Haematology Flashcards
1
Q
What are the main causes of lymphadenopathy?
A
- Infectious
- viruses: EBV, CMV, HIV, hepatitis, HSV, rubella
- bacteria
- fungi
- parasites - Malignant disorders
- primary haematological disorders: lymphoma, myeloid disorders
- solid tumour metastases - Disorders with immunological mechanism
- autoimmune disorders: SLE, RA, vasculitis
- sarcoidosis
2
Q
What are the main causes of splenomegaly?
A
- Haematological disorders:
- haemolysis
- thalassaemia major and intermedia
- sickle cell anaemia
- haemolytic anaemia - Malignancies
- lymphomas
- leukaemias
- myeloma
- metastases of solid tumours - Inflammation
- sarcoid
- serum sickness
- SLE, RA - Infection
- viral: hepatitis, EBV, CMV
- bacterial
- parasitic: malaria, schistosomiasis, toxoplasmosis
- infective endocarditis
- fungal - Congestive
- cirrhosis
- heart failure
- thrombosis of portal, hepatic or splenic veins - Non-malignant, infiltrative:
- Niemann-Pick disease
- amyloid
- glycogen storage disease
- Gaucher’s disease
- Haemophagocytic lymphohistiocytosis
3
Q
What are the three major types of anaemia and what are their causes?
A
- Microcytic hypochromic anaemia
- iron deficiency
- thalassaemia - Normocytic normochromic anaemia
- acute bleeding
- haemolysis
- marrow infiltration
- anaemic of chronic disease (esp. CKD) - Megaloblastic or macrocytic
- B12/folate deficiency
- alcoholism
- liver disease
- hypothyroidism
- myelodysplasia
4
Q
Where are the palpable lymph nodes?
A
- cervical
- supraclavicular
- axillary
- inguinal
5
Q
Where are the non-palpable lymph nodes?
A
- hilar
- mediastinal
- abdominal/retroperitoneal
- generalised lymphadenopathy
6
Q
What are the common causes of cervical lymphadenopathy?
A
- bacterial infection
- EBV, rubella, TB
- lymphoma (frequently unilateral)
- head-neck tumours (frequently unilateral)
7
Q
What are the common causes of axillary lymphadenopathy?
A
- bacterial infection
- lymphoma
- breast cancer
- melanoma
8
Q
What are the common causes of supraclavicular lymphadenopathy?
A
- lung, retroperitoneal or gastrointestinal tumours
- lymphoma
- chest or retroperitoneal bacterial or fungal infection
9
Q
What are the common causes of inguinal lymphadenopathy?
A
- bacterial infections of lower extremity, genitals or perianal regions
- pelvic tumours, lymphoma
- venereal diseases (lymphogranuloma venereum, syphilis)
10
Q
How is lymphoma broadly categorised?
A
Divided broadly into:
- Hodgkin’s lymphoma
- Non-Hodgkin’s lymphoma
- indolent lymphoma (follicular lymphoma, CLL/SLL, MCL, MZL)
- aggressive lymphoma (diffuse large B cell lymphoma)
- very aggressive lymphoma (Burkitt’s lymphoma and Acute Lymphoblastic Lymphoma)
11
Q
What are the principles of treatment for lymphomas?
A
- Low grade lymphoma
- not curable
- only treat if there is indication to treat
- exception: need to treat MCL, follicular lymphoma may be curable with radiotherapy - High grade lymphoma
- curable
- always treat DLBCL - Burkitt’s or ALL:
- very curable
- MUST treat, otherwise fatal
12
Q
What methods are used to diagnose lymphoma?
A
- Histology
- look at tissue biopsy down a microscope (FNA is not diagnostic)
- architecture
- morphology (small cells = low grade; large cells = high grade) - Flow cytometry or immunohistochemistry
- look for cell surface markers - Cytogenetics
- particular genes are either diagnostic or prognostic for lymphoma
- detects deletions, translocations, etc. - Molecular PCR
13
Q
What symptoms might you find on history and examination of a patient with lymphoma?
A
- Symptoms of proliferation:
- B symptoms: weight loss, drenching night sweats, recurrent fever - Symptoms related to organ damage or mechanical obstruction
- specific organ damage
- large lymph nodes - Symptoms associated with bone marrow failure
- anaemia: tiredness, postural hypotension, SOB, pale sclera, tachycardia
- recurrent infections
- bleeding, bruising
14
Q
What are the two categories of multiple myeloma?
A
- Smouldering MM
- criteria for MM has been met (para-protein >30grams/L or bone marrow plasma cells >10%) but the disease is quiescent
- defined by lack of end organ damage
- no evidence that treatment will prolong survival
- treat small group: MM with positive biomarkers - Active MM
- defined by end organ damage: CRAB
- C: hypercalcaemia due to cytokines causing bone resorption
- R: renal damage due to hypercalcaemia and light chain toxicity
- A: anaemia due to bone marrow invasion
- B: bone pain due to cytokines causing bone resorption
15
Q
What proportion of smouldering MM patients are treated?
A
MM with positive biomarkers are treated.
- defined as myeloma with MRI lesions
- do not have active disease but benefit from treatment
- if patient is found to have smouldering MM, need to consider MRI scan for detection of positive biomarkers
