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5th (Final year) > Haematology > Flashcards

Haematology Flashcards

1
Q

What is MCV, MCH, MCHC and HCT on the FBC?

A

MCV: Mean corpuscular vol.
- Avg. Vol. of an RBC

MCH: Mean corpuscular haemoglobin
- Avg. mass of haemoglobin per RBC

MCHC: Mean corpuscular haemoglobin conc.
- The concentration of haemoglobin per given vol. of blood.

HCT: Haematocrit
- How many cells in relation to plasma.

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2
Q

What does pancytopaenia mean?

A

Low haemoglobin, neutrophils and platelets

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3
Q

What are three main groups of blood cells?

A

Red cells

White cells

Platelets

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4
Q

Blood investigations for anaemia?

A

FBC

  • Hb
  • MCV
  • MCH
  • Red cell count

Blood film
- Morphology of cells

Haematinics

  • B12
  • Folate
  • Ferritin
  • Iron
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5
Q

What is high haemoglobin levels called?

A

Polycythaemia

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6
Q

What is polycythaemia?

A

High haemoglobin levels

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7
Q

What is low haemoglobin levels called?

A

Anaemia

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8
Q

Causes of Polycythaemia (high levels of Hb)?

A

Primary
- PRV (haematological Ca.)

Secondary: High EPO

  • Appropriate e.g. High altitude
  • Inappropriate: Ca.

Reactive:

  • Dehydration
  • Diuretics
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9
Q

If someone has Raised urea, Normal creatinine and anaemia what is likely going on?

A

GI bleed.

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10
Q

WCC low or normal likely what type of infection?

A

Viral

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11
Q

WCC high likely what type of infection?

A

Bacterial

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12
Q

What is raised platelets called?

A

Thrombocytosis

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13
Q

Causes of thrombocytosis?

A

MOST COMMON

  • Infection/inflammation
  • Splenectomy

Primary
- as part of another myeloproliferative disorder

Reactive

  • Iron deficiency
  • Haemorrhage
  • Severe haemolysis
  • Postoperative trauma
  • Infection, inflammation
  • Malignancy
  • Hyposplenism
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14
Q

What is thrombocytopaenia?

A

Low platelets

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15
Q

What might give you thrombocytopaenia?

A

Viral infection

Lupus

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16
Q

What might give you lymphopaenia (reduced)?

A

HIV
Steroids (common)/immunosuppression -
Lymphoma
Bone marrow failure

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17
Q

What might give you lymphocytosis (raised)?

A

Viral infections and bacterial infections

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18
Q

What is a microcytic hypochromic picture (in FBC results?), what is it associated with?

A

Raised platelets

Lowered MCV, MCH and MCHC

Low ferritin and high transferrin

Iron deficiency anaemia or thalassaemia

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19
Q

How might Von-Willibrands present?

A

Very positive FH of bleeding (male and female)

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20
Q

What blood test is abnormal in Von willibrands

A

Clotting screen - APTT

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21
Q

What happens to transferrin in iron deficiency anaemia?

A

Increases (as we measure free levels and it has nothing to bind to)

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22
Q

Causes of iron deficiency anaemia?

A

Blood loss

Malabsorption e.g. coeliac

Poor dietary intake (rarely a cause in UK)

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23
Q

Treatment of iron deficiency anaemia?

A

Oral iron (not well tolerated), ferrous sulphate is best.

If unable to take oral iron or needed rapidly then can do iron infusion

Never do blood transfusion

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24
Q

What may cause pancytopaenia with macrocytosis?

A

B12 deficiency
Folate deficiency
Liver disease
Hypothyroidism

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25
Q

Why do you get Pancytopenia with B12 and folate deficiency?

A

B12 is a co-enzyme needed to bring folate into cells and folate is needed for the manufacture for Nucleic acids (important especially in new cells) This affects rapidly dividing tissue such as bone marrow (hair and GI too)

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26
Q

Causes of B12 deficiency?

A

Pernicious anaemia is most common in the UK (no intrinsic factor)

Gastrectomy - as no acid to absorb it

Inadequate diet e.g. Vegans or vegetarians.

Intestinal causes e.g. crohns, ileal resection.

27
Q

If you suspect pernicious anaemia what history and examination should you concentrate on?

A

Family Hx of other autoimmune diseases

Neurological examination, focus on vibration and touch (DCML)

28
Q

Causes of folate deficiency?

A

Poor dietary intake - often chronic alcoholism

Malabsorption in coeliac disease

Increased use in pregnancy or haemolytic anaemia

29
Q

Where is iron absorbed?

A

Stomach, duodenum and first bit of jejunum (where there is acid)

30
Q

What bloods would you order in pernicious anaemia (low B12)? What would you find?

A

FBC - Anaemia

Blood film - Hypersegmented neutrophils

Low B12, Raised Folate

31
Q

What is LDH in blood tests?

A

Lactate dehydrogenase, it is a general marker of disease and is raised in many conditions, such as cancer, HIV, HF, lung and liver disease, it shoots up in haemolysis.

32
Q

How would you treat B12 deficiency?

A

B12 injection

No need for transfusion, and transfusion may cause harm (2’ to cardiomyopathy caused by the low B12)

33
Q

What would you find in blood tests after giving B12 to check to see in treatment is working after 3 days?

A

Reticulocytes will have been raised (may not have corrected the anaemia yet though

B12 will be raised

Lower K+ and raised Na+

34
Q

Blood results in haemolytic anaemia?

A

Reticulocytosis (increased immature RBCs)
+ve cooms tets
Haptoglobin very low
Lactate dehydrogenase

35
Q

Clinical findings in haemolytic anaemia?

A

Organomegaly
Anaemia
Jaundice

36
Q

How can you classify the different haemolytic anaemias?

A

Hereditary

  • Membrane
  • Enzyme
  • Haemoglobin chain disorder

Acquired

37
Q

What is the makeup of adult haemoglobin? What are the inherited haemoglobin chain haemolytic anaemic disorders?

A

2 Alpha, 2 Beta chains

B chain

  • Sickle cell
  • Haemoglobin E
  • Thalassaemia

Alpha chains
- Alpha thalassaemia - doesn’t really affect people.

38
Q

Geographical distribution of B-Thalassaemia?

A

Middle east, cyprus and greece

39
Q

How does B-Thalassaemia present?

A
  • 3-4 years old
  • Tired, floppy baby, growth failure
  • Protruding belly (organomegaly)
  • Jaundice
  • Flat bridged nose
40
Q

How do you treat B thalassaemia?

A

Bone marrow transplant is curative (not always possible though)

Red cell infusion is treatment (although will cause iron overload)

  • Normal treatment for iron overload is venesection, but can’t do this as anaemic
  • So need to use a chelating agent - deferoxamine
41
Q

What is myeloma?

A

Ca. of mature B cells

42
Q

What are the features of myeloma (diagnostic and otherwise)?

A

CRAB

hyperCalcaemia
Renal impairment
Anaemia
Bone lesions & Bone pain (70%)

Diagnostic

  1. Paraprotein (can not be present if non-secretory)
  2. Lytic lesions
  3. +ve Bone marrow biopsy

Free light chains in bloods

43
Q

What is the emergency scenario you need to exclude in an ‘off legs’ pt with Myeloma (or other Ca.)? Management?

A

Spinal cord compression

Fluids
Steroids
Bisphosphonates
Furosemide

44
Q

Most common causes of hypercalcaemia in inpatient and outpatient?

A

Inpatient - Ca.

Outpatient - Hyperparathyroidism

45
Q

Management of a bone marrow crisis?

A
  • O2
  • Analgesia
  • Fluids
  • Exchange transfusion
  • Hydroxycarbomide (raises foetal Hb)
46
Q

Complications of sickle cell? Prophylaxis?

A

Hyposplenism
- Can get encapsulated bacterial infection

Need to vaccinate for:

  • Haemophilus
  • Meningococcus
  • Pneumococcus
47
Q

Inheritance pattern for sickle cell?

A

Autosomal recessive

48
Q

What is spherocytosis?

A

Autosomal dominant inherited membrane disorder, affected red cells are destroyed in the spleen.

49
Q

Presentation of hereditary spherocytosis? (inc. blood tests).

A

Any age - Haemolytic anaemia, Splenomegaly, Jaundice (gallstones or haemolysis).

Positive FH

Raised MCV 
Raised Reticulocytes (immature red cells)
MCHC raised
50
Q

Management of hereditary spherocytosis?

A

Cholecystectomy and splenectomy

51
Q

What happens to the levels of ferritin, transferrin in the different types of anaemia?

A

Iron deficiency anaemia

  • Low ferritin
  • Raised Transferrin

Anaemia of chronic disease

  • Normal or raised ferritin
  • Reduced transferrin
52
Q

What conditions may cause a transient rise in the APTT, with no symptoms? (Dr Roy pre-surgery)

A

Factor 12 deficiency

Lupus - antiphospholipid

Repeat the bloods and if still raised should do test without antiphospholipids in vial

53
Q

Would you ask for a clotting screen when on warfarin? What would you ask for instead?

A

No - ask for INR

54
Q

What is the pathophysiology behind heparin induced thrombocytopenia?

A

Antibody forms against platelet-heparin complex and activates them - forming clots and lowering platelet level (as they have been activated).

55
Q

What anticoagulant do you give in renal failure (<30 GFR)?

A

Unfractionated Hep

56
Q

What are the common DOACs? Their mechanisms?

A

Rivaroxaban - Factor Xa
Apixaban - Factor Xa
Dabigatran - Antithrombin

57
Q

What is the most common inherited bleeding disorder?

A

Haemophilia A

58
Q

What is the presentation for platelet bleeding disorders/thrombocytopenia?

A

Bleeds

  • Epistaxis
  • Gums
  • Haemoptysis, Haematemesis, Haematuria

Spontaneous bruising

Petechiae (<5mm) or Purpura (5-9mm)

59
Q

Why do people with bleeding disorders have an increased risk of arthritis?

A

Bleeding into the joint (synovial vessels)

60
Q

What type of stones do people with spherocytosis typically develop?

A

Bilirubin stone

61
Q

Why do people with spherocytosis often need cholecystectomy/splenectomy?

A

Chole - for bilirubin stones

Splenectomy - eliminates anaemia (as less Red cells are destroyed) - curative in most patients.

Chole is mostly done at the time of splenectomy is stones are present.

62
Q

Painless jaundice normally means?

A

Pancreatic Ca.

63
Q

Where does iron usually deposit in haemachromotosis?

A

Heart
Liver
Skin
Pancreas

5th (Final year) (34 decks)

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