Haematology Flashcards
What is anaemia?
Low Hb concentration due to reduced cell mass or increased plasma volume
Anaemia can be classified based on…
Mean Corpuscular Volume (MCV):
- Microcytic
- Normocytic
- Macrocytic
What are the general symptoms and signs of anaemia?
Symptoms:
- Fatigue
- Dyspnoea
- Palpitations
- Headache
Signs:
- Pallor
- Pale mucous membranes
- Tachycardia
What are the 3 main causes of microcytic anaemia?
- Iron deficiency
- Thalassaemia
- Anaemia of chronic disease
Where is iron absorbed in the body?
Duodenum
What are the causes of iron deficiency anaemia?
- Diet lacking in iron
- Malabsorption
- Hookworm
- Pregnancy and breastfeeding
Give some specific signs of iron deficiency anaemia
- Brittle hair and nails
- Atrophic glossitis
- Kolionychia
- Angular stomatitis
How is iron deficiency anaemia investigated?
- FBC will show hypochromic microcytic anaemia
- Serum ferritin: low
- Reticulocyte count: low
- Endoscopy: checking for possible GI bleed related cause
Describe the pharmacological management of iron deficiency anaemia
Ferrous sulfate
What are the side effects of the pharmacological management of iron deficiency anaemia?
Side effects of ferrous sulfate:
- Black stools
- GI disturbance: nausea, diarrhoea, constipation
- Epigastric abdominal pain
What are the 3 main causes of normocytic anaemia?
- Acute blood loss
- Combined haematinic deficiency (iron and B12)
- Anaemia of chronic disease
Give some examples of conditions which can result in a patient having anaemia of chronic disease
- CKD
- Rheumatoid arthritis
- SLE
- Cancer
GIve 3 main causes of macrocytic anaemia
- Pernicious anaemia (B12 deficiency)
- Folate deficiency
- Alcohol excess
Where in the body is folate absorbed?
Jejunum
What are the causes of folate deficiency?
- Diet lacking in folate
- Malabsorption
- Anti-folate drugs, e.g. Methotrexate
- Pregnancy
How is folate deficiency anaemia investigated?
- FBC: macrocytic anaemia
- Erythrocyte folate level: low
Describe the pharmacological management of folate deficiency anaemia
Folic acid
Where/how is vitamin B12 absorbed in the body?
- Terminal ileum
- Bound to intrinsic factor
Give a specific sign which may indicate pernicious anaemia
Neurological problems
What are the causes of pernicious anaemia?
- Diet lacking in vitamin B12
- Malabsorption
- Conditions affecting parietal cell function/intrinsic factor, e.g. gastrectomy, atrophic gastritis, autoimmune destruction of intrinsic factor
How is pernicious anaemia investigated?
- FBC: macrocytic anaemia
- Autoantibody screen
Describe the pharmacological management of pernicious anaemia
Vitamin B12
What is haemolytic anaemia?
When RBCs are destroyed before the normal lifespan of 120 days
What are the signs of haemolytic anaemia?
- Gallstones
- Jaundice
- Leg ulcers
- Splenomegaly
What are the causes of haemolytic anaemia?
Inherited and acquired causes
Inherited:
- Membranopathies
- Enzymopathies
- Haemoglobinopathies
Acquired:
- Autoimmine
- Infections
- Secondary to systemic disease
How is haemolytic anaemia investigated?
- Reticulocyte count: increased
- Blood film: presence of Schistocytes
Describe the pharmacological and interventional management of haemolytic anaemia
Pharmacological:
- Folate and iron supplementation
- Immunsuppression
Interventional:
- Splenectomy
What is aplastic anaemia?
Bone marrow failure - reduction in number of pluripotent stem cells causes lack of haemopoiesis (production of blood cells)
What are the symptoms/signs of aplastic anaemia?
- Increased susceptibility to infection
- Increased bruising
- Increased bleeding (especially from nose and gums)
How is aplastic anaemia investigated?
- FBC: pancytopenia
- Bone marrow biopsy: hepatocellular marrow with increased fat spaces
Describe the pharmacological and interventional management of aplastic anaemia
Pharmacological:
- Immunosuppression
Interventional:
- Blood/platelet transfusion
- Bone marrow transplant
What are the three haematological cancers we need to know?
- Lymphoma
- Myeloma
- Leukaemia
What is lymphoma? How is lymphoma classified?
Malignant neoplasm of mature lymphocytes in lymphoid tissue
Classified into:
Hodgkin’s
Non-hodgkin’s
What are the symptoms and signs of lymphoma?
Symptoms:
- Fever
- Night sweats
- Fatigue
- Weight loss
Signs:
- Painless lymphadenopathy
Describe the epidemiology of:
a) Hodgkin’s lymphoma
b) Non-hodgkin’s lymphoma
a) Bimodal incidence (young and old)
b) Mostly old
How is lymphoma investigated?
Lymph node biopsy (presence of Reed-Sternberg cells is diagnostic of Hodgkin’s lymphoma)
What is the name of the system used for staging lymphoma? Describe each of the stages
Ann Arbor system:
- Stage I: involvement of single lymph node region
- Stage II: involvement of two or more lymph node regions on same side of the diaphragm
- Stage III: involvement of lymph node regions ABOVE and BELOW the diaphragm
- Stage IV: diffuse extralymphatic disease
Describe the management of lymphoma
Chemotherapy and radiotherapy
Monoclonal antibodies, e.g. Rituximab
Give some factors which increase the risk of developing lymphoma
- Previous infection with Epstein Barr virus
- Immunosuppression, e.g. medication, HIV/AIDS
What is malaria?
Disease caused by Plasmodium parasite, which is transmitted via mosquito bite
Different types: Plasmodium falciparum is most common
What are the symptoms and signs of malaria?
FEVER AND EXOTIC TRAVEL = MALARIA UNTIL PROVEN OTHERWISE
Symptoms:
- Fever
- Fatigue
- Myaligia
- Diarrhoea/vomiting
Signs:
- Black urine
- Jaundice
- Hepatosplenomegaly
- Anaemia
How is malaria investigated?
- Thick blood film to show presence of parasites
- RDP (rapid diagnostic test) to detect plasmodium antigens
Describe the pharmacological management of malaria
Quinine
Doxycycline
What is deep vein thrombosis?
A blood clot that develops in a deep vein in the body, usually in the leg
Give some risk factors for developing a DVT
- Age
- Obesity
- Immobility, e.g. long haul flights, long-term bed rest
- Pregnancy
What are the symptoms and signs of DVT?
Symptoms:
- Hot, swollen, painful, red calf
Signs:
- Ankle oedema, pitting oedema
How is DVT investigated?
- D-dimer test for exclusion only - NOT diagnostic (-ve result = not DVT)
- Ultrasound doppler is diagnostic
Describe the pharmacological management of DVT
- LMW heparin
- Warfarin
How can DVT be prevented in hospital?
- Early mobilisation following surgery
- Compression stockings
- Leg elevation
Leukaemia can be divided into the following types…
Acute myeloid leukaemia (AML)
Acute lymphoblastic leukaemia (ALL)
Chronic myeloid leukaemia (CML)
Chronic lymphocytic leukaemia (CLL)
What is acute myeloid leukaemia?
Malignant neoplasm of immature white blood cells of the myeloid line (myeloblasts) in the bone marrow
What is acute lymphoblastic leukaemia?
Malignant neoplasm of immature white blood cells of the lymphoid line (lymphoblasts) in the bone marrow
Describe the epidemiology of acute myeloid leukaemia and acute lymphoblastic leukaemia
- AML is associated with older people
- ALL is the commonest childhood malignancy
What is chronic myeloid leukaemia?
Malignant neoplasm of mature white blood cells of the myeloid line (granulocytes and monocytes) in the bone marrow
What is chronic lymphocytic leukaemia?
Malignant neoplasm of mature white blood cells of the lymphoid line (lymphocytes) in the bone marrow
Which type of leukaemia is associated with the Philadelphia chromosome?
Chronic myeloid leukaemia
Describe the pathophysiology that leads to the symptoms of leukaemia
“Crowding out” of bone marrow with neoplastic white blood cells inhibits haemopoiesis (production of normal blood cells)
Describe the symptoms of leukaemia
Symptoms of anaemia:
- Dyspnoea
- Fatigue, weakness
- Palpitations
- Headache
Other symptoms:
- Increased susceptibility to infection/bruising/bleeding
- Bone pain
Describe the management of acute leukaemia
- Chemotherapy
- Bone marrow transplant
Describe the management of chronic leukaemia
- Chemotherapy
- CML: if Philadelphia chromosome positive = Imatinib (tyrosine kinase inhibitor)
What is myeloma?
Malignant neoplasm of plasma cells in the bone marrow
Describe the investigation of myeloma
- Bone marrow aspiration shows excess plasma cells
- X ray: pepperpot skull
- Bence Jones protein in urine
- Blood film - roleaux formation
Describe the management of myeloma
- Chemotherapy
- Bone marrow transplant
What is polycythaemia?
Increase in haemoglobin, packed cell volume and number of circulating RBCs
What types of polycythaemia are there?
- Primary (increased sensitivity to EPO), e.g. mutations in JAK2 gene, EPOR gene
- Secondary (increased production of EPO), e.g. due to renal cell carcinoma, hypoxia
Describe the investigation of polycythaemia
- FBC: haematocrit increased
- Genetic testing, e.g. for JAK2 gene mutation
Describe the management of primary and secondary polycythaemia
Primary = venesection, aspirin Secondary = treat cause, e.g. RCC
Describe the investigation of glucose 6 phosphate deficiency
Blood film - bite and blister cells
What is the definition of neutropenic sepsis?
Temp > 38 degrees
and absolute neutrophil count > 1 x 10^9
What syndrome can result from chemotherapy?
What is is characterised by?
How is it managed?
- Tumour lysis syndrome
- Hyperkalaemia, hyperuricaemia, hyperphosphataemia, hypocalcaemia
- To prevent give allopurinol
- To treat give urgent IV fluids and correct electrolytes
What is the mechanism of action of…
a) Heparin
b) Warfarin
a) Inhibition of factor Xa (coagulation cascade)
b) Inhibits activation of vitamin K stores in the body, so inhibits production of vitamin K-dependent clotting factors (10, 9, 7 and 2)
What scoring system is used for DVT?
Wells score
Give some categories and examples of red cell disorders
- Haemoglobinopathies, e.g. sickle cell disease (disorder of quality), thalassaemia (disorder of quanitity)
- Enzymopathies, e.g. glucose 6 phosphate deficiency
- Membranopathies, e.g. spherocytosis (vertical derformity), elliptocytosis (horizontal deformity)
Describe the investigation of sickle cell disease
Blood film: SICKLED erythrocytes
Describe the investigation of thalassaemia
Blood film: target cells
Describe the pathophysiology of thalassaemia
Ineffective erythropoiesis
Premature haemolysis
Describe the investigation of membranopathy
Blood film: osmotic fragility test
Describe the pathophysiology of thrombocytopenia
Reduced platelet production in bone marrow and increased peripheral destruction of platelets
