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Yr 3 ALS > Haematology > Flashcards

Haematology Flashcards

1
Q

Haematocrit

A

Volume of RBC’s: Total blood volume

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2
Q

Transferrin

A

Iron transport in plasma

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3
Q

Ferritin

A

Iron storage

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4
Q

Iron deficiency anemia

  • Type
  • Diagnostics
  • Clinical signs
A
  • Microcytic
  • Low Fe, Low Ferritin, High Total Fe Binding
  • Post cricoid webs, angular stomatitis, koilinychia, atrophic glossitis
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5
Q

Sideroblastic anemia

  • Type
  • Causes
  • Histology sign
A
  • Microcytic
  • Congenital & Acquired (alcohol, mylodysplasia, cancer, anti-TB regimes)
  • Sideroblasts in bone marrow (erythrocytes with iron deposits)
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6
Q

Beta-Thalassemia

A

Dysfunction of Hb chains causing a microcytic anemia

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7
Q

Anemia of chronic disease

  • Cause and type
  • Diagnostics
  • Treatment options for a patient in renal failure
A
  • A combination of decreased Iron release, EPO release and RBC survival. Normocytic anemia
  • Low Fe, Fe binding capacity, normal ferritin
  • Recombinant EPO
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8
Q

Aplastic anemia

  • Type and etiology
  • Causes
  • Diagnostics - histology features
A
  • Normocytic (sometimes microcytic). caused by hypocellular marrow and blood cell complete deficiency
  • Congenital, ideopathic, benzenes, chemo, HIV/Hep
  • Pancytopenia, hypocellular marrow (increased fat spaces)
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9
Q

Name 4 causes of normocytic haemolytic anemia

A
  • Spherocytosis
  • Thalessemia
  • Sickle cell
  • G6PD deficiency
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10
Q

Name 5 causes of acquired haemolytic anemia

A
  • Autoimmune
  • Transfusion reactions
  • Haemolytic disease of the newborn
  • Prosthetic valves
  • Drugs: eg dapsone (blister RBC’s) and penicillin
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11
Q

Name two subtypes of macrocytic anemia

A
  • Megaloblastic bone marrow

- Normoblastic bone marrow

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12
Q

Causes of megalobastic anemia and histological signs

A
  • B12 and folate deficiency

- Hypersegmented neutrophils

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13
Q

Causes of Normoblastic anemia

A
  • alcohol
  • liver disease
  • hypothyroidism
  • pregnancy
  • drugs
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14
Q

Name the autoimmune type of macrocytic anemia

A

Pernicious anemia

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15
Q
  • Aetiology of pernicious anemia
  • Associated conditions
  • Risk
  • Diagnostics
  • Treatment
A
  • Autoimmune atrophy of gastric mucosa due to deficiency of intrinsic factor. Decreased B12 and folate
  • Blood group A, Thyroid disease, Addisons, Rheumatoid
  • Predisposes gastric carcinoma
  • Hypersegmented neutrophils, low WCC, low B12 and folate, autoAb’s parietal cells and I factor
  • IM “balamin” B12 + folate injection
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16
Q

Polycythaemia Vera

  • Diagnostic picture
  • Aetiology
A
  • High RBC. Hb, haematocrit, WCC/Plt

- Secondary to hypoxia or abnormal EPO secretion - cancer and myloproliferative diseases

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17
Q

Thrombotic sickle cell crisis

A
  • Painful and vaso-occlusive
  • Precipitated by infection/dehdration
  • Can cause necrosis and infarct
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18
Q

Sequestration sickle cell crisis

A

-Sickling within organs (spleen and lungs) causing pooling of blood

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19
Q

Acute sickle cell chest syndrome

A

-SOB, chest pain and hypoxia, pulmonary infiltrates

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20
Q

Sickle cell aplastic crisis

A
  • Associated with Parvovirus

- Suddenfall in Hb and reticulocytes

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21
Q

Haemolytic sickle cell crisis

A

-Rare and sudden fall in Hb due to increased haemolysis

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22
Q

Features of Hodgkins lymhoma, hallmark cell found on node biopsy and associated viruses

A
  • More common in men
  • Reed-Sternberg cells “Owl” (from B cells)
  • Associated with CMV and EBV
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23
Q

What subtype of Hodgkins lymphoma is associated with fibrotic bands/ lacuner cells and is the most common form

A

Nodular Sclerosing Lymphoma

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24
Q

What subtype of hodgkins lymphoma is more common in men and has the best prognosis

A

Lymphocyte rich lymphoma

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25
Q

Which subtype of Hodgkins lymphoma is linked to EBV and is not associated with fibrotic bands

A

Mixed cellularity lymphoma

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26
Q

What subtype of Hodgkins of lymphoma has the poorest prognosis and is associated with immunosupression (HIV).

A

Lymphocyte depleted lymphoma

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27
Q

What diagnostic test is indicative of poor prognosis of Hodgkins lymphoma

A

Serum lactate dehydrogenase LDH

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28
Q

What is the staging for Hodgkins Lymphoma

A

Ann Arbour

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29
Q

Gold standard treatment regime for Hodgkins Lymphoma

A

ABVD+ Radio

  • Adriamycin
  • Bleomycin
  • Vinblastine
  • Dacarbazine
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30
Q

How to differentiate between Hodgkins and non Hodgkins lymphoma

A
  • No Reed-Sternberg cells (owl cells)

- more common in older generations

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31
Q

Low grade lymphoma

  • Prognostic course
  • 3 types (MFL)
A
  • Relapse and remit, although less aggressive are less curable
  • MALT, Follicular, Lymphocytic
32
Q

High grade lymphoma

  • Prognostic course
  • 4 types
A
  • More aggressive but more likely to be cured

- Burkitt, Lymphoblastic, Diffuse, Large B cell

33
Q

What Virus is associated with Burkitts lymphoma and why is this.
What is the microscopic sign associated with Burkitts

A
  • Malaria lowers resistance to EBV

- Starry Sky microscopic sign

34
Q

Chemo regime for High grade lymphoma

A 
R-CHOP
R = Rituximab
C = Cyclophosphamide
H = Hydroxydaunorubicin
O = Oncovin
P = Prednisolone
35
Q

Associated diagnostic features of Myloma

A
  • Rogue Ig formation
  • IgG/IgA (Bence Jones Proteins) G most common
  • M-bands
  • Light chains
  • Rouleax Formation on blood film
36
Q

Haematological side effect of Myloma

A

Hyper-viscosity syndrome = Increased blood cells

37
Q

Symptoms of Myloma (Hyper-CRAB)

A
  • Hyperviscosity
  • Calcium
  • Renal failure
  • Anemia
  • Bone lesions
38
Q

AML

  • Population most effected
  • Histological sign
  • Genetics
  • Staging
A
  • Older adults (80% adult leukemia)
  • Auer rods and blast cells
  • PML-RAR genes 15:17
  • French-American -British (FAB)
39
Q

ALL

  • Population most effected
  • Histological sign
  • Staging
A
  • Most common childhood type - associated with Downs!
  • Always blast cells
  • French-American-British
40
Q

CML

  • Population most effected
  • Most common symptoms
  • Genetics
  • Complications
  • Treatment
A
  • Almost exclusively adults
  • Slow progression, asymptomatic or hepatosplenomegaly
  • Philadelphia chromosome t(9:22) translocation + BCR-abl
  • Blast crisis = final stage, behaves like acute. May become AML
  • Tyrosine Kinase inhibitors
41
Q

CLL

  • Population most effected
  • Symptoms
  • Histological sign (HINT: crushed little lads)
  • Staging
  • 2 complications
A
  • Most commonly older adults (commonest in western world 55+)
  • Pancytopenia
  • Smudge/Smear cells
  • Rai Staging
  • Warm haemolytic anemia and hypogammaglobulinemia
42
Q

Richter syndrome and diagnostic feature

A

CLL transforms into aggressive non-hodgkins lymphoma

-Lactate dehydrogenase

43
Q

Common complication of lytic metastasis and diagnostic feature

A
  • Hypercalcemia

- High ALP

44
Q

Treat bony metastasis (2 drugs)

A
  • Biphosphanates

- Denosumab

45
Q

What Leukemia is most likely to be precursor by mylodysplastic syndrome

A

AML

46
Q

Acute Haemolytic transfusion reaction

  • Aetiology
  • Symptoms
  • Treatment
A
  • Due to mismatch ABO group
  • Fever or hemolysis within 24hrs
  • Halt transfusion/replace fluid and dialayse if necessary
47
Q

Delayed Haemolytic transfusion reaction

  • Aetiology
  • Symptoms
  • Treatment
A
  • Undetectable Ab levels or new Ags formed against new blood
  • Less severe form of acute
  • Supportive often no treatment needed
48
Q

Febrile non-haemolytic transfusion reaction

  • Aetiology
  • Symptoms
  • Treatment
A
  • Release of inflammatory signals from donor blood WBC
  • Fever
  • Halt transfusion and give antipyretic
49
Q

Allergy or anaphylactic transfusion reaction

-Treatment

A

-Halt transfusion and give antihistamine or adrenaline

50
Q

Purpura transfusion reaction

  • Aetiology
  • Symptoms
  • Treatment
A
  • Rare thrombocytopenia due to anibodies against platelets
  • Purple skin
  • IV immunoglobulins
51
Q

TACO & TRALI Treatment

A

-Supportive care

52
Q

Graft vs Host Reaction

  • Timeline
  • Patient group at risk
  • Treatment
A
  • 1 wk post transfusion
  • High mortality, immunosupressed patient
  • Immunosupression
53
Q

VW Disease

  • Genetics
  • Symptoms
  • Diagnostics
A

-Autosomal dominant
-Mucosal/Gi bleeding, bruising and menorrhagia
+APTT, +Bleeding time

54
Q

Hemophilia A

  • Genetics
  • Factor affected
  • Symptoms
  • Diagnostics
A

-X-Linked recessive
-Factor VIII
-Joint bleeds, haematuria, IC hemorrhage
+APTT, Normal Bleed time, +Prothrombin time

55
Q

Hemophilia B (Christmas disease)

  • Genetics
  • Factor affected
  • Symptoms
  • Diagnostics
A
  • X-Linked recessive - less common
    -Factor IX
    -Joint bleeds, haematuria, IC hemorrhage, nosebleeds
    +APTT, Normal Bleed time, Normal Prothrombin time`
56
Q

Drug contraindication with bleeding disorders

A

NSAID’s

57
Q

Fresh Frozen plasma

  • Content
  • Indication
A
  • Whole blood without RBC + clotting factors

- Used for those with significant clotting problems

58
Q

Cryoprecipitate

  • Content
  • Indication
A
  • Factor 8, 13, VWF, Fibronectin. Produced from FFP

- Used to replace fibrinogen, often given to hemophiliacs and VW disease. No cross match needed

59
Q

Prothrombin complex

  • Content
  • Indication
A
  • Factors 2, 9 and 10

- Reversal of anticoagulant with hemorrhage (warfarin)

60
Q

Platelets

  • Indication
  • Risk
A
  • Treat bleeding patients with low platelet count eg cancer/chemo
  • Bacterial cross contamination due to warmer storage
61
Q

Sepsis 6

HINT: OBALFU

A
  • O2 titrate to 94%
  • Blood cultures
  • Antibiotics IV
  • Lactate serial measurements
  • Fluid replacement
  • Urine output
62
Q

MOA Riveroxaban

A

Direct Factor Xa Inhibitor

63
Q

MOA Dabigatran

A

Direct Thrombin Inhibitor

64
Q

Neoadjuvant and Adjuvant chemo

HINT: A=After

A 
Neoadjuvant = Before surgery
Adjuvant  = mop up after surgery
65
Q

Thrombophilia - other name and mechanism

A

Hypercoagulablity - excess clotting capacity = DVT risk

66
Q

thrombocytopenic purpura - symptoms

A

Decreased platelets - can be autoimmune or thrombotic

Bruising and petechiea

67
Q

What histological sybtype are most Head and Neck cancers

A

Squamus cell carcinoma

68
Q

Oropharyngeal cancer

  • R:factors
  • Patient profile
A
  • HPV biggest risk factor

- younger, non smokers, richer

69
Q

Nasopharyngeal cancer

  • R:factors
  • Patient profile
A
  • EPB virus associated

- Common in south China and Taiwain by a lot

70
Q

Treatment head and neck cancers

A

Surgery and radio

*surgery especially used in oral cancers

71
Q

3 Types of antiemetics

A
  • Dopamine antagonists
  • Antihistamine
  • 5-hydroxytryptamine (5-Ht3 antagonist)
72
Q

Dopamine antagonists

  • examples
  • sites action
  • SE
A
  • Domperidome + Metocloperamide
  • Antagonise D2 receptors in CRTZ also on GIT = accelerate GI emptying
  • extrapyramidal, tardive dyskinesia, hyperprolactineamia
73
Q

Anti-emetic antihistamine

  • example
  • sites action
  • SE
A
  • Cyclizine
  • Antagonise H1 receptors CRTZ and reduce transmission from vestibular apparatus to CRTZ
  • Drowsiness, anti-muscarining, contraindicated BPH
74
Q

5-hydroxytryptamine (5-Ht3 antagonist)

  • example
  • clinical indication
  • sites action
  • SE
A
  • Ondansetron
  • 5-HT3 receptors in CRTZ + GIT
  • Often post op and chemo
  • ↑QT, constipation, ↓BP/HR
75
Q

Absolute contraindications for anti-emesis

A

GI obstruction or haemmorhage

Yr 3 ALS (10 decks)

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