Haematology Flashcards
1
Q
What is myeloma?
A
A malignant tumour of the bone marrow, characterised by monoclonal proteins
2
Q
What are the common features of myeloma?
A
- tiredness and malaise
- bone/back pain
- infections
- non-specific
3
Q
What investigations would you do for myeloma?
A
- FBC = generally anaemic
- ESR = raised
- high calcium
4
Q
What is amyloidosis?
A
- Build-up of an abnormal protein called amyloid in organs and tissues throughout the body.
- Can lead to organ failure
5
Q
What is the treatment for myeloma?
A
- Control symptoms (pain medication) and supportive measures
- chemotherapy and steroids
- radiotherapy - ‘spot welding’
6
Q
What are the 4 things to remember with myeloma?
A
- CRAB
- calcium
- renal
- anaemia
- bone disease
7
Q
Name the types of leukaemia.
A
- Acute Myeloid leukaemia (AML)
- Chronic Myeloid leukaemia (CML)
- Acute lymphoblastic leukaemia (ALL)
- Chronic lymphocytic leukaemia (CLL)
8
Q
What is leukaemia?
A
- malignant proliferation of haemopoietic cells
9
Q
What are the general symptoms of leukaemia?
A
- anaemia
- SOB/fatigue
- thrombocytopenia - bruising and rash
- infection - fevers/rigors
10
Q
What are the basic investigations for leukaemia?
A
- FBC
- coagulation screen
- bone marrow aspirate and trephine biopsy
11
Q
What is chronic myeloid leukaemia (CML)?
A
- The proliferation of myeloid cells
- 15% of leukaemias
- Mostly 40-60 year olds
12
Q
What are the symptoms of CML?
A
- insidious (gradual)
- weight loss
- tiredness
- fever/sweats
- bleeding
13
Q
What are the signs of CML?
A
- Splenomegaly (most common) - enlargement of spleen
- Hepatmegaly
- Anaemia and bruising
14
Q
What investigations would you do for CML?
A
- FBC - raised WCC (all). Hb = low/normal
- Cytogenetics FISH/PCR - show Philadelphia chromosome
15
Q
What is the 1st line treatment for CML?
A
- Imatinib
- 2nd line is dasatinib
16
Q
What are other treatments for CML?
A
- chemotherapy - hydroxycarbimide
- stem cell treatment - only cure, used mainly in younger patients
17
Q
What is chronic lymphocytic leukaemia (CLL)?
A
- Accumulation of mature B cells that have escaped programmed cell death
- Commonest leukaemia
18
Q
What are the symptoms for CLL?
A
- Often asymptomatic
- Anaemia/prone to infection
- weight loss
- anorexia
19
Q
What are the signs for CLL?
A
- Enlarged rubbery non-tender nodes
- Splenomegaly
20
Q
What are the investigations for CLL?
A
FBC - raised lymphocytes
21
Q
What are the complications with CLL?
A
- Autoimmune haemolysis leading to decreased RBCs
- infection
- marrow failure
22
Q
What is the treatment for CLL?
A
- Often none required in early disease
- More advanced = rituximab
23
Q
What is acute lymphocytic leukaemia (ALL)?
A
- Malignancy of B/T lymphocyte cell lines
- Commonest cancer of childhood
24
Q
What are the symptoms and signs of ALL?
A
- bone pain
- marrow failure
- Enlarged liver and spleen
- CNS involvement - cranial nerve palsies
25
What is acute myeloid leukaemia (AML)?
- Malignancy of myeloid cell lines
| - Commonest acute leukaemia in adults
26
What are the symptoms and signs of AML?
- Marrow failure
- Infiltration
- gum hypertrophy
27
What investigations are used in ALL?
- FBC = decreased RBC and platelets
- Blood film = basts cells unless confined to bone marrow
- Lumbar puncture - CNS involvement
28
What is the treatment for ALL?
- Supportive e.g. blood/fluids
- Chemotherapy
- bone marrow transplantation
29
What investigations are used in AML?
- FBC = decreased RBC and platelets
| - Clotting screen = DIC may occur
30
What is the treatment for AML?
- Supportive
| - Chemotherapy
31
What is lymphoma?
- A malignant growth of white blood cells, predominantly in the lymph nodes
32
How does lymphoma present?
- Variety of ways
- Nodal disease
- Enlarged liver/spleen
- Systemic symptoms e.g. weight loss, fever etc.
33
How is lymphoma diagnosed?
- Blood film
- cytogenetics
- lymph node biopsy = most common
- diagnosis is COMPLEX
34
How is lymphoma categorized?
- With a WHO performance status
| - varies from 0 being asymptomatic to 3 being symptomatic, but not bed-bound and 5 being death
35
How does Hodgkin Lymphoma present?
- painless non-tender, RUBBERY lymph node enlargement
| - B symptoms e.g. sweats and weight loss
36
What is the treatment for Hodgkin lymphoma?
- Stages 1-2A = combination chemo then radio
| - Stage 2B-4 = combination chemo
37
What is the epidemiology of Hodgkin Lymphoma?
- peak incidence in young adults and elderly
| - risk factors include obesity and post-transplantation
38
What is Non-Hodgkin lymphoma?
- All lymphomas without Reed-Sternberg cells
39
What are the symptoms of non-hodgkin lymphoma?
- painless non-tender, RUBBERY lymph node enlargement
| - skin involvement
40
What is the treatment for non-hodgkin lymphoma?
- Chemo and radiotherapy
41
What is the prognosis for NHL?
- Variable but generally worse than Hodgkin's
42
What is anaemia?
- Reduced red cell mass = +/- Hb concentration
43
What are the different types of anaemia?
- Microcytic = MCV <80
- Normocytic = MCV 80-100
- Macrocytic = MCV >100
44
How does microcytic anaemia present?
- Iron deficiency
| - Thalassaemia - Hb disorder
45
How would you investigate iron deficiency?
- Measure serum ferritin
46
What would a raised reticulocyte count show?
Blood loss or haemolytic anaemia
47
What would a decreased reticulocyte count show?
Production problem, potentially seen in iron deficiency anaemia
48
What are the symptoms of iron deficiency?
- Koilonychia (spoon nails)
- Angular stomatitis - affects corners of mouth
- Atrophic glossitis
- Brittle hair and nails
49
How do you treat iron deficiency?
- Ferrous sulphate - iron tablets
50
What are the side effects of ferrous sulphate?
- BLACK STOOL
- Constipation
- Diarrhoea
- Epigastric pain
- GI irritation
- Nausea
51
How does normocytic anaemia present?
- Acute blood loss
| - combined haematinic deficiency
52
How does macrocytic anaemia present?
- B12/folate deficiency
- Alcohol excess/liver disease
- Metabolic disease e.g. hypothyroidism
53
What are the symptoms and signs of anaemia?
- Fatigue
- Faintness
- Breathlessness
- Reduced exercise tolerance
- Pale skin
- tachycardia
54
What are other causes of B12 deficiency?
- Atrophic gastritis
- Gastrectomy
- Crohn's Disease
- Coeliac Disease
55
What is sickle cell disease?
Group of inherited conditions that affect RBCs, with the most serious being sickle cell anaemia
56
What are symptoms of sickle cell disease?
- Issues in bones
- Avascular necrosis
- Osteoarthritis
- PAH
- Acute chest syndrome is the worst
57
How would you manage sickle cell disease?
- Transfusion = with non-sickle cell blood
58
What is neutrophilia and why can it occur?
- Too many white blood cells
| - Infection, inflammation and malignancy
59
What can cause low iron levels?
- low iron diet
- blood loss
- breastfeeding
- hookworm
- malabsorption
- pregnancy
60
What can cause a folate deficiency?
- Poor folate diet
- malabsorption
- pregnancy
- anti-folate drugs (methotrexate)
61
What are the 3 categories for red cell disorders?
- Haemoglobinopathy
- Membranopathy
- Enzymopathy
62
What is membranopathy?
- Autosomal dominal condition causing a deficiency in a protein used to make red cell membrane
63
What are the symptoms of membranopathy?
- Neonatal jaundice
- Enlarged spleen
- gallstones
64
What is the treatment for membranopathy?
- Folic acid
| - Splenectomy
65
Which patients might be over anti-coagulated?
- Vit K antagonists e.g. warfarin
| - NOACs e.g. apaxiban
66
What are the symptoms of over prescribing anti-coagulants?
- bruising
- bleeding
- epistaxis
