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FRACP Shuyu > Haematology > Flashcards

Haematology Flashcards

1
Q

amount of plasma cells in myeloma

A

> 10% plasma cells in bone marrow

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2
Q

prevalence of MGUS in >70yr

A

10%

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3
Q

difference between smouldering and MM

A

lack of symptoms in smouldering (does not satisfy clinical sx)

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4
Q

mechanism of hypercalcaemia in MM

A

plasma cells secrete RANK-ligand which stimulates osteoclasts

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5
Q

purpose of autologous SCT transplants

A

to allow for giving high dose chemotherapy

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6
Q

purpose of allogeneic SCT

A

1) allows for chemo with repalcement of marrow with healthy cells
2) Immune response against malignancy

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7
Q

Donor recipient matching in HSCT

A

HLA
Class I - HLA-A, -B, -C
Class II - HLA-DRB1, DQB1, DPB1
standard BMT considers 6 loci (so 12 alleles between 2 parents)

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8
Q

Alternatives to mismatch transplant

A 
haploidentical relative (half-match) (higher risk of GVHD)
Umbilical cord blood - more permissive of HLA mismatches (used more frequently in paediatrics)
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9
Q

PBSC - peripheral blood stem cells

Collection; GvHD risk and graft failure risk

A

G-CSF mobilisation and apheresis
Exclusive source for autologous (and most allogeneic)
Higher chronic GvHD risk than marrow
Lower graft failure rate

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10
Q

When are bone marrow donor sources preferred?

A

Non-malignant disease (e.g. aplastic anaemia) as no benefit from GvHD

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11
Q

3 criteria for HSCT

A
  • Does the disease require a transplant
  • Suitable available donor
  • Patient sufficiently fit
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12
Q

Most common indications for autologous transplant

A

MM
NHL
Hodgkin’s

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13
Q

Most common indications for allogeneic transplant

A 
AML
ALL
NHL
MDS
CML (less common with immunotherapy)
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14
Q

Donor priorities

A

Matched sibling, matched unrelated, haplo, cord

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15
Q

what recovers first after a HSCT

A

NK cells, then CD8, then CD4, then B cells

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16
Q

acuteGVHD timing and involvement

A

Within 100 days of BMT

Predominantly skin, gut, liver

17
Q

chronicGVHD manifestation

A

predominantly fibrotic process

18
Q

prevention of chronic GVHD

A

cyclophosphamide

19
Q

open chromatin

A

chromosomes open and actively transcribing DNA

sign of aggressive malignancy

20
Q

What biopsy is preferred for diagnosis of lymphoma

A

excisional biopsy

21
Q

Lymphoma stageing

A

I - lymph nodes in 1 group
II - lymph nodes multiple groups in 1 side of the body
III - lymph node groups on both sides of the body
IV - organ involvement (excluding spleen; or stage E disease which is the involvement of an adjacent organ to the lymph nodes)

A or B based on whether they have B symptoms

22
Q

What is the significance of B symptoms

A

That they have larger disease bulk

23
Q

When is a diagnostic LP indicated in lymphoma

A

ALL, aggressive lymphomas w evidence of stage IV disease
High risk sites
High LHD

24
Q

Chemo regimen for early stage Hogkin’s

A

ABVD
local radiotherapy
more cycles if unfavourable disease

25
Q

Chemo regimen for advanced stage Hogkin’s

A

ABVD

26
Q

Lines of treatment for DLBCL

A

R-CHOP x 6
H-hyperCVAD x 8

Mini-R-CHOP in older adults

27
Q

What factors prognosticate lymphoma

A 
age
LHD
ECOG
Stage >1
2 or more extranodal sites

IPI - international prognostic index

28
Q

Burkitt’s chemotherapy regime

A

R-CODOX-M/R-IVAC

29
Q

Primary CNS lymphoma cell lineage origin

A

B cells due to lymphoid tissue in brain

30
Q

What immunodeficiency is BTK deficiency associated with

A

Brunton’s gammaglobuinaemia

31
Q

What haematological conditions is ibrutinib used to treat

A

CLL, mantle cell leukaemia

32
Q

PE mortality - sudden death and 1 week mortality

A

25% and 30%

33
Q

optimal treatment duration for VTE

A

In general, there is a low recurrence rate after 3 months
there is a low absolute risk for provoked distal DVTs so maybe they only need 6 weeks of anticoagulation

After 3 months, there is an assessment to determine indefinite continuation of anticoagulation

34
Q

what provocation factor of VTE is assoc w the lowest recurrence rate

A

surgery (<1%)

35
Q

what age group is associated with a higher early recurrence

A

younger patients

36
Q

who to consider indefinite low dose NOAC after 3 mo anticoagulation

A

everyone aside from transient provoking and distal DVT

37
Q

anticoagulation management in non low risk surgery

A

Warfarin - determine if bridging is required

  • bridging is associated with increased bleeding but no benefit to thromboembolism
  • very high risk to consider bridging (AF w CHADVASC >6, SSE within 3 months, mitral stenosis)

NOAC - does not need bridging because similar half life to LMWH

  • low risk of thrombosis (0.4%)
  • stop 48hr pre-op (72 hr if CKD, dabigatran or high risk consequences of bleeding)
  • normally recommence NOAC 2-3 days

SEE SLIDES

38
Q

How to monitor dabigatran post op

A

dilute thrombin clotting time

FRACP Shuyu (65 decks)

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