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Finals > Haematology > Flashcards

Haematology Flashcards

1
Q

What different information can you get from bone marrow aspirate v trephine

A

aspirate = myeloid:erythroid, orderly/complete maturation, presence of abnormal cells

trephine = cells:fat, no of diff cells present, presence of abnormal infiltrates, changes to stroma/bone

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2
Q

Which area does a leukaemia affect

A

bone marrow

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3
Q

Which area does a lymphoma affect

A

lymph nodes

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4
Q

What is the difference between acute and chronic haematological malignancies?

A

acute = cell growth arrested at early stage of differentiation`

chronic = cell growth arrested at later stage of development. already partially developed

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5
Q

What are the features of ALL

A 
most common in children 2-4y
infection
bleeding/brusing
tiredness
bone pain (secondary to bone marrow infiltration)
splenomegaly
hepatomegaly
testicular swelling
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6
Q

What are the risk factors for ALL

A

genetics

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7
Q

What investigations need to be done in ALL

A

FBC, clotting, LDH, U+E LFT
blood film
bone marrow aspirate and trephine
immunophenotyping

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8
Q

what is the management of ALL

A

remission induction - chemo
maintenance
CNS prophylaxis

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9
Q

What are the features of AML

A 
most common 50-60y
anaemia: pallor, lethargy, weakness
neutropenia: whilst white cell counts may be very high, functioning neutrophil levels may be low leading to frequent infections etc
thrombocytopenia: bleeding
splenomegaly
bone pain
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10
Q

What conditions can progress into AML

A

Myelodysplastic syndrome
aplastic anaemia
myelofibrosis

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11
Q

What investigations need to be done in AML

A

FBC, clotting, LDH, U+E, LFTs
blood film
bone marrow aspiration

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12
Q

what is the management of AML

A

induction
post remission consolidation
stem cell transplantation

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13
Q

Which cells are affected in CLL

A

monoclonal proliferation of well-differentiated lymphocytes which are almost always B-cells

immature, unreactive, accumulate in bone marrow, don’t die when they should

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14
Q

What are the features of CLL

A 
often none
constitutional: anorexia, weight loss
bleeding, infections
lymphadenopathy more marked than CML
splenomegaly
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15
Q

What investigations need to be done in CLL

A 
FBC 
blood film
bone marrow aspirate and trephine
lymph node biopsy
immunophenotyping
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16
Q

What cells are seen on a blood film in CLL

A

smear/smudge cells

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17
Q

What is the genetic abnormality present in most CML

A

philadelphia chromosome
translocation between 9 and 22
BCR-ABL gene codes for a fusion protein which has tyrosine kinase activity in excess of normal

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18
Q

Which cells are affected in CML

A

myeloproliferative disorder of haemopoeitic stem cells affecting one or all cell lines - erythroid, platelet, myeloid

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19
Q

Describe the phases of CML

A

chronic - 4-5y. asymptomatic, immune system fine

accelerated - 15-29% blasts in the marrow/blood, low platelets, RBC and granulocytes

blastic - >=30% blasts in blood/marrow plus severe constitutional symptoms

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20
Q

What are the features of CML

A

anaemia: lethargy
weight loss
splenomegaly/hepatomegaly
night sweats

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21
Q

What investigations need to be done in CML

A

FBC LDH
Blood film
bone marrow aspirate and trephine
cytogenetics - philadelphia chromosome

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22
Q

What is the difference between a group and save and a cross match?

A

group and save - gives blood group and screens for abnormal antibodies. no blood is issued

cross match - patient and donor blood mixed. blood issued if no immune reaction

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23
Q

How are blood samples like group and save and cross match meant to be taken

A

two separate samples
three points of ID
informed consent from patient for blood transfusion
label bottles by bedside by hand
complete request form by patient’s bedside

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24
Q

What is the threshold for red cell transfusion

A

Hb <70g/L

Hb <80g/L if acute coronary syndrome

25
Q

What does FFP contain

A

clotting factors, albumin, immunoglobulin

26
Q

What are the indications for giving FFP

A

(i) Disseminated Intravascular Coagulation (DIC);
(ii) Any haemorrhage secondary to liver disease;
(iii) All massive haemorrhages (commonly given after the 2nd unit of packed red cells)

27
Q

What are the indications for giving platelets

A

(i) Haemorrhagic shock in a trauma patient;
(ii) Profound thrombocytopenia <20 x 109/L
(iii) Bleeding with thrombocytopenia - if < 100 x 10 9 for patients with severe bleeding, or bleeding at critical sites, such as the CNS
(iv) Pre-operative platelet level <50 x 109/L

28
Q

What does cryoprecipitate contain

A

fibrinogen
von willebrand factor
factor VII
fibronectin

29
Q

What are the indications for giving cryoprecipitate

A

(i) DIC with fibrinogen <1g/L;
(ii) von Willebrands Disease; or
(iii) Massive haemorrhage

30
Q

When is CMV -ve blood inidcated

A

if risk of congenital CMV infection - causes cerebral palsy or sensorineural deafness

pregnancy
intrauterine transfusion
neonates <28 days

31
Q

When is irradiated blood indicated

A

if increased risk of graft versus host disease

eg:
Those receiving blood from first or second-degree family members
Patients with Hodgkin’s Lymphoma
Recent haematpoietic stem cell (HSC) transplants
After Anti-Thymocyte Globulin (ATG) or Alemtuzumab therapy
Those receiving purine analogues (e.g. fludarabine) as chemotherapy
Intra-uterine transfusions
congenital cellular immune deficiency

32
Q

What onservations should be carried out when giving a blood transdusion

A

obs including temperature

before, 
after 1 min,
after 15 mins, 
after 1 hour, 
at completion
33
Q

What size cannula should blood be given through? Why?

A

green - 18G
grey - 16G

prevents shearing of the red blood cells as they through a too narrow tube

34
Q

What are some acute complications of a blood transfusion

A 
acute haemolyic
non-haemolytic febrile
allergic
infective
TRALI
fluid overload
hyperkalaemia
35
Q

What causes an acute haemolytic reaction to a blood transfusion

A

Incompatible transfused red cells react with the patient’s own anti-A or anti-B antibodies or other alloantibodies (eg, anti-rhesus (Rh) D, RhE, Rhc and Kell)

Complement can be activated and may lead to disseminated intravascular coagulation (DIC).

36
Q

What are the features of acute haemolytic reaction to a blood transfusion

A

within a few minutes of start of transfusion:

fever
abdominal and chest pain
agitation
hypotension

37
Q

How should an acute haemolytic reaction to a blood transfusion be managed

A

stop the transfusion immediately!!!

Keep the intravenous (IV) line open with saline.
Give oxygen and fluid support.
Monitor urine output, usually following catheterisation. Maintain urine output at more than 100 ml/hour, giving furosemide if this falls.
Consider inotrope support if hypotension is prolonged.
Treat DIC appropriately - seek expert advice early and transfuse platelets/fresh frozen plasma (FFP) guided by the coagulation screen and bleeding status.
Inform the hospital transfusion department immediately.

38
Q

What causes a non-haemolytic febrile reaction to a blood transfusion

A

patient antibodies to transfused white cells.

39
Q

What are features of a non-haemolytic febrile reaction to a blood transfusion

A

occurs near end of or after transfusion
fever >1 degrees from baseline
rigors

40
Q

How should a non-haemolytic febrile reaction to a blood transfusion be managed?

A

lowing or stopping the transfusion

giving paracetamol.

41
Q

What causes an allergic response to a blood transfusion

A

antibodies that react with proteins in transfused blood components.
IgE or IgG mediated

42
Q

What are the features of an allergic response to a blood transfusion

A

Urticaria and itching are common within minutes of starting a transfusion.

anaphylaxis:
acutely dyspnoeic due to bronchospasm and laryngeal oedema and may complain of chest pain, abdominal pain and nausea.

43
Q

How is an allergic response to a blood transfusion managed?

A

slowing the transfusion
giving antihistamine
transfusion may be continued if there is no progression at 30 minutes.

anaphylaxis: IM adrenaline, steroids, bronchodilators

44
Q

What is TRALI and what causes it?

A

Transfusion-related acute lung injury

donor plasma contains antibodies against the patient’s leukocytes.
leads to acute respiratory distress

45
Q

What are the features of TRALI

A

within 6 hours of transfusion

dyspnoea
non-productive dry cough
hypoxia
frothy sputum
fever
rigors
46
Q

What are the features of TRALI on CXR

A

multiple perihilar nodules

infiltration of the lower lung fields

47
Q

How is TRALI managed

A

Give high-concentration oxygen, IV fluids and inotropes (as for acute respiratory distress syndrome).

SENIOR HELP

Monitor blood gases, serial CXR and CVP/pulmonary capillary pressure.

Ventilation may be urgently required - discuss with ICU.

48
Q

What are some long term complications of blood transfusion

A 
infection
iron overload
Graft versus host disease
post transfusion purpura
delayed haemolysis of red cells
49
Q

What causes graft versus host disease

A

T lymphocytes

50
Q

What are the features of GvHD

A

occurs between day 4 and day 30 following transfusion

high fever
diffuse erythematous skin rash progressing to erythroderma, diarrhoea and abnormal liver function.

Patients deteriorate with bone marrow failure and death occurs through overwhelming infection.

51
Q

What causes post transfusion purpura

A

platelet-specific alloantibodies,

52
Q

What are the features of post transfusion purpura

A

occurs 5-9 days following transfusion.

Bleeding associated with a very low platelet count develops

53
Q

Which patients are at increased risk of allergic reaction to a blood transfusion

A

those with severe IgA deficiency

they may develop antibody to IgA

54
Q

How is a microcytic or normocytic anaemia managed in pregnancy

A

oral iron should be considered as the first step,

further investigations only required if no rise in haemaglobin after 2 weeks.

55
Q

Which blood product carries the highest risk of bacterial infection with transfusion? Why?

A

platelets

stored at room temperature

56
Q

How should a patient on warfarin with a major bleed be managed

A

STOP warfarin
5mg Vit K IV
FFP

57
Q

How should a patient on warfarin with a minor bleed and INR >5 be managed

A

STOP warfarin
1-3mg Vit K IV - repeat if INR still >5 at 24 hours
restart warfarin when INR <5.0

58
Q

How should a patient on warfarin with no bleed and INR >8 be managed

A

STOP warfarin
1-5mg Vit K PO - repeat if INR still >5 at 24 hours
restart warfarin when INR <5.0

59
Q

How should a patient on warfarin with no bleed and INR 5-8 be managed

A

withhold 1-2 doses of warfarin

reduce the maintenance dose

Finals (32 decks)

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