Haematology Flashcards
What is the pathophysiology of myeloma
Cloned malignant plasma cells all produce the same immunoglobulin in large quantities. Leading to secretion of immunoglobulins
What are histological features of a malignant plasma cell
Prominent ER, centrally placed nucleus and hof
What are plasmocytomas
Cancers of the plasma, can be within or outside the bone marrow
What is waldenstroms macroglobulinaemia
IgM related plasma dysfunction
What are the presentations of myeloma
CRAB hypercalceamia, Renal disease, anaemia, bone disease
What causes anaemia in myeloma
Plasma cells infiltrating the bone marrow and also excessive WBC reducing the blood volume or RBC
What is rouleaux
Stacks of erythrocytes on blood film, caused by high protein. Seen in myeloma
What is the most common cause of death in myeloma
Infection due to monoclonal Ig causing immune surpression
What causes renal disease in myeloma
Light chain deposition, high calcium, dehydration and NSAIDS
What is amyloidosis
Extracellular deposition of fibrillar protein, leads to abnormal clinical signs. Can be due to light chain deposition.
When should you suspect myeloma
Rouelaux, back pain, high ESR, high calcium and unexplained anaemia
What should you do if you suspect myeloma
Check immunoglobulins in serum and urine
What can cause lumps in the neck
Malignancy or reactive lymph nodes due to infection or inflammation
What can cause primary immunodeficiency
Ataxia telangiectasia or Wiscott-Aldrich syndrome
What can cause secodnary immunodeficiency
HIV, transplant recipients
Which infections can cause lymphoma
EBV, HTLI-1 and helicobacter pylori
What causes nodal disease in lymphoma
Accumulation of cancerous WBC
Name 3 systemic B symptoms in Lymphoma
Loss of apetite, weight loss, drenching night sweats
What causes drenching night sweats in lymphoma
Cyotkines from WBC
What is classified as weight loss
Unintentional loss of 10% in 6 months
What is WHO performance score 0
Asymptomatic, no restriction
What is WHO performance score 1
Symptomatic but completely ambulatory, restricted strenuous activity but can carry out light work
What is WHO performance score 2
Symptomatic, less than 50% in bed (waking hours). No work but self care
What is WHO performance score 3
Symptomatic, more than 50% in bed, not bed bound. Limited self care
What is WHO performance score 4
Bedbound, no self care, limited to bed or chair
What is WHO performance score 5
Death
Name a low grade NHL
Follicular lymphoma
Name a high grade NHL
Diffuse Large B cell lymphoma
Name a very high grade NHL
Burkitt’s lymphoma
What is the treatment of stage 1-2A hodgkins lymphoma
Short course combination chemotherapy followed by radiotherapy
What is the treatment of stage 2B-4 hodgkins lymphoma
Combination chemotherapy
Which chemotherapy causes cardiomyopathy
Anthracyclines
Which chemotherapy causes lung damage
Bleomycin
Which chemotherapy causes peripheral neuropathy
Vinca alkaloids
Name a monoclonal antibody used for NHL treatment
Rituximab, targets CD-20 on B cells. it is a chimeric antibody with few side effects. CD20 is unique to B cells
Name a radioimmunotherapy used for NHL treatment
Zevalin
Name a T cell engaging therapy used for NHL treatment
Blinatunomab, bi specific anitbody which targets CD19 on B cells and CD3 on T cells, directing the immune system
What is red marrow
Where platelets, rbc and wbc are made
What is white marrow
Fat, you get more as you age
Which cells are affected in acute leukaemia
Immature
Which cells are affected in chronic leukaemia
Mature
Which cells are affected in chronic myeloid leukaemia
Basophil, Neutrophil and eosinophil
Which cells are affected in chronic lymphatic leukaemia
B lymphocytes
Which cells are affected in chronic lymphoblastic leukaemia
Lymphoblast
Which cells are affected in chronic myeloid leukaemia
Myeloblast
Name a congenital risk factor for leukaemia
Down’s syndrome
Name environmental risk factors for leukaemia
Radiotherapy, chemotherapy and benzene and other chemicals
What are signs of anaemia in leukaemia
Shortness of breath, fatigue, may not be pronounced in the young
What are the signs of thrombocytopenia in leukaemia
Bruising, bleeding (usually mucosal) and rash
What are the signs of infection in leukaemia
Fever and rigors
What type of rash does thrombocytopenia cause
Pin prick, pink rash which does not go away on touch - purpura, petechiae
What is a sign of lyphoma/ lymphoblastic leukaemia
Night sweats
What do blasts look like
very little cytoplasm and indistinct nucleioli
Which specialist investigations are used in leukaemia
Flow cytometry, cytogenetic analysis and bone marrow biopsy
Who gets acute lymphoblastic leukaemia
Young children, median age 3.5 (also 16-24 and old age but rare)
Who gets acute myeloid leukaemia
Older adults, peak age 70 (much rarer in children)
What is supportive leukaemia treatment
Blood products, symptom relief and reduce the chance of infection
What is a hickman line
Allows direct blood access, goes straight into the right atrium
How does aspergillos behave
It is a fungus which is angioinvasive and targets vessles
What causes acute relative polycythaemia
Dehydration
What causes chronic relative polycythaemia
Obesity, HTN, high alcohol and tobacco intake
What is polycythaemia
an increase in the haematocrit of the blood
What is polycythaemia vera
disease in which there are more RBC and also more WBC and platelets, it is treated with blood letting. Symptoms include head aches, thromboses, plethora, itching and cyanosis
What disease is caused by excessive proliferation of haematoipoietic myeloid stem cells into RBC
Polycythaemia vera
What disease is caused by excessive proliferation of haematopoietic myeloid stem cells into RBC
Chronic myeloid leukaemia
What disease is caused by excessive proliferation of haematopoietic myeloid stem cells into platelets
Essential thrombocytopenia
What disease is caused by excessive proliferation of haematopoietic stem cells into fibroplasts
Myelofibrosis
Which mutation is associated with polycythaemia vera
JAK2
What is venesection
Blood letting
How is polycythaemia treated in high risk/older people
Hydroxycarbamide
How is polycythaemia treated in pregnant women
Alpha interferon
How is polycythaemia normally treated
Venesection
Which chains are present in adult haemoglobin
2 alpha, 2 beta
Which chains are present in foetal haemoglobin
2 alpha, 2 gamma
When does foetal haemoglobin switch to adult haemoglobin and what is the effect
At 6 months, reducing the oxygen affinity
What causes sickle cell structure
valine to glutamine point mutation (A to T) in 6th codon in beta globin gene causes the formation of haemoglobin S
What inheritance pattern do sickle cell and thallasaemia show
Autosomal recessive
What is priapism
persistent and painful erection of the penis
How does sickle cell disease effect RBC
Causes polymerisation of haemoglobin molecules this precipitates out, damages red blood cells and renders them useless
How do the causes of alpha and beta thalassaemia differ
Alpha mainly caused by mutatations, beta caused by deletions
Define thalassaemia
Globin chain disorders resulting in diminished synthesis in one or more globin chains with subsequent reduction in the haemoglobin
What are the different types of thalassaemia
Major - transfusion dependent, Intermedia - less severe, can survive without transfusions, Carrier/Heterozygote - asymptomatic
Which type of anaemia does thalassaemia cause
microcytic
What would be the blood results for someone with Beta thallasaemia
Hb, MCV and MCH very low
What does MCV stand for
Mean corpuscular volume
What does MCH stand for
Mean corpuscular haemoglobin
What is a consequence of transfusion
High Iron, this can lead to deposition in organs causing renal, cardiac and pituitary failure
What is the result of 4 alpha thalassaemia genes
Hydrops foetalis - not compatible with life (Barts hydrops)
What happens with increasing numbers of faulty alpha thalassaemia genes
Increasing severity, 1 is normal or minimal changes, 2 more marked and 3 moderately severe
Where is alpha thalassaemia found
Eastern meditteranean or the far east
Name disease modifying treatment in sickle cell disease
Transfusion, stem cell transplant, hydroxycarbamide
What are membranopathies
Deficiencies of red cell membrane proteins caused by a variety of autosomal dominant genetic lesions
Name two membranopathies
Spherocytosis and elliptocytosis (shape changes)
What is a spherocyte
Horizontal membranopathy
What is an eliptocyte
Vertical membranopathy
Which RBC membrane protein is commonly missing in membranopathies
Spectrin
What causes slapped cheek syndrome
Parovirus and haemolytic anaemia. Reduced RBC production and there is already reduced lifespan so leads to has large effect. Occurs in children and in epidemics.