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Phase 3b/finals > Haematology > Flashcards

Haematology Flashcards

1
Q

Name 2 causes of microcytic anaemia

A

iron deficiency, chronic disease

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2
Q

Name 2 causes of normocytic anaemia

A

Blood loss, combined haematinic deficiency

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3
Q

Name 3 causes of macrocytic anaemia

A

B12 deficiency, alcohol excess, hypothyroidism

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4
Q

What is the treatment for iron deficiency anaemia?

A

Oral ferrous sulphate

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5
Q

Where is intrinsic factor produced?

A

Parietal cells in the stomach

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6
Q

What does intrinsic factor bind?

A

Vitamin B12

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7
Q

Where is B12 absorbed?

A

terminal ileum

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8
Q

What is perinicious anaemia?

A

Autoimmune disease against the parietal cells

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9
Q

Glossitis, jaundice and peripheral nerve damage are signs of what kind of anaemia?

A

B12 deficiency

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10
Q

Acute pain in the hands and feet of an African child may indicate?

A

Painful crisis, sickle cell anaemia

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11
Q

Where would an adult most likely get pain in a sickle cell crisis?

A

Long bones, ribs, spine and pelvis

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12
Q

Which gene is responsible for sickle cell?

A

HbS

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13
Q

What would you find on FBC in sickle cell anaemia?

A

High reticulocytes

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14
Q

What drug is used as prophylaxis of painful crises in sickle cell anaemia?

A

Hydroxycarbamide

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15
Q

How are patients with sickle cell anaemia managed?

A

Folic acid, flu and pneumococcal vaccinations and daily penicillin

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16
Q

“Disproportionate microcytic anaemia” is found in…

A

beta thalassaemia trait

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17
Q

How is beta-thalassaemia major managed?

A

repeat transfusions and desferrioxamine

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18
Q

How does alpha thalassaemia, 2 chains affected?

A

hypochromic and microcytic, normal Hb

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19
Q

How does alpha thalassaemia, 3 chains affected?

A

hypochromic microcytic anaemia with splenomegaly

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20
Q

How does alpha thalassaemia, all 4 chains affected?

A

Hydrops fetalis, miscarriage

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21
Q

What happens if you eat fava beans and you have G6PD deficiency?

A

Haemolysis

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22
Q

Name 3 drugs which can cause haemolysis in those with G6PD deficiency

A

sulphonamides, quinolones, nitrofurantoin

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23
Q

Briefly describe the meaning of polycythaemia

A

too many red blood cells/increased Hb concentration in the blood

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24
Q

Gout, ruddy face, thrombosis and splenomegaly may be due to…

A

Polycythaemia

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25
Q

What happens if someone with polycythaemia has a hot bath?

A

They get itchy

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26
Q

What would you see in the blood of someone with polycythaemia?

A

Increased haematocrit, neutrophils and basophils, decreased erythropoietin.

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27
Q

What mutation causes primary polycythaemia/polycythaemia rubra vera?

A

JAK-2 Kinase

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28
Q

Name some causes of secondary polycythaemia?

A

COPD, altitute, sleep apnoea

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29
Q

What initiates DIC?

A

Release of tissue factor

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30
Q

Name 3 causes of DIC

A

sepsis, surgery, amniotic fluid embolism

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31
Q

Briefly describe ITP?

A

Idiopathic/Immune thrombocytopenic purpura: immune-mediated reduction in platelet count

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32
Q

What may cause ITP?

A

Infection or vaccination

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33
Q

What is the treatment for ITP?

A

None, usually self limiting

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34
Q

What is seen on FBCs in ITP?

A

Low platelets, everything else is normal

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35
Q

What is the classic pentad of Thrombotic Thrombocytopenic Purpura?

A
  1. Fever
  2. Altered Mental status
  3. Haemolytic anaemia
  4. Kidney damage
  5. Thrombocytoopenia
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36
Q

What is thromboctopenia?

A

Low platelets

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37
Q

How is TTP managed?

A
  1. Plasma exchange
  2. Prednisolone
  3. Aspirin
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38
Q

What type of leukaemia are people with Downs Syndrome predisposed to?

A

ALL

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39
Q

What chromosome is linked to CML?

A

Philadelphia chromosome

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40
Q

What causes the philadelphia chromosome?

A

t(9:22)

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41
Q

What is the normal % of blast cells in bone marrow?

A

1-2%

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42
Q

What % of blast cells are seen in acut leukaemia?

A

> 20%

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43
Q

What acute leukaemia is more common in adults?

A

Acute Myeloid Leukaemia, AML

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44
Q

Which chromosome deletions are poor prognositc factors in AML?

A

Chromosome 5 and 7

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45
Q

What is seen on blood film in AML?

A

Auer rods

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46
Q

Which chromosome translation is associated with AML?

A

t(15:17)

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47
Q

What is the diagnostic enzyme in AML?

A

Myeloperoxidase

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48
Q

What does an increase in granulocytes at different stages of maturation indicate?

A

CML - chronic myeloid leukaemia

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49
Q

What is the first line treatment of CML?

A

Imatinib

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50
Q

What is the most common malignancy affecting children?

A

ALL

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51
Q

What indicates a positive diagnosis of ALL?

A

Positive TdT

52
Q

Which translocation is seen in childhood ALL?

53
Q

What would you be worried about in a patient with CLL who suddenly becomes unwell?

A

Richter’s transformation to high-grade lymphoma

54
Q

What would you see on blood flim in CLL?

A

Smudge/smear cells (weak B cells that burst on the blood film)

55
Q

Rubbery, painless enlarged cervical lymph nodes is indicative of?

A

Hodgkin’s Lymphoma

56
Q

Name 4 features of Hodgkin’s lymphoma:

A
  1. Fever
  2. Night sweats
  3. Hepatosplenomegaly
  4. > 10% weightloss
57
Q

Describe the 4 stages of Hodgkin’s lymphoma:

A
  1. single lymph node
  2. 2 or more lymph nodes on the same side of the diaphragm
  3. lymph nodes involved on both sides of the diapragm
  4. Involvement of extra nodal sites
58
Q

What would you see on histology in hodgkin’s lymphoma?

A

Reed-Sternberg cells

59
Q

How is Hodgkin’s lymphoma diagnosed?

A

Lymph node removed and histology

60
Q

What age group(s) most likely to get Hodgkin’s lymphma?

A

20s and 60s

61
Q

Which virus predisposes non-Hodgkin lymphoma?

A

Epstein Barr virus

62
Q

What characteristic of an enlarged lymph node would point to Hodgkin’s lymphoma (over non-hodgkin’s lymphoma)

A

Pain on drinking alcohol = Hodgkin

63
Q

How is non Hodgkin Lymphoma staged?

A

Ann-Arbor system

64
Q

Extra nodal disease would point towards…?

A

Non-Hodgkin’s lymphoma

65
Q

What do the abnormal plasma cells in someone with myeloma secrete?

A

PARA PROTEINS

66
Q

What are the 4 symptoms/signs of myeloma?

A
  1. HyperCalcaemia
  2. Renal impairment
  3. Anaemia
  4. Lytic bone lesions
67
Q

What would you see in the urine of someone with myeloma?

A

Bence-Jones proteins

68
Q

What would you see on bone marrow biopsy in myeloma?

A

> 10% plasma cells

69
Q

Name 2 drugs used in the treatment of myeloma

A

Thalidomide, dexamethasone

70
Q

What may myelodysplasia progress into?

71
Q

What is given as prophylaxis for tumour lysis syndrome?

A

IV allopurinol

72
Q

In a patient who has just started chemotherapy, you notice the potassium and phosphate is HIGH and the calcium is LOW, what has happened?

A

Tumour Lysis Syndrome

73
Q

Give the blood features of tumour lysis syndrome

A
  1. High potassium and phosphate
  2. Low calcium
    Raised creatinine
74
Q

In DIC what is raised in the blood?

A

Fibrin degradation products or D-Dimerq

75
Q

What is the typical blood picture in DIC?

A

Low platelets, prolonged bleeding, prothrombin and APTT, D-Dimer, schistocytes

76
Q

What is the typical blood picture in warfarin?

A

Prolonged prothrombin

77
Q

What is the typical blood picture in aspirin?

A

Prolonged bleeding

78
Q

What is the typical blood picture in Heparin?

A

Prolonged APTT

79
Q

What does raised HbA2 alongside anaemia indicate?

A

Beta thalassaemia trait

80
Q

Which non-Hodgkin’s lymphoma has the worst prognosis?

A

Lymphocyte depleted

81
Q

What 3 things would you see on a blood film in hyposplenism (e.g. post splenectomy?)

A

Howell-Jolly bodes
Target cells
Pappenheimer bodies

82
Q

What would you see on a blood film in iron-deficiency anaemia

A

Target cells

Pencil poikiloytes

83
Q

What would you see on a blood film in myelofibrosis?.

A

Tear drop poikiloctyes

84
Q

What would you see on a blood film in intravascular haemolysis?

A

Schistocytes

85
Q

Hypersegemnted neutrophils would be seen on a blood film in which condition?

A

megaloblastic anaemia/folate deficiency anaemia

86
Q

What does factor V leiden predispose you to?

87
Q

What is the 1st line treatment of DVT in pregnant women?

A

LMWH subcut

88
Q

What is the DVT scoring system?

A

Well’s score

89
Q

If the Well’s score is>2 what does this mean?

A

DVT LIKELY

> doppler ultrasound and D-Dimer

90
Q

What should you do if DVT is likely but you cannot ultrasound?

A

Do a D-Dimer within 4 hours and give LMWH

91
Q

What to do if a DVT is unlikely (Well’s <1)?

A

D-Dimer before ultrasound (if d-dimer is positive)

92
Q

What is the treatment regimen for a “provoked” DVT diagnosis?

A
  1. LMWH

2. Warfarin for 3 months

93
Q

Why would you treat a DVT with warfarin for 6 months?

A

If the DVT is unprovoked (e.g. no surgery or significant immobility)

94
Q

What investigations are needed in a patient with unprovoked DVT?

A

CXR
Blood tests
Urinalysis

95
Q

What additional investigations are advised in patients >40 with unprovoked DVT?

A

abdo-pelvis CT

Mammogram

96
Q

Splenomegaly and raised platelets are seen in?

A

Chronic myeloid leukaemia

97
Q

What blood test should you order to screen for coeliac disease?

98
Q

What does the Total Iron Binding Capacity (TIBC) look like in iron deficiency anaemia?

99
Q

What is the most common inherited bleeding disorder?.

A

Von Willebrand’s disease

100
Q

What is the inheritance pattern of Von Willebrand?

A

Autosomal dominant

101
Q

Name 3 causes of secondary polycythaemie

A

COPD
Altitude
Obstructive sleep apnoea

102
Q

How does rivaroxiban work?

A

direct factor Xa inhibitor

103
Q

What is the most common type of hodkin’s lymphoma?

A

Nodular sclerosing

104
Q

When would you consider a platelet transfusion?

A

when platelets are <30

105
Q

When would you do a red blood cell transfusion in someone with acute coronary syndrome?

A

when Hb is <70

106
Q

When would you do a red blood cell transfusion in someone without acute coronary syndrome?

107
Q

What are thrombotic crises also known as?

A

Painful cirses, in sickle cell anaemia

108
Q

What may be affected in a sequestration crisis?

A

spleen and lungs

109
Q

A patient with sickle cell presents with SOB, chest pain, pulmonary infiltrates and low pO2, what is happening?

A

Acute chest syndrome

110
Q

What may cause a sudden drop in haemaglobin of someone with sickle cell or spherocytosis?

A

Parvovirus infection

111
Q

What may parvovirus cause in patients with sickle cell?

A

Aplastic crises

112
Q

When would you give cryoprecipitate?

A

Massive haemorhage or uncontrolled bleeding due to haemophilia

113
Q

What does cryoprecipitate contain?

A

Factor VIII, fibrinogen, vWf, factor XIII

114
Q

How is autoimmune haemolytic anaemia diagnosed?

A

Antiglobulin test, Coomb’s Test

115
Q

What is seen on lymph node biopsy in Burkitt’s lymphoma?

A

Starry-sky appearance

116
Q

What illness is associated with Burkitt’s lymphoma?

A

EBV, epstein barr virus

117
Q

What would you see on the blood film in megaloblastic anaemia?

A

Hypersegmented neutrophils

118
Q

Name 2 causes of megaloblastic anaemia

A

B12 and folate deficiency

119
Q

What would a Heinz body on blood film indicate?

A

G6PD deficiency

120
Q

Name 3 drugs that cause haemolysis in G6PD deficiency:

A

primaquine
ciprofloxacin
sulph- drugs

121
Q

What would you see on the blood film in G6PD deficiency?

A

bite cless, blister cells and Heinz bodies

122
Q

Itching after being in the bath is a classic symptom of…

A

Polycythaemia rubra vera

123
Q

Which clotting factor is deficient in haemophilia A?

A

Factor VIII

124
Q

What is Richter’s transformation?

A

Chronic lymphocytic leukaemia becomes non-hodgkin’s lymphoma

125
Q

What condition may you develop if you have CLL?

A

HIgh grade/Non-Hodgkin’s lymphoma

126
Q

Smear/smudge cells are found in…

A

CLL (crushed little lymphocytes)

127
Q

Name 2 drugs which are prophylactic against tumour lysis syndrome

A

Allopurinol and rasburicase

Phase 3b/finals (19 decks)

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