Haematology Flashcards
What is lymphoma?
Malignant proliferation of lymphocytes
Lymph nodes, liver, spleen
Rubbery enlarged glands
What tests should be done for lymphoma?
- Viral screen
- Excision/CT guided biopsy
- Contrast CT neck, thorax, abdo, pelvis
- FBC, LDH
What are the symptoms of lymphoma?
Painless lymphadenopathy
Fever, weight loss, night sweats, lethargy
How is lymphoma staged?
- Single lymph node
- 2 lymph nodes same side of the diaphragm
- Regions on both sides of the diaphragm
- Extra-nodal site - BM, liver, spleen
A - absence of constitutional symptoms
B - symptoms
X - bulky disease
E - single extra-nodal site
What are some features of Hodgkin’s lymphoma?
Commonest type = nodular sclerosing 2 peaks: young adults and elderly Linked to EBV Reed-Sternberg cells Radiotherapy and chemotherapy
What are some features of Non-Hodgkin’s lymphoma?
Most are B cell
Gut extra-nodal disease common
Split into indolent and aggressive
Associated with immunodeficiency - HIV, EBV, H pylori
What is myeloma?
Clonal B cell malignancy with proliferation of plasma cells
Accumulate in bone marrow and secrete m-protein
Other Ig levels are low
What are some clinical features of myeloma?
Osteolytic lesions - backache, wedge # Hypercalcaemia Anaemia, neutropenia, thrombocytopenia Recurrent bacterial infections Renal impairment - light chain deposition
What investigations should be done for suspected myeloma?
FBC - normocytic anaemia ESR UEs - raised urea, creatinine and calcium X-rays Bone marrow biopsy Serum and/or urine electrophoresis
What are the diagnostic criteria for myeloma?
- Monoclonal protein band in serum electrophoresis
- Plasma cells on BM biopsy
- Evidence of end organ damage - hypercalcaemia, anaemia, renal insufficiency
- Bone lesions
What is the management of myeloma?
Analgesia (not NSAIDs) Bisphosphonates Anaemia - transfuse Hydration Treat infections Chemo
What are some complications of myeloma?
Hypercalcaemia
Spinal cord compression
Hyperviscosity
Acute renal injury
What is leukaemia and what are the four types?
Malignant neoplastic process involving one of the white cell lines Acute lymphoblastic Acute myeloid Chronic lymphocytic Chronic myeloid
What are the features of ALL?
B or T cell lineages
Arrests maturation and promotes uncontrolled proliferation of immature blast cells
Marrow failure
Infiltration - hepatosplenomegaly, lymphadenopathy
What tests should be done for ALL?
Blood film and BM biopsy
CXR and CT
LP (CNS involvement)
What is the treatment of ALL?
Blood/platelet transfusion IV fluids Allopurinol Hickman line Treat infections aggressively
What are some features of acute myeloid leukaemia?
Progresses rapidly
Can be a long term complication of chemotherapy
Auer rods
Intensive chemo and BM transplant
What are some features of chronic myeloid leukaemia?
Uncontrolled proliferation of myeloid cells - increased WCC
Philadelphia chromosome
Massive splenomegaly, hepatomegaly, anaemia, bruising
What is chronic lymphocytic leukaemia?
Accumulation of functionally incompetent B cells
What 3 things halt bleeding?
- Vasoconstriction
- Gap plugging by platelets
- Coagulation cascade
What can cause issues with vasoconstriction?
CTD Senile purpura Infection - meningococcal, measles Steroids Henoch-Scholein purpura
What can cause issues with platelet?
Aplastic and megaloblastic anaemia Myeloma, leukaemia Cytotoxic drugs, radiotherapy ITP SLE DIC, TTP
What does the APTT monitor?
Intrinsic pathway
Factors XII, XI, IX, VIII, VII
What does PT monitor?
Extrinsic pathway
Factors X, VII, V, II
Prothrombin and fibrinogen
What are some causes of an increased PT?
Warfarin
Factor VII deficiency
Factors II, V, X deficiency
What are some causes of an increased APTT?
Heparin
VII-XII deficiency
Von-Willebrands
What are some causes of an increased PT and APTT?
Vitamin K deficiency
DIC
Heparin toxicity
What are the three types of von-Willebrands?
- Reduced amount of vW protein
- Abnormal vW protein
- Little or no vW protein
What are some features of haemophilia?
X-linked recessive
A = factor VIII deficiency
B - factor IX deficiency
Avoid NSAIDs and IM injections
What are some causes of normocytic anaemia?
Acute blood loss
Anaemia of chronic disease
Haemolytic anaemia
What are some causes of microcytic anaemia?
Iron deficiency
Thalassaemia
Sideroblastic
What are some causes of macrocytic anaemia?
B12 or folate deficiency
Alcohol excess
Reticulocytosis
Marrow infiltration
What investigations should be done for IDA?
Coeliac serology
If not menstruating - urgent gastroscopy and colonoscopy
What are some causes of anaemia of chronic disease?
Chronic infection Vasculitis RA Malignancy CKD
What is sideroblastic anaemia?
Ineffective erythropoiesis leads to increased iron absorption
Post chemo, radio, anti-TB drugs
Suspect if refractory microcytic anaemia
What investigations should be done for macrocytic anaemia?
LFTs, TFTs, serum B12 and folate
What is pernicious anaemia?
Parietal cell antibodies leads to lack of intrinsic factor
IF binds to B12 in stomach - without it cannot be absorbed in terminal ileum
What are the signs and symptoms of B12 deficiency?
Pallor, mild jaundice, glossitis
Irritability, depression, psychosis, dementia
Subacute degeneration of spinal cord
What is haemolytic anaemia?
Premature breakdown of RBCs before their normal lifespan
In circulation = intravascular
Macrophages of liver/spleen/BM = extravascular
What tests should be done for haemolytic anaemia?
FBC, LDH
Urinary urobilinogen
Thick and thin films for malaria
Reticulocytes, bilirubin, haptoglobin
What are the types of Coomb’s positive anaemia?
- Drug induced
- Autoimmune haemolytic anaemia
- Warm = IgG mediated, extravascular - steroids
- Cold = IgM mediated, intravascular
What are some causes of Coomb’s negative anaemia?
Autoimmune hepatitis
Hepatitis B and C
Post vaccination
Piperacillin, rituximab
What are some hereditary causes of haemolytic anaemia?
G6PD deficiency
Pyruvate kinase deficiency
Hereditary spherocytosis
Sickle cell anaemia
What are some features of G6PD deficiency?
X-linkd
Episodic intravascular haemolysis
Bite and blister cells
What are some features of pyruvate kinase deficiency?
Autosomal recessive
Decreased ATP production, decreased RBC survival
Haemolysis + splenomegaly + jaundice
Sputnik cells
What are some features of hereditary spherocytosis?
Autosomal dominant
Spherical RBCs get trapped in spleen
Cause of neonatal jaundice
What is sickle cell anaemia?
Production of abnormal Hb results in vaso-occlusive crises
Autosomal recessive
Hb electrophoresis confirms diagnosis
What are some features of sickle cell crises?
Triggers: cold, infection, hypoxia, dehydration
Small blood vessels are occluded - infarction
Severe pain due to bony infarction
IV opioids, fluids and antibiotics
What is acute chest in SCA?
Pulmonary infiltrates involving complete lung segments
Pain, fever, tachypnoea, wheeze, cough
What are some complications of SCA?
Splenic infarction Poor growth Chronic renal failure Gallstones Iron overload Lung damage
What is thalassaemia?
Genetic disease of unbalanced Hb synthesis
Decreased or no production of one global chain
