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Paddy Phase 2 Qs > Haematology > Flashcards

Haematology Flashcards

1
Q

What age does myeloma usually present?

A

Average age is 60

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2
Q

Which infection is associated with primary gastric lymphoma?

A

Helicobacter Pylori Infection

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3
Q

What are the risk factors for leukaemia?

A 
Radiation
Benzene 
Smoking
Prior Blood disorders
Certain Genetic Disorders such as Down's Syndrome
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4
Q

How does bone destruction present in Multiple Myeloma?

A

Bone pain - back ache is most common, osteolytic lesions, pathological fractures, spinal cord compression and hypercalcaemia. “Pepperpot skull”

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5
Q

How does thrombocytopenia present?

A

Bruising, Bleeding - mucosal usually, rash (due to low platelet count)

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6
Q

Which leukaemia is more common in children andwhich is more common in adults?

A

Acute Lymphoblastic Leukaemia is more common in children. Think ALL my children.

Acute Myeloid Leukaemia is more common in middle aged and elderly.

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7
Q

What happens to the blood cells in myeloma?

A

Rouleaux: Blood cells stick together with too much protein

Normocytic Anaemia

High ESR

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8
Q

How is pernicious anaemia treated?

A

Intramuscular hydroxocobalamin (Vitamin B12)

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9
Q

What can occur if a sickle cell crisis is not managed?

A

Stroke could occur

Acute Chest Syndrome: Hypoxia, Sickles, Lung Infarction Cycle

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10
Q

What is the treatment for chronic myeloid leukaemia?

A

Imatinib, a tyrosine kinase inhibitor

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11
Q

Which drugs are used for treatment of myeloma?

A

Dexamethasone for infections
Bisphosphonates slow down progression of disease (inhibit osteoclastic activity)
Disease treated with an alkylator, steroid and novel agent

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12
Q

What are some of the differential diagnosis of neck lump?

A

Infective: Cat scratch Disease, Glandular Fever, TB, Viral Disease, Underlying Neck structure, embryology remnant

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13
Q

Which features are common in both Acute Myeloid Leukaemia and Acute Lymphoblastic Leukaemia?

A

Anaemia, Neutropenia & Thrombocytopenia

ANT

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14
Q

How Is Thalassaemia Treated?

A

Alpha is not compatible with life

Beta requires lifelong transfusions

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15
Q

What is the name of the protein that can be found in the urine of individuals suffering with multiple myeloma and what does it contain?

A

Bence Jones Protein (can be kappa or lambda) and contains light chains

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16
Q

What is a lymphoma?

A

A Malignant Growth of White Blood Cells, Predominantly in lymph nodes. Can also be in blood, bone marrow, liver, spleen etc

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17
Q

What is Haemophilia B (Christmas Disease) ?

A

Coagulation Deficiency of factor IX - X linked recessive

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18
Q

How is Multiple Myeloma diagnosed?

A

Two out of the three diagnostic features should be present:
- Paraproteinaemia on serum protein immunofixation or Bence Jones protein in the urine

  • Radiological evidence (CT, MRI) of lytic bone lesions
  • An increase in bone marrow plasma cells on bone marrow aspirate or trephine biopsy.
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19
Q

How Does anaemia present?

A

Shortness of Breath, Fatigue

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20
Q

In Hodgkin’s Lymphoma which markers may be seen in the blood?

A

ESR usually raised
Serum lactate dehydrogenase (LDH) is raised
May be slightly anaemic

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21
Q

How do you manage febrile neutropenia?

A

1) See Patient
2) Put in a cannula
3) Give antibiotics

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22
Q

How do you manage a sickle cell crisis?

A

1) See the patient
2) Control the pain
3) Put in a cannula and start fluids

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23
Q

What are the three main symptoms of lymphoma?

A

Lump on neck, Fatigue, Sweats

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24
Q

What can cause Iron deficiency?

A

Blood Loss
Increased Demands such as growth and pregnancy
Decreased Absorption (e.g. small bowel disease or post gasterectomy)
Poor Intake

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25
Q

How is advanced Hodgkin’s Lymphoma treated?

A

Cyclical Combination Chemotherapy - 8 cycles of ABVD

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26
Q

What is polycythaemia?

A

Increase in Hb, PCV (packed cell volume) and RCC (Red cell count)

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27
Q

Which investigations should be performed when suspcious of Multiple Myeloma?

A

Blood Count (may show anaemia, thrombocytopenia and leucopenia) - ESR will be high

Serum Biochemistry may show evidence of renal failure and hypercalcaemia.

Serum ß-2 microglobulin and albumin are used in prognosis

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28
Q

What is pernicious anaemia?

A

An autoimmune condition in which there is atrophic gastritis with loss of parietal cells, hence failure of intrinsic factor production - thus Vit B12 malabsorption

29
Q

Which Lymphoma has better survival rates?

A

Hodgkins Lymphoma - 80% curable

30
Q

What are some of the supportive treatments of Leukaemia?

A

Correction of Anaemia, Thrombocytopenia & Coagulation abnormalities by administration of blood, platelets and blood products

Treatment of Infection with IV Antibiotics
Prevention of the acute tumour lysis syndrome

31
Q

What do you do when you suspect spinal cord compression?

A

1) Keep Patient in Bed
2) Steroids: Dexamethasone
3) Urgent MRI

32
Q

What is hyperviscosity syndrome?

A

Malignant plasma cells churn out a lot of Ig. This protein increases the thickness of blood.

33
Q

What are the symptoms of hyperviscosity syndrome?

A

Headaches, Neurological Symptoms, Blurred Vision, Fatigue, Mucosal Bleeding, Confusion or altered mental state, Shortness of Breath

34
Q

Which leukaemia is characterized by the presence of the philadelphia chromosome?

A

Chronic Myeloid Leukaemia

35
Q

Which chromosome abnormality is associated with leukaemia?

A

The Philadelphia chromosome - found in 97% of cases with chronic myeloid leukaemia.

36
Q

What are the four types of leukaemia?

A

Acute Myeloid Leukaemia, Acute Lymphoblastic Leukaemia, Chronic Myeloid Leukaemia and Chronic Lymphocytic Leukaemia

37
Q

How are Hodgkins and Non-Hodgkins lymphoma differentiated?

A

In Hodgkins lymphoma, histology will show Reed Sternberg Cells (binucleate or multinucleate malignant B lymphocytes)

38
Q

How does end organ damage present in Myeloma?

A 
CRAB
Calcium (High)
Renal Failure
Anaemia
Bone Disease
39
Q

What causes AKI in Multiple Myeloma?

A

Deposition of Light Chains in tubules, hypercalcaumia, hyperuricaemia and amyloid deposition in the kidneys

40
Q

What are the systemic ‘B’ symptoms associated with lymphoma?

A

Fever, Drenching Night Sweats and Weight Loss (more than 10% in 6 months)

41
Q

What is tumour lysis syndrome?

A

Chemo kills cancer cells which release intracellular components as they die, kidney can be overwhelmed by this and crystallisation and renal failure can occur.

42
Q

How is leukaemia diagnosed?

A

Finding more than 20% blasts on bone marrow examination

43
Q

What are some of the causes of microcytic anaemia?

A

Iron deficiency
Anaemia of Chronic Disease
Thalassaemia

44
Q

How is a diagnosis made in acute leukaemia?

A

Blood film & bone marrow aspirate:
Blood count shows anaemia and thrombocytopenia - white cell count usually raised

Blood film shows characteristic leukaemic blast cells

Bone marrow aspirate shows increased cellularity, with high % of abnormal lymphoid or myeloid blast cells.

45
Q

What does Rituximab do?

A

Monoclonal Antibody treatment. Targets CD-20 Cells expressed on cell surface of B Cells - delivered via radiotherapy.

46
Q

How is Hodgkins lymphoma staged Ann Arbour Staging?

A

I - Involvement of single lymph node region
II - Involvement of 2 or more lymph node regions on same side of the diaphragm
III - Involvement of lymph node regions on both sides of diaphragm
IV - Diffuse or disseminated involvement of one or more extralymphatic organs or tissues

47
Q

What are some of the clinical features of anaemia?

A 
Fatigue
Faintness
Breathlessness
Skin & Mucous membranes pale
Tachycardia
Systolic Flow Murmur
48
Q

Name and give a brief outline of the three main types of haematological malignancy.

A

Myeloma - malignancy of plasma cells of bone marrow
Lymphoma - B and T cell malignancies ( Hodgkin and non Hodgkins )
Leukaemia - malignant neoplasms of the haemopoietic stem cells

49
Q

Which cells are malignant in Myeloma?

A

Plasma Cells

50
Q

What are some of the causes of normocytic anaemia?

A 
Acute Blood Loss
Anaemia of Chronic disease
Combined Deficiency (Iron & Folate for example)
Marrow Infiltration or fibrosis
Endocrine Disease
Haemolytic anaemias
51
Q

How does Neutropenic Sepsis Present?

A

Fever, Rigors, General MAlaise, Low Blood Pressure, sometimes cardiovascular collapse (suspect particularly if chemotherapy in last 3 months & temperature)

52
Q

What are some of the causes of macrocytic anaemias?

A 
Vitamin B12 deficiency
Folate deficiency
Normoblastic 
Alcohol
Increased Reticulocytes (Haemorrhage, haemolysis)
Liver Disease
Hypothyroidism
Drug Therapy
53
Q

How does Spinal Cord Compression present?

A

Back pain, Neuropathic pain, leg weakness or numbness, saddle anaesthesia, loss of sphincter control, urinary retention, decreased anal tone, residual bladder volume more than 200ml

54
Q

Which lymphoma is found most often in African children?

A

Burkitt’s Lymphoma

55
Q

What are the 3 main clinical features of Multiple Myeloma?

A

Bone Destruction

Bone Marrow Infiltration with plasma cells

Acute Kidney Injury

56
Q

Which blood test measures the size of red blood cells?

A

MCV - Mean Corpuscular Volume

57
Q

Which infection is thought to play a role in pathogenesis of Hodkins Lymphoma?

A

Epstein-Barr Virus (EBV)

58
Q

What is Von Willebrands Disease?

A

Von willebrands Factor contributes to platelet adhesion to damaged subendothelium and stabilisation of factor VIII in plasma. Deficiency of vWF leads to defetive platelet function and factor VIII deficiency.

59
Q

How does bone marrow infiltration with plasma cella present in multiple myeloma?

A

Anaemia, Infections & Bleeding

60
Q

Which antibodies/immunoglobulins are most associated with multiple myeloma?

A

IgG and IgA

61
Q

Which chromosomes are translocated in Philadelphia chromosome?

A

9 and 22.

62
Q

What is thalassaemia?

A

Globin chain disorder resulting in diminished synthesis of one or more globin chains, reduction in haemoglobin

63
Q

How is myeloma managed? What is the survival rate?

A

Palliative Care, Chemotherapy and Autologous Stem Cell Transplantation - median survival is 5 years. Incurable disease

64
Q

How is Thalassaemia Intermedia treated?

A

Still need blood transfusions but not as often. Also when too much iron is deposited in organs, chelation is required.
Endocrine Supplementation also required

65
Q

What will be seen in blood of someone with tumour lysis syndrome?

A

Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia
Hyperuricaemia

66
Q

How is early stage Hodgkin’s Lymphoma treated?

A 
ABVD - Brief Chemotherapy followed by involved field irradiation
Adriamycin
Bleomycin
Vinblastine
Dacarbazine
67
Q

What are the haematological emergencies?

A 
Febrile Neutropenia (Sepsis)
Spinal Cord Compression
Tumour Lysis Syndrome
Sickle Cell Chest Crisis
Hyperviscosity Syndrome
Hypercalcaemia
68
Q

What happens to immunoglobulins in myeloma?

A

It stars in bone marrow, only one Immunoglobulin gets copied and there is no differentiation. Light chains are produced.

Paddy Phase 2 Qs (15 decks)

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