Haematology Flashcards

Question

Rx B12 def

Answer 1

IM hydroxycobalamin 3x per week for 2 weeks then once every 3 months If also folic acid deficiency R the B12 first to avoid precipitating the subacute combined degeneration of the cord

Answer 2

What is it ^Hb ``` Aetiology Primary - Vera - JAK2 Secondary Hypoxia - Altitude - COPD - Obstructive sleep apnoea - ``` Ectopic EPO - Hepatoma - Hyperneohroma - - Cerebellar haemangioma Presentation - Ruddy appearance - Pruritis - worse after bath/ shower - Hyperviscosity - VTE - HTN, dizziness, tinnitus visual ∆ - Angina, IC - Splenomegaly (suggests vera) Investigations - JAK2 - Hb ^ - If WCC and platelets^ vera - Ferritin Management - Venesection - Hydroxyurea - Low dose aspirin

Answer 3

Aetiology Idiopathic Drugs ``` Types - Warm - IgG - at body temp Associated with CLL - Cold - IgM - at 4-7deg Associated with lymphoma + infections Presentation - Cold peripheries - Anaemia picture ``` Investigations - Positive DAT (direct antiglobulin test - coombes test) Management - Steroids - Immunosuppression - Splenectomy

Answer 4

Warm - IgG - CLL, SLE, Methyldopa | Cold - IgM - Lymphoma, EBV

Answer 5

Autoimmune haemolytic anaemia

Answer 6

Defined as Pancytopenia Hypoplastic bone marrow Features RBC – anaemia WCC – infection Platelets - bleeding ``` Aetiology Congenital (fanconi) Idiopathic Infections TB Benzene Radiation Hepatitis Parvovirus B19 ``` Rx Transplant/ abx

Answer 7

Pernicious anaemia

Answer 8

Pathophysiology IL-1 an 6 Upregulate hepcidin which down regulates ferroportin which exports iron from enterocytes  less free iron ``` Causes Infection Neoplasm Autoimmune Degenerative Endocrine – DM ``` ``` Investigations Iron – low TIBC – low Transferrin saturations ^ Ferritin ^ ``` Management Rx cause RBC transplant

Answer 9

Anaemia of chronic disease is usually normocytic HOWEVER If its microcytic and AoCD Ferritin ^^^ TIBC - LOW

Answer 10

Iron low TIBC LOW Transferrin sats high Ferritin high

Answer 11

Aetiology Unknown 2nd most common blood cancer Pathophysiology Disorder of the PLASMA cells that make immunoglobulins - so they just chuck out loads of light chains (paraproteins) ``` Presentation - CRAB Calcium ^ (due to RANK-L expression) Renal (AKI and CKD) - Nephrocalcinosis - Amyloidosis (light chains) - Anaemia (pancytopenia) - Bones Osteoporosis Pathological # Bone pain RAINDROP SKULL ``` Other - Raised ESR + hyper viscosity

Answer 12

Criteria - Monoclonal plasma cells in marrow >10% - Monoclonal protein in serum/urine (electrophoresis) - any 3 of CRAB Investigations - FBC - pancytopenia - U+E - raised - ESR - raised - Ca2+ raised - PO4 + ALP - normal Serum/urine Electrophoresis to look for paraprotein Bone marrow biopsy CT scan XR - raindrop skull ``` Management - Rx each symptom Bisphosphonates + analgesia Renal - fluids Hyperviscosity - VTE prophylaxis ``` Chemo/radio/ transplant

Answer 13

1) Monoclonal plasma cells in marrow >10% 2) Monoclonal protein in serum/urine 3) Any of CRAB

Answer 14

Aetiology EBV ``` Presentation Painless lymphadenopathy - rubbery Pain is worse on alcohol (specific) Pel Ebstein fever (weeks) B symptoms Pruritis Hepatosplenomegaly Dyspnoea, haemoptysis, cough ``` ``` Investigations CXR - BHL Lymph node biopsy - reed sternberg cells Normocytic anaemia CT/PET staging ``` management ABVD chemo

Answer 15

``` EBV Other infection (H.Pylori - MALT) Chemo/radio Radiation Immunocompromised Hx Coeliac ```

Answer 16

``` Types 1) Diffuse (most common) 2) Follicular - BCL 3) Burkitt Africa - jaw involvement Outside Africa - abdomen involvement Starry sky appearance 4) Mantel 5) Marginal zone - with H. pylori 6) Lymphoplasmocytic ```

Answer 17

R- CHOP | If CD20 - rituximab

Answer 18

``` Age >45 B symptoms present WCC >15000 Lymphocyte count <600 Albumin <40 Hb <10.5 Stage IV disease Male ```

Answer 19

Nodular sclerosing - good - most common Mixed cellularity - good - 20% Lymphocyte predominant - best prog - 5% Lymphocyte depleted - worst - rare

Answer 20

Aspirin - thromboxane A2 inhibitor Clopidogrel/ticagrelor - P2Y12 inhibitor GpIIaIIIb inhibitor -

Answer 21

Vitamin K antagonist - warfarin Direct Xa inhibitors - apixaban Anti thrombin III - heparin Direct thrombin inhibitors - dabigatran

Answer 22

What is it Lack factor VIII – A Lack factor IX - B Aetiology X linked Presentation Haemoarthrosis Mucosal bleed eg gums Prolonged bleeding after dental procedures Investigations PT normal APTT HIGH Management Give factor VIII or IX

Answer 23

What is it Lack in von willebrand Aetiology AD – chromosome 12 Pres Bruising, bleeding, epistaxis etc Investigations Prolonged PT Management Desmopressin

Answer 24

``` Aetiology Post infection (up to 4 weeks) ``` Presentation Bleeding Investigations Low platelets Rx Will resolve within 3 months

Answer 25

``` Features Fever Thrombocytopenia Haemolytic anaemia Renal dysfunction Neurological ∆ ``` Pathophysiology Antibodies against an enzyme that cleaves vWF ``` Investigations Low platelets Haemolytic anaemia Schistocytes on blood film LDH Bilirubin ``` Management Urgent plasma exchange – do NOT give platelets Prednisolone Antiplatelet

Answer 26

Pallor/fatigue/SOB/Palpitations/dizziness Angular stomatitis Atrophic glossitis Pica Nails - koilonychia (spoon)

Answer 27

Hypokalaemia

Answer 28

Ab IF Ab parietal cells Shillings test - radioactive B12

Answer 29

``` Painless lymphadenopathy - rubbery Pain is worse on alcohol (specific) Pel Ebstein fever (weeks) B symptoms Pruritis Hepatosplenomegaly Dyspnoea, haemoptysis, cough ```

Answer 30

- Venesection - Hydroxyurea - Low dose aspirin