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Sheff Phase 4 > Haematology > Flashcards

Haematology Flashcards

1
Q

Macrocytic anaemia 3 DDx

A 
deficiencies of folate and vitamin B12, 
liver disease
alcohol excess
untreated hypothyroidism
myelodysplastic syndromes
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2
Q

macrocytic anaemia 3 Ix

A

B12/folate
thyroid functions tests
liver function tests
blood film to confirm macrocytosis and exclude myelodysplastic syndrome

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3
Q

Diet that often -> b12 deficiency?

A

vegan

[b12 in meat and dairy]

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4
Q

Pernicious anaemia is?

mx?

A

autoimmune condition with antibodies directed
against gastric parietal cells or intrinsic factor itself,
-> prevents absorption and binding of B12 from the diet

intramuscular hydroxycobalamin

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5
Q

Mx sickle cell crisis

A

high-flow oxygen, intravenous
fluids, thromboprophylaxis, antibiotics

consider transfusion

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6
Q

Why abx in sickle cell crisis

A

sickle cell patients will have autoinfarcted their spleen
in childhood, rendering them functionally
asplenic

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7
Q

3 causes of pleuritic chest pain

A
  • Pleural inflammation secondary to bacterial or viral chest infections
  • Pulmonary embolus
  • Asthma
  • Rib fractures/pathology
  • Subphrenic abscess/intra-abdominal sepsis
  • Lung masses
  • Connective tissue disorders/autoimmune disorders
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8
Q

Biochem common findings with upper GI bleed

A

acute - raised platelets
Urea raised - [more than creatinine]
Anaemia

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9
Q

Initial Mx of upper GI bleed ? After resus? Scoring system for upper GI bleed mortality?

A

good venous access (minimum of two large-bore cannulae),
Bloods FBC, LFT, clotting tests,
Group and save, and a cross-match for four units of packed red cells.
Volume replaced with colloid

After resus
All anticoagulants, antiplatelets, NSAIDs stopped
High dose PPI
Endoscopy within 24hrs

Rockall score

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10
Q

Name 3 causes of upper GI bleed

A 
–– Peptic ulcer disease
–– Oesophagogastric varices
–– Arteriovenous malformations
–– Mallory–Weiss tears
–– Tumours and erosions
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11
Q

Main DDx in an older person with normocytic anaemia

A

• Anaemia of chronic disease
• Most haemolytic anaemias
• Mixed causes of anaemia
- [If Iron and folate/b12 deficient it is possible that they ‘cancel’ each other out leading to a normal MCV]

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12
Q

Name 2 congenital causes of haemolytic anaemia

A

sickle cell disease,
thalassaemia,
glucose-6-phosphate dehydrogenase deficiency,
hereditary spherocytosis

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13
Q

Name 3 acquired causes of haemolytic anaemia

A 
Autoimmune
infections – particularly Mycoplasma pneumoniae or Clostridium perfringens
sepsis, 
drugs, 
burns, 
metallic heart valves
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14
Q

Basic bloods / Hx make you suspicious of autoimmune anaemia - what further Ix do you want?

A 
blood film, 
reticulocyte count, 
Coombs’ test, 
unconjugated bilirubin 
LDH
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15
Q

In autoimmune haemolytic anaemia, what provokes

their uptake by the reticuloendothelial system and promote red cell haemolysis

A

RBCs are coated in either

antibodies (IgG) or complement (C3d)

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16
Q

2 main DDx in rapid onset anaemia

A

bleeding

autoimmune

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17
Q

Mx of autoimmune haemolytic anaemia

A

remove any precipitating cause, and immunosuppression
with high-dose steroid therapy
[can add ciclospoin / azathioprine….. transfusion may be indicated]

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18
Q

Name 3 DDx of pancytopenia

A 
Post-chemotherapy (transient)
• Haematinic deficiency (B12 or folate)
• Autoimmune conditions
• Sepsis
• Bone marrow infiltration from lymphoma or other metastatic malignancy
• Myelodysplastic syndrome
• Acute or chronic leukaemias
• Acute viral infections
• Drug induced
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19
Q

Peripheral lymphocytosis DDx

A

ALL, CLL, Lymhoma

EBV, CMV

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20
Q

three most common causes for bilateral hilar lymphadenopathy

A

Sarcoidosis
lymphoma
TB

21
Q

name 3 causes of raised LDH

A
  • Myocardial injury
  • Malignancy (especially lymphoma)
  • Liver disease
  • Lung disease
  • Haemolysis
22
Q

DDx of thrombocytopenia

A
  • Immune thrombocytopenic purpura
  • Drug-induced thrombocytopenia
  • Acute viral infection (e.g. HIV, hepatitis C)
  • Sepsis
  • Underlying haematological malignancy/myelodysplastic syndrome
23
Q

Immune thrombocytopenic purpura
Lab findings?
Mx?

A

Low platelets - all other results normal [unless bleeding -> anaemia]

Steroids
-transfusion not indicated unless major haemorrhage

24
Q

Treatment of DVT in pregnancy

A

LWMH - usually continue throughout pregnancy

25
Q

Antibiotic that interacts with warfarin?

A

macrolides - erythromycin / clari

inhibit metabolism of warfarin -> increased INR

26
Q

Post surgery - sudden thrombocytopenia… What drug are you worried has caued? Other DDx?

A

herparin -> heparin induced thrombocytopenia
[autoimmune agaist heparin bound to platets]
[Usually occurs 5–14 days after exposure to
heparin]

sepsis / infection

ITP

27
Q

Anaemia with splenomegaly, thrombocytosis and a raised LDH Dx?
Usual mutation?
Mx?

A

myleofibrosis
JAK2

Supportive - analgesia / transfusion if required
JAK2 inhibitors [very few in development]
Definitive - allogenic stem cell transplant

28
Q

What is meant by apparent polycythemia?
true Pimary vs secondary ?

mx?

A

decrease in plasma volume
-haematocrit increases

Primary - myeloproliferative neoplasm usually JAK2
Secondary - Increased erythropoietin production

Venesection
hydroxycarbamide, - reduce platlet count

29
Q

Causes of secondary polycythemia

A
  • Chronic hypoxia (lung disease, heart disease, high altitude)
  • Long-term smoking
  • Abnormal haemoglobins
  • Increased erythropoietin production (renal tumours, other malignancies)
30
Q

Myelofibrosis features?
Key cell?

Differentiate from CML

A

fibrosis and ineffective erythropoiesis / marrow failure
Massive hepatosplenomegaly

Tear drop (dacrocytosis)

NO philidelphia chromosome

31
Q

Smear cells in

A

CLL

32
Q

B Sx

A

fever, night sweats, and weight loss

33
Q

Suspicious of lymphoma - Key things you’ll look for OE

A

lumps at lymph nodes

Hepato / splenomegaly

34
Q

Staging of lymphoma

A

ann arbour

35
Q

Name 3 signs pf iron deficient anaemia OE

A 
Tachy cardia /pnea 
Pallor 
Ejection systolic murmur 
angular cheilitis 
atrophic glossitis 
spoon shaped nails
36
Q

bar microcitic anaemia what other blood test findings in iron deficiency

A

low serum ferritin

raised total iron binding capacity

37
Q

Long term drugs sickle cell

A

hydroxyurea (hydroxycarbamide)
penicilin
folic acid

38
Q

most common Ig in myeloma

A

IgG

39
Q

3 Acute complications of myeloma

A

hypercalcaemia
spinal cord compression
hyperviscosity
acute renal failure

40
Q

2 Reasons why myeloma pt susceptible to infection

A

Bone marrow infiltration

Overexpression of 1 Ig -> Underexpression of others

41
Q

Drug and class for CML

A

imatinib - tyrosine kinase inhibitor (oral)

42
Q

What Hb level for transfusion regardless of Sx

A

<7g/dL

43
Q

2 Early and Late complications of transfusion

A 
Early - 
Acute haemolytic reaction
allergic / anaphylaxis
Transfusion related acute lung injury 
fluid overload 
Late 
Iron overload 
GVHD
Infection 
post transfusion purpura
44
Q

What is a massive transfusion?

A

transfusion of the entire volume of blood / 10 units in 24 hours

45
Q

2 types of macrocytic anaemia and an eg of each

A

megaloblastic - B12/folate deficiency, cytotoxic drugs

Non-megaloblastic - alcohol, liver disease, hypothyroid, pregnancy, reticulocytosis

46
Q

Ix for pernicious anaemia

mX

A

parietal cell / intrinsic factor antibody serology
shilling test

IM hydroxycobalamin

47
Q

Mx options Haem A

A

Factor VIII

Desmopressin

48
Q

How could a 70-year-old lady be Dx with Haemophilia

A

Aquired - autoantibodies to factor VIII

49
Q

When do you get alcohol induced pain

A

lymphoma

Sheff Phase 4 (26 decks)

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