Haematology Flashcards
What is anaemia?
A decrease in haemoglobin in the blood below the reference range
Anaemia - 3 Types
Microcytic - MCV <80
Normocytic - MCV 80-100
Macrocytic - MCV >100
Microcytic anaemia - Causes
Iron deficiency
Haemoglobinopathies (Thalassaemia)
CKD
Iron deficiency - Causes
Bleeding (Menorrhagia - heavy menstrual bleeding)
Poor diet/malabsorption
Breastfeeding
Iron deficiency - Investigation
Serum ferritin
Endoscopy - GI bleeding
What is reticulocyte count?
Rate at which RBCs are being made in bone marrow
Causes of raised and low reticulocyte count
Raised - blood loss, haemolytic anaemia
Low count - production problem (iron deficiency anaemia)
Iron deficiency - Symptoms
Atrophic glossitis
Brittle hair/nails
Angular stomatitis
Iron deficiency - Treatment
Ferrous sulphate (Iron tablets)
Ferrous sulphate - Side effects
Constipation Diarrhoea Nausea GI irritation Epigastric pain
Normocytic anaemia - Causes
Acute blood loss
CKD
Macrocytic anaemia - Causes
B12/folate deficiency
Alcoholism/liver disease
Hypothyroidism
3 sources of folate
Green vegetables
Fruit
Offal (animal organ meat)
Folate deficiency - Causes
Malabsorption
Poor diet
Pregnancy (increased demand)
Pernicious anaemia - Pathophysiology
Vitamin B12 malabsorption, B12 needed for RBC production
Pernicious anaemia - Treatment
Vit B12 injections/tabs
B12 deficiency - Causes
Atrophic gastritis
Gastrectomy
Crohn’s disease
Coeliac disease
Anaemia - Signs and symptoms
Signs - Pale skin, tachycardia
Symptoms - Fatigue, faintness, breathlessness, reduced exercise tolerance
Why might patients on anti-coag drugs (warfarin) be over anti-coagulated?
Bad patient compliance
Artificial valves
New/interacting drugs
Over anti-coagulation - Symptoms
Bruising Bleeding Haemoptysis (coughing up blood from lungs/bronchi) Haematemesis (vomiting of blood) Epistaxis - nose bleed
What is disseminated intravascular coagulation (DIC) ?`
Thrombosis followed by bleeding
Disseminated intravascular coagulation (DIC) - Causes
Malignancy Septicaemia Pregnancy Trauma Infection Liver disease
Disseminated intravascular coagulation (DIC) - Treatment
Blood transfusion
Thrombocytopenia - Causes
Reduced platelet production in bone marrow
Excessive peripheral destruction of platelets
Enlarged spleen
Immune thrombocytopenic purpura (ITP) - Pathophysiology
Autoimmune destruction of platelets
Immune thrombocytopenic purpura (ITP) - Symptoms
Easy bruising
Epistaxis (nose bleeds)
Menorrhagia (menstrual bleeding)
Purpura (skin haemorrhages)
Immune thrombocytopenic purpura (ITP) Investigations
Blood tests - Reduced platelets, detection of platelet autoantibodies
Immune thrombocytopenic purpura (ITP) - Treatment
Prednisolone (corticosteroid)
Splenectomy
Deep vein thrombosis (DVT) - Virchow’s triad
Stasis
Vessel wall injury
Hypercoagulability
DVT/thromboembolism - Causes
Age Obesity Varicose veins Long haul traveling Immobility/bed rest Plasminogen deficiency Thrombophilia Pregnancy
DVT/thromboembolism - Symptoms
Calf pain/swelling/warmth
Ankle oedema
Pitting oedema
DVT/thromboembolism - Investigations
FBC - platelets
Doppler - Wells scote
DVT/thromboembolism - Treatment
Heparin
Warfarin
NOACs
DVT/thromboembolism - Prevention
Stockings
Leg elevation
What is polycythaemia?
Increase in Hb, PCV (packed cell volume) and RBCs
Polycythaemia - Primary causes
Polycythaemia vera - genetic mutation in JAK2 gene, increased RBC production due to bone marrow cells more sensitive to Epo (erythropoietin)
Primary familial/congenital polycythaemia - genetic mutation in EPOR gene, increased RBC production in response to Epo
Polycythaemia - Secondary causes
More RBCs due to more circulating Epo due to (Chronic hypoxia, high altitude - poor O2 delivery, tumours releasing excess Epo)
Polycythaemia - Symptoms
Easy bleeding/bruising
Fatigue
Dizziness
Headaches
Polycythaemia - Investigations
FBC
Bone marrow biopsy
Genetic testing for JAK2 gene
Polycythaemia - Treatment
Blood letting
Aspirin (reduces clots)
Chronic myeloid leukaemia - Pathophysiology
Proliferation of myeloid cells
Chronic myeloid leukaemia - Signs and symptoms
Signs - Splenomegaly, hepatomegaly, anaemia, bruising
Symptoms - Weight loss, tiredness, fever, sweats, bleeding, abdo discomfort
Chronic myeloid leukaemia - Investigations
FBC - Raised WCC (all myeloid cells raised - neutrophils, macrophages, basophils)
Cytogenetics (PCR/FISH/karyotype) - Philadelphia chromosome
Chronic myeloid leukaemia - Treatment
Imatinib/dasatinib (Tyrosine kinase inhibitor)
Hydroxycarbimide (chemo)
Stem cell transplant (curative outcome)
Chronic lymphocytic leukaemia - Pathophysiology
Accumulation of mature B cells that have escaped apoptosis
Chronic lymphocytic leukaemia - Signs and symptoms
Signs - Enlarged rubbery non-tender nodes, splenomegaly, hepatomegaly
Symptoms - Anaemia, weight loss, sweats, anorexia
Chronic lymphocytic leukaemia - Investigations
FBC - Raised lymphocytes RAI staging (1-5 scale)
Chronic lymphocytic leukaemia - Complications
Autoimmune haemolysis (decreased RBCs)
Infection
Marrow failure
Chronic lymphocytic leukaemia - Treatment
Stem cell transplant
Rituximab (Chemo)
Radiotherapy
Acute lymphocytic/myeloid leukaemia - Pathophysiology
Lymphocytic - Malignancy of T/B cell lines
Myeloid - Malignancy of myeloid cell lines
Acute lymphocytic/myeloid leukaemia - Epidemiology
Lymphocytic - Childhood
Myeloid - Adults
Acute lymphocytic/myeloid leukaemia - Signs and symptoms
Lymphocytic - Bone pain, marrow failure, hepatosplenomegaly, lymphadenopathy, cranial nerve palses, meningism
Myeloid - Marrow failure, hepatosplenomegaly, gum hypertrophy
Acute lymphocytic/myeloid leukaemia - Investigation
Lymphocytic - FBC (Low RBC, low platelets), clotting screen (DIC occurs), lumbar puncture, cytogenetics
Myeloid - FBC (Low RBC, low platelets), clotting screen (DIC occurs)
Acute lymphocytic /myeloid leukaemia - Treatment
Supportive - bloods, platelets, fluids
Chemo
Bone marrow transplant
Marrow failure - Deficiencies
Hb
WBC
Platelets
Marrow failure - Signs and symptoms
Anaemia
Tiredness
Recurrent infections
Thrombocytopenia - bruising, nose/gums bleeding
Difference between lymphoma and leukaemia
Leukaemia - Malignancy of lymphocyte precursors arising in bone marrow
Lymphoma - Malignancy of mature lymphocytes arising in lymphatics
Lymphoma - 2 Types
Hodgkin’s lymphoma - Reed-sternberg cells
Non-hodgkin’s lymphoma - No reed-sternberg cells
Hodgkin’s lymphoma - Signs and symptoms
Signs - Enlarged lymph nodes, hepatosplenomegaly
Symptoms - Painless, non-tender rubbery lymph node enlargement (cervical, axillary, inguinal), fever, weight loss, night sweats, alcohol-induced lymph node pain, lethargy (lack of energy/enthusiasm)
Hodgkin’s lymphoma - Investigation
Biopsy
Histology (Reed-sternberg cells)
Ann-arbor system (1-4 scale)
Hodgkin’s lymphoma - Treatment
Chemo
Radio
Non-hodgkin’s lymphoma - Pathophysiology
Lymphoma without reed-sternberg cells
Includes gastric MALT (Mucosa associated lymphoid tissue)
Non-hodgkin’s lymphoma - Risk factors
H.pylori
HIV
Toxins
Non-hodgkin’s lymphoma - Symptoms
Same as hodgkin’s
Also GI symptoms - Abdo pain, diarrhoea, vomiting
Non-hodgkin’s lymphoma - Treatment
Chemo - Rituximab
Prednisolone (steroid)
Myeloma - Pathophysiology
Malignant proliferation of plasma B lymphocytes accumulating in bone marrow, leading to overproduction of Ig causing renal dysfunction
Myeloma - Signs and symptoms (CRAB)
Hypercalcaemia
Renal impairment (Decreased urine output, oedema)
Infection
Anaemia
Thrombocytopenia (bleeding)
Osteolytic bone lesions (Pepperpot skull - fractures)
Backache
Myeloma - Investigations
Bloods - Raised urea and creatinine
X-ray of skull (Pepperpot skull)
Myeloma - Complications
Hypercalcaemia
Spinal cord compression
Hyperviscosity
Acute kidney injury
Myeloma - Treatment
Analgesia and bisphosphonates (bone pain)
Transfusion (anaemia)
Chemo
Warfarin overdose - Treatment
Vit K
Beriplex
Anaemia - 3 Types and their Causes
Microcytic - Iron deficiency
Normocytic - Blood loss
Macrocytic - B12/Folate deficiency
