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Final 3b > Haematology > Flashcards

Haematology Flashcards

1
Q

Write out all the types of anaemia in MCV groups

A

MICROCYTIC ANAEMIA

  • Iron deficiency
  • Thalassaemia
  • Sideroblastic
  • Anaemia of chronic disease

NORMOCYTIC ANAEMIA

  • Acute blood loss
  • Pregnancy
  • Anaemia of chronic disease (80%)
  • Bone marrow infiltration
  • Haemolytic anaemias
  • Renal disease
  • Endocrine
  • aplastic anaemia

MACROCYTIC ANAEMIA

  • B12
  • Folate
  • Liver
  • Alcohol
  • Hypothyroid
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2
Q

Iron deficiency anaemia

Aetiology
Presentation
Investigations
Management

A

Low iron in the blood

Aetiology (uptake in the duodenum) 
1) Decreased intake (dark green leafy vegetables + meat) 
2) Decreased absorption 
- Coeliac/ gastric surgery 
3) Chronic bleeding 
- Peptic ulcer 
- Hookworm
- Diverticulitis 
- Malignancy 
- Menorrhagia 
4) Increased use 
Infancy 
Pregnancy 
Presentation 
Pallor/fatigue/SOB/Palpitations/dizziness 
Angular stomatitis 
Atrophic glossitis 
Pica 
Nails - koilonychia (spoon) 
Investigations 
Hb - low 
Ferritin - low 
Total iron binding capacity - HIGH 
Blood film - ∆ size and shape (poikilocytosis/ anisocytosis) 
FIND CAUSE 
- endoscopy urgent 2ww
Men <11 
Women <10 
- Anti TTG
Management 
Rx cause, iron rich diet 
Ferrous sulphate supplement until at least 3 months after iron is restored 
SE: 
- Dizziness 
- N+V 
- Constipation/ diarrhoea 
- Black stools
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3
Q

Findings in iron deficiency anaemia

A

Hb - low
Ferritin - low
Total iron binding capacity - HIGH
Blood film - ∆ size and shape (poikilocytosis/ anisocytosis)

FIND CAUSE 
- endoscopy urgent 2ww
Men <11 
Women <10 
- Anti TTG
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4
Q

Who gets an endoscopy in iron deficiency anaemia and when

A

Endoscopy urgent 2ww

Men <11
Women <10

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5
Q

Where is iron absorbed

A

Duodenum

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6
Q

Sideroblastic anaemia

What is it 
Aetiology 
Presentation 
Investigations 
Management
A

What is it
Defect in the production of protoporphyrin
so normally Protoporphyrin + Fe –>Haem, + global –> Haemoglobin

Aetiology

1) Genetic - X linked (delta AS2 defect)
2) Lead, TB meds, Alcohol, myelodysplasia

Presentation
- Iron overload in
Heart, Liver, Kidneys
Symptoms of anaemia

Investigations

  • Hb - low
  • Ferritin ^
  • Total iron binding capacity - low

Bone marrow - Sideroblasts + ^ iron stores

Management
- Stop cause
- Iron chelater
Desferrioxamine

  • Consider B6 (pyridoxine)
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7
Q

Aetiology of sideroblastic anaemia

A

1) Genetic - X linked (delta AS2 defect)

2) Lead, TB meds, Alcohol, myelodysplasia

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8
Q

Haemolytic anaemias

Types, common blood findings + symptoms

A

Types

  • Sickle cell
  • Hereditary spherocytosis
  • Thalassaemia
  • G6PD
    (autoimmune)

Common blood

  • ^ reticulocytes
  • Low Hb
  • ^ Bilirubin
  • ^ LDH

Symptoms

  • Jaundice, pale stools, dark urine
  • Symptoms of anaemia
  • Aplastic crisis ^ risk
  • Pigmented gall stones
  • Hepatosplenomegaly
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9
Q

Hereditary spherocytosis

What is it 
Aetiology 
Presentation 
Investigations 
Management
A

What is it - defect in red cell membrane

Aetiology

  • AD genetic
  • North Europeans

Presentation
- Haemolytic anaemia picture

Investigations 
- Hb low 
- Reticulocytes ^ 
- Genetics 
- Blood film - spherocytes (+ howell jolly bodies
EMA binding test 
(usually blood film + genetics = enough)

Management
- Splenectomy

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10
Q

Hereditary spherocytosis

Aetiology + epidemiology

A

AD

Northern Europeans

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11
Q

Investigations for Hereditary spherocytosis

A

Blood film - spherocytes (+ Howell Jolly bodies)

Hb low
Reticulocytes ^

EMA binding test
Genetic testing

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12
Q

Sickle cell anaemia

What is it 
Aetiology 
Presentation 
Investigations 
Management
A

What is it
Mutation in which Glutamate –> Valine + causes polymerisation of the beta global chain when it is deoxygenate –> sickle shaped RBC

Aetiology
- AR

Presentation 
- Jaundice 
- Anaemia/ FTT
- Crises 
Painful 
- Acute chest syndrome - chest pain/SOB etc 
AVN femoral head 
Stroke 
Long bone pain 
DACTYLITIS - particularly in children

Haemolytic
Aplastic - B19
Sequestration - bleeding into spleen

NOTE: may not present until 6m as when HbA fully takes over

Investigations
Usually picked up on the Guthrie test

  • Haemolytic picture (low Hb, ^reticulocytes)
  • Hb electrophoresis
    HbSS (Homozygous)
    HbAS (trait)

Blood film

  • Sickle cells
  • Howell jolly bodies
  • ? target cells
Management 
Painful crises - O2 and analgesia 
Hydroxyurea (stimulate HbF production) 
Blood transfusion if severe 
Avoid precipitants 
Flu vaccine 
One off pneumococcal vaccine 
Prophylactic penicillin
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13
Q

Precipitants of sickle cell crisis

A 
Hypoxia 
Dehydration 
Exercise 
Stress 
Infection
Cold
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14
Q

Investigations for sickle cell anaemia

A

Usually picked up on the Guthrie test

  • Haemolytic picture (low Hb, ^reticulocytes)
  • Hb electrophoresis
    HbSS (Homozygous)
    HbAS (trait)

Blood film

  • Sickle cells
  • Howell jolly bodies
  • ? target cells
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15
Q

Osteomyelitis cause in sickle cell

A

Salmonella

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16
Q

G6PD deficiency

What is it 
Aetiology 
Presentation 
Investigations 
Management
A

What is it
Defect in G6PD enzyme

Aetiology
X linked - THINK only gonna be boys

Presentation 
Same as normal haemolytic picture + 
Precipitated by 
- Abx (macrolide, cephalosporin)
- Anti-malarials 
- Infection 
- Fava beans 
Investigations 
- Normal haemolytic picture 
- Blood film 
Heinz bodies 
Bite cells 
Hemi-ghosts

Management

  • Stop precipitant
  • Renal support
  • Transfusion if severe
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17
Q

Thalassaemia

What is it 
Aetiology 
Presentation 
Investigations 
Management
A

What is it
Defect in either alpha or beta globe chains
Beta can be major, intermedia, minor - med
Alpha - S.E Asia

Aetiology
AR

Presentation
FTT and hepatosplenomegaly in 1st year of life
Haemolytic picture
Skull bossing and maxillary overgrowth

Investigations 
Hb electrophoresis!!!
HbA - none 
HbA2 - raised 
HbF - raised

Blood film - target cells

Haemolytic anaemic bloods

Management
- Blood transfusions (+/- iron chelator)

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18
Q

Alpha thalassaemia problems

A

Hydrops foetalis

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19
Q

Folate deficiency

What is folate for
Where is folate found
Where is it absorbed

A

What is folate for
- DNA synthesis and repair

Where is folate found
- Nuts, Liver, green leaves

Where is it absorbed
- Duodenum + proximal jejunum

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20
Q

Folate deficiency

Aetiology
Presentation
Investigations
Management

A

Aetiology
Decreased intake
Increased need - pregnancy
Decreased absorption - coeliac

Presentation 
- Headache 
- SKIN 
Exfoliative dermatitis 
Glossitis 
Dysphagia

Investigations

  • Hb - low - macrocytic megaloblastic
  • Folate - low

Blood film
Hypersegmented neutrophils

Management
Folic acid - 5mg

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21
Q

investigations of folate deficiency

A

Bloods

  • Hb low (macrocytic megaloblastic)
  • Folate low

Film
Hypersegmented neutrophils

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22
Q

Hypersegmented neutrophils are found in what

A

Megaloblastic anaemias

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23
Q

B12 deficiency

What is B12
Where is it found
Where is in absorbed (overview)

A

What is B12
- Used for DNA synthesis and neuro

Where is it found
- Meat, fish, dairy

Where is in absorbed
- terminal ilium
B12 is released from food by peptic acid. Then parietal cells produce intrinsic factor - IFB12 complex –> gets absorbed in the terminal ileum

24
Q

B12 deficiency

Aetiology
Presentation
Investigations
Management

A 
Aetiology 
- Decreased intake (vegans) 
- Decreased absorption - Coeliac, crohn's 
- Drugs 
PPI,H2, metformin
Presentation 
Anaemia symptoms 
Neuro 
- Memory problems 
- Parasthesia 
- Peripheral neuropathy 
- Ataxia 
- Psychosis

Spinal cord degeneration

  • upgoing planters
  • Decreased reflexes

MOUTH

  • Glossitis
  • Angular chelitis

Investigations

  • Hb low - macrocytic megaloblastic
  • B12 low

Blood film
Hypersegmented neutrophils

Management
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

hydroxycobalamin SE - hypokalaemia

25
Q

Rx B12 def

A

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

26
Q

Polycythaemia

What is it 
Aetiology 
Presentation 
Investigations 
Management
A

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
27
Q

Autoimmune haemolytic anaemia

Aetiology
Types
Presentation
Investigations

A

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
28
Q

Types of autoimmune haemolytic anaemia and their associations

A

Warm - IgG - CLL, SLE, Methyldopa

Cold - IgM - Lymphoma, EBV

29
Q

Cold peripheries and positive DAT

A

Autoimmune haemolytic anaemia

30
Q

Aplastic anaemia

A

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

31
Q

lemon tinge

A

Pernicious anaemia

32
Q

Anaemia of chronic disease

Pathophysiology
Causes
Investigations
Management

A

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

33
Q

How to differentiate between anaemia of chronic disease and iron defieicny anaemia

A

Anaemia of chronic disease is usually normocytic HOWEVER

If its microcytic and AoCD
Ferritin ^^^
TIBC - LOW

34
Q

Blood results for anaemia of chronic disease

Iron
TIBC
Transferrin sats
Ferritin

A

Iron low
TIBC LOW
Transferrin sats high
Ferritin high

35
Q

Myeloma

Aetiology
Pathophysiology
Presentation

A

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

36
Q

Myeloma

Investigations
Criteria
Management

A

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

37
Q

Myeloma criteria

A

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

38
Q

Hyperviscosity in which cancer

A

MYELOMA

39
Q

Hodgkin’s lymphoma

A

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

40
Q

Lymphoma RFs

A 
EBV 
Other infection (H.Pylori - MALT) 
Chemo/radio 
Radiation 
Immunocompromised 
Hx 
Coeliac
41
Q

Hodgkins lymphoma is associated with which risk factor

A

EBV

42
Q

Non Hodgkin’s lymphoma Types

A 
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
43
Q

NHL Rx

A

R- CHOP

If CD20 - rituximab

44
Q

Lymphoma

Poor prognostic factors

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

Hodgkin’s classification

A

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

46
Q

Types of antiplatelet and action

A

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

47
Q

Types of anticoagulants

A

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

48
Q

haemophilia

A

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

49
Q

VWD

A

What is it
Lack in von willebrand

Aetiology
AD – chromosome 12

Pres
Bruising, bleeding, epistaxis etc

Investigations
Prolonged PT

Management
Desmopressin

50
Q

ITP

A 
Aetiology
Post infection (up to 4 weeks)

Presentation
Bleeding

Investigations
Low platelets

Rx
Will resolve within 3 months

51
Q

TTP

A 
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

52
Q

Pres of iron deficiency anaemia

A

Pallor/fatigue/SOB/Palpitations/dizziness
Angular stomatitis
Atrophic glossitis

Pica

Nails - koilonychia (spoon)

53
Q

SE hydroxycobalamin

A

Hypokalaemia

54
Q

Pernicious anaemia investigations

A

Ab IF
Ab parietal cells
Shillings test - radioactive B12

55
Q

Symptoms of lymphoma (incl HL)

A 
Painless lymphadenopathy - rubbery 
Pain is worse on alcohol (specific) 
Pel Ebstein fever (weeks) 
B symptoms 
Pruritis 
Hepatosplenomegaly 
Dyspnoea, haemoptysis, cough
56
Q

Rx polycythaemia

A
  • Venesection
  • Hydroxyurea
  • Low dose aspirin

Final 3b (2 decks)

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