Haematology Flashcards
Haematocrit
Volume of RBC’s: Total blood volume
Transferrin
Iron transport in plasma
Ferritin
Iron storage
Iron deficiency anemia
- Type
- Diagnostics
- Clinical signs
- Microcytic
- Low Fe, Low Ferritin, High Total Fe Binding
- Post cricoid webs, angular stomatitis, koilinychia, atrophic glossitis
Sideroblastic anemia
- Type
- Causes
- Histology sign
- Microcytic
- Congenital & Acquired (alcohol, mylodysplasia, cancer, anti-TB regimes)
- Sideroblasts in bone marrow (erythrocytes with iron deposits)
Beta-Thalassemia
Dysfunction of Hb chains causing a microcytic anemia
Anemia of chronic disease
- Cause and type
- Diagnostics
- Treatment options for a patient in renal failure
- A combination of decreased Iron release, EPO release and RBC survival. Normocytic anemia
- Low Fe, Fe binding capacity, normal ferritin
- Recombinant EPO
Aplastic anemia
- Type and etiology
- Causes
- Diagnostics - histology features
- Normocytic (sometimes microcytic). caused by hypocellular marrow and blood cell complete deficiency
- Congenital, ideopathic, benzenes, chemo, HIV/Hep
- Pancytopenia, hypocellular marrow (increased fat spaces)
Name 4 causes of normocytic haemolytic anemia
- Spherocytosis
- Thalessemia
- Sickle cell
- G6PD deficiency
Name 5 causes of acquired haemolytic anemia
- Autoimmune
- Transfusion reactions
- Haemolytic disease of the newborn
- Prosthetic valves
- Drugs: eg dapsone (blister RBC’s) and penicillin
Name two subtypes of macrocytic anemia
- Megaloblastic bone marrow
- Normoblastic bone marrow
Causes of megalobastic anemia and histological signs
- B12 and folate deficiency
- Hypersegmented neutrophils
Causes of Normoblastic anemia
- alcohol
- liver disease
- hypothyroidism
- pregnancy
- drugs
Name the autoimmune type of macrocytic anemia
Pernicious anemia
- Aetiology of pernicious anemia
- Associated conditions
- Risk
- Diagnostics
- Treatment
- 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
Polycythaemia Vera
- Diagnostic picture
- Aetiology
- High RBC. Hb, haematocrit, WCC/Plt
- Secondary to hypoxia or abnormal EPO secretion - cancer and myloproliferative diseases
Thrombotic sickle cell crisis
- Painful and vaso-occlusive
- Precipitated by infection/dehdration
- Can cause necrosis and infarct
Sequestration sickle cell crisis
-Sickling within organs (spleen and lungs) causing pooling of blood
Acute sickle cell chest syndrome
-SOB, chest pain and hypoxia, pulmonary infiltrates
Sickle cell aplastic crisis
- Associated with Parvovirus
- Suddenfall in Hb and reticulocytes
Haemolytic sickle cell crisis
-Rare and sudden fall in Hb due to increased haemolysis
Features of Hodgkins lymhoma, hallmark cell found on node biopsy and associated viruses
- More common in men
- Reed-Sternberg cells “Owl” (from B cells)
- Associated with CMV and EBV
What subtype of Hodgkins lymphoma is associated with fibrotic bands/ lacuner cells and is the most common form
Nodular Sclerosing Lymphoma
What subtype of hodgkins lymphoma is more common in men and has the best prognosis
Lymphocyte rich lymphoma
Which subtype of Hodgkins lymphoma is linked to EBV and is not associated with fibrotic bands
Mixed cellularity lymphoma
What subtype of Hodgkins of lymphoma has the poorest prognosis and is associated with immunosupression (HIV).
Lymphocyte depleted lymphoma
What diagnostic test is indicative of poor prognosis of Hodgkins lymphoma
Serum lactate dehydrogenase LDH
What is the staging for Hodgkins Lymphoma
Ann Arbour
Gold standard treatment regime for Hodgkins Lymphoma
ABVD+ Radio
- Adriamycin
- Bleomycin
- Vinblastine
- Dacarbazine
How to differentiate between Hodgkins and non Hodgkins lymphoma
- No Reed-Sternberg cells (owl cells)
- more common in older generations
Low grade lymphoma
- Prognostic course
- 3 types (MFL)
- Relapse and remit, although less aggressive are less curable
- MALT, Follicular, Lymphocytic
High grade lymphoma
- Prognostic course
- 4 types
- More aggressive but more likely to be cured
- Burkitt, Lymphoblastic, Diffuse, Large B cell
What Virus is associated with Burkitts lymphoma and why is this.
What is the microscopic sign associated with Burkitts
- Malaria lowers resistance to EBV
- Starry Sky microscopic sign
Chemo regime for High grade lymphoma
R-CHOP R = Rituximab C = Cyclophosphamide H = Hydroxydaunorubicin O = Oncovin P = Prednisolone
Associated diagnostic features of Myloma
- Rogue Ig formation
- IgG/IgA (Bence Jones Proteins) G most common
- M-bands
- Light chains
- Rouleax Formation on blood film
Haematological side effect of Myloma
Hyper-viscosity syndrome = Increased blood cells
Symptoms of Myloma (Hyper-CRAB)
- Hyperviscosity
- Calcium
- Renal failure
- Anemia
- Bone lesions
AML
- Population most effected
- Histological sign
- Genetics
- Staging
- Older adults (80% adult leukemia)
- Auer rods and blast cells
- PML-RAR genes 15:17
- French-American -British (FAB)
ALL
- Population most effected
- Histological sign
- Staging
- Most common childhood type - associated with Downs!
- Always blast cells
- French-American-British
CML
- Population most effected
- Most common symptoms
- Genetics
- Complications
- Treatment
- 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
CLL
- Population most effected
- Symptoms
- Histological sign (HINT: crushed little lads)
- Staging
- 2 complications
- Most commonly older adults (commonest in western world 55+)
- Pancytopenia
- Smudge/Smear cells
- Rai Staging
- Warm haemolytic anemia and hypogammaglobulinemia
Richter syndrome and diagnostic feature
CLL transforms into aggressive non-hodgkins lymphoma
-Lactate dehydrogenase
Common complication of lytic metastasis and diagnostic feature
- Hypercalcemia
- High ALP
Treat bony metastasis (2 drugs)
- Biphosphanates
- Denosumab
What Leukemia is most likely to be precursor by mylodysplastic syndrome
AML
Acute Haemolytic transfusion reaction
- Aetiology
- Symptoms
- Treatment
- Due to mismatch ABO group
- Fever or hemolysis within 24hrs
- Halt transfusion/replace fluid and dialayse if necessary
Delayed Haemolytic transfusion reaction
- Aetiology
- Symptoms
- Treatment
- Undetectable Ab levels or new Ags formed against new blood
- Less severe form of acute
- Supportive often no treatment needed
Febrile non-haemolytic transfusion reaction
- Aetiology
- Symptoms
- Treatment
- Release of inflammatory signals from donor blood WBC
- Fever
- Halt transfusion and give antipyretic
Allergy or anaphylactic transfusion reaction
-Treatment
-Halt transfusion and give antihistamine or adrenaline
Purpura transfusion reaction
- Aetiology
- Symptoms
- Treatment
- Rare thrombocytopenia due to anibodies against platelets
- Purple skin
- IV immunoglobulins
TACO & TRALI Treatment
-Supportive care
Graft vs Host Reaction
- Timeline
- Patient group at risk
- Treatment
- 1 wk post transfusion
- High mortality, immunosupressed patient
- Immunosupression
VW Disease
- Genetics
- Symptoms
- Diagnostics
-Autosomal dominant
-Mucosal/Gi bleeding, bruising and menorrhagia
+APTT, +Bleeding time
Hemophilia A
- Genetics
- Factor affected
- Symptoms
- Diagnostics
-X-Linked recessive
-Factor VIII
-Joint bleeds, haematuria, IC hemorrhage
+APTT, Normal Bleed time, +Prothrombin time
Hemophilia B (Christmas disease)
- Genetics
- Factor affected
- Symptoms
- Diagnostics
- X-Linked recessive - less common
-Factor IX
-Joint bleeds, haematuria, IC hemorrhage, nosebleeds
+APTT, Normal Bleed time, Normal Prothrombin time`
Drug contraindication with bleeding disorders
NSAID’s
Fresh Frozen plasma
- Content
- Indication
- Whole blood without RBC + clotting factors
- Used for those with significant clotting problems
Cryoprecipitate
- Content
- Indication
- Factor 8, 13, VWF, Fibronectin. Produced from FFP
- Used to replace fibrinogen, often given to hemophiliacs and VW disease. No cross match needed
Prothrombin complex
- Content
- Indication
- Factors 2, 9 and 10
- Reversal of anticoagulant with hemorrhage (warfarin)
Platelets
- Indication
- Risk
- Treat bleeding patients with low platelet count eg cancer/chemo
- Bacterial cross contamination due to warmer storage
Sepsis 6
HINT: OBALFU
- O2 titrate to 94%
- Blood cultures
- Antibiotics IV
- Lactate serial measurements
- Fluid replacement
- Urine output
MOA Riveroxaban
Direct Factor Xa Inhibitor
MOA Dabigatran
Direct Thrombin Inhibitor
Neoadjuvant and Adjuvant chemo
HINT: A=After
Neoadjuvant = Before surgery Adjuvant = mop up after surgery
Thrombophilia - other name and mechanism
Hypercoagulablity - excess clotting capacity = DVT risk
thrombocytopenic purpura - symptoms
Decreased platelets - can be autoimmune or thrombotic
Bruising and petechiea
What histological sybtype are most Head and Neck cancers
Squamus cell carcinoma
Oropharyngeal cancer
- R:factors
- Patient profile
- HPV biggest risk factor
- younger, non smokers, richer
Nasopharyngeal cancer
- R:factors
- Patient profile
- EPB virus associated
- Common in south China and Taiwain by a lot
Treatment head and neck cancers
Surgery and radio
*surgery especially used in oral cancers
3 Types of antiemetics
- Dopamine antagonists
- Antihistamine
- 5-hydroxytryptamine (5-Ht3 antagonist)
Dopamine antagonists
- examples
- sites action
- SE
- Domperidome + Metocloperamide
- Antagonise D2 receptors in CRTZ also on GIT = accelerate GI emptying
- extrapyramidal, tardive dyskinesia, hyperprolactineamia
Anti-emetic antihistamine
- example
- sites action
- SE
- Cyclizine
- Antagonise H1 receptors CRTZ and reduce transmission from vestibular apparatus to CRTZ
- Drowsiness, anti-muscarining, contraindicated BPH
5-hydroxytryptamine (5-Ht3 antagonist)
- example
- clinical indication
- sites action
- SE
- Ondansetron
- 5-HT3 receptors in CRTZ + GIT
- Often post op and chemo
- ↑QT, constipation, ↓BP/HR
Absolute contraindications for anti-emesis
GI obstruction or haemmorhage
