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Finals > Haematology > Flashcards

Haematology Flashcards

1
Q

which Ig is raised in acute infection

A

IgM

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2
Q

what are the iron storage compounds

A

hemosiderin (tissues) and ferritin (blood)

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3
Q

what inhibits iron absorption from small bowel? where is it secreted from?

A

hepcidin

liver

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4
Q

what can cause iron overload?

A

haemochromatosis (low hepcidin)
thalassaemia
excess intake - diet, oral therapy, transfusions

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5
Q

what does a low mean cell HB (MCH) suggest?

A

hypochromic anaemia

- iron deficiency, thalassaemia, AOCD

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6
Q

what does a high//low reticulocyte count suggest

A

high: haemolytic anaemia, active bleed
low: impaired RBC production (kidney failure, chronic disease, aplasia - BM disease)

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7
Q

causes of microcytic anaemia

A

hypochromic: iron deficiency / sideroblastic / thalassaemia
normochromic: chronic disease

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8
Q

blood findings in anaemia of chronic disease

A

microcytic
normochromic
low reticulocytes

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9
Q

investigations in iron deficient anaemia

A

microcytosis
low iron and ferritin
GI investigations - endoscopy, colonoscopy

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10
Q

management of iron deficient anaemia

A

oral ferrous sulfate aiming for >10 Hb increase per week
continue for 3/12 after return to normal level
may use IV in kidney disease/ poor absorption

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11
Q

how much should 1 unit RBCs increase Hb?

A

10g/L

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12
Q

causes of sideroblastic anaemia

A

congenital / dysplasia - myeloma / MDS

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13
Q

blood findings in sideroblastic anaemia

A

high iron and ferritin(cant be made into Hb)
low Hb
low haematocrit
hypochromic

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14
Q

causes of normocytic anaemia

A

aplastic

haemolytic: SCA, GPD6, autoimmune, infection

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15
Q

what is aplastic anaemia, presentation and management

A

normocytic anaemia
pancytopenia
infections , anaemia, thrombocytopenia - bleeding and bruising
neutropenic regimen and transfusions

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16
Q

blood findings in haemolytic anaemia

A

raised reticulocytes, bilirubin and LDH

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17
Q

normocytic anaemia with raised reticulocytes and coombs test +ve? treatment

A

acquired immune mediated haemolytic anaemia
IgG = warm type - steroids
IgM = cold type - keep warm

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18
Q

haemolytic anaemia , coombs test -ve ?

A

non immune mediated anaemia

infection, trauma, DIC, TTP, HUS, liver disease

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19
Q

haemolytic anaemia with heinz bodies on blood films? causes?

A

GPD6 deficiency

x linked - triggered by aspirin, antimalarials, cephalosporins, fava beans, infection

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20
Q

management of GPD6 deficieny

A

folic acid

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21
Q

normoblastic causes of macrocytic anaemia

A

pregnancy, liver disease, myelodysplasia, hypothyroidism

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22
Q

causes of megaloblastic macrocytic anaemia

A

pernicious anaemia, B12 defic, folate defic

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23
Q

a macrocytic megaloblastic anaemia without neuro signs is due to what? (+hypersegmented neutrophils)

A

folate deficiency

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24
Q

causes of folate deficiency, symptoms and treatment ?

A

malnutrition, alcoholism, bowel disease/malabsorption, pregnancy, methotrexate, trimethoprim, antiepileptics

macrocytic anemia, weight loss, anorexia, tachycardia

PO folic acid for 4 months (correct B12 first)

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25
Q

should you correct B12 or folic acid first ? and Why?

A

b12

subacute degeneration of the cord

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26
Q

what can cause B12 deficiency?

A

malnutrition, alcoholism, malabsorption, pernicious anaemia

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27
Q

presentation of B12 deficiency?

A 
macrocytic anaemia
lemon skin - jaundice and pallor
posterior column degeneration - upgoing plantars, loss of reflexes
paresthesia
ataxia
sub acute degeneration of the cord
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28
Q

triad of symptoms in B12 deficinecy

A

anemia
neuropsych
peripheral neuropathy

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29
Q

management of B12 deficieny

A

IM hydroxocobalamin + folic acid

30
Q

investigations in pernicious aneamia

A 
intrinsic factor Ab, antiparietal cell Ab
serum gastrin (raised)
schillings test - B12 uptake scan
31
Q

what are the myeloproliferative disorders

A

polycythaemia (RBCs)
CML (WBCs)
myelofibrosis (stroma)

32
Q

management of sickle cell bone crisis

A 
cross match blood
analgesia
O2
warm fluids
Abx
blood transfusion
33
Q

management of sickle cell chest crisis

A 
oxygen
spirometry
broad spec Abx
transfusion
fluids
34
Q

diagnosis of sickle cell

A

new born blood screen

presents around 4 months - howell jolley bodies on film and Hb electrophoresis

35
Q

male toddler bleeding into muscle and joints?

A

haemophilia

36
Q

teenager having mucocutaneous bleeding +/- menorrhagia?

A

von willebrand’s disease

37
Q

will APTT be normal/high/low inhameophillia?

A

increased

38
Q

management of hemophilia A and B

A

A: recombinant factor 8
B: recombinant factor 9

39
Q

management of VWD

A

recombinant factor 8

40
Q

young woman with mucocutaneous bleeding and solitary low platelets? management

A

immune thrombocytopenia

IVIg , prednisolone, platelets

41
Q

pentad in thrombotic thrombocytopenic purpura

A
  1. thrombocytopenia,
  2. microangiopathic haemolytic anaemia,
  3. fever,
  4. renal abnormalities,
  5. neurological abnormalities
42
Q

presentation of thrombotic thrombocytopenic purpura

A

child with prodrome of bloody diarrhoea (e. coli/ shigella)

fever, AKI, anaemia, thrombocytopenia

43
Q

ill patient with generalised bleeding for >3 sites? management?

A

DIC

ICU, platelets, FFP

44
Q

investigations in DIC

A

decreased platelets, fibrinogen, clotting factors (5&8)

increased PT, aPTT, D-dimer

45
Q

causes of acquired thrombophilia

A

antiphospholipid syndrome
OCP
pregnancy

46
Q

causes of inheritied thrombophilia

A 
factor V leidin
protein C defic
protein S defic
antithombin defic
prothrombin mutation
47
Q

what should be screened for in unprovoked VTE?

A 
factor V leidin
protein C defic
protein S defic
antithombin defic
prothrombin mutation
48
Q

how do you reverse warfarin?

A

vitamin k - takes 24h

prothrombin complex

49
Q

which drugs affect platelet function and which affect coagulation cascade?

A

platelets: aspirin and clopidogrel
coagulation: warfarin (factors 2,7,9,10) heparin

50
Q

causes of massive splenomegaly

A

CML
malaria
myelofibrosis

51
Q

what is factor V leiden?

A

activated protein C deficiency

52
Q

how does thalassemia present?

A

microcytic anaemia
skull bossing
hepatosplenomegaly

53
Q

diagnosis of thalassaemia

A

Hb electrophoresis

54
Q

how does leukemia present?

A

pancytopenia - infections, anaemia, bleeding/ bruising

55
Q

what do you see on peripheral film in leukaemia

A

blast cells

56
Q

most common leukaemia in children? investigations?

A

acute lymphoblastic
CXR and CT - mediastinal widening
LP - CNS involvement

57
Q

management of ALL

A

chemo (remission inducing, consolidation, maintenance - 2 years)
CNS prophylaxis - methotrexate
allogenic bone marrow transplant

58
Q

most common form of leukaemia in adults? investigations?

A

chronic lymphocytic anaemia
raised lymphocytes
peripheral film - smudge and smear cells
CT - binet staging

59
Q

management of CLL

A

stage A-B: WW

C-D: chemo and BM transplant

60
Q

what haematological malignancy is associated with the philadelphia chromosome?

A

chronic myeloid leukaemia

61
Q

investigations and management in CML?

A

FISH cytogenetics - philadelphia
BM biopsy - hypercellular/ hypergranular
imatinib - tyrosine kinase i

62
Q

what is AML associated with?

A

auer rods on biopsy

rapidly progressive

63
Q

what can trigger hodgkins lymphoma

A

EBV, SLE, RA

64
Q

what differentiates HL from NHL

A

HL has reed sternberg cells

65
Q

staging in lymphoma?

A

Ann Arbour

66
Q

some examples of non hodgkin’s lymphoma and triggers

A 
MALT - H pylori
diffuse B cell - HIV
Burkitt's - EBV
also primary CNS and follicular
other triggers: SLE, RA, sjogren's, coeliac
67
Q

diagnosis should be queried in unresolving back pain

A

multiple myeloma

68
Q

investigations when ?multiple myeloma

A

ESR, blood film, electrophoresis

69
Q

diagnosis of multiple myeloma

A

monoclonal proteins in blood/urine (bence jones) on electrophoresis

increased plasma cells on BM biopsy

end organ damage (kidney, hypercalcaemia, anaemia)

osteolytic bone lesions

70
Q

management of multiple myeloma

A 
manage the symptoms 
chemo
dexamethasone
bone marrow transplant
VTE prophylaxis 
plasmapheresis

monitor 6/12 with urine

71
Q

osteoporosis + raised ESR is what until proven otherwise?

A

multiple myeloma

Finals (18 decks)

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