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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
should you correct B12 or folic acid first ? and Why?
b12 | subacute degeneration of the cord
26
what can cause B12 deficiency?
malnutrition, alcoholism, malabsorption, pernicious anaemia
27
presentation of B12 deficiency?
``` macrocytic anaemia lemon skin - jaundice and pallor posterior column degeneration - upgoing plantars, loss of reflexes paresthesia ataxia sub acute degeneration of the cord ```
28
triad of symptoms in B12 deficinecy
anemia neuropsych peripheral neuropathy
29
management of B12 deficieny
IM hydroxocobalamin + folic acid
30
investigations in pernicious aneamia
``` intrinsic factor Ab, antiparietal cell Ab serum gastrin (raised) schillings test - B12 uptake scan ```
31
what are the myeloproliferative disorders
polycythaemia (RBCs) CML (WBCs) myelofibrosis (stroma)
32
management of sickle cell bone crisis
``` cross match blood analgesia O2 warm fluids Abx blood transfusion ```
33
management of sickle cell chest crisis
``` oxygen spirometry broad spec Abx transfusion fluids ```
34
diagnosis of sickle cell
new born blood screen presents around 4 months - howell jolley bodies on film and Hb electrophoresis
35
male toddler bleeding into muscle and joints?
haemophilia
36
teenager having mucocutaneous bleeding +/- menorrhagia?
von willebrand's disease
37
will APTT be normal/high/low inhameophillia?
increased
38
management of hemophilia A and B
A: recombinant factor 8 B: recombinant factor 9
39
management of VWD
recombinant factor 8
40
young woman with mucocutaneous bleeding and solitary low platelets? management
immune thrombocytopenia | IVIg , prednisolone, platelets
41
pentad in thrombotic thrombocytopenic purpura
1. thrombocytopenia, 2. microangiopathic haemolytic anaemia, 3. fever, 4. renal abnormalities, 5. neurological abnormalities
42
presentation of thrombotic thrombocytopenic purpura
child with prodrome of bloody diarrhoea (e. coli/ shigella) | fever, AKI, anaemia, thrombocytopenia
43
ill patient with generalised bleeding for >3 sites? management?
DIC | ICU, platelets, FFP
44
investigations in DIC
decreased platelets, fibrinogen, clotting factors (5&8) | increased PT, aPTT, D-dimer
45
causes of acquired thrombophilia
antiphospholipid syndrome OCP pregnancy
46
causes of inheritied thrombophilia
``` factor V leidin protein C defic protein S defic antithombin defic prothrombin mutation ```
47
what should be screened for in unprovoked VTE?
``` factor V leidin protein C defic protein S defic antithombin defic prothrombin mutation ```
48
how do you reverse warfarin?
vitamin k - takes 24h | prothrombin complex
49
which drugs affect platelet function and which affect coagulation cascade?
platelets: aspirin and clopidogrel coagulation: warfarin (factors 2,7,9,10) heparin
50
causes of massive splenomegaly
CML malaria myelofibrosis
51
what is factor V leiden?
activated protein C deficiency
52
how does thalassemia present?
microcytic anaemia skull bossing hepatosplenomegaly
53
diagnosis of thalassaemia
Hb electrophoresis
54
how does leukemia present?
pancytopenia - infections, anaemia, bleeding/ bruising
55
what do you see on peripheral film in leukaemia
blast cells
56
most common leukaemia in children? investigations?
acute lymphoblastic CXR and CT - mediastinal widening LP - CNS involvement
57
management of ALL
chemo (remission inducing, consolidation, maintenance - 2 years) CNS prophylaxis - methotrexate allogenic bone marrow transplant
58
most common form of leukaemia in adults? investigations?
chronic lymphocytic anaemia raised lymphocytes peripheral film - smudge and smear cells CT - binet staging
59
management of CLL
stage A-B: WW | C-D: chemo and BM transplant
60
what haematological malignancy is associated with the philadelphia chromosome?
chronic myeloid leukaemia
61
investigations and management in CML?
FISH cytogenetics - philadelphia BM biopsy - hypercellular/ hypergranular imatinib - tyrosine kinase i
62
what is AML associated with?
auer rods on biopsy | rapidly progressive
63
what can trigger hodgkins lymphoma
EBV, SLE, RA
64
what differentiates HL from NHL
HL has reed sternberg cells
65
staging in lymphoma?
Ann Arbour
66
some examples of non hodgkin's lymphoma and triggers
``` MALT - H pylori diffuse B cell - HIV Burkitt's - EBV also primary CNS and follicular other triggers: SLE, RA, sjogren's, coeliac ```
67
diagnosis should be queried in unresolving back pain
multiple myeloma
68
investigations when ?multiple myeloma
ESR, blood film, electrophoresis
69
diagnosis of multiple myeloma
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
management of multiple myeloma
``` manage the symptoms chemo dexamethasone bone marrow transplant VTE prophylaxis plasmapheresis ``` monitor 6/12 with urine
71
osteoporosis + raised ESR is what until proven otherwise?
multiple myeloma

Finals (18 decks)

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