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Phase 2a NEW > Haematology > Flashcards

Haematology Flashcards

1
Q

Plasma cell dyscrasias (disorders)

A 
MGUS - Monoclonal gammopathy of undetermined significance 
Myeloma
Solitary plasmacytoma
Multiple solitary plasmacytoma
Extramedullary plasmacytoma
Waldenstrom's macroglobulinemia
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2
Q

Multiple myeloma

A

Bone marrow cancer
Neoplastic proliferation of bone marrow plasma cells
Characterised by - a monoclonal protein in serum or urine, lytic bone lesions (tend to be in skull, spine, pelvis), CRAB (elevated Ca, Renal failure, Anaemia, Bone lesions)

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3
Q

Multiple myeloma - Presentation

A

Tiredness, malaise
Bone/back pain (sometimes with fractures)
Infections
Purpura
Proteinuria
Raynaud’s
Lab - anaemia/abnormal FBC, renal failure, hypercalcaemia, raised globulins, raised ESR, serum/urine paraprotein

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4
Q

Blood film - Rouleaux

A

Peripheral blood smear

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5
Q

The commonest type of myeloma

A

IgG

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6
Q

Myeloma - Chromosomal abnormalities

A

t (11;14) - most common

13q - associated with treatment resistance

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7
Q

Myeloma - Investigations

A

CT/MRI/PET
Rouleaux blood film
Bone marrow aspiration/biopsy

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8
Q

Cause of death in myeloma

A

Infection

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9
Q

Amyloidosis

A

Proteinuria

Lower limb swelling

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10
Q

Amyloidosis

A

When an abnormal protein called amyloid builds up in your tissues and organs.
When it does, it affects their shape and how they work.

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11
Q

Myeloma - Treatment (CTD)

A

Supportive - Antibiotics
Radiotherapy - spot welding
Chemo (CTD) - Cyclophosphamide, Thalidomide, Dexamethasone

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12
Q

Myeloma vs lymphoma

A

Myeloma - plasma cells

Lymphoma - lymphocytes

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13
Q

Lymphoma - Common features

A

Enlarged lymph gland
Loss of appetite/weight loss
Night sweats

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14
Q

Lymphoma - Signs

A

Lymph gland enlargement

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15
Q

Lymphoma - Investigations

A

Biopsy bone marrow

Bloods - Hb, WBC, Platelets

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16
Q

Lump in the neck - Differential diagnosis

A

Infective lymph node (bacterial/viral) - TB (tender)

Tumour (solid)

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17
Q

Lymphoma - Treatment

A

Chemo - R-CHOP (Non-Hodgkin’s - specific)
Rituximab (Monoclonal Ab treatment)
Chlorambucil
Radiotherapy (local)

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18
Q

Immune thrombocytopenic purpura (ITP)

A

Bleeding disorder in which the immune system destroys platelets
Too few platelets in the blood

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19
Q

Lymphoma

A

Malignant growth of WBCs - lymphocytes
Commonly in lymph nodes
Also in blood, bone marrow, liver, spleen

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20
Q

Lymphoma vs leukaemia

A

Lymph glands - Lymphoma
Bloods - Leukaemia
Both involve lymphocytes

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21
Q

Lymphoma - Causes

A

Immunodeficiency - HIV
Infection - EBV, H-pylori
Autoimmune

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22
Q

Lymphoma - Investigations

A 
Blood film 
Bone marrow aspirate 
Lymph node biopsy 
Immunophenotyping (CD20 expressed by B lymphocytes) - Rituximab (MAb) targets CD20 
Cytogenetics - FISH
PCR
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23
Q

Lymphoma - Staging

A 
Blood tests - FBCs, LFTs
Viral serology 
CT - chest, abdo
CXR
PET 
Bone marrow biopsy
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24
Q

Lymphoma - subtypes

A

Hodgkin

Non-hodkin

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25
Q

Lymphoma - Hodgkin’s

A

Histological feature - Reed-Sternberg cells

Painless

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26
Q

Hodgkin’s - Staging

A

Stage 1-4

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27
Q

Hodgkin’s - Treatment

A

Radio
Chemo - ABVD (Anthracyclines and bleomycin are examples of one of these)
Bone marrow transplant

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28
Q

Non-Hodgkin’s - Grades

A

Low grade (Follicular) - slow-growing, incurable
Treatment of low-grade - MAb
High grade (diffuse large B cell lymphoma) - Nodal presentation, curable
Treatment of high grade - MAb

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29
Q

MAb

A

Rituximab
Targeted treatment
Anti CD-20
Targets CD20 expressed on cell surface of B-cells
Chimeric protein (mix of mouse/human proteins)
Minimal SEs (as opposed to chemo)

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30
Q

Acute leukaemia - Investigation

A

FBC - Hb, Plts, WBCs
Blood film
U&Es - B12, folate, iron levels
LFTs
Bone marrow aspirate and biopsy - identify blasts (large cells with very little cytoplasm
Immunophenotyping (confirms cells type - myeloid or lymphoid)

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31
Q

Acute leukaemia - Symptoms

A

Symptomatic anaemia - Tiredness, fatigue, lightheadedness, palpitations, SOB (on exertion)
Symptomatic thrombocytopenia - Bruising/bleeding
Symptomatic low WBC - Infections
Symptomatic high WBC - Due to leukostasis or tumour lysis
Extramedullary disease - disease infiltration in skin, gums (hypertrophied)
Coagulopathy - DIC due to sepsis

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32
Q

Acute leukaemia - Differential diagnosis

A

CML
AML
Severe sepsis

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33
Q

Cytopenias (Differentials for eachother)

A 
B12/Folate/iron deficiencies
DIC
Infections - HIV (viral), TB (bacterial)
Lymphoma
Leukemia 
Myeloma
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34
Q

Bone marrow biopsy and aspirates

A

Identify blasts - large cells with very little cytoplasm

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35
Q

Leukaemia - Types

A 
AML
ALL
CML
CMML
CLL
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36
Q

AML - Blast

A

Myeloblast

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37
Q

ALL - Blast

A

Lymphoblast

38
Q

CML - Blast

A

Phils

39
Q

CMML - Blast

A

Monocytes

40
Q

CLL - Blast

A

B lymphocyte

41
Q

Blast maturity and leukaemia prognosis

A

Immature - Acute

Mature - Chronic

42
Q

AML - Treatment

A

Chemo - Anthracycline
Supportive
Hickman line aids delivery of medication and taking of bloods
Allogeneic stem cell transplant

43
Q

Chemo - SEs

A 
Loss of appetite
Allergy
Fatigue
Cytopenias 
Hair loss
44
Q

Anaemia

A

Reduced red cell mass (reduced Hb conc)

Hb is THE identifiable component

45
Q

3rd trimester of pregnancy

A

Increased RCM

Reduced Hb

46
Q

Anaemia - Consequences

A

Reduced oxygen transport
Tissue hypoxia
Physiological compensatory changes - increase tissue perfusion (tachycardia), increase oxygen transfer to tissues, increase RBC production

47
Q

Anaemia - Pathological consequences

A 
Myocardial fatty change
Aggravate angina/claudication 
Fatty change in liver 
Skin and nail atrophic changes 
CNS cell death (cortex and basal ganglia)
48
Q

RBC balance

A

Production - bone marrow
Removal - Spleen, liver, bone marrow, blood loss
Test - reticulocytes level

49
Q

Anaemia - Types

A

Microcytic - small - iron deficiency, thalassaemia (Hb inherited condition)
Normocytic - normal - acute blood loss
Macrocytic - large - B12/folate deficiency, alcohol/liver

50
Q

MCV

A

Mean cell volume (size)

51
Q

Iron deficiency anaemia

A

Test - Ferritin (storage marker for iron)

Tends to be caused by cancer

52
Q

B12 deficiency - Investigation

A

Intrinsic factor Ab
Schilling test
Coeliac Ab

53
Q

Combined haematinic deficiency

A

Malabsorption

54
Q

Anaemia - Tests

A 
FBC
Blood film
Reticulocyte count
U/Es
LFTs
TSH
B12
Folate
Ferritin
55
Q

Iron deficiency

A

Microcytic hyperchromic anaemia

56
Q

B12 deficiency

A

Macrocytic anaemia with polysegmented neutrophils

57
Q

Hemoglobinopathies

A

Disorders of quality - Sickle cell disease (abnormal molecule/variant Hb)
Disorders of quantity - Thalassaemia (reduced prod)

58
Q

Hemoglobin S

A

Variant due to point mutation

59
Q

Sickle cell disease

A

Carriers of HbS are symptom free
Carriage offers protection against facliparum malaria
Multi-system disorder
Excruciating bone pain
Strokes tend to occur in children
Blockage of small vessels is root of problem

60
Q

Sickle cell disease - Presentation

A

Acute - painful crisis, sickle chest syndrome, stroke

Chronic - Renal impairment, pulmonary hptn, joint damage

61
Q

Sickle cell disease - Treatment

A

Transfusion
Hydroxycarbamide
Stem cell transplant

62
Q

Thalassaemia

A 
Globin chain disorders, diminished synthesis of one or more globin chains, reduction in Hb as a result
Genetic lesions (deletions and mutations) - Alpha and beta thal
63
Q

Beta thalassemia major

A

Infants
Symptoms - Pale
Treatment - Transfusion, iron chelation
Monitoring - Ferritin, DEXA scan (bone health)

64
Q

Membranopathies

A

Deficiency of red cell membrane proteins caused by a variety of genetic lesions
Elliptocytosis (horizontal), spherocytosis (vertical)
Children
Jaundice
Gall stones
Treatment - folic acid, splenectomy

65
Q

Parvovirus

A

Decreased RBC prod
Poor prognosis in sickle cell disease
Lead to haemolytic anaemia

66
Q

Enzymopathies

A

G6PD deficiency
Pyruvate kinase deficiency
Lead to haemolytic anaemia

67
Q

Platelet abnormalities

A

Number

Function

68
Q

Platelet physiology

A

Produced in bone marrow
Megakaryocyte fragments (anuclear)
Regulated by thrombopoietin (produced in liver) - stimulates prod
Adhesion and aggregation to form platelet plug
Removed by spleen

69
Q

Platelets - Surface proteins

A

ABO
HPA
Glycoprotein 1a
Platelets activated by adhesion to VWF via GP1b and collagen via GP1a
Platelet activation leads to release of alpha granules containing fibrinogen

70
Q

Platelet - Mechanism of function

A

Adhesion
Release
Aggregation
Procoagulant healing

71
Q

Platelets - Tests

A

FBC - Levels
Blood film - Appearance
PFA (Platelet function analysis)

72
Q

Bleeding - Causes

A 
Injury
Vascular disorders
Low platelets 
Abnormal platelet function
Defective coagulation
73
Q

Platelet dysfunction - Clinical features

A

Mucosal bleeding
Easy bruising
Haematomas
Purpura

74
Q

Low platelets - Causes

A

Prod failure - Marrow failure/suppression, drugs

Increased removal - Splenomegaly

75
Q

Impaired platelet function - Causes

A

Glanzmann disorder - Deficiency of GP1a/b

VW disease

76
Q

Thrombocytopenia

A

Decreased prod by bone marrow
Low B12/folate
Reduce TPO due to liver disease
Infection
Increased destruction (ITP-Immune thrombocytopenia)
Consumption of platelets (DIC - Disseminated intravascular coag, TTP - Thrombotic thrombocytopenic purpura)
Medications which affect platelet function - Clopidogrel, Aspirin

77
Q

Immune thrombocytopenia

A

IgG Ab bind to platelets

Treatment - Steroids (immunosuppression), IV Ig, platelets

78
Q

TTP

A

Spontaneous platelet aggregation in microvasculature due to a reduction in ADAMSTS13 protease enzyme
Consumption of platelets
RBC fragments - Schistocytes

79
Q

Schistocytes

A

RBC fragments

80
Q

Haematology - most likely exam topics

A 
CML
Rituximab 
Hodgkin's lymphoma 
Myeloma 
Anaemia
81
Q

CML

A 
FBC - High WCC
Blood film - Basophilia 
Splenomegaly 
Slow onset
40-60 yo
Key diagnostic feature - Philadelphia chromosome (t9:22) - Abnormal tyrosine kinase leads to abnormal proliferation of WBCs
Treatment (targeted) - Imatinib (TKI)
82
Q

Rituximab

A

MAb
Targets CD20 expressed on surface of B cells (targets and reduces B cells)
Chimeric mouse-human protein (only SEs are related to the mouse proteins - allergy)

83
Q

Hodgkin’s lymphoma - age group

A

Young adults

Elderly

84
Q

Myeloma

A

Skeletal survey - lytic lesions

Production of osteoclast-activating factors

85
Q

Sclerotic vs lytic lesions

A

Sclerotic - Regrowth

Lytic - Dissolved with no regrowth

86
Q

Normocytic anaemia

A

Combined haematinic disease

87
Q

Sickle cell anaemia

A

Chronic haemolytic anaemia - with jaundice
Raised reticulocyte count
Haemoglobinopathy

88
Q

Reticulocyte count

A

Production failure - Low levels

Increased removal - Raised

89
Q

Neutrophilia

A

Physiological response to bacterial infections

90
Q

Aspirin - Antiplatelet effect

A

Irreversible inhibitor of cyclooxygenase enzyme

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