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Finals > Haematology > Flashcards

Haematology Flashcards

1
Q

Sx of anaemia?

A

fatigue, dyspnoea, faintness

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2
Q

Severe anaemia bloods?

Signs?

A

< 8g/dL

Tachycardia, cardiac enlargement, increased CO

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3
Q

Transports iron?

A

Transferrin

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4
Q

Stores iron?

A

Ferritin, haemosiderin

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5
Q

Pres of iron-def anaemia?

Signs?

A

Fatigues, faintness, dyspnoa

+/- :
Pallor
Nail changes [koilonychia (spoon), brittle]
Hair loss
Mouth [angular stomatitis, atrophic glossitis]

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6
Q

Cause of iron-def ?

A 
Inadequate intake (h.pylori)
Poor absorption (coeliac)
Excess loss (GI bleed)
Excess iron requirement
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7
Q

Ix in iron-def anaemia?

A

Hb <13g/dL (men), <12g/dL (women)
MCV = microcytic
Blood smear
Iron studies

Coeliac autoantibodies
Endoscopy

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8
Q

Why may ferritin be high in iron-def?

A

Acute phase protein so increases in inflam

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9
Q

DDx for iron-def anaemia?

A

Chronic disease

Sideroblastic anaemia

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10
Q

Mx of iron-def?

A

Ferrous sulphate

+/- transfusion

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11
Q

SE of ferrous sulphate

A

Constipation
Black stools
Vomit

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12
Q

When would you suspect sideroblastic anaemia

A

Microcytic hypochromic anaemia

NOT responding to iron

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13
Q

Cause of sideroblastic anaemia?

A

Ineffective erythropoesis [cant incorporate iron into Hb]

Congenital - X-linked

Acquired - MDS, myeloma

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14
Q

Ix in sideroblastic anaemia

A

Hb
MCV
Iron studies

MARROW ASPIRATE

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15
Q

Mx of sideroblastic

A

Iron chelation

Desferrioxamine

Avoid alcohol / Vit C

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16
Q

B thalassmia?

A

Inherited microcytic anaemia

Mutation to beta-globin gene

Ineffective erythropeiss

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17
Q

Sx of b thalassemia

A

Bony changes - skull bossing

Hepatosplenomegaly

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18
Q

ix in b thalassemia

A 
FBC
Blood smear
Hb analysis
LFT
Skull xray
Abdo USS
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19
Q

Mx of b thalassemia

A

Genetic counselling
Transfusion
Iron chelation

Splenectomy
BMT

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20
Q

comps of thalassemia

A

Thrombotic
Iron overload
Transfusion reactions

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21
Q

Causes of haemolysis

A

Liver macrophages

Spleen

Red cell destruction by immune system

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22
Q

Hereditary causes of haemolytic anaemia?

A

G6PDD

Hereditary spherocytosis

SC, thalassemia

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23
Q

Test for immune mediated haemolytic anaemia?

A

Direct antiglobulin +ve (Coombs)

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24
Q

Causes of non-immune mediated haemolytic anaemia?

A

Infection (malaria) , trauma

DIC, TTP, HUS, HELLP

Paroxysmal nocturnal haemoglobinuria

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25
Q

Dx of paroxysmal nocturnal haemoglobinuria?

A

Urinary haemosiderin

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26
Q

Ix in haemolytic anaemia?

A 
FBC
MCV is increased! (reticulocytes)
Unconj bilirubin
Urinalysis
Blood film
Coombs test
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27
Q

Mx of haemolytic anaemia?

A

Folic acid supplement

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28
Q

Pres of G6PDD?

A

Prolonged neonatal jaundice

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29
Q

Mx of G6PDD?

A

Fluids
Folic acid
Transfusion

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30
Q

Anaemia of chronic disease?

A

Decreased RBC production and survival

Normocytic normochromic
Low reticulocytes, low iron, elevated ferritin

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31
Q

Pres of ickle cell disease?

A

Cresentic shaped Hb –> disrupt blood flow and break –> painful crisis, organ damage, increased infections

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32
Q

Triggers of sickle cell crisis

A 
CHIDS
Cold
Hypoxia
Infection
Dehydration
Stress
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33
Q

Areas affected by sickle cell crisis?

A

Chest - pain, fever, dyspnoea, tachypnoea

Bone infarction - avasc necrosis of femoral head

Acute abdo - mesenteric ischaemia

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34
Q

Dx of sickle cell?

A

Newborn screening

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35
Q

Mx of sickle cell crisis

A 
Corss match
Analgesia
O2
IV fluids
Abx 
\+/- blood transfusion
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36
Q

Cause of megaloblastic anaemia?

A

B12/folate deficiency

Defective DNA synthesis –> leukopenia and thrombocytopenia

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37
Q

Dietary sources of folate?

A

Green veg
Nuts
Liver

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38
Q

Causes of folate deficiency?

A

Poor diet

Increased demand (pregnancy, renal disease)

Malabsorp (coeliac)

Drugs, alcohol, MTX

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39
Q

Signs of folate def

A

Headache
Anaemia
Wt loss
Glossitis, dermatitis

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40
Q

Mx of folate def

A

Folic acid oral

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41
Q

Pres of B12 def?

A

Macrocytic anaemia with peripheral neuropathy and neuropsych complaints

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42
Q

Dietary sources of V12

A

Meat
Fish
Dairy

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43
Q

Which cell is needed for b12 absorption?

A

Parietal cells produce Intrinsic Factor

44
Q

Mouth signs of b12 deficiency

A

Glossitis (painful!),

Angular chelitis

45
Q

Neuro sx of b12 def

A

Subacute degen of spinal cord + peripheral neuorpath + dementia + ataxia + paraesthesia

46
Q

Mx of b12 def

A

IM hydroxycobalamin
Oral folic acid

+/- blood transfusion

47
Q

Pernicious anaemia?

A

Autoimmune atrophic gastritis + autoantibodies to IF

48
Q

Leukaemia?

A

Excess of abnormal white cells in peripheral blood

Can be myeloid of lymphoid

49
Q

Pres of acute leukaemia?

A

Bone pain, fever, lethargy, night sweats, wt loss

Anaemia, thrombocytopenia, neutropenia

Headache, lymphadenopathy, hepatosplenomegaly

50
Q

Dx of AML

A

Tends to be >75yo

Bone marrow blasts > 20%

51
Q

Ix in AML

A

FBC
Blood film - blasts + auer rods
Bone marrow biopsy - blasts > 20%
Coag

52
Q

Tumour lysis syndrome?

A

Electrolyte + metabolic disturbance due to breakdown of large number cancer cells (common in leukaemia)

Hyperuricaemia, hyperphosphataemia, hyperkalaemia, hypocalcaemia, +/- renal impairment)

53
Q

Mx of tumour lysis syndrome?

A

IV fluids

Allopurinol in chemo reigime

+/- Haemodialysis

54
Q

Chromosomal assos with ALL

A

Philadelphia - t(9,22)

55
Q

Pres of ALL

A

Most common tumour of childhood <5yo. / > 45yo
Assos with Down’s syndrome

Bruising, pancytopaenia

56
Q

Ix of ALL

A 
FBC
Blood film - blasts
Coag
Bone marrow biopsy
CXR
57
Q

seen on CXR of ALL

A

mediastinal widening

58
Q

Comps of ALL

A

Tumour lysis syndrome
Neutropenic sepsis
Pancytopenia
Chemo SEs

59
Q

Mx of ALL

A

Hydration, allopurinol, prophylactic abx/anti-virals/antifungals
Transfusions
Chemo + imatinib

60
Q

Mx of CML

A

Imatinib
Chemo
Stem cell transplant

61
Q

What happens in CLL?

A

B lymphocytes avoid apoptosis –> invade liver, spleen and bone marrow

> 55yo

62
Q

Sx of CLL?

A

> 55yo
Haemolytic anaemia
Can transfrom into lymphoma [Infiltration, B sx] = Richters transformation

63
Q

Ix in CLL?

A

FBC
Blood film - smudge cells
CT

64
Q

Mx of CLL

A

Chemo

+/- stem cell transplant

65
Q

Lymphoma vs leukaemia?

A 
Lymphoma = solid
Leukaemia = circulating

“lemon vs lemonade”

66
Q

Most common type of NHL?

A

Diffuse B-Cell lymphoma

can produce Ig

67
Q

Pres of NHL?

A

Lymphadenopathy, dry cough, bone marrow, spleonmegaly

B sx

68
Q

Ix in NHL?

A

FBC
LN biopsy
CT/MRI

69
Q

HL from what cells?

A

Mature B cells

70
Q

Pres of HL?

A

Cervical/supraclav lymphadenopathy (painless)

B sx in 30%

71
Q

Which cells seen in HL?

A

Reed-Sternberg

look like an owl

72
Q

Aetiology of HL?

A

immunodef
EBV
AI - SLE

73
Q

Mediastinal adenopathy is common in HL –> how would this present?

A

Dry cough, dyspnoea, chest pain

SVCO

74
Q

Multiple myeloma?

A

Clonal proliferation of plasma cells in bone marrow –> overprod of Ig

75
Q

Dx of MM?

A

Serum + urine protein electrophoresis

76
Q

Pres of MM?

A

Bone pain
Anaemia

Fatigue, infections, hypercalcamiea, RENAL IMPAIRMENT

77
Q

Features of MM?

A 
OLD CRAB
Old age
Calcium raised
Renal insufficiency
Anaemia
Bone disease
78
Q

What causes renal impairment in MM?

A

Deposition of Tamm-Horsfall protein in LoH

79
Q

Mx of MM?

A

Bisphosphonates
Blood transfusion/EPO
Hydration

80
Q

Polycythaemia?

A

Increased proportion of Hb in blood

81
Q

Pres of PRV?

A

Hyperviscosity

Pruritis

82
Q

Ix in PRV?

A

FBC

JAK2 mutation

83
Q

Mx of PRV?

A

Hydroxycarbamide (decreases bone marrow production)
+ aspirin

Manage CV RFs

84
Q

What regulates platelet production?

A

Thrombopoeitin (from the liver)

85
Q

When does ITP occur?

A

Children post viral illness

86
Q

Ix in ITP

A

FBC
LFTs
peripheral smear
BM biopsy

87
Q

Mx of ITP

A

Acute –> IVIg, pred, pt transfusion

Chronic –> rituximab + splenectomy

88
Q

Pres of TTP?

A

EMERGENCY!

Fever
Renal failure
Haemolytic anaemia
Thrombocytopenia
Neurological change
89
Q

Cause of TTP?

A

Absence of VWF cleaving protein –> platelet aggregation in microvasculature + haemolysis

90
Q

Seen on blood smear in TTP?

A

Microangiopathic blood film with SCHISTOCYTES

91
Q

Mx of TTP?

A

Urgent plasma exchange + prednisolone + aspirin

DO NOT GIVE PLATELETS

92
Q

Drug to target antibody production?

A

Rituximab

93
Q

Pres of DIC?

A

Systemic collapse –> tachycardia, hypotension, oliguria

Bleeding –> bruising, purpura

94
Q

Mx of DIC?

A

Platelet transfusion

FFP

95
Q

Haemophillia inheritance?

A

X-linked recessive

96
Q

Pres of haemophillia?

A

Boys - toddlers

Bleeding into muscles + joints

97
Q

Pres of VWD?

A

Teens

Bleeding into mucus membranes and skin

98
Q

Haemophillia A & B factors?

A 
A = 8 deficient
B = 9 deficient
99
Q

Avoid in haemophillia?

A

IM injections
Aspirin
NSAIDs

100
Q

Cause of VWD?

A

AD chromosome 12

101
Q

Mx of VWD?

A

IV desmopressin

102
Q

Vit K for which factors?

A

1972

103
Q

What is prolonged in liver disease?

A

PT

104
Q

Staging for lymphoma?

A

Ann-Arbor

105
Q

HL vs NHL age?

A

HL = younger 20-34

106
Q

Stages of CML

A

Chronic (asympto - 5y)
Accelerated (anaemia, thrombocytopaenia) - more blast cells in blood
Blast (pancytopaenia - can be fatal) >30% blasts

PHILADELPHIA CHROMOSOME

Finals (20 decks)

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