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Obs & Gyny - Risk Factors > Haematology > Flashcards

Haematology Flashcards

1
Q

AML translocation

A

8:21

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2
Q

AML Epidemiology

A

Older people (mean age 70)

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3
Q

AML histology

A

1) 20% blasts in marrow
2) Large myeloblasts
3) Auer Rods - crystallised myeloperoxidase

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4
Q

AML presenting

A
  • Pallor
  • Fatigue
  • Gingivitis
  • Splenomegaly
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5
Q

AML Investigations

A

Bone Marrow aspiration and trephination

FBC
Clotting Screen 
Blood film
CXR, ultrasound
ECG 
Echo
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6
Q

AML Management

A

Inpatient chemotherapy

Stem cell transplant

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7
Q

CML translocation

A

Philadelphia chromosome (9;22)

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8
Q

CML epidemiology

A

Older people 60-65

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9
Q

CML presentation

A
  • Incidental finding
  • Splenomegaly, bruising
  • B symptoms (fever, night sweats, weight loss)
  • Abdominal fullness
  • Gout
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10
Q

CML investigations

A
  • FBC
  • Peripheral blood smear
  • U&Es
  • Aspiration and trephination -> Flow cytometry, cytogenetics (Philadelphia), molecular (PCR studies)
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11
Q

CML management

A

1) Tyrosine kinase inhibitors

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12
Q

ALL epidemiology

A

Children & 40+

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13
Q

ALL risk factors

A

Down’s syndrome
EBV
Genetic

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14
Q

ALL translocation

A

Philadelphia poor prognosis

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15
Q

ALL presenting

A
  • Fatigue, dizziness, palpitations
  • Severe & unusual bone pain
  • Fever
  • Dyspnoea (mass symptoms if large thymic mass)
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16
Q

ALL investigations

A
  • FBC
  • Peripheral blood smear
  • U&Es
  • CLOTTING
  • Aspiration and trephination -> Flow cytometry, cytogenetics (Philadelphia), molecular (PCR studies)

Imaging

  • CXR (mediastinal mass)
  • Echocardiogram
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17
Q

Goals of chemotherapy in ALL

A

To eliminate more than 99% of the initial burden of leukaemic cells.
To restore rapidly normal haematopoiesis.
To restore previous performance status.

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18
Q

Special management after remission in ALL

A

CNS prophylaxis - intrathecal chemotherapy

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19
Q

CLL presentation

A

Often incidental

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20
Q

CLL epidemiology

A

Older people

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21
Q

CLL management

A

Watch and wait

Chemo

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22
Q

CLL special progression

A

5% transform into DBCL - all lymph nodes should be checked at examination

23
Q

CML monitorings (CML!!)

A

Monitor cytogenetic response throughout

treatment – FISH looking at % of PH+ cells

24
Q

CLL histology

A

Smudge cells

25
Q

When to treat CLL

A
  • doubling of lymphocyte count in 6 months
  • marrow failure
  • recurrent infections
  • massive or progressive splenomegaly
  • systemic symptoms
  • immune mediated cytopenias
26
Q

CML additional treatment (CML!!)

A

Stem cell transplant

  • graft versus host
  • veno-occlusive disease
27
Q

CLL management

A

Chemotherapy if active disease

Stem cell transplant

28
Q

Causes of massive (>8cm) splenomegaly in all people

A

CML
Malaria
Lymphatic filiriasis
Cirrhosis

29
Q

Causes of massive splenomegaly in young people

A
  • Glandular fever
  • Haemolytic disease -thallasaemias
  • ALL
30
Q

What considerations need before starting hydroxycarbamide

A

hepatic and renal function

fertility and contraception

31
Q

How to measure CML remission

A

Haematologic remission (normal FBC count, physical examination, ie no organomegaly).

Cytogenetic remission (normal chromosome returns with 0% Ph-positive cells).

Molecular remission (negative PCR result for the mutational BCR-ABL m-RNA).

32
Q

Three phases of CMLA

A

Chronic
Accelerated
Blast phase

33
Q

What to do if treatment with imatinib but no cytogenetic remission?

A

Different TKI

34
Q

How to investigate anaemia

A

FBC
B12, folate, ferritin
Coagulation screen

35
Q

What medication to give in AML before definitive treatment

A

hydration, allopurinol
blood transfusion
aciclovir & anti-fungal
hydroxycarbamide

36
Q

AML prognosis (3)

A

age, cell type and the burden of the diseas

37
Q

AML remission in younger patients (young adult & child)

A

In younger patients, complete remission rates of at least 80% may be reached, with five-year overall survival about 40%.

38
Q

Myeloma presentaiton

A

Calcium metabolism
Renal problems
Anaemia
Bone pain

39
Q

Myeloma investigations

A 
Myeloma screen
- serum PROTEIN electrophoresis
- serum free light chain 
Urine microscopy
- Bence jones protein
40
Q

Myeloma disease response measurement

A

Paraproteins

41
Q

Multiple myeloma vs asymptomatic myeloma vs MGUS

A 
MM
- >10% bone marrow plasma cells
- >30g/l monoclonal protein 
-> CRAB symptoms 
Asymptomatic
-> as above but no CRAB symptoms
MGUS 
-> <10% bone marrow plasma cells
-> <30g/l monoclonal protein 
-> No CRAB
42
Q

Management MM

A

Young - autologous bone marrow transplant

Elderly - melphalan and steroids

43
Q

Hodgkin’s lymphoma key bits

A
  • Lymphadenopathy
  • Pain with alcohol
  • Mediastinal mass
  • B symptoms Fever, night sweats, weight loss
  • Anne Arbor staging
  • younger patients
44
Q

Key considerations in management of young HL

A

fertility

45
Q

What scan used in HL

A

PET scan

46
Q

Four types NHL

A

Low grade/indolent
- Follicular, MALT
High grade/agressive
- DBCL, Burkitt’s

47
Q

Polycythaemia rubra vera presentation

A
  • routine
  • fatigue, itchyness
  • thrombosis (stroke/DVT)
  • Budd chiari
48
Q

What is Budd chiari

A

Hepatic vein thrombosis resulting in RUQ pain, ascites,

49
Q

Three causes of secondary polycythaemai

A

COPD
EPO use
Eisenmenger syndrome

50
Q

Mutation associated with PCRV

A

JAK2

51
Q

Other myelodysplastic syndrome

A

Essential thrombocythaemia

Myelofibrosis

52
Q

How to manage PCRV

A

Aspirin
Phlebotomy
Hydroxycarbamid

53
Q

Essential thrombocythaemia symptoms

A

Bleeding + thrombosis

54
Q

Essential thrombocythaemia management

A

Hydroxycarbamide

Obs & Gyny - Risk Factors (18 decks)

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