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Haematology Flashcards

1
Q

Two positions of a DVT?
Which is more dangerous?
Which is more common?

A

Proximal or distal
Proximal = dangerous
Distal = common

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2
Q

Two ways a DVT can happen?

Why is this important?

A

Provoked - by injury

Spontaneous - will need further management to prevent recoccurrence

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3
Q

Symptoms of a DVT? (5) Why?

Added symptoms if a PE has occurred? (5)

A

Inflammation, pain, swelling, redness, warmth around the area:
BECAUSE superficial veins being used

PE: dyspnoea, pleuritic chest pain, cough, cyanosis, shock

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4
Q

Risk factors for a DVT? (5)

A 
Elderly
Lack of movement
Hormones
Pregnancy
Cancer
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5
Q

How to diagnose a DVT?
Diagnostic
Test used to rule out?
Differentials for DVT? (2)

A

Usually: Ultrasound compression test
Sometimes: Venography
D-dimer
Cellulitis, CHF

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6
Q

How is a DVT treated:
Small clots?
Large clots?
Future management? (3)

A

Small clots may resolve on their own

Large clots: acute = LMW heparin or fondaparinux

Future: education, IVC filter, anticoagulant therapy (DOACs, heparins, warfarin)

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7
Q

What is the definition of anaemia?
How is it measured in practice?
Normal ranges for male and female?
Example of why this may not always represent a true anaemia

A

Reduced red cell mass

Male (131-166 g/L of Hb)
Female (110-147g/L of Hb)

Via haemoglobin concentration

Pregnancy: has a reduced Hb (due to increased plasma volume), but actually an increased RCM (red cell mass)

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8
Q

CAUSES classification of anaemia

4 types and examples of each

A
  • Haemorrhagic (blood loss): trauma, operation, ulcers, haemorrhoids
  • Haemolytic (increased destruction): sickle cell, malaria, autoimmune, PNH, enzymes, DIC
  • Hypoplastic (production failure): renal failure, PRCA, anaplastic
  • Dyshaemopoietic (production failure): chronic disease, thalassaemia, iron deficiency, folate and B12
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9
Q

RED BLOOD CELL SIZE classification of anaemia

3 types and big examples of each

A
  • Microcytic (<80) - Iron deficiency, Chronic disease, Thalassaemia, Sideroblastic anaemia (TICS)
  • Normocytic (80-100) - Chronic disease, Acute blood loss, combined haematinic

• Macrocytic (>100) - foetus, alcohol, hypothyroid, reticulocytosis, B12/folate, cirrhosis
FAT RBC

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10
Q

Name 4 causes of an iron deficiency anaemia
What would you see on a blood film?
Signs of iron deficiency? (4)

A

Dietary, parasites, menorrhagia, CANCER

Blood film: PENCIL SHAPE CELLS, HYPOCHROMIC

Brittle hair & nails, atrophic glossitis, kolionychia (spoon nails), angular stomatitis (inflammation at corners of mouth)

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11
Q

How does a sideoblastic anaemia work?

What does it look like on a blood film?

A 
Iron is available but unable to enter the RBC
Ringed sideroblasts (iron deposits with Prussian stain)
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12
Q

How does anaemia of chronic disease work?

Common in…?

A

Chronic disease uses up iron, stopping haemoglobin being formed
Common in hospitalised patients

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13
Q

Basic pathophysiology of a B12 or folate deficiency?

Key finding on blood film?

A

Problems with DNA synthesis in erythroblasts
Blood film:
Macrocytic cells w/ hypersegmented neutrophils

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14
Q

Name the two key enzymopathies?

A

G6PD deficiency & pyruvate kinase deficiency

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15
Q

G6PD:
Signs + symptoms (3)
What can cause a crisis?
Mainly affects…., why?

A

Often asymptomatic
Crisis: haemolysis, jaundice & anaemia
Crisis is precipitated by fava beans, infections or drugs

Mainly affects men, X-linked

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16
Q

Two membranopathies?
Symptoms?
Treatment?

A

Spherocytosis & elliptocytosis

Jaundice, gallstones, normally seen in childhood

Folic acid

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17
Q

What does PRV stand for?
What is it?
Association with what mutation?
Become more common with….

A

Polycythaemia rubra vera

Too many RBCs produced by bone marrow

Associated with JAK2 mutation (90% of cases)

More common with increasing age

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18
Q

Side effects of iron tablets?

A

Black stools, constipation, diarrhoea, nausea, GI upset, abdominal pain

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19
Q

PRV:
Symptoms: (7)
Diagnosis: (2)
Treatment:

A

Symptoms: may be asymptomatic, itching after hot bath, erthromelagia (burning sensation in fingers and toes), facial plethora, splenomegaly, gout, headaches, dizziness

Diagnosis: Raised red cell mass on chromium studies & splenomegaly

Treatment: Keep haematocrit below 0.45, venesection, hydroxycarbamide (make HbF), aspirin

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20
Q

Why is sickle cell disease & thalassaemia more common in African populations?
Both what type of inheritance?

A

Aetiology note: Carrier is protected against malaria, hence Sub-Saharan Africa prevalence

Recessive inheritance

21
Q

SICKLE CELL ANAEMIA:
What is Haemoglobin S made of?
What is the problem with HbS

A

2 alpha, 2 beta-S (mutated)

HbS: deoxygenated area leads to polymerisation and deformation - intravascular haemolysis

22
Q

Investgiations of sickle cell anaemia?
3 main complications?
Basic management - acute and chronic?

A

Blood smear
Protein electrophoresis (shows HbS)
Sickle solubility chest (new-born screen)

Complications: Splenic infarction, poor growth, renal failure

Management:
ACUTE: analgesia, rehydration, possible blood transfusion (bronchodilators: salbutamol)
CHRONIC: hydroxycarbamide, prophylaxis for infections, bone marrow transplant

23
Q

3 categories in signs and symptoms of sickle cell anaemia, examples in each

A

Anaemia - enlarged cheeks, hair on end apperance on skull
Hepatomegaly (RBC production in liver)
Vaso-occlusion - dactylitis, pain crises, auto-splenectomy, strokes

24
Q

What can cause an aplastic crisis?

A

Parvovirus B19

25
Basic principles of thalassaemia Twp types of thalassaemia? Main treatment: General presents when?
Diminished synthesis of one or more globin chains - resulting in reduction BETA: (reduced/absence beta chain production) ALPHA: (reduced/absence alpha chain production) Regular transfusions Presents in childhood - pale, crying, failure to feed
26
Three coagulation tests? | What does each measure? (intrinsic or extrinisic)
* aPTT (activated partial thromboplastin time) - intrinsic * PTT (prothrombin time) - extrinsic * INR (international normalized ratio) formed from PTT
27
Name 3 main DOACs/NOACs
apixiban rivaroxaban dabigatran
28
What are the characteristic symptoms of a platelet disorder (4) vs a coagulation disorder (1)
PLATELET Mucosal bleeding (epistaxis - nosebleed, gum bleeding, menorrhagia) Easy bruising (ecchymosis) Petechiae (small) and purpura (large) COAGULATION Deep tissue and joint bleeding
29
What does VWF stand for? | What are it's 3 main roles?
Von Willebrand Factor • Bring platelets in contact with sub-endothelium • Make platelets bind to each other • Bind to factor 8 (protecting it from destruction)
30
Two types of Haemophilia? What factor is deficient in each? Which is more common? Genetic note?
Two types • Haemophilia A - factor 8 deficiency (treated with IV factor 8) • Haemophilia B - factor 9 deficiency Haemophilia A is more common X-linked recessive: mainly male
31
Name 4 aetiologies of microangiopathic haemolytic anaemias?
TTP - thrombotic thrombocytopenic purpura DIC - disseminated intravascular coagulation HUS - Haemolytic uremic syndrome Valvular disease (stenosis or prosthetic)
32
What is anaplastic anaemia? | 3 key points of symptoms?
A rare stem cell disorder leading to pancytopenia and hypoplastic bone marrow Anaemia (low Hb), Infection (low WBC), Bleeding (low platelets)
33
Which is more common ITP or TTP? | What does each stand for?
ITP Immune thrombocytopenic purpura (also idiopathic thrombocytopenic purpura) Thrombotic thrombocytopenic purpura
34
``` Basic physiology of ITP? Presentation in chronic? Presentation in acute? Normal symptoms? Is there splenomegaly? 3 treatment points "diagnosis of ..." ```
Autoimmune destruction of platelets by the spleen Acute: children 2 weeks after infection Chronic: females of reproductive age Features: easy bruising, purpura, epistaxis May be asymptomatic No splenomegaly Corticosteroids (prednisolone) IV IG Splenectomy Diagnosis of exclusion
35
What does DIC stand for? Basic physiology? Causes? (5) Management principle?
Disseminated Intravascular Coagulation Widespread clotting which consumes platelets and then causes bleeding Causes: Malignancy, septicaemia, trauma, infections, haemolytic transfusion reactions Treat underlying cause
36
What gene/protein is TTP associated with? Basic pathophysiology? "The terrible pentad"?
Thrombotic thromobcytopenis purpura (TTP) ADAMTS13 - normally inhibits vWF, loss of it causes platelets binding to vWF Fever, Neurologic, Renal, Anaemia, Platelets
37
What is multiple myeloma a cancer of? Percentage in bone marrow? 3 types of multiple myeloma? What is the name of the protein formed? What does it do?
Plasma cells >10% Symptomatic Asymptomatic (smouldering) Monoclonal gammopathy of undertermined significance (MGUS) (not technically multple myeloma) Paraprotein (light chain) - damages the kidney
38
``` What are the key symptoms of multiple myeloma? Bloods would show: FBC = ? Normal antibodies = ? Hyper or hypocalc = ? Creatinine = ? Bence Jones = ? X-ray = ? ```
CRAB: hyperCalcaemia, Renal failure, Anaemia, Bone lesions (also infections, fatigue, back pain (spinal cord fracture), dehydration) FBC = Anaemia, thrombocytopenia, low WBC? Normal antibodies = decreased Hyper or hypocalc = hypercalcaemia Creatinine = Increased Bence Jones = Increased (paraprotein in urine) X-ray = Lytic bone lesions
39
Staging of Hodgkin's lymphoma?
Ann Arbor system 1: involvement of single lymph node region 2: two ore more lympho node regions on same side as diaphragm 3: involvement of lymph node regions on both sides of diaphragm 4: diffuse extralymphatic disease A = absence of symptoms B = symptoms present
40
What is the common presentaiton of lymphoma?
Painless lymphadenopathy Fever, weight loss, night sweats Possible bowel obstruction and pancytopenia
41
Two types of lymphoma - how do you distinguish between these two?
Hodgkin's & Non-hodgkin's Hodgkin's shows Reed-Sternberg cells under the microscope
42
Note on incidence of Hodgkin's lymphoma? Key antibody treatment in lymphoma? CD__? Association with what two viruses?
Bimodal - young adults and elderley RITUXIMAB (CD20) EBV & HIV
43
Two categories in Non-Hodgkin's lymphoma? 2 examples from each category? Note on prognosis of each?
Low grade: follicular, MALT Better treatment, slightly better prognosis High grade: diffuse large B cell, Burkitt's lymphoma Slightly worse prognosis, more aggressive
44
General symptoms of acute leukaemia? Pathophysiology behind 3 categories of these symptoms? What percentage is needed for a leukaemia diagnosis?
Anaemia: tiredness, fatigue, pallor Thrombocytopenia: bruising or bleeding Leukopenia: infections Increased in blast cells in bone marrow leads to crowding out: Greater than 20% in bone marrow
45
Two chromosomal associations with ALL? ALL is normally found in... Also an association with what syndrome?
9:22 Philadelphia 12:21 Normally found in childhood Down's syndrome
46
What does ALL stand for? Two major types of ALL? What is ALL positively stained with to differentiate it from AML?
Acute lymphoblastic leukaemia B-cell and T-cell Nuclear staining for TdT
47
Who is normally seen with AML? What is the key finding on blood film? Some examples of the subtypes?
Elderly Auer rods (myeloperoxidase staining) Varying maturation subtypes, promyelocytic, monocytic, etc...
48
Chronic leukaemia symptoms?
Same as acute Anaemia, thrombocytopenia & leukocytopenia Not always symptomatic though
49
CML is common in what age group? What chromosomal abnormality? Explain this mechanism What is it called when CML becomes AML? Common mechanism behind this?
Middle age Philadelphia t(9;22) Forms BCR-ABL gene which turns on Tyrosine Kinase, causing build-up (on-switch) Called a BLAST CRISIS - often due to double of Philadelphia chromosome

Phase 2a (9 decks)

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