Haematology Flashcards
1
Q
What are the 3 main causes of microcytic anaemia?
A
- Iron deficiency
- Thalassaemia
- Chronic disease
2
Q
What are the 3 main causes of normocytic anaemia?
A
- Combined haemanitic deficiency (iron and B12)
- Anaemia of chronic disease
- Acute blood loss
3
Q
What are the 3 main causes of macrocytic anaemia?
A
- B12/Folate Deficiency
- Hypothyroidism
- Alcohol excess/liver disease
4
Q
Name 3 symptoms of anaemia?
A
Fatigue, breathlessness, reduced exercise tolerance, angina, claudification, palpitations
5
Q
Name 3 signs of anaemia?
A
Pallor and conjunctival pallor, tachycardia, systolic flow murmur, kolionchyia, pale mucus membranes
6
Q
How is anaemia classified?
A
By MCV - mean corpuscular volume (average RBC size)
Microcytic MCV <80
Normocytic MCV 80-100
Microcytic >100
7
Q
Name 3 compensatory physiological changes of anaemia?
A
a) Increased tissue perfusion
b) Increase O2 transfer to tissues
c) Increased RBC production
8
Q
Name 4 pathological consequences of anaemia?
A
- Myocardial fatty change
- Aggravate angina
- Skin and nail atrophic changes
- CNS cell death
- Fatty change in lober
9
Q
What test is used to see how quickly RBC’s are being made in the bone marrow?
A
Reticulocyte count
10
Q
What marker do you use to detect iron levels?
A
Serum ferritin - which is low
Transferrin would be high
11
Q
What does anaemia with jaundice suggest?
A
Haemolysis
12
Q
Give 4 signs of iron deficiency anaemia?
A
Brittle hair and nails, Kolionchyia, angular stomatis (mouth ulcers), atrophic glottitis (painful tongue)
13
Q
What does oncholysis (Detachment of nail from nail bed) suggest?
A
Hypothyroidism or psoraisis
14
Q
Name 4 causes of iron deficiency anaemia?
A
Hookworm, GI bleeding, Manorrhagia, poor diet, malabsorption (coeliac), increased demand eg pregnancy
15
Q
When may serum ferritin results be unreliable?
A
Also an acute phase protein and increases with inflammation eg infection
16
Q
How is iron deficiency anaemia treated and give a side effect of this?
A
Oran iron- ferrous sulphate
Constipation
17
Q
Name 3 diseases which cause anaemia of chronic disease?
A
Vasculitis, rheumatoid, renal failure, TB, SLE
18
Q
Name 5 respiratory diseases that cause clubbing ?
A
Bronchial cancer (usually not small cell) Bronchiectasis Fibrosing alveoli's Mesothelioma TB
19
Q
Name 4 GI causes that cause clubbing?
A
IBD
Cirrhosis
GI Lymphoma
Malabsorption
20
Q
Name 3 cardiovascular causes of clubbing?
A
Cyanotic congenital heart disease
Endocarditis
Aneurisims
Infected grafts
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
22
Q
Name 3 side effects of ferrous sulphate tablets?
A
Constipation, diarrhoea, epigastric pain, GI irritation, nausea
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
24
Q
Other than pernicious anaemia name 3 other causes of B12 deficiency?
A
Chrons, Coeliac, gastritis
25
What is the pathophysiology behind thalassaemia?
Autosomal recessive condition, leads to defective synthesis of globin chains --> decreased Hb production --> premature RBC destruction
26
What is the outcome for a patient with 4 deletions in alpha thalassaemia?
Hydrops foetalis - stillborn - cannot carry oxygen
27
What is the outcome for a patient with 3 deletions in alpha thalassaemia?
Severe anaemia
28
What is the presentation in a patient with B-thalassameia intermedia?
Moderate anaemia - splenomegaly and bone abnormalities
29
What is the presentation in a patient with B-thalassameia major?
Presents in 1st year of live- severe anaemia - failure to thrive and chronic infections
30
How do you treat beta thalassaemia?
Blood transfusions, iron chelation (desferrioxamine) , ascorbic acids
31
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?
Glutamine for Valine
32
What is the sickle cell trait protective against?
Malaria and G6PD
33
What is sickle cell crisis precipitated by?
Dehydration, cold weather, infection, hypoxia, acidosis
34
How is acute chest syndrome in sickle cell caused?
Caused by infection/fat emboli from necrotic bone leading to pulmonary infarction
35
What is the presentation of sickle cell crisis?
Children acute pain in hands and feet
Adults bone pain in ribs and spine
Pain accompanied by fever
36
What is the presentation of acute chest syndrome in sickle cell crisis?
SOB, chest pain, hypoxia and new changes on CXR
37
Name the investigations for sickle cell disease?
FBC- Decreased Hb and increased reticulocyte
Blood film = sickled erythrocytes
Hb electrophoresis is diagnostic
Neonate heel prick test
38
What is the most reliable indicator to detect polycythaemia?
Packed cell volume PCV - also known as haematocrit
39
Name a primary cause of polycythamia?
Polycythaemia rubra vera (PRV)
40
Name 3 secondary causes of polycythaemia?
EPO excess (tumour secretion of EPO) , altitude, lung disease eg chronic hypoxia (CPOD), smoking, abnormal RBC structure
41
Name 4 signs of Polycythaemia rubra vera (PRV)?
```
Plethroric appearance (red face)
Hyperviscosity
Thrombosis - DVT
Splenomegaly
Gout from increased RBC turnover
```
42
What genetic mutation do patient with Polycythaemia rubra vera (PRV) have ?
JAK2 mutation
43
What is the treatment for Polycythaemia rubra vera (PRV)?
Aspirin- prevent complications
Venesection
Bone Marrow suppression (hyrdoxycarbamide)
Alpha interferon for women in child bearing age
44
Name 3 signs of PE?
Tacycardia, tacynpnoea, localised pleural rub, raised JVP, hypotension, pleural effusion
45
What would you see on ECG of patient with PE?
T wave inversion, S wave lead1, Q wave lead 1 and inverted T wave lead 3 is classic but not often seen
46
What is the GOLD standard diagnosis of DVT?
Ultrasound compression test
47
Name the infection stages of malaria?
Sporoziote , merozoite (in liver-reproduce asexually) , Hypnoziote (P.ovale and P. vivax) , Trophozoites - inside RBC
48
Name 4 symptoms of malaria?
Fever, chills and sweats, anaemia, jaundice, myalgia, fatigue
49
Name 2 ways you would diagnose malaria?
Blood test - thick film and thin films
| Lateral flow assay - rapid diagnostic test
50
Name 2 treatment methods for falciparum malaria?
IV artenusate, IV quinine
51
What is the treatment for Non-falciparum malaria?
PO Chloroquine
52
What is febrile neutropenia and give 3 causes?
Abnormally low neutrophil count <1.0
| Chemotherapy, bone marrow problem, B12/folate deficiency
53
Name 3 circumstances when to suspect neutropenic sepsis (febrile neutropenia)?
1. Anyone had chemo in last 3 months
2. Patient presents with isolated hypotension
3. Patient presents with fever, chills and rigors
54
What is the management of a patient with febrile neutropenia?
Take blood cultures
Broad spectrum IV antibiotics as per local guideline eg
Taxocin and gentamicin
55
What is the name of a mutation that leads to a 1% chance of transforming to myeloma?
MGUS
56
In Myeloma presentation, what does OLD CRABB stand for?
```
Old - age 70
Calcium levels elevated
Renal failure - antibody light chain deposition (bence jones)
Anaemia
Bone lytic lesions
Bacterial infections
```
57
Name 6 ways you can investigate myeloma?
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
58
Which blood cancer is an AIDS defining illness?
Lymphoma (Non-Hodgkin)
59
What is the treatment for non-hodgkins lymphoma?
R-CHOP
| Rituximab + combination chemo
60
Why do you use Rituximab in CLL?
CLL = proliferation of B-lymphocytes which express CD20 on surface.
Rituximab is a CD20 Mab which can target B-cells
61
Which type of lymphoma is extra -nodal involvement more common?
Non-Hodgkins
62
What is the clinical presentation of Hodgkins lymphoma?
Painless lymphadenopathy (cervical) described as rubbery, disease in mediastinum = cough and B symptoms
63
What are the 3, B (constitutional) symptoms?
Fever, night sweats and weight loss
64
What are the 4 stages of the Ann Arbor classification?
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
If stage 2B-4 of ann-arbor classification what treatment would you offer?
Combination chemo- ABVD
66
Which is the most common leukaemia?
Chronic lymphocytic
67
What is the first line treatment method for chronic myeloid leukaemia?
Tyrosine Kinase inhibitors - Imatinib - philadelphia chromosome increases tyrosine kinase activity
68
Which leukaemia is mostly asymptomatic?
Chronic lymphocytic
69
Which leukaemias are associated with downs (trisomies)?
CLL and ALL
70
What are the 4 characteristic features of ALL?
1. Lymphadenopathy (only leukaemia that shows this)
2. Hepatosplenomegaly
3. CNS involvement
4. Bone pain
71
Which treatment method used in ALL and other aggressive cancers eg Burkitts lymphoma prevents tumour lysis syndrome?
Allupurinol
72
What are the 2 characteristic presentations of AML?
Hepatosplenomegaly
| Gum infiltration
73
Which disease is preticipated by broad beans, drugs (aspirin) or illness?
Oxidative crisis causes by G6PD deficiency
| Get bite and blister cells on blood
74
What is hereditary spherocytosis?
Autosomal dominant condition where spherical RBC get trapped in spleen - diagnose with osmotic fragility test
75
What are the clinical features of Immune thrombocytopenic purpura?
Easy bruising, epistaxis, pupura, menorrhagia
76
Which 3 conditions cause increased destruction of platelets?
Non Immune = DIC and TTP
| Immune = ITP
77
Name 3 causes of disseminated intravascular coagulation?
Malignancy, septicaemia, infections, trauma, birth
| (end game of serious illness), pancreatitis
78
In Thrombotic Thrombocytopenic Purpura, there is a reduction in which protease enzyme?
ADAMTS13
79
How manage you treat spinal cord compression?
MRI - Diagnostic
| Dexamethasone
80
What is pathophysiology of tumour lysis syndrome?
Chemotherapy causes release of intracellular comopenents eg urea, kidney becomes overwhelmed leads to tumour lysis syndrome
81
What are the signs of tumour lysis syndrome?
1st -Hyperkalaemia - arrhythmia
2nd- Hyperphosphataemia, Hyperuricaemia, Hypocalcaemia - seizures
3. AKI
82
Name 3 treatment methods for tumour lysis syndrome?
Rasburicase (increase renal excretion of uric acid)
Vigirious IV fluids
Monitor and treat K+
Dialysis if needed
83
What is hyper-viscosity syndrome?
Malignant plasma cells produce lots of immunoglobulins which increases thickness of blood
84
What are the symptoms of hyper-viscosity syndrome?
Headaches, blurred vision, fatigue, shortness of breath, musical bleeding
85
What are the signs of hyper-viscosity syndrome?
Papilloedema, peripheral oedema
86
What is an example of autoimmune cause of anaemia?
Malaria
87
What is an example of hereditary cause of anaemia?
1. Glucose 6 phosphate deficiency
2. Hereditary spherocyotisis
3, Sickle cell and thalassaemia
88
What is released in increased red blood cell breakdown?
Serum lactate deyhdrogenase
89
What is a symptom of G6PD?
Rapidly anaemia and jaundiced
90
Name 2 symptoms of polycythamemia?
Itchy skin- typically worse after bath
Easy bruising/bleeding
Due to hyper viscosity = dizziness/ headaches
91
What are the risk factors for PE and DVT?
Age, pregnancy, trauma, surgery, obesity, immobility, thrombophillia, travel
92
What is the definition of sensitivity?
Sensitivity is the ability of a test to correctly identify those with the disease
93
What is the definition of specificity?
Specificity is the ability of the test to correctly identify those without the disease
94
Give an example of a factor Xa Inhibitor?
Rivaroxiban
| DOAC
95
How do you reverse the effect of warfarin?
Give them vitamin K
96
What does a Wells score of more than 2 indicate?
Likely DVT - Ultrasound scan and D-Dimer
97
What is abcximab an example of ?
Glycoprotein IIb/IIIa receptor antagonist
98
What is the pathophysiology of TTP?
Clears Von Willebrand factor
99
When to transfuse in sickle cell anaemia ?
1. Hb or reticulocyte fall
2. Suspect CNS event
3. Multi-organ failure
4. Severe chest crisis
100
Give a) 3 immediate side effects of chemo and b) 3 late side effects of chemo?
Immediate = Alopecia, neutropenia (infections), anaemia, thrombocytopenia
Late = nephrotoxicity, infertility, pulmonary fibrosis, cardiotoxicity, psychological
101
Which blood cancer exhibits bimodal age distribution (20s and 60s)?
Hodgkins lymphoma
102
What cytokine activates osteoclasts in multiple myeloma?
Il-6
103
What is the GOLD standard investigation in multiple myeloma?
IgG electrophoresis
104
Which blood cancer is associated with pain when drinking alcohol?
Hodgkins Lymphoma
105
What are the causes of pancytopenia?
1. Iatrogenic
2. Infective - HIV, EBV
3. Malignancy- myeloma, lymphoma
4. Severe folate/B12 deficiency
106
Name 5 haematological investigations you could do to diagnose leukamaemia?
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
Which leukaemia do you get Auer rods?
AML
108
What is the presentation of CLL?
Enlarged non-tender lymph node + constitutional symptoms
| 50% asymptomatic
109
What is myeloma a cancer of?
Malignancy proliferation of clonal plasma cells (fully-differentiated B-lymphocytes)
110
Give 4 complications of myeloma?
1. Hypercalcemia - rehydrate with surgery
2. Spinal Cord compression - MRI, dexamethasone
3. Hyperviscotiy - plasmapheresis
4. AKI
111
Name 3 risk factors/ causes of lymphoma?
Immunodeficient eg HIV or transplant recipient
Autoimmune disorders eg SLE
Infection eg EBV or H.pylori
Obesity
112
Give 3 causes of folate deficiency?
Poor diet - poverty, alcoholics
Increased demand
Malabsorption eg coeliac and tropical sprue
Drugs eg methotrexate
113
In which 3 conditions can blood results be misleading?
Dehydration
Acute major blood loss
Pregnancy
114
What 5 components of the blood would you look at when diagnosing anaemia?
White cell and platelet count, blood film, reticulocyte count, haematinics
115
What symptoms does B12 deficiency cause?
Lemon tinged skin, angular chelonia (sore mouth), dementia, peripheral neuropathy
116
Which foods is a)folate found in and b) Vitamin B12?
a) Green vegetables, nuts, beans, beef, fruit and offal
| b) Meat, fish, dairy products
117
In haemolytic anaemia what would the reticulocyte count be?
Increase reticulocytes
118
What are the symptoms of haemolytic anaemia?
Anaemia, jaundice, gallstones, liver and spleen enlargement and leg ulcers
119
Name 4 components/complications of sickle cell crisis?
Acute chest
Dactylics
Strokes
Priapsim
120
How do you diagnose acquired or hereditary haemolytic anaemia?
Coombs test
121
Which 3 pathophysiological process stop bleeding?
1. Vasoconstriction
2. Platelets plug the gap
3. Blood coagulates
122
Give 4 treatment methods for Sickle cell disease?
```
Hydroxycarmabide - reduces effect of sickling
Pneumococcal and influenza vaccine
Penecillin as prophlaxis
Analgesics for bone pain during crisis
Transfusion
```
123
What is haemophilia?
Effects factor 8, X-linked recessive condition causes haemotmas
124
Give 3 causes of vitamin K deficiency?
Anticoagulants (warfarin K antagonist)
Biliary obstruction (no fat absorption)
Haemorrhoagic diseases
Liver disease (1972 made in liver)
125
What is the non-medical primary prevention of DVT?
Early mobilisation
Compression stockings
Leg elevation
126
Give an a) positive and b) negative of using DOAC eg rivaroxiban as oppose to warfarin ?
a) No wafarrin clinic with monitoring
b) Irreversible, there is no antidote
Eg too much warfarin give vitamin K
127
Give 4 investigations you may do in a patient with Polycythamia?
1. FBC = Raised PCV, haematocrit, HB and RBC
2. Genetic - JAK2 testing
3. Serum EPO (decrease)
4. Red cell mass studies
128
Give 5 supportive treatment methods for myeloma?
1. Bisphosphonates
2. Regular IV immunoglobulin infusions (infections)
3. Blood transfusion and EPO
4. Hydration and dialysis
5. Chemo /radio
129
What are the symptoms of spinal cord compression?
Back pain, loss of spinchter control (LUTS symptoms)
130
What are the clinical signs of spinal cord compression?
Decreased power in legs, decrease reflexes (spastic), decreased sensation, saddle anaesthesia, bladder residual volume >200ml
131
Name 3 causes of hyper viscosity syndrome?
1. Increased Igs in myeloma
2. Increased blood cells in hyper proliferative states eg PRV
3. Reduced deformibil9ity of RBC - eg sickle cell
132
Give 3 common presentations of hyper viscosity syndrome?
1. Visual changes eg blurring
2. Mucosal bleeding
3. Neurological symptoms
133
What is the initial management of hyper viscosity syndrome?
Cannula, fluids and plasmapheresis
134
Give 3 precipitants of G6PD deficiency?
Broad beans, illness, drugs (primaquine, quinolines)
135
Give 2 ways to diagnose G6PD deficiency?
1. Blood film = Bite and blister cells
| 2. NADH secretion
136
What is the most common cause of ITP and give an example of a treatment method?
```
Viral infection (esp children)
Treatment = Immunosuppression eg steroids or tranexamic acid
```
137
What is the pathophsyiology of ITP?
IgG antibodies form to platelet and megakaryocyte surface glycoproteins
138
What is the pathophysiology of DIC?
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
What is the pathophysiology of TTP?
Spontaneous aggregation in microvasculature, failure to break down von willebrand factor
140
How would you treat TTP?
Urgent plasma exchange and immunosuppression
141
When would eosinophils be raised?
Parasitic infections
142
Why do acute leaukaemias have a worse prognosis than chronic?
They affect plastic cells whereas chronic affect cells that have already differentiated
143
A patient comes in with PE, Wells score is a)>4 what is 1st line investigation and b) <4?
a) CPTA then LMWH
| b) D-dimer
