Incr ferritin

IL 6 mediated -> liver hepcidin production

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5
Q

Beta thalassemia

A 
Microcytic anaemia
Iron studies normal
Target cells
Minor= 1 beta globin chain
Major= 2 beta globin chains 
Severe anaemia, req reg transfusions, skull bossing hepatosplenomegaly
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6
Q

Chronic alcohol consumption

A

Non megaloblastic macrocytic anaemia

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7
Q

Chronic renal failure

A

Normocytic normochromic anaemia

Reduced EPO secretion

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8
Q

Lead poisoning

A

Microcytic anaemia

Basophilic stippling
Pappenheimer bodies

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9
Q

Causes of MAHA

A 
TTP
HUS 
DIC
SLE
Schistocytes aka helmet cells, incr BR, jaundice
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10
Q

Paroxysmal nocturnal haematuria

A

Haemolysis
Haemoglobinuria
Ham’s test +ve

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11
Q

Myelofibrosis

A 
Tear drop cells / dacrocytes
Circulating megakaryocytes
BM aspirate dry, bloody tap
Pancytopenia 
Hepatosplenomegaly - extra medullary haematopoiesis
Abnormal MKcytes release PDGF + TGF beta
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12
Q

Megaloblastic anaemia

A

Cabot rings

Hyper segmented neutrophils

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13
Q

Haemophilia A

A

F VIII deficiency

Low APTT

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14
Q

ITP/ AITP

A

2 wks after viral illness in children
Self limiting
Type 2 hypersensitivity reaction vs GpIIb/IIIa

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15
Q

ITTP

A 
MAHA
Fever
Renal failure
Fluctuating CNS signs
Haematuria
Low platelets
ADAMTS13 mutation -> vWF multimers -> platelet thrombi 
Req plasma exchange
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16
Q

Glanzmann’s

A

GpIIb/IIIa mutation

Causes coagulation

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17
Q

Haemophilia B

A

Factor IX deficiency

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18
Q

Osler Weber Rendu

Aka hereditary haemorrhagic telangiectasia

A

AD
Telangiectasia on skin + mucous membranes
= epistaxis + GI bleeds

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19
Q

Bernard soulier syndrome

A

GpIb mutation

Receptor for VWF in clot formation

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20
Q

Prothrombin G20210A

A

Inherited thrombophilia
Guanine -> adenine
= amplification of PT production
Predisposition to DVT + PE

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21
Q

Factor V Leiden

A 
AD inherited thrombophilia
Arginine -> glutamine
Impaired degradation of FV by protein C
Incr risk DVT + miscarriage
Test function of APC
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22
Q

Antiphospholipid syndrome

A

AI thrombophilia
Anti cardiolipin + lupus anticoagulant
Bind to phospholipids on cell surface -> trigger Coag cascade
Incr risk DVT + miscarriage

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23
Q

Buerger’s

Aka thromboangitis obliterans

A

Small + med vasculitis of vessels of hands + feet
Assoc with smoking
Claudication
Gas gangrene + amputation
Corkscrew appearance of arteries on angiogram

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24
Q

Protein C or S deficiency

A

Inherited thrombophilia / rarely : warfarin / liver disease
Impaired degradation of FVa + FVIIIa
Incr risk DVT

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25
Q

Anti thrombin deficiency

A

Inherited thrombophilia

Usually inhibits FII (thrombin) + FXa

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26
Q

Transfusion complications:

Fluid overload

A

Dyspnoea
Incr JVP
Pink frothy sputum
Due to too fast transfusion rate >2ml/kg/hr
Or in those with pre-existing cardiac or renal failure

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27
Q

Transfusion complications:

GVHD

A

Donor lymphocytes attack recipient cells
Especially skin + GIT
Diarrhoea, macpap rash, skin necrosis
Irradiate donor blood to reduce risk

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28
Q

Transfusion complications:

Anaphylaxis

A

Incr risk in those with IgA deficiency

Due to IgA in donor blood

29
Q

Transfusion complications:

TRALI

A

Acute non cardiogenic pulmonary oedema within 6 hrs
Dry cough, dyspnoea, fever
Anti WBC Ab in donor blood attack host leukocytes
Donor has had sensitising event e.g. Transfusion/transplant

30
Q

Transfusion complications:

Immed haemolytic transfusion reaction

A

Within 1-2 hrs post transfusion
ABO incompatibility
Abdo + loin pain, vomiting, facial flushing, haemoglobinuria
Host IgG + IgM -> donor RBCs = removed by retic endothel syst

31
Q

Transfusion complications:

Febrile non-haemolytic reaction

A

After pregnancy
Antileukocytic Abs form
Low fever rigors

32
Q

Transfusion complications:

Fe overload

A

In cases of recurrent transfusion: thalassemia SCD
Bronzed skin
Short stature
Heart failure

33
Q

Transfusion complications:

Bacterial infection

A

High fever, rigors, hypotension

Hep B, hep C, HIV

34
Q

Transfusion complications:

Delayed haemolytic transfusion reaction

A

> 24 hrs post transfusion

Milder than immed haemolytic reactions

35
Q

Hairy cell leukaemia

A 
CLL subtype
Middle aged men
Hair like projections on tumour cells
CD25 (IL2-R) + CD 11c
Tartrate-resistant acid phosphatase: TRAP
Splenomeg, hepatomeg, pancytopenia
36
Q

CML

A 
Elderly
Elevated: neutrophils, basophils, eosinophils
BM: hyper cellular
T(9;22) BCR-Abl 
Imatinib
37
Q

AML

A 
BM: >20% myeloblasts blasts
Ayer rods
t(8;21)
FLT3 gene
CD13, CD33, CD34
Seen in Downs
38
Q

CLL

A

Smudge CeLLs
elderly men
>4000 cells per microlitre
Small lymphocytes in lymph nodes with irregular nuclei
Mixed with larger prolymphocytes -> aggregate to proliferation centres
Hypogammaglobulinaemia
Reiter’s transformation -> DLBCL

39
Q

ALL

A

Paediatric

BM: >20% lymphoblasts

40
Q

APML

A

AML M3 subtype
Faggot cells: loads of Auer rods
PML-RARA
ATRA asap to prevent DIC

41
Q

Adult T cell leukaemia/lymphoma

A

Assoc with HTLV1
Endemic in Japan + Carribean
Clover leaf nuclei in ATL cells
LNpathy, hepatsplenomeg, skin lesions, hypoCa

42
Q

Large granular lymphocytic leukaemia

A

Blood: large lymphocytes
BM: azurophilic granules

43
Q

T cell prolymphocytic leukaemia

A

Aggressive T cell leukaemia

Inv Chr 14 (q11;q32)

44
Q

Burkitt’s lymphoma

A 
Latent EBV, most prevalent in Africa 
children + teenagers
C-Myc Chr 8
Starry sky
Endemic: mandibles mass 
Non endemic: abdominal mass
45
Q

Hodgkin’s lymphoma

A

EBV -> NF-kappaB activation
Reed Sternberg cells (binuc/multinuc surrounded by eosinophils)
Painless asymmetrical LNpathy, except with ETOH
Fluctuates in size
Pel-Ebstein fever
B sx
Extra nodal involvement rare

46
Q

Mantle cell lymphoma

A

Elderly men
t(11;14)
Bcl1 + Ig heavy chain
Overextension cyclin D1

47
Q

Follicular lymphoma

A 
Middle aged
t(14;18)
Over expression Bcl2
Centrocytes, centroblasts
Non aggressive but difficult to cure
48
Q

Diffuse Large B Cell Lymphoma

A 
Elderly
Large lymphocytes with diffuse pattern of growth
Immunodef - assoc with EBV
Body cavity based - assoc with HHV8
Follicular lymphoma can transform
CLL can transform - Reiters
49
Q

Mycosis fungoides

A

Cutaneous T cell lymphoma
Elderly men
Rash like lesions
Appear similar to eczema/psoriasis

50
Q

Angio centric lymphoma

A

Cutaneous mass in nasal area
Tumour cells express NK cell markers
Oft infected with EBV

51
Q

Essential thrombocythaemia

A

High platelet count >600
Bleeding + thrombosis
BM: hyper cellular giant platelets, MKcyte clustering, hyperplasia
Rx: hydroxyurea, anagrelide

52
Q

Multiple myeloma

A

BM: >10% plasma cells, multi nuc, prom nucleoli
Rouleaux
IgG, IgA, para proteins
Paraprotein bands > 30g/L on electrophoresis
Incr ESR + Ca, punched out lytic lesions on XR (n ALP)
Bench Jones proteins in urine

53
Q

Polycythaemia Rubra Vera

A

JAK2 gene, exon 2, V167F
Incr Hb low EPO
Gout = incr cell turnover
Headaches, dizziness, stroke = hyperviscosity
Plethoric, pruritic after baths, peptic ulcer = hyper mast cell degran

54
Q

Hereditary spherocytosis

A 
AD haemolytic anaemia
Dysfunct: spectrin/ankyrin/ band 4.2
\+ve osmotic fragility -ve Coombs 
Jaundice, splenomeg, pigment gallstones 
\+ve fhx
55
Q

Hyposplenism

A 
Howell Jolly bodies
Target cells
Uncleared RBCs
Lymphocytosis
Macrocytosis
Acanthocytes: speculated RBCs
56
Q

Precautions to take in Hyposplenism

A

Penicillin V prophylaxis
Pneumococcal conjugate vaccine
Hib vaccine
Meningococcal vaccine

57
Q

Diseases in which splenectomy may be required

A 
Thalassemia
Pyruvate kinase deficiency
AIHA
ITP
Ellipto + spherocytosis
58
Q

Cold AIHA

A 
IgM mediated 28-31 Celsius
Causes:
CLL
Lymphoma
Mycoplasma
EBV
Idiopathic
59
Q

Paroxysmal cold haemoglobinuria

A

AI haemolytic anaemia
Children following infection
Donate Landsteiner antibodies
IgG antiglobulins at low temperatures

60
Q

Smouldering myeloma

A

Paraprotein >30g/L
Clonal plasma cells >10%
No myeloma related organ/ tissue impairment

61
Q

MGUS

A

Serum paraprotein

62
Q

Combined Polycythaemia

A

Aka smokers Polycythaemia
Carbon monoxide -> incr EPO = incr red cell mass
+ smoker’s reduced plasma volume

63
Q

Marginal zone lymphoma

A

Chronic antigen stimulation -> malig transformation
B cell NHL
Extranodal: MALT= stomach, lung, thyroid, breast, synovium, lac, saliv
Nodal:
Splenic:

64
Q

Nodular lymphocytic HL

A 
Non classical
Lymphocytic + histiocytic Reed Sternberg variant 'popcorn cells'
Children or 30-40yrs
More common in Afro Carribean 
Peripheral LNpathy without B sx
65
Q

Nodular sclerosis classical HL

A

Nodular growth pattern fibrous bands separating nodules

66
Q

Mixed cellularity classical HL

A

Heterogenous group

Diffuse/ vaguely nodular pattern without band forming sclerosis

67
Q

Lymphocytic rich HL

A

Nodular growth pattern

Background infiltrate: mainly lymphocytes

68
Q

Lymphocyte depleted HL

A

Diffuse growth pattern
Hypocellular
Lack of inflammatory cells

Toni's Pathology (6 decks)

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