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Phase 2a > Haematology > Flashcards

Haematology Flashcards

1
Q

What is anaemia?

A

Low Hb concentration due to reduced cell mass or increased plasma volume

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2
Q

Anaemia can be classified based on…

A

Mean Corpuscular Volume (MCV):

  • Microcytic
  • Normocytic
  • Macrocytic
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3
Q

What are the general symptoms and signs of anaemia?

A

Symptoms:

  • Fatigue
  • Dyspnoea
  • Palpitations
  • Headache

Signs:

  • Pallor
  • Pale mucous membranes
  • Tachycardia
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4
Q

What are the 3 main causes of microcytic anaemia?

A
  • Iron deficiency
  • Thalassaemia
  • Anaemia of chronic disease
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5
Q

Where is iron absorbed in the body?

A

Duodenum

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6
Q

What are the causes of iron deficiency anaemia?

A
  • Diet lacking in iron
  • Malabsorption
  • Hookworm
  • Pregnancy and breastfeeding
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7
Q

Give some specific signs of iron deficiency anaemia

A
  • Brittle hair and nails
  • Atrophic glossitis
  • Kolionychia
  • Angular stomatitis
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8
Q

How is iron deficiency anaemia investigated?

A
  • FBC will show hypochromic microcytic anaemia
  • Serum ferritin: low
  • Reticulocyte count: low
  • Endoscopy: checking for possible GI bleed related cause
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9
Q

Describe the pharmacological management of iron deficiency anaemia

A

Ferrous sulfate

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10
Q

What are the side effects of the pharmacological management of iron deficiency anaemia?

A

Side effects of ferrous sulfate:

  • Black stools
  • GI disturbance: nausea, diarrhoea, constipation
  • Epigastric abdominal pain
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11
Q

What are the 3 main causes of normocytic anaemia?

A
  • Acute blood loss
  • Combined haematinic deficiency (iron and B12)
  • Anaemia of chronic disease
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12
Q

Give some examples of conditions which can result in a patient having anaemia of chronic disease

A
  • CKD
  • Rheumatoid arthritis
  • SLE
  • Cancer
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13
Q

GIve 3 main causes of macrocytic anaemia

A
  • Pernicious anaemia (B12 deficiency)
  • Folate deficiency
  • Alcohol excess
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14
Q

Where in the body is folate absorbed?

A

Jejunum

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15
Q

What are the causes of folate deficiency?

A
  • Diet lacking in folate
  • Malabsorption
  • Anti-folate drugs, e.g. Methotrexate
  • Pregnancy
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16
Q

How is folate deficiency anaemia investigated?

A
  • FBC: macrocytic anaemia

- Erythrocyte folate level: low

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17
Q

Describe the pharmacological management of folate deficiency anaemia

A

Folic acid

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18
Q

Where/how is vitamin B12 absorbed in the body?

A
  • Terminal ileum

- Bound to intrinsic factor

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19
Q

Give a specific sign which may indicate pernicious anaemia

A

Neurological problems

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20
Q

What are the causes of pernicious anaemia?

A
  • Diet lacking in vitamin B12
  • Malabsorption
  • Conditions affecting parietal cell function/intrinsic factor, e.g. gastrectomy, atrophic gastritis, autoimmune destruction of intrinsic factor
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21
Q

How is pernicious anaemia investigated?

A
  • FBC: macrocytic anaemia

- Autoantibody screen

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22
Q

Describe the pharmacological management of pernicious anaemia

A

Vitamin B12

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23
Q

What is haemolytic anaemia?

A

When RBCs are destroyed before the normal lifespan of 120 days

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24
Q

What are the signs of haemolytic anaemia?

A
  • Gallstones
  • Jaundice
  • Leg ulcers
  • Splenomegaly
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25
Q

What are the causes of haemolytic anaemia?

A

Inherited and acquired causes

Inherited:

  • Membranopathies
  • Enzymopathies
  • Haemoglobinopathies

Acquired:

  • Autoimmine
  • Infections
  • Secondary to systemic disease
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26
Q

How is haemolytic anaemia investigated?

A
  • Reticulocyte count: increased

- Blood film: presence of Schistocytes

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27
Q

Describe the pharmacological and interventional management of haemolytic anaemia

A

Pharmacological:

  • Folate and iron supplementation
  • Immunsuppression

Interventional:
- Splenectomy

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28
Q

What is aplastic anaemia?

A

Bone marrow failure - reduction in number of pluripotent stem cells causes lack of haemopoiesis (production of blood cells)

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29
Q

What are the symptoms/signs of aplastic anaemia?

A
  • Increased susceptibility to infection
  • Increased bruising
  • Increased bleeding (especially from nose and gums)
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30
Q

How is aplastic anaemia investigated?

A
  • FBC: pancytopenia

- Bone marrow biopsy: hepatocellular marrow with increased fat spaces

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31
Q

Describe the pharmacological and interventional management of aplastic anaemia

A

Pharmacological:
- Immunosuppression

Interventional:

  • Blood/platelet transfusion
  • Bone marrow transplant
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32
Q

What are the three haematological cancers we need to know?

A
  • Lymphoma
  • Myeloma
  • Leukaemia
33
Q

What is lymphoma? How is lymphoma classified?

A

Malignant neoplasm of mature lymphocytes in lymphoid tissue

Classified into:
Hodgkin’s
Non-hodgkin’s

34
Q

What are the symptoms and signs of lymphoma?

A

Symptoms:

  • Fever
  • Night sweats
  • Fatigue
  • Weight loss

Signs:
- Painless lymphadenopathy

35
Q

Describe the epidemiology of:

a) Hodgkin’s lymphoma
b) Non-hodgkin’s lymphoma

A

a) Bimodal incidence (young and old)

b) Mostly old

36
Q

How is lymphoma investigated?

A

Lymph node biopsy (presence of Reed-Sternberg cells is diagnostic of Hodgkin’s lymphoma)

37
Q

What is the name of the system used for staging lymphoma? Describe each of the stages

A

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
38
Q

Describe the management of lymphoma

A

Chemotherapy and radiotherapy

Monoclonal antibodies, e.g. Rituximab

39
Q

Give some factors which increase the risk of developing lymphoma

A
  • Previous infection with Epstein Barr virus

- Immunosuppression, e.g. medication, HIV/AIDS

40
Q

What is malaria?

A

Disease caused by Plasmodium parasite, which is transmitted via mosquito bite
Different types: Plasmodium falciparum is most common

41
Q

What are the symptoms and signs of malaria?

A

FEVER AND EXOTIC TRAVEL = MALARIA UNTIL PROVEN OTHERWISE

Symptoms:

  • Fever
  • Fatigue
  • Myaligia
  • Diarrhoea/vomiting

Signs:

  • Black urine
  • Jaundice
  • Hepatosplenomegaly
  • Anaemia
42
Q

How is malaria investigated?

A
  • Thick blood film to show presence of parasites

- RDP (rapid diagnostic test) to detect plasmodium antigens

43
Q

Describe the pharmacological management of malaria

A

Quinine

Doxycycline

44
Q

What is deep vein thrombosis?

A

A blood clot that develops in a deep vein in the body, usually in the leg

45
Q

Give some risk factors for developing a DVT

A
  • Age
  • Obesity
  • Immobility, e.g. long haul flights, long-term bed rest
  • Pregnancy
46
Q

What are the symptoms and signs of DVT?

A

Symptoms:
- Hot, swollen, painful, red calf

Signs:
- Ankle oedema, pitting oedema

47
Q

How is DVT investigated?

A
  • D-dimer test for exclusion only - NOT diagnostic (-ve result = not DVT)
  • Ultrasound doppler is diagnostic
48
Q

Describe the pharmacological management of DVT

A
  • LMW heparin

- Warfarin

49
Q

How can DVT be prevented in hospital?

A
  • Early mobilisation following surgery
  • Compression stockings
  • Leg elevation
50
Q

Leukaemia can be divided into the following types…

A

Acute myeloid leukaemia (AML)
Acute lymphoblastic leukaemia (ALL)

Chronic myeloid leukaemia (CML)
Chronic lymphocytic leukaemia (CLL)

51
Q

What is acute myeloid leukaemia?

A

Malignant neoplasm of immature white blood cells of the myeloid line (myeloblasts) in the bone marrow

52
Q

What is acute lymphoblastic leukaemia?

A

Malignant neoplasm of immature white blood cells of the lymphoid line (lymphoblasts) in the bone marrow

53
Q

Describe the epidemiology of acute myeloid leukaemia and acute lymphoblastic leukaemia

A
  • AML is associated with older people

- ALL is the commonest childhood malignancy

54
Q

What is chronic myeloid leukaemia?

A

Malignant neoplasm of mature white blood cells of the myeloid line (granulocytes and monocytes) in the bone marrow

55
Q

What is chronic lymphocytic leukaemia?

A

Malignant neoplasm of mature white blood cells of the lymphoid line (lymphocytes) in the bone marrow

56
Q

Which type of leukaemia is associated with the Philadelphia chromosome?

A

Chronic myeloid leukaemia

57
Q

Describe the pathophysiology that leads to the symptoms of leukaemia

A

“Crowding out” of bone marrow with neoplastic white blood cells inhibits haemopoiesis (production of normal blood cells)

58
Q

Describe the symptoms of leukaemia

A

Symptoms of anaemia:

  • Dyspnoea
  • Fatigue, weakness
  • Palpitations
  • Headache

Other symptoms:

  • Increased susceptibility to infection/bruising/bleeding
  • Bone pain
59
Q

Describe the management of acute leukaemia

A
  • Chemotherapy

- Bone marrow transplant

60
Q

Describe the management of chronic leukaemia

A
  • Chemotherapy

- CML: if Philadelphia chromosome positive = Imatinib (tyrosine kinase inhibitor)

61
Q

What is myeloma?

A

Malignant neoplasm of plasma cells in the bone marrow

62
Q

Describe the investigation of myeloma

A
  • Bone marrow aspiration shows excess plasma cells
  • X ray: pepperpot skull
  • Bence Jones protein in urine
  • Blood film - roleaux formation
63
Q

Describe the management of myeloma

A
  • Chemotherapy

- Bone marrow transplant

64
Q

What is polycythaemia?

A

Increase in haemoglobin, packed cell volume and number of circulating RBCs

65
Q

What types of polycythaemia are there?

A
  • 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
66
Q

Describe the investigation of polycythaemia

A
  • FBC: haematocrit increased

- Genetic testing, e.g. for JAK2 gene mutation

67
Q

Describe the management of primary and secondary polycythaemia

A 
Primary = venesection, aspirin
Secondary = treat cause, e.g. RCC
68
Q

Describe the investigation of glucose 6 phosphate deficiency

A

Blood film - bite and blister cells

69
Q

What is the definition of neutropenic sepsis?

A

Temp > 38 degrees

and absolute neutrophil count > 1 x 10^9

70
Q

What syndrome can result from chemotherapy?
What is is characterised by?
How is it managed?

A
  • Tumour lysis syndrome
  • Hyperkalaemia, hyperuricaemia, hyperphosphataemia, hypocalcaemia
  • To prevent give allopurinol
  • To treat give urgent IV fluids and correct electrolytes
71
Q

What is the mechanism of action of…

a) Heparin
b) Warfarin

A

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)

72
Q

What scoring system is used for DVT?

A

Wells score

73
Q

Give some categories and examples of red cell disorders

A
  • 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)
74
Q

Describe the investigation of sickle cell disease

A

Blood film: SICKLED erythrocytes

75
Q

Describe the investigation of thalassaemia

A

Blood film: target cells

76
Q

Describe the pathophysiology of thalassaemia

A

Ineffective erythropoiesis

Premature haemolysis

77
Q

Describe the investigation of membranopathy

A

Blood film: osmotic fragility test

78
Q

Describe the pathophysiology of thrombocytopenia

A

Reduced platelet production in bone marrow and increased peripheral destruction of platelets

Phase 2a (16 decks)

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