Haematology Flashcards
Deep venous thrombosis - Diagnosis
- Plasma D-dimer
- Fibrinogen degradation product when clot dissolves
- Not diagnostic -> raised in cancer, preg, post-op - Compression ultrasound
- Popliteal V
Anaemia - Definition
Decrease of Hg in blood below ref ranges for age and sex of individual.
Due to decreased cell mass or increased plasma volume
Macrocytic Anaemia - Causes
- B12 deficiency
- Folate deficiency
- Alcohol excess
- Hypothyroidism
- Immunosuppression
Chronic Myeloid Leukaemia - Cause
Translocation of a gene on chromosome 9 and 22 (BCR/ABL fusion gene)
Tyrosine kinase activity
Stimulate cell division Philadelphia chromosome
Hodgkin’s vs Non-Hodgkin’s lymphoma
HL - Reed sternberg cells (mirror image nuclei)
NHL - no characteristic cells
Hodgkin’s Lymphoma - Ann Arbor classification
I - single lymph node region II - 2+ nodes on same side of diaphragm III - Nodes on both diaphragm IV - Beyond lymph nodes - Liver A/B - B symptoms (fever, weight loss, night sweats)
Tumour lysis syndrome - Definition
- Life threatening
2. Malignant cells breakdown - neuro, cardio and renal complications
Tumour lysis syndrome - Signs
- High uric acid
- Hyperkalaemia
- Hypocalcaemia
- Hyperphosphatemia
Hyperkalcaemia - ECG
- Loss of P waves
- Wide QRS complex
- Tall tended T waves
Tumour lysis syndrome - Treatment
- Aggressive hydration
- Allopurinol (xanthine oxidase inhibitor) / rasburicase (recombinant urate oxidase) –> reduce uric acid production
- Monitor electrolytes –> refer to dialysis
Acute lymphoblastic Leukaemia - Clinical presentation
- Anaemia
- Infection
- Bleeding
- Bone pain
- Lymphadenopathy
Acute lymphoblastic leukaemia - Diagnosis
- High WCC
- Blast cells on blood film / bm
- CXR and CT scan –> mediastinal and abdo lymphadenopathy
- Lumbar puncture –> CNS involvement
Febrile neutropenia - Definition
- T> 38 degrees
2. Absolute neutrophil count <1 x109 / L
Myeloma - Pathology
- Cancer of plasma cells
- Progressive bm failure
(cytokines –> stim osteoclast and inhibit osteoblast) - Monoclonal paraprotein
- Immunoparesis
- Hypercalcaemia
Hodgkin’s lymphoma - Treatment
R-CHOP R = Rituximab (monoclonal Ab --> CD20 expressed on B cells) C = Cyclophosphamide H = Hydroxy-daunorubicin O = Oncovin (vincristine) P = Prednisolone
Early - 3mths
Late - 6mths w radiotherapy
Hodgkin’s Lymphoma - Epidemiology
- Male
- Teenagers 13-19
- Elderly >65
- EBV
Myeloma - X ray
- Lytic “punched out” lesions
- Pepper pot skull
- Vertebral collapse - Fractures
- Osteoporosis
Ondansetron
- Anti-emetic drug
2. 5HT2 antagonist
Microcytic anaemia - Causes
- Iron deficiency anaemia
- Anaemia of chronic disease
- Thalassaemia
Sickle Cell Anaemia - reticulocytes
Increased
Bacterial infection = raised …
Neutrophils
Febrile neutropenia - Treatment
- Broad spectrum IV antibiotics w/out waiting for results w/in 1hr of admission
- Do not catheterise if neutropenic –> increased infection risk
Aspirin - How it works
- Inhibits cyclo-oxygenase (COX) irreversibly
2. Inhibits thromboxane formation –> less platelet aggregation
Thalassaemia - Blood film
Target cells
Glucose-6-phosphate dehydrogenase deficiency - Diagnosis
- Blood count normal b/ween attacks
- Blood film in attack
- Irregularly contracted cells
- Increased reticulocytes
- BIte cells (indentation in membrane) - Low G6PD enzyme levels
Hypochromic anaemia
Pale
Microcytic
Folate deficiency - causes
- Poor intake
- Increased demand
- Malabsorption
- Anti-folate drugs (methotrexate)
DVT - risk factors
- Obesity
- Immobility
- Varicose V
- Pregnancy
- Trauma