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CP3 Medicine > Haematology > Flashcards

Haematology Flashcards

1
Q

What are the general S+S of anaemia (7 +4)

A

Asymp
Non specific: fatigue / headache / weakness

CV: angina / SOB on exertion / palpitations / IC

Pallor
Cardiac failure
Tachycardia
Systolic murmur

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2
Q

List some specific signs of certain types of anaemia (4)

A

Koilonychia - Fe defc
Jaundice - haemolytic
Leg ulcers - sickle
Bone marrow expansion (abnormal facies + fractures) - thalassaemia

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3
Q

When is transfusion indicated in anaemia + how should it be given?

A

If anaemia is severe

Caution of heart failure: transfuse slowly + w. furosemide

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4
Q

List the causes of microcytic anaemia (4)

A

Fe defc (blood loss unless proven otherwise)
Thalassaemia
Lead poisoning
Sideroblastic anaemia

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5
Q

List the causes of normocytic anaemia (8)

A 
Acute blood loss
Anaemia of chronic disease
Pregnancy
Dimorphic blood film (micro+macro)
Renal anaemia
Haemolytic anaemia
Marrow failure
Connective tissue disorders
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6
Q

List the causes of macrocytic anaemia (6)

A 
Alcohol excess (or severe liver disease)
B12 defc (Pernicious / Crohn's)
Folate defc (coeliac)
Myelodysplastic syndromes
Severe hypothyroidism
Reticulocytosis haemolytic
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7
Q

What are the normal Hb levels in men + women

What is the normal range for MCV

A

Men: Hb >13.5
Women: Hb >11.5

MCV Normal range: 80–96fL

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8
Q

List some specific peripheral stigmata of microcytic anaemia (3)

A

Koilonychia
Angular stomatitis
Brittle hair/nails

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9
Q

What would Iron studies show in Fe defc anaemia

A

Reduced Fe
Reduced Ferritin
Raised TIBC
Raised transferrin receptors

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10
Q

List some causes for Fe defc anaemia (8)

A 
Hookworm (worldwide)
Menorrhagia
GI bleed
Coeliac (reduced absorption)
Post-gastrectomy
Growth / Pregnancy
Premature infants
Prolonged breast fed
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11
Q

What further Ix should be done in microcytic anaemia (2)

A

Blood film

Iron studies

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12
Q

What are the features of Paterson-Brown-Kelley (Plummer-Vinson) syndrome (5)
How is it treated

A 
Dysphagia
Odynophagia
Oesophageal webs
Fe defc anaemia
Glossitis / Chelitis

Fe supplementation + Oesophageal widening

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13
Q

What are the features of:
B minor (trait) thalassmia
B major (Cooley’s) thalassaemia
Alpha thalassaemia

A

Trait: Asymp/Worsens in preg, mild microcytic (confused w. Fe defc)

Major, presents in 1st yr:
Severe anaemia / FTT
Hepatosplenomegaly / Abnorm facies

Alpha: Barts hydrops (4) / haemolytic sx / asymp

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14
Q

What Ix can be done into thalassaemia?

A

Blood film:

Targets cells + Nucleated RBCs

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15
Q

What diseases are usually responsible for anaemia of chronic disease (ACD)

A

Due to predominate WBC prodn:

Chronic infection
Rheumatoid disorders
Malignancy
CKD

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16
Q

What further Ix should be done in normocytic anaemia

A

NB if clear h/o menorrhagia – NONE

Iron studies
Coeliac screen
Recent travel – stool microscopy
No obvious source – OGD/Colonoscopy
Bone marrow biopsy
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17
Q

List the causes for bone marrow failure (6)

A 
Aplastic anaemia
Haematological malignancies
Metastasis
Myelofibrosis
Myelodysplasia
Parvovirus (stops marrow erythropoiesis)
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18
Q

What further Ix should be done in macrocytic anaemia + why (5)

What further Ix should be done if B12 is shown to be low (2)

A 
Blood film: 
Hypersegmented neutrophils = B12/Fol defc
Target cells (liver disease)

LFTs:
Liver cause
Raised bili B12/Fol

TFTs: severe hypothyroid

Bone marrow biopsy:
Megaloblasts = B12-Fol // Myelodysplasia

Serum B12-Fol

If B12 low:
Anti-parietal Ab / anti-IF Ab
Schilling (gold standard) (pernicious vs small bowel)

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19
Q

List some causes for B12 defc (10)

A

VEGANS

Impaired stomach binding:
Pernicious anaemia
Gastrectomy
Congenital IF absence

Small bowel:
Crohn’s
UC backwash ileitis
Bacterial overgrowth

On mild defc:
Pancreatitis
Coeliac
Metformin

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20
Q

List some causes for Folate defc (9)

A

Dietary: defc/anorexia
Alcohol excess
Malabs: Coeliac

Anti-folates (trimethoprim, MTX)

Pregnancy
Premature

Malignancy
Inflamm conditions
XS RBC prodn e.g. haemolysis

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21
Q

List the differentials for haemolytic anaemia (2: 3+5)

A

Intrinsic (hereditary):
Haemoglobinopathies – sickle / thalassaemia
Membranopathies – spherocytosis / eliptocytosis
Enzymopathies – G6PD / PK defc

Extrinsic (acquired):
Autoimmune – lymphproliferatives // others e.g. SLE
Alloimmune – Rh / transfusion / transplant
Drugs – e.g. penicillins
Parasites – plasmodium
Microangiopathic – DIC

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22
Q

What Ix results (FBC+LFTs) would suggest a haemolytic picture? (4)

A

Increased breakdown:
Macrocytic
Raised bilirubin
Raised LDH

Increased prodn:
Raised reticulocytes

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23
Q

What further Ix should be done if suspect haemolytic anaemia? (6)

A

Blood film
Coombs’

Hb electrophoresis
Plasma haptoglobin
Urinary haemosiderin
Enzyme assays

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24
Q

What occurs in a sequestration crisis?

A

Organomegaly
Severe anaemia
Shock

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25
Q

What is seen on blood film of:
Thalassaemia
G6PD
Microangiopathic

A

Thalassaemia: hypochromic / microcytic

G6PD: Heinz bodies / ‘bite/blister’ cells

DIC: schistocytes

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26
Q

List some complications of sickle cell anaemia (8)

A 
Bone infarction (necrosis)
Renal infarction (CKD)
Splenic infarction (hyposplenism)
Painful dactylitis
Chronic leg ulcers
Chronic lung damage
Fe overload (transfusions)
CVA
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27
Q

How does a sickle cell crisis present?
(Sickle Cell Acute Presentation) (4)

List some precipitating factors (4)

A

Severe bone pain**
CVA (Cerebral infarct)
Acute abdo (acute mesenteric ischaemia)
Priapism

Dehydration
Hypoxia
Cold
Infection

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28
Q

What is an aplastic crisis?
What is it due to?
How is it managed?

A

Sudden reduced bone marrow prodn

Due to parvovirus

Self-resolves 2wks but may need transfusion

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29
Q

Outline the acute management of sickle cell crises

A 
A–E (inc. high flow O2 / fluids)
Strong analgesia
FBC / X-match / Reticulocytes
Infection screen (culture/MSU/CXR)
LMWH (prophylaxis)
Transfusion
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30
Q

Outline the long-term management of sickle cell anaemia

A 
Lifelong transfusions
Lifelong folate supplements
Pneumococcal vx / Pen V (hyposplenism)
Hydroxycarbamide/hydroxyurea if freq crises (HbF prodn)
Bone marrow transplant (curative)
31
Q

What are the possible features of G6PD

A

African / Mediterranean males
Asymp
Oxidative crises:
Rapid anaemia / jaundice

32
Q

What may trigger a crisis in G6PD (3)

A

Drugs: aspirin / sulphonamides / primaquine
Broad beans
Illness

33
Q

How does PK defc present? (3)

A

Neonatal jaundice
Chronic jaundice (later)
Hepatosplenomegaly

34
Q

What types of acquired haemolytic anaemia are

Coombs’ +ve / –ve

A

Coombs’ +ve:
Drug-induced
Autoimmune
Alloimmune

Coombs’ –ve:
Infection
Microangiopathic

35
Q

List some causative drugs of drug-induced haemolytic anaemia (3)

List some causes of autoimmune haemolytic anaemia

A

Methyldopa
Quinidine
Penicillin

Idiopathic**
2º to lymphoproliferatives

36
Q

List some causes of microangiopathic haemolysis (6)

A 
Malignant HTN / Pre-Eclampsia
DIC
Thrombotic thrombocytopenic purpura
HUS
Vasculitis (SLE)
Mechanical heart valves
37
Q

List the DDx for neutrophilia (6)

A 
Bacterial infection
Inflammatory
Stress e.g. surgery/burns
Corticosteroids
Disseminated malig
Myeloproliferative conditions
38
Q

List the DDx for neutropenia (6)

A 
Cytotoxics 
Marrow failure
Severe sepsis
Viral infection
Hypersplenism e.g. Felty's
Neutrophil Abs e.g. SLE
39
Q

List the DDx for lymphocytosis (3)

A

Chronic infection (e.g. TB, hepatitis)
Viral infection
Myeloproliferatives

40
Q

List the DDx for lymphopenia (6)

A 
SLE
HIV
Cytotoxics
Marrow failure
Corticosteroids
Uraemia
41
Q

List some RFs for Hodgkin’s lymphoma (4)

A

Obese
FH
SLE
EBV

42
Q

What are the features of Hodgkin’s lymphoma (7)

A 
Painless 'rubbery' LNs
Alcohol –> painful LNs
B symptoms (profuse night sweats)
SVC/Bronchial Obstrn
Pleural effusion
Hepatosplenomegaly (50%)
S/o cachexia
S/o anaemia
43
Q

How may non-Hodgkin’s present ? (4)

A

Nodal (75%): superficial LNs
Extra-nodal (20%): gut / skin / lungs / CNS / testes
B Sx (NB wt loss = dissem)
Bone marrow failure

44
Q

What Ix done if suspecting lymphoma?

A 
Bloods:
FBC 
Blood film / ESR
U+Es / Ca
LDH

CT - staging

LN excisional biopsy (± image guided / laparotomy)

45
Q

What are some poor prognostic factors for lymphoma (3)

A

Raised LDH
Age >60
Disseminated

46
Q

List any RFs for multiple myeloma (2)

A

Age >70

Afro-Caribbean

47
Q

What are the features of multiple myeloma (CRAB)

A

Ca: hypercal
Renal impairment
Anaemia: bone marrow failure
Bone: osteolytics (backache / patho #s)

48
Q

What Ix are done if suspecting multiple myeloma?

A

Urine:
Serum/urine electrophoresis (monoclonal paraprot band)
Urine Bence-Jones protein

FBC (normochromic normocytic) 
Blood film (rouleaux formn) 
ESR (raised)
UEs (deranged)
Ca (raised)
ALP (normal)

Skeletal XR

Bone marrow biopsy (clonal plasma bands)

49
Q

What are the features of acute leukaemia?

A

B Sx
Bone pain
Bone marrow failure
Hepato/splenomegaly

50
Q

What Ix are done into acute leukaemia?

A 
FBC
Blood film (blasts)
CXR (T-ALL mediastinal widening)
Bone marrow aspiration (confirm Dx)
PET scan (check for mets)
UEs/LFTs/ECG/ECHO - therapy planning
51
Q

What are the features of CLL? (6)

A 
Asymp** (incidental FBC)
Anaemic
Infection prone
B Sx (severe)
Enlarged painless LNs
Hepatosplenomegaly
52
Q

When is Tx indicated in CLL?

A 
Symptomatic
Cytogenetic markers (of poor prig)
53
Q

What is Richter’s syndrome?

A

Transformation of CLL into diffuse large B-cell lymphoma (type of NHL)

Refractory to Tx / poor prog

54
Q

List the Rai Prognosis Classifications of CLL (4)

A

Stage 0: lymphocytosis only; 13yrs
Stage 1: lymphocytosis + enlarged LNs; 8yrs
Stage 2: lymphocytosis + hepatosplenomeg; 5yrs
Stage 3: lymphocytosis + anaemia; 2yrs
Stage 4: lymphocytosis + thrombocytopenia; 1yr

55
Q

List some features of hyperviscosity that may be seen PCV (polycyth rubra) (7)

A 
Thrombotic complications
Headache
Dizziness / vertigo
Facial plethora
Burning in fingers/toes (erythromelalgia)
Splenomegaly
Gout (turnover)
56
Q

List some causes of aplastic anaemia

A

Autoimm:
Drugs / viruses / irradiation

Inherited: Fanconi anaemia

57
Q

List the DDx causes of thrombocytopenia (3+5 THISA)

A

Reduced Prodn:
Marrow failure
Marrow infiltration
Aplastic anaemia

Excess destrn:
TTP
HUS
ITP
Sequestration (hypersplenism)
Autoimm (SLE/Viruses)
58
Q

What is the management of ITP in adults?

A

1st: Corticosteroids
± IVIG (if req rapid rise platelets)
± Platelet transfusions (massive h’age)
2nd: Splenectomy

59
Q

Which part of coag pathway is the Prothrombin Time (PT) measuring?
What can prolonged PT be indicative of? (2)

A

Tests EXTRINSIC

Prolonged in:
Liver disease
Warfarin

60
Q

Which part of coag pathway is the APTT testing?

What can cause APTT to be prolonged? (3)

A

Intrinsic

Factors 8/9/11/12 defc
APL
Heparin usage

61
Q

Which part of coag pathway is the Thrombin Time testing?

What may cause TT to be prolonged?

A

Thrombin Time - testing common pathway

Prolonged in fibrinogen defc

62
Q

List some non-Warfarin causes of Vit K defc (3)

A

Malabsorption
Cholestatic jaundice
Abx (gut flora disturbances)

63
Q

Differentiate Haemophilia A and B

A

A: Factor 8 defc (lots spent muts)
B: Factor 9 defc (aka Christmas disease)

Both X-linked recessive

64
Q

Outline the management of haemophilia

A

Avoid NSAIDs / IMs

Minor bleed: compression / elevation / desmopressin
Major (e.g. haemarthrosis): recombinant factor 8/9

65
Q

What will be see on coag studies in VWd?

A

Raised APTT

Platelets / INR normal

66
Q

How is VWd treated in mild/severe?

A

Mild: tranexamic acid
Severe: desmopressin/recomb VIII

67
Q

What is a possible ‘antidote’ for NOACs, used in a major bleed

A

Prothrombin complex concentrate (Octaplex)

68
Q

What pts must dose alteration of NOACs be considered?

A

CKD (NOACs renally excreted)

NB surgical pts NO BRIDGING ANTICOAG REQ

69
Q

List some causes for thrombophilia (3+1)

A

Inherited:
APC resistance (Factor V Leiden mutation)
Antithrombin III defc
Prothrombin gene mutation

Acquired:
APL syndrome

70
Q

List indications for screening for a thrombophilia (6)

A 
Arterial thrombosis <50
Venous thrombosis <40
Unusual thrombosis site (mesenteric, portal)
Familial VTE
Recurrent unexplained VTE
Recurrent miscarriages
71
Q

List some conditions that cause target cells seen on a blood film (5)

A 
Obstructive liver disease
Thalassaemia
Fe defc anaemia
Sickle 
Post-splenectomy
72
Q

What are the features of an acute haemolytic transfusion reaction (5)

How is it managed?

A 
Agitation
Abdo/chest pain
BP low
DIC Sx
Pyrexia

STOP transfusion
A–E
0.9% saline

73
Q

List the possible complications of blood transfusion (7)

A 
Haemolytic (immed/delayed)
Febrile reaction
Infection transmission
Hyperkalaemia 
Fe overload
ARDS
Coagulopathy

CP3 Medicine (7 decks)

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