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Phase 2a Summaries > Haematology > Flashcards

Haematology Flashcards

1
Q

What are the 3 main causes of microcytic anaemia?

A
  1. Iron deficiency
  2. Thalassaemia
  3. Chronic disease
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2
Q

What are the 3 main causes of normocytic anaemia?

A
  1. Combined haemanitic deficiency (iron and B12)
  2. Anaemia of chronic disease
  3. Acute blood loss
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3
Q

What are the 3 main causes of macrocytic anaemia?

A
  1. B12/Folate Deficiency
  2. Hypothyroidism
  3. Alcohol excess/liver disease
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4
Q

Name 3 symptoms of anaemia?

A

Fatigue, breathlessness, reduced exercise tolerance, angina, claudification, palpitations

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5
Q

Name 3 signs of anaemia?

A

Pallor and conjunctival pallor, tachycardia, systolic flow murmur, kolionchyia, pale mucus membranes

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6
Q

How is anaemia classified?

A

By MCV - mean corpuscular volume (average RBC size)
Microcytic MCV <80
Normocytic MCV 80-100
Microcytic >100

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7
Q

Name 3 compensatory physiological changes of anaemia?

A

a) Increased tissue perfusion
b) Increase O2 transfer to tissues
c) Increased RBC production

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8
Q

Name 4 pathological consequences of anaemia?

A
  1. Myocardial fatty change
  2. Aggravate angina
  3. Skin and nail atrophic changes
  4. CNS cell death
  5. Fatty change in lober
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9
Q

What test is used to see how quickly RBC’s are being made in the bone marrow?

A

Reticulocyte count

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10
Q

What marker do you use to detect iron levels?

A

Serum ferritin - which is low

Transferrin would be high

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11
Q

What does anaemia with jaundice suggest?

A

Haemolysis

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12
Q

Give 4 signs of iron deficiency anaemia?

A

Brittle hair and nails, Kolionchyia, angular stomatis (mouth ulcers), atrophic glottitis (painful tongue)

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13
Q

What does oncholysis (Detachment of nail from nail bed) suggest?

A

Hypothyroidism or psoraisis

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14
Q

Name 4 causes of iron deficiency anaemia?

A

Hookworm, GI bleeding, Manorrhagia, poor diet, malabsorption (coeliac), increased demand eg pregnancy

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15
Q

When may serum ferritin results be unreliable?

A

Also an acute phase protein and increases with inflammation eg infection

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16
Q

How is iron deficiency anaemia treated and give a side effect of this?

A

Oran iron- ferrous sulphate

Constipation

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17
Q

Name 3 diseases which cause anaemia of chronic disease?

A

Vasculitis, rheumatoid, renal failure, TB, SLE

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18
Q

Name 5 respiratory diseases that cause clubbing ?

A 
Bronchial cancer (usually not small cell) 
Bronchiectasis
Fibrosing alveoli's 
Mesothelioma 
TB
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19
Q

Name 4 GI causes that cause clubbing?

A

IBD
Cirrhosis
GI Lymphoma
Malabsorption

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20
Q

Name 3 cardiovascular causes of clubbing?

A

Cyanotic congenital heart disease
Endocarditis
Aneurisims
Infected grafts

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21
Q

What would a) high and b) low reticulocyte count suggest?

A

a) Blood loss or haemolytic anaemia

b) Production problem eg iron deficiency anaemia

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22
Q

Name 3 side effects of ferrous sulphate tablets?

A

Constipation, diarrhoea, epigastric pain, GI irritation, nausea

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23
Q

What is pernicious anaemia?

A

Macrocytic anaemia , autoimmune destruction of parietal cells leads to loss of intrinsic factor production leads to B12 malabsorption, B12 needed to make RBC

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24
Q

Other than pernicious anaemia name 3 other causes of B12 deficiency?

A

Chrons, Coeliac, gastritis

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25
Q

What is the pathophysiology behind thalassaemia?

A

Autosomal recessive condition, leads to defective synthesis of globin chains –> decreased Hb production –> premature RBC destruction

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26
Q

What is the outcome for a patient with 4 deletions in alpha thalassaemia?

A

Hydrops foetalis - stillborn - cannot carry oxygen

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27
Q

What is the outcome for a patient with 3 deletions in alpha thalassaemia?

A

Severe anaemia

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28
Q

What is the presentation in a patient with B-thalassameia intermedia?

A

Moderate anaemia - splenomegaly and bone abnormalities

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29
Q

What is the presentation in a patient with B-thalassameia major?

A

Presents in 1st year of live- severe anaemia - failure to thrive and chronic infections

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30
Q

How do you treat beta thalassaemia?

A

Blood transfusions, iron chelation (desferrioxamine) , ascorbic acids

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31
Q

In sickle cell disease there is a mutation of thiamine for adenine in 6th codon of beta gene, what amino acid change does this cause?

A

Glutamine for Valine

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32
Q

What is the sickle cell trait protective against?

A

Malaria and G6PD

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33
Q

What is sickle cell crisis precipitated by?

A

Dehydration, cold weather, infection, hypoxia, acidosis

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34
Q

How is acute chest syndrome in sickle cell caused?

A

Caused by infection/fat emboli from necrotic bone leading to pulmonary infarction

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35
Q

What is the presentation of sickle cell crisis?

A

Children acute pain in hands and feet
Adults bone pain in ribs and spine
Pain accompanied by fever

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36
Q

What is the presentation of acute chest syndrome in sickle cell crisis?

A

SOB, chest pain, hypoxia and new changes on CXR

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37
Q

Name the investigations for sickle cell disease?

A

FBC- Decreased Hb and increased reticulocyte
Blood film = sickled erythrocytes
Hb electrophoresis is diagnostic
Neonate heel prick test

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38
Q

What is the most reliable indicator to detect polycythaemia?

A

Packed cell volume PCV - also known as haematocrit

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39
Q

Name a primary cause of polycythamia?

A

Polycythaemia rubra vera (PRV)

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40
Q

Name 3 secondary causes of polycythaemia?

A

EPO excess (tumour secretion of EPO) , altitude, lung disease eg chronic hypoxia (CPOD), smoking, abnormal RBC structure

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41
Q

Name 4 signs of Polycythaemia rubra vera (PRV)?

A 
Plethroric appearance (red face) 
Hyperviscosity 
Thrombosis - DVT 
Splenomegaly 
Gout from increased RBC turnover
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42
Q

What genetic mutation do patient with Polycythaemia rubra vera (PRV) have ?

A

JAK2 mutation

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43
Q

What is the treatment for Polycythaemia rubra vera (PRV)?

A

Aspirin- prevent complications
Venesection
Bone Marrow suppression (hyrdoxycarbamide)
Alpha interferon for women in child bearing age

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44
Q

Name 3 signs of PE?

A

Tacycardia, tacynpnoea, localised pleural rub, raised JVP, hypotension, pleural effusion

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45
Q

What would you see on ECG of patient with PE?

A

T wave inversion, S wave lead1, Q wave lead 1 and inverted T wave lead 3 is classic but not often seen

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46
Q

What is the GOLD standard diagnosis of DVT?

A

Ultrasound compression test

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47
Q

Name the infection stages of malaria?

A

Sporoziote , merozoite (in liver-reproduce asexually) , Hypnoziote (P.ovale and P. vivax) , Trophozoites - inside RBC

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48
Q

Name 4 symptoms of malaria?

A

Fever, chills and sweats, anaemia, jaundice, myalgia, fatigue

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49
Q

Name 2 ways you would diagnose malaria?

A

Blood test - thick film and thin films

Lateral flow assay - rapid diagnostic test

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50
Q

Name 2 treatment methods for falciparum malaria?

A

IV artenusate, IV quinine

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51
Q

What is the treatment for Non-falciparum malaria?

A

PO Chloroquine

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52
Q

What is febrile neutropenia and give 3 causes?

A

Abnormally low neutrophil count <1.0

Chemotherapy, bone marrow problem, B12/folate deficiency

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53
Q

Name 3 circumstances when to suspect neutropenic sepsis (febrile neutropenia)?

A
  1. Anyone had chemo in last 3 months
  2. Patient presents with isolated hypotension
  3. Patient presents with fever, chills and rigors
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54
Q

What is the management of a patient with febrile neutropenia?

A

Take blood cultures
Broad spectrum IV antibiotics as per local guideline eg
Taxocin and gentamicin

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55
Q

What is the name of a mutation that leads to a 1% chance of transforming to myeloma?

A

MGUS

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56
Q

In Myeloma presentation, what does OLD CRABB stand for?

A 
Old - age 70 
Calcium levels elevated 
Renal failure - antibody light chain deposition (bence jones) 
Anaemia 
Bone lytic lesions 
Bacterial infections
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57
Q

Name 6 ways you can investigate myeloma?

A
  1. Rouleaux formation on blood film
  2. Bence jones protein (monoclonal protein in urine)
  3. X-Ray- pepper-pot skull
  4. FBC - Raised Ca
  5. Electrophoresis = IgG
  6. Bone marrow biopsy
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58
Q

Which blood cancer is an AIDS defining illness?

A

Lymphoma (Non-Hodgkin)

59
Q

What is the treatment for non-hodgkins lymphoma?

A

R-CHOP

Rituximab + combination chemo

60
Q

Why do you use Rituximab in CLL?

A

CLL = proliferation of B-lymphocytes which express CD20 on surface.
Rituximab is a CD20 Mab which can target B-cells

61
Q

Which type of lymphoma is extra -nodal involvement more common?

A

Non-Hodgkins

62
Q

What is the clinical presentation of Hodgkins lymphoma?

A

Painless lymphadenopathy (cervical) described as rubbery, disease in mediastinum = cough and B symptoms

63
Q

What are the 3, B (constitutional) symptoms?

A

Fever, night sweats and weight loss

64
Q

What are the 4 stages of the Ann Arbor classification?

A
  1. Confined to single lymph node
  2. Involvement of ≥2 nodal areas same side diaphram
  3. Involvement of nodes on both sides of diaphram
  4. Spread beyond the lymph nodes
    A or B symptoms
65
Q

If stage 2B-4 of ann-arbor classification what treatment would you offer?

A

Combination chemo- ABVD

66
Q

Which is the most common leukaemia?

A

Chronic lymphocytic

67
Q

What is the first line treatment method for chronic myeloid leukaemia?

A

Tyrosine Kinase inhibitors - Imatinib - philadelphia chromosome increases tyrosine kinase activity

68
Q

Which leukaemia is mostly asymptomatic?

A

Chronic lymphocytic

69
Q

Which leukaemias are associated with downs (trisomies)?

A

CLL and ALL

70
Q

What are the 4 characteristic features of ALL?

A
  1. Lymphadenopathy (only leukaemia that shows this)
  2. Hepatosplenomegaly
  3. CNS involvement
  4. Bone pain
71
Q

Which treatment method used in ALL and other aggressive cancers eg Burkitts lymphoma prevents tumour lysis syndrome?

A

Allupurinol

72
Q

What are the 2 characteristic presentations of AML?

A

Hepatosplenomegaly

Gum infiltration

73
Q

Which disease is preticipated by broad beans, drugs (aspirin) or illness?

A

Oxidative crisis causes by G6PD deficiency

Get bite and blister cells on blood

74
Q

What is hereditary spherocytosis?

A

Autosomal dominant condition where spherical RBC get trapped in spleen - diagnose with osmotic fragility test

75
Q

What are the clinical features of Immune thrombocytopenic purpura?

A

Easy bruising, epistaxis, pupura, menorrhagia

76
Q

Which 3 conditions cause increased destruction of platelets?

A

Non Immune = DIC and TTP

Immune = ITP

77
Q

Name 3 causes of disseminated intravascular coagulation?

A

Malignancy, septicaemia, infections, trauma, birth

(end game of serious illness), pancreatitis

78
Q

In Thrombotic Thrombocytopenic Purpura, there is a reduction in which protease enzyme?

A

ADAMTS13

79
Q

How manage you treat spinal cord compression?

A

MRI - Diagnostic

Dexamethasone

80
Q

What is pathophysiology of tumour lysis syndrome?

A

Chemotherapy causes release of intracellular comopenents eg urea, kidney becomes overwhelmed leads to tumour lysis syndrome

81
Q

What are the signs of tumour lysis syndrome?

A

1st -Hyperkalaemia - arrhythmia
2nd- Hyperphosphataemia, Hyperuricaemia, Hypocalcaemia - seizures
3. AKI

82
Q

Name 3 treatment methods for tumour lysis syndrome?

A

Rasburicase (increase renal excretion of uric acid)
Vigirious IV fluids
Monitor and treat K+
Dialysis if needed

83
Q

What is hyper-viscosity syndrome?

A

Malignant plasma cells produce lots of immunoglobulins which increases thickness of blood

84
Q

What are the symptoms of hyper-viscosity syndrome?

A

Headaches, blurred vision, fatigue, shortness of breath, musical bleeding

85
Q

What are the signs of hyper-viscosity syndrome?

A

Papilloedema, peripheral oedema

86
Q

What is an example of autoimmune cause of anaemia?

A

Malaria

87
Q

What is an example of hereditary cause of anaemia?

A
  1. Glucose 6 phosphate deficiency
  2. Hereditary spherocyotisis
    3, Sickle cell and thalassaemia
88
Q

What is released in increased red blood cell breakdown?

A

Serum lactate deyhdrogenase

89
Q

What is a symptom of G6PD?

A

Rapidly anaemia and jaundiced

90
Q

Name 2 symptoms of polycythamemia?

A

Itchy skin- typically worse after bath
Easy bruising/bleeding
Due to hyper viscosity = dizziness/ headaches

91
Q

What are the risk factors for PE and DVT?

A

Age, pregnancy, trauma, surgery, obesity, immobility, thrombophillia, travel

92
Q

What is the definition of sensitivity?

A

Sensitivity is the ability of a test to correctly identify those with the disease

93
Q

What is the definition of specificity?

A

Specificity is the ability of the test to correctly identify those without the disease

94
Q

Give an example of a factor Xa Inhibitor?

A

Rivaroxiban

DOAC

95
Q

How do you reverse the effect of warfarin?

A

Give them vitamin K

96
Q

What does a Wells score of more than 2 indicate?

A

Likely DVT - Ultrasound scan and D-Dimer

97
Q

What is abcximab an example of ?

A

Glycoprotein IIb/IIIa receptor antagonist

98
Q

What is the pathophysiology of TTP?

A

Clears Von Willebrand factor

99
Q

When to transfuse in sickle cell anaemia ?

A
  1. Hb or reticulocyte fall
  2. Suspect CNS event
  3. Multi-organ failure
  4. Severe chest crisis
100
Q

Give a) 3 immediate side effects of chemo and b) 3 late side effects of chemo?

A

Immediate = Alopecia, neutropenia (infections), anaemia, thrombocytopenia

Late = nephrotoxicity, infertility, pulmonary fibrosis, cardiotoxicity, psychological

101
Q

Which blood cancer exhibits bimodal age distribution (20s and 60s)?

A

Hodgkins lymphoma

102
Q

What cytokine activates osteoclasts in multiple myeloma?

A

Il-6

103
Q

What is the GOLD standard investigation in multiple myeloma?

A

IgG electrophoresis

104
Q

Which blood cancer is associated with pain when drinking alcohol?

A

Hodgkins Lymphoma

105
Q

What are the causes of pancytopenia?

A
  1. Iatrogenic
  2. Infective - HIV, EBV
  3. Malignancy- myeloma, lymphoma
  4. Severe folate/B12 deficiency
106
Q

Name 5 haematological investigations you could do to diagnose leukamaemia?

A
  1. FBC - anaemia, neutropenia, thrombocytopenia
  2. Blood film
  3. Bone marrow biopsy - aspirate
  4. Cytogenetics or chromosomal abnormalities
  5. LP for CNS involvement in ALL
107
Q

Which leukaemia do you get Auer rods?

A

AML

108
Q

What is the presentation of CLL?

A

Enlarged non-tender lymph node + constitutional symptoms

50% asymptomatic

109
Q

What is myeloma a cancer of?

A

Malignancy proliferation of clonal plasma cells (fully-differentiated B-lymphocytes)

110
Q

Give 4 complications of myeloma?

A
  1. Hypercalcemia - rehydrate with surgery
  2. Spinal Cord compression - MRI, dexamethasone
  3. Hyperviscotiy - plasmapheresis
  4. AKI
111
Q

Name 3 risk factors/ causes of lymphoma?

A

Immunodeficient eg HIV or transplant recipient
Autoimmune disorders eg SLE
Infection eg EBV or H.pylori
Obesity

112
Q

Give 3 causes of folate deficiency?

A

Poor diet - poverty, alcoholics
Increased demand
Malabsorption eg coeliac and tropical sprue
Drugs eg methotrexate

113
Q

In which 3 conditions can blood results be misleading?

A

Dehydration
Acute major blood loss
Pregnancy

114
Q

What 5 components of the blood would you look at when diagnosing anaemia?

A

White cell and platelet count, blood film, reticulocyte count, haematinics

115
Q

What symptoms does B12 deficiency cause?

A

Lemon tinged skin, angular chelonia (sore mouth), dementia, peripheral neuropathy

116
Q

Which foods is a)folate found in and b) Vitamin B12?

A

a) Green vegetables, nuts, beans, beef, fruit and offal

b) Meat, fish, dairy products

117
Q

In haemolytic anaemia what would the reticulocyte count be?

A

Increase reticulocytes

118
Q

What are the symptoms of haemolytic anaemia?

A

Anaemia, jaundice, gallstones, liver and spleen enlargement and leg ulcers

119
Q

Name 4 components/complications of sickle cell crisis?

A

Acute chest
Dactylics
Strokes
Priapsim

120
Q

How do you diagnose acquired or hereditary haemolytic anaemia?

A

Coombs test

121
Q

Which 3 pathophysiological process stop bleeding?

A
  1. Vasoconstriction
  2. Platelets plug the gap
  3. Blood coagulates
122
Q

Give 4 treatment methods for Sickle cell disease?

A 
Hydroxycarmabide - reduces effect of sickling
Pneumococcal and influenza vaccine 
Penecillin as prophlaxis 
Analgesics for bone pain during crisis 
Transfusion
123
Q

What is haemophilia?

A

Effects factor 8, X-linked recessive condition causes haemotmas

124
Q

Give 3 causes of vitamin K deficiency?

A

Anticoagulants (warfarin K antagonist)
Biliary obstruction (no fat absorption)
Haemorrhoagic diseases
Liver disease (1972 made in liver)

125
Q

What is the non-medical primary prevention of DVT?

A

Early mobilisation
Compression stockings
Leg elevation

126
Q

Give an a) positive and b) negative of using DOAC eg rivaroxiban as oppose to warfarin ?

A

a) No wafarrin clinic with monitoring
b) Irreversible, there is no antidote
Eg too much warfarin give vitamin K

127
Q

Give 4 investigations you may do in a patient with Polycythamia?

A
  1. FBC = Raised PCV, haematocrit, HB and RBC
  2. Genetic - JAK2 testing
  3. Serum EPO (decrease)
  4. Red cell mass studies
128
Q

Give 5 supportive treatment methods for myeloma?

A
  1. Bisphosphonates
  2. Regular IV immunoglobulin infusions (infections)
  3. Blood transfusion and EPO
  4. Hydration and dialysis
  5. Chemo /radio
129
Q

What are the symptoms of spinal cord compression?

A

Back pain, loss of spinchter control (LUTS symptoms)

130
Q

What are the clinical signs of spinal cord compression?

A

Decreased power in legs, decrease reflexes (spastic), decreased sensation, saddle anaesthesia, bladder residual volume >200ml

131
Q

Name 3 causes of hyper viscosity syndrome?

A
  1. Increased Igs in myeloma
  2. Increased blood cells in hyper proliferative states eg PRV
  3. Reduced deformibil9ity of RBC - eg sickle cell
132
Q

Give 3 common presentations of hyper viscosity syndrome?

A
  1. Visual changes eg blurring
  2. Mucosal bleeding
  3. Neurological symptoms
133
Q

What is the initial management of hyper viscosity syndrome?

A

Cannula, fluids and plasmapheresis

134
Q

Give 3 precipitants of G6PD deficiency?

A

Broad beans, illness, drugs (primaquine, quinolines)

135
Q

Give 2 ways to diagnose G6PD deficiency?

A
  1. Blood film = Bite and blister cells

2. NADH secretion

136
Q

What is the most common cause of ITP and give an example of a treatment method?

A 
Viral infection (esp children) 
Treatment = Immunosuppression eg steroids or tranexamic acid
137
Q

What is the pathophsyiology of ITP?

A

IgG antibodies form to platelet and megakaryocyte surface glycoproteins

138
Q

What is the pathophysiology of DIC?

A

Cytokine release leads to systemic activation of clotting cascade causing microvascular thrombosis and organ failure but at the same time there is bleeding due to consumption of clotting factors

139
Q

What is the pathophysiology of TTP?

A

Spontaneous aggregation in microvasculature, failure to break down von willebrand factor

140
Q

How would you treat TTP?

A

Urgent plasma exchange and immunosuppression

141
Q

When would eosinophils be raised?

A

Parasitic infections

142
Q

Why do acute leaukaemias have a worse prognosis than chronic?

A

They affect plastic cells whereas chronic affect cells that have already differentiated

143
Q

A patient comes in with PE, Wells score is a)>4 what is 1st line investigation and b) <4?

A

a) CPTA then LMWH

b) D-dimer

Phase 2a Summaries (12 decks)

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