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Cancer Care > Haematology > Flashcards

Haematology Flashcards

1
Q

How long does it take to produce a neutrophil?

A

7-10 days

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2
Q

What is the quickest response for releasing neutrophils?

A

Demargination

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3
Q

Give some causes of neutrophilia

A 
Infection/inflammation
Steroids, adrenaline, GCSE
Cold/heat/surgery 
Myeloprofilerative disorder 
Malignancy
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4
Q

What is the lifespan of a neutrophil?

A

12-18 hours

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5
Q

What is GCSF used for?

A

It stops the WCC dropping too low during chemotherapy

Therefore can be a cause of neutrophilia

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6
Q

Give some causes of neutropenia

A 
Chemotherapy agents
Anticonvulsants, carbimazole, IBD meds
Viral infection 
BM failure 
Immune mediated - SLE
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7
Q

Give some causes of lymphocytosis

A 
Viral infections: EBV, CMV, influenza
Leukaemia, lymphoma
MI
Sickle cell crisis
Trauma
RA
Splenectomy
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8
Q

What is the commonest cause of a >6 week lymphocytosis?

A

Chronic lymphocytic leukaemia

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9
Q

Give some causes of a lymphopenia

A 
Malignancy - Hodgkin’s or NHL
RA, SLE
Chemotherapy
Burns
Anorexia nervosa
Renal or liver failure
Sarcoidosis 
Aplastic anaemia
Myelodysplatic syndromes
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10
Q

Give some causes of eosinophilia

A

Allergic conditions:asthma, eczema, hayfever
Allergic reaction to medication
Parasites; tapeworm, hookworm, schistosomiasis
Hodgkin’s lymphoma
Sarcoidosis
Irradiation

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11
Q

What is aquagenic pruritus?

A

Itching when exposed to hot water

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12
Q

What is polycythaemia Vera?

A

All blood cell types are produced excessively
Particular increase in the RBCs
This is a myeloproliferative neoplasm
Linked with JAK2 mutation

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13
Q

What do smear cells indicate?

A

Chronic lymphocytic leukaemia

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14
Q

Define leukaemia

A

A group of disorders that are characterised by the accumulation of malignant white cells in the bone marrow (primarily) and peripheral blood

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15
Q

How can we tell if BM failure is acute or chronic?

A

Mature cells present if chronic

Immature cells present if acute

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16
Q

Is CLL curable?

A

No

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17
Q

CLL is a disorder of which cells?

A

B cells

B1

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18
Q

How might CLL present?

A 
Insidious onset
Recurrent infections 
Enlarged LNs
Mucocutaneous bleeding 
Tiredness and fatigue
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19
Q

Are B symptoms common in CLL?

A

No

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20
Q

What are the B symptoms?

A

Fever
Weight loss
Night sweats

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21
Q

What degree of weight loss is considered worrying?

A

> 10% in the last 6 months

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22
Q

Give a differential diagnosis for low Hb, low WCC and low platelets

A

Acute leukaemia until proven otherwise : ALL/AML
Aplastic anaemia
B12 deficiency

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23
Q

What is the purpose of flow cytometry?

A

To see if the lineage is lymphoid or myeloid

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24
Q

What blood tests need doing if you suspect DIC?

A

PT
APTT
Fibrinogen

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25
Q

How many days from diagnosis do you have to treat a haematological malignancy?

A

7 days

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26
Q

What are the signs of leukostasis?

A

Respiratory distress
Decreased mental status
Priapism

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27
Q

What gene diagnoses CML and how do we detect it?

A

BCR-ABL

FISH

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28
Q

What disease is the Philadelphia chromosome linked to?

A

Chronic myeloid leukaemia

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29
Q

What is the management of CML?

A

Tyrosine kinase inhibitor

BM transplant

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30
Q

What age groups get Hodgkin’s lymphoma?

A

15-30 years

>60 years

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31
Q

What proportion of patients have B symptoms in Hodgkin’s lymphoma?

A

Third

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32
Q

What other disease is Hodgkin’s linked to?

A

EBV exposure

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33
Q

What is the prognosis for Hodgkin’s lymphoma?

A

Good

80% cure

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34
Q

What is the management of Hodgkin’s?

A

Radiotherapy

Chemotherapy ABVD combo

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35
Q

What medicines are in the ABVD combo?

A

Adriamycin (doxorubicin)
Bleomycin
Vinblastine
Dacarbazine

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36
Q

Describe the Ann Arbor Staging

A 
I = 1 LN region
II = 2 + LN regions
III = 2+ LN regions on different sides of diaphragm 
IV = extralymphatic spread
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37
Q

What are the classic 3 signs of myeloma?

A

Anaemia
Back pain
High ESR

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38
Q

Myeloma makes what type of bone lesions?

A

Lytic

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39
Q

How do we diagnose myeloma?

A

Histology >10% plasma cells in BM
Paraprotein or excess light chains
Myeloma related organ dysfunction

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40
Q

What is the management of myeloma?

A

Steroids - dexamethasone
Chemo - cyclophosphamide
Thalidomide
Proteasome inhibitors

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41
Q

What is the CRAB mnemonic for myeloma?

A

C - calcium increase
R - renal insufficiency
A - anaemia
B - bone lesions

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42
Q

Why can tinnitus occur in severe anaemia?

A

Hyperdynamic circulation

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43
Q

Name some causes of microcytic anaemia

A 
Iron deficiency 
Anaemia of chronic disease
Thalassaemia
Hereditary spherocytosis 
Sideroblastic anaaemia
Hodgkin’s disease
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44
Q

What is dysfunctional in haemochromatosis?

A

DMT 1 transporters are overzealous in the duodenum

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45
Q

What is ferroportin?

A

A protein which dictates how much iron is brought into the circulation

46
Q

What cells recycle iron from RBCs?

A

Macrophages

47
Q

How is iron stored?

A

2/3 in RBCs
Intracellular ferritin in Spleen, liver and bone marrow
Myoglobin
Iron containing enzymes

48
Q

What is the natural iron turnover in a day?

A

1 mg

49
Q

What is the maximum iron that can absorbed from a diet?

A

20-25 mg/ day

50
Q

What will a blood film show in iron deficiency anaemia?

A

Variable RBC size and shape
Microcytes
Hypochromia
Target cells

51
Q

Why might ferritin be increased in an iron deficiency anaemia?

A

Ferritin is an acute phase reactant and therefore can by raised with acute inflammation

52
Q

What are the non-megaloblastic causes of macrocytosis?

A 
Chronic alcohol excess
Liver disease
Haemolysis 
Hypothyroidism 
Pregnancy
53
Q

What are the megaloblastic causes of macrocytosis?

A

B12 or folate deficiency
Primary bone marrow disorders eg. Myelodysplasia
Drugs interfering with DNA synthesis eg. Azathioprine

54
Q

What does megaloblastic mean?

A

The nucleus is more immature than the cytoplasm

55
Q

If B12 is low, what other test needs ordering?

A

Anti- IF

Intrinsic factor antibodies

56
Q

Give some causes of B12 deficiency

A

Pernicious anaemia
Post total gastrectomy
Vegan
Terminal ileum disease eg. Crohn’s, worms, diverticula

57
Q

How long do the body stores of B12 last?

A

2-3 years

58
Q

What are the causes of folate deficiency?

A

Poor diet
Increased requirement: pregnancy, haemolysis, haemodialysis
Malabsorption
Drugs eg. Trimethoprim

59
Q

How long do body stores of folate last?

A

3 months

60
Q

What are the serious complications of B12 deficiency?

A

Peripheral neuropathy

Subacute combined degeneration of cord

61
Q

What are the causes of normocytic anaemia?

A 
Acute blood loss
Anaemia of chronic disease
Renal failure
Marrow failure
Hypothyroidism 
Pregnancy
Haemolysis
62
Q

Name some hereditary causes of haemolysis

A

Sickle cell anaemia, thalassaemia
G6PD deficiency
Hereditary spherocytosis, elliptocytosis

63
Q

Name some acquired causes of haemolysis

A

Infections via complement activation
Physical damage eg. DIC
Drug induced
Autoimmune

64
Q

What is included in a haemolysis screen?

A 
FBC, reticulocyte count, blood film
Direct Coombs test
Bilirubin (unconjugated)
LDH
Haptoglobin
65
Q

What is the role of haptoglobin?

A

To mop up free Hb

66
Q

Beta 2 microglobulin is a tumour marker for …

A

Myeloma
CLL
some lymphomas

67
Q

What gene do we look for in CML?

A

BCR - ABL

68
Q

What is the tumour marker for non Hodgkin lymphoma?

A

CD20

69
Q

What are the haem red flags?

A 
Anaemia
Persistent or recurrent infections
Fever
Night sweats
Neck lumps
Unexplained bleeding or bruising 
Bone pain
Pruritus
70
Q

Describe Ann Arbor staging

A

I : 1 LN group involved
II: 2 LN groups on same side of diaphragm
III: >2 LN groups on both sides of diaphragm
IV: extralymphatic organ involvement

71
Q

Name some causes of mild splenomegaly

A

Acute splenitis
Acute congestion
Infectious mononucleosis
Acute febrile disorders

72
Q

Name some causes of moderate splenomegaly

A 
Chronic congestion
Acute leukaemia
Hereditary spherocytosis 
Thalassaemia major
AI haemolytic anaemia
Amyloidosis
73
Q

Name some causes of massive splenomegaly

A 
Chronic myeloproliferative disorders
CLL
Hair cell laeukaemia
Lymphomas
Malaria
Primary splenic neoplasms
74
Q

What can MGUS turn into?

A

Myeloma

75
Q

What is DIC?

A

Clotting system becomes overactive and clots form in the small vessels. This uses up all the clotting factors so it can lead to excessive bleeding

76
Q

Name some causes of DIC

A

Infections (sepsis)
Cancer
Trauma/major surgery
Pregnancy and childbirth

77
Q

What percentage of ALL occurs in children?

A

60%

78
Q

What percentage of AML occurs in children?

A

20%

79
Q

What percentage of CML associated with BCR ABL?

A

> 90%

80
Q

Name some risk factors for AML development

A

Prolonged exposure to benzene and petroleum
Prior chemotherapy with alkylating agents
Down syndrome
Bloom syndrome
Fanconi anaemia

81
Q

How does leukaemia present?

A

Fatigue
Bruising or bleeding esp mucosal surfaces
Fever
Infections

82
Q

What complications can hyperviscosity lead to?

A

Priapism
Tinnitus
Retinal haemorrhage
CVA

83
Q

What is the treatment for acute leukaemia?

A

Combination chemotherapy to achieve remission

Supportive therapies eg. Abx, RBCs, platelets

84
Q

Broadly, how is CLL treated?

A

Only treat if Sx arise
Chemotherapy
Steroids
Rituximab

85
Q

What percentage of patients with Hodgkin’s have a normal lifespan?

A

80

86
Q

When are the peaks for Hodgkin’s?

A

20s and 60s

87
Q

What is the most common subtype of Hodgkin’s?

A

Nodular sclerosing

88
Q

What investigations would you order for suspected Hodgkin’s?

A

FBC, ESR, U+E, LFT, ALP,LDH
Biopsy of involved LN
CXR and CT CAP
Consider BM biopsy

89
Q

What is the treatment of Hodgkin’s?

A

Stage 1-2a radiotherapy

Stage 2b + chemotherapy

90
Q

What is the combination chemo given for Hodgkin’s?

A

ABVD

Adriamycin, bleomycin, vinblastine, dacarbazine

91
Q

What factors would indicate a poor prognosis in Hodgkin’s?

A 
B symptoms
>45 years old
Bulky mediastinal disease
Extranodal involvement 
Decreased haematocrit or increased ESR
Increased CD30 and IL2
92
Q

What percentage of patients with Hodgkin’s have a normal lifespan?

A

80

93
Q

When are the peaks for Hodgkin’s?

A

20s and 60s

94
Q

What is the most common subtype of Hodgkin’s?

A

Nodular sclerosing

95
Q

What investigations would you order for suspected Hodgkin’s?

A

FBC, ESR, U+E, LFT, ALP,LDH
Biopsy of involved LN
CXR and CT CAP
Consider BM biopsy

96
Q

What is the treatment of Hodgkin’s?

A

Stage 1-2a radiotherapy

Stage 2b + chemotherapy

97
Q

What is the combination chemo given for Hodgkin’s?

A

ABVD

Adriamycin, bleomycin, vinblastine, dacarbazine

98
Q

What factors would indicate a poor prognosis in Hodgkin’s?

A 
B symptoms
>45 years old
Bulky mediastinal disease
Extranodal involvement 
Decreased haematocrit or increased ESR
Increased CD30 and IL2
99
Q

What is the median age of presentation of NHL?

A

50+

100
Q

What investigations would you do for suspected NHL?

A 
Excisional biopsy
FBC, U+E, LDH, Beta 2 microglobulin 
BM aspirate/trephine
CXR
CT CAO
101
Q

What is the management of low grade NHL?

A

Radiotherapy
Chemotherapy - cyclophosphamide, vinocristine
Prednisolone
Rituximab

102
Q

What is the management for intermediate or high grade NHL?

A

Radiotherapy and combination chemo

CHOP

103
Q

What is myeloma?

A

A clonal proliferation of mature plasma cells that secrete Ig leading to an overproduction of a single Ig class (paraprotein)

104
Q

What is the management of myeloma?

A 
Correct any deficits
Allopurinol 
Opiates and RT for bone pain
Chemo: cyclophosphamide, thalidomide and dexamethasone 
Stem cell transplant
105
Q

What is the 5 year survival of myeloma?

A

35%

106
Q

What is Waldenstroms macroglobulinaemia?

A

Rare type of slow growing NHL
Lymphoplasmacytic cells become abnormal and can build up in LNs, BM or Spleen
Makes large amounts of IgM

107
Q

Was is included in RCHOP therapy?

A 
Rituximab 
Cyclophosphamide 
Doxorubicin (hydroxy..)
Vincristine (oncovin)
Prednisolone
108
Q

What is RCHOP chemo used for?

A

Non-Hodgkins lymphoma

109
Q

What is included in ABVD chemo?

A

Doxorubicin (adriamycin)
Bleomycin
Vinblastine
Dacarbazine

110
Q

What is ABVD chemo used for?

A

Hodgkin lymphoma

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