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PHASE 2A > Haematology > Flashcards

Haematology Flashcards

1
Q

What is myeloma?

A

Cancer of differentiated B lymphocytes (plasma cells)

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2
Q

Describe the pathophysiology of myeloma

A

Accumulation of malignant plasma cells in bone –> progressive bone marrow failure
Production of one excess immunoglobulin (monoclonal paraprotein)

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3
Q

What monoclonal paraprotein is usually produced in myeloma?

A 
IgG = 55%
IgA = 20%
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4
Q

What is mono-clonality?

A

Abnormal proliferation of a single clone of plasma cell leading to immunoglobulin secretion and causing organ dysfunction especially to the kidney

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5
Q

Give 3 symptoms of myeloma

A
  1. Tiredness
  2. Bone/back pain
  3. Infections
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6
Q

Give 4 signs of myeloma

A

CRAB

  1. Calcium is elevated
  2. Renal failure
  3. Anaemia
  4. Bone lesions
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7
Q

Why is calcium elevated in myeloma?

A

Increased bone resorption and decreased bone formation so more calcium in the blood

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8
Q

Why might someone with myeloma have anaemia?

A

BM infiltrated with plasma cells = anaemia, neutropenia (infections) and thrombocytopenia (bleeding)

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9
Q

Why might someone with myeloma have renal failure?

A

Due to light chain deposition

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10
Q

What investigations might you do in someone who you suspect has myeloma?

A
  1. Bloods and blood film
  2. Blood marrow aspirate and trephine biopsy
  3. Electrophoresis
  4. X-ray
  5. Urinalysis
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11
Q

What would you expect to see on the blood film taken from someone with myeloma?

A

Rouleaux formation (aggregation of RBCs)

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12
Q

What are you looking for on a bone marrow biopsy taken from someone with myeloma?

A

Increase plasma cells

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13
Q

What are you looking for on electrophoresis in a patient with myeloma?

A

Monoclonal protein band

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14
Q

What would you expect to see on the x-ray taken from someone with myeloma?

A

Lytic ‘punched out’ lesions –> pepper pot skull, vertebral collapse
Fractures
Osteoporosis

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15
Q

What might the urine of someone with myeloma contain?

A

Bence-jones protein - immunoglobulin light chains with kappa or lamda lineage

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16
Q

What does a diagnosis of myeloma require?

A
  1. Monoclonal protein band in serum or urine
  2. Increased plasma cells on bone marrow biopsy
  3. Hypercalcaemia/renal failure/anaemia
  4. Bone lesion on skeletal survey
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17
Q

Describe the treatment for symptomatic myeloma

A 
Bone pain = analgesia 
Bisphosphonates (zolendronate)   
Blood transfusion - for anaemia
Fluids and dialysis - renal failure
Chemotherapy 
Stem cell transplant
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18
Q

How is myeloma bone disease usually assessed?

A

X-ray

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19
Q

Suggest 3 ways in which multiple myeloma can lead to AKI

A
  1. Deposition of light chain
  2. Hypercalcaemia
  3. Hyperuricaemia
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20
Q

What kind of anaemia is seen in patients with multiple myeloma?

A

Normochromic normocytic

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21
Q

What chemotherapy regime is used in patients with myeloma?

A

VAD (fitter people) or CTD (less fit people)

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22
Q

What is leukaemia?

A

A malignant proliferation of haemopoietic stem cells (immature blood cells)

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23
Q

Name 4 sub types of leukaemia

A
  1. AML - Acute Myeloid Leukaemia
  2. CML - Chronic Myeloid Leukaemia
  3. ALL - Acute Lymphoblastic Leukaemia
  4. CLL - Chronic Lymphoblastic Leukaemia
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24
Q

What is acute myeloid leukaemia (AML)?

A

Neoplastic proliferation of blast cells (immature blood cells)
Acute malignant transformation of myeloid progenitor cells

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25
Q

What can increase the risk of developing AML?

A
  1. Preceding haematological disorders
  2. Prior chemotherapy
  3. Exposure to ionising radiation
  4. Down’s syndrome
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26
Q

Give 5 symptoms of leukaemia

A
  1. Anaemia
  2. Infection
  3. Bleeding
  4. Hepatomegaly
  5. Splenomegaly
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27
Q

Why are anaemia, infection and bleeding symptoms of leukaemia?

A

Because of bone marrow failure

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28
Q

Why are hepatomegaly and splenomegaly symptoms of leukaemia?

A

Because of tissue infiltration

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29
Q

What investigations do you do on someone who you suspect has leukaemia?

A
  1. Blood film
  2. Bone marrow biopsy
  3. Lymph node biopsy
  4. Immunophyenotyping
  5. Cytogenetics
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30
Q

What would you expect to see on a blood film and bone marrow biopsy in someone you suspect to have AML?

A

Blood film = anaemia and thrombocytopenia

BM biopsy = leukaemic blast cells

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31
Q

Describe the treatment for AML

A
  1. Supportive therapy (blood transfusions, infections prophylaxis etc)
  2. Chemotherapy - curative vs palliative
  3. Bone marrow transplant
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32
Q

What is chronic myeloid leukaemia (CML)?

A

Uncontrolled clonal proliferation of myeloid cells (basophils, eosinophils and neutrophils)

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33
Q

What chromosome is present in >80% of people with CML?

A

Philadelphia chromosome

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34
Q

Give 4 symptoms of CML

A

Insidious onset

  1. Symptomatic anaemia
  2. Abdominal pain - splenomegaly
  3. Weight loss
  4. Tiredness
  5. Gout
  6. Bleeding
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35
Q

What would the FBC from someone with CML look like?

A

High WCC

Anaemia - normochromic and normocytic

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36
Q

What is the treatment for CML?

A

Imatinib = tyrosine kinase inhibitor

Stem cell transplant

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37
Q

Why does the Philadelphia chromosome cause CML?

A

Froms fusion gene BCR/ABL on chromosome 22 –> tyrosine kinase activity –> stimulates cell division

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38
Q

What is acute lymphoblastic leukaemia (ALL)?

A

Uncontrolled proliferation of immature lymphoblast cells (lymphoid progenitor cells)
Acute malignant transformation of lymphoid progenitor cells

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39
Q

Give 4 signs of ALL

A
  1. BM failure
  2. Heaptosplenomelgay
  3. Lymphadenopathy
  4. Headache and CN palsies
  5. Mediastinal masses with SVC obstruction
    Due to organ infiltration
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40
Q

What is the treatment for ALL?

A

Chemotherapy
Supportive therapy - Blood and platelet transfusion, Allopurinal (prevents tumour lysis syndrome)
Bone marrow transplant

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41
Q

What is Chronic lymphoblastic leukaemia (CLL)?

A

Proliferation of mature B lymphocytes leads to accumulation of mature B cells that have escaped apoptosis
Chronic malignant transformation of mature lymphoid cells

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42
Q

What may be seen on the blood film of someone with CLL?

A

Smudge cells on histology

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43
Q

What is the treatment for CLL?

A
  1. Do nothing
  2. Chemotherapy
  3. Monoclonal antibodies
  4. Bone marrow transplant
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44
Q

Is ALL more common in adults or children?

A

Mainly a childhood disease

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45
Q

Give 4 symptoms of ALL

A
  1. Bone pain
  2. Recurrent infections (neutropenia)
  3. Pale and tired (anaemia)
  4. Bruising (low platelets)
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46
Q

Give 3 environmental causes of leukaemia

A
  1. Radiation exposure
  2. Chemicals (benzene compounds)
  3. Drugs
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47
Q

What is lymphoma?

A

Malignant proliferation of lymphocytes, normally in the lymph nodes

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48
Q

Although predominantly in the lymph nodes, what other organs can lymphoma effect?

A
  1. Blood
  2. Bone marrow
  3. Liver
  4. Spleen
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49
Q

Give 4 risk factors for lymphoma

A
  1. Primary immunodeficiency
  2. Secondary immunodeficiency - HIV, transplant recipients
  3. Infections - EBV, H. pylori, HTLV-1
  4. Autoimmune disorders - SLE, RA
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50
Q

Describe the pathophysiology of lymphoma

A

Impaired immunosurveillance and infected B cells escape regulation and proliferate

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51
Q

Give 4 symptoms of lymphoma

A
  1. Enlarged lymph nodes in arm/neck
  2. Symptoms of compression syndromes
    3, General systemic ‘B’ symtoms - weight loss, night sweats, malaise
  3. Hepatosplenomeglay
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52
Q

What investigations might you do in someone who you suspect has lymphoma?

A
  1. Blood fim
  2. Bone marrow biopsy
  3. Lymph node biopsy
  4. Immunophenotyping
  5. Cytogenetics (karyotyping/FISH)
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53
Q

What staging investigations might you do in someone with lymphoma?

A
  1. Blood tests
  2. CT scan chest, abdomen, pelvis
  3. Bone marrow biopsy
  4. PET scan
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54
Q

What are the 2 sub-types of lymphoma

A
  1. Hodgkins lymphoma

2. Non-hodgkins lymphoma

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55
Q

What are symptoms of Hodgkins lymphoma?

A
  1. Painless lymphadenopathy

2. Presence of ‘B’ symptoms - fever, weight loss, night sweats, lethargy

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56
Q

What is needed for the diagnosis of Hodgkins lymphoma?

A

Presence of Reed-Sternberg cells (in lymph node biopsy)

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57
Q

What blood results may you seen in someone with Hodgkins lymphoma?

A

High ESR
Low Hb
High serum lactase dehydrogenase

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58
Q

Describe the staging go Hodgkins lymphoma

A

Stage 1 = confined to a single lymph node region
Stage 2 = Involvement of two or more nodal areas on the same side of the diaphragm
Stage 3 = Involvement of nodes on both sides of the diaphragm.
Stage 4 = Spread beyond the lymph nodes e.g. liver.
Each stage is either ‘A’ - absence of ‘B’ symptoms or ‘B’ - presence of ‘B’ symptoms

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59
Q

What is treatment for stage 1 - 2A Hodgkins lymphoma?

A

Short course chemotherapy followed by radiotherapy

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60
Q

What is the treatment for stage 2B - 4 Hodgkins lymphoma?

A

Cyclic chemotherapy and radiotherapy

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61
Q

What chemotherapy regime is used for the treatment of Hodgkins lymphoma?

A 
ABVD regime:
Adriamycin
Bleomycin
Vinblastine
Dacarbazine
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62
Q

What treatment is used for a relapse of Hodgkins lymphoma?

A

Stem cell transplant

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63
Q

What are the possible complications of treatment for Hodgkins lymphoma?

A
  1. Secondary malignancies
  2. IHD
  3. Infertility
  4. Nausea
  5. Alopecia
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64
Q

What is non-hodgkins lymphoma?

A

Any lymphoma not involving Reed-Sternberg cells

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65
Q

Describe low-grade non-hodgkins lymphoma

A

E.g. Follicular lymphoma
Slow growing
Often advanced at presentation
Often incurable (mens survival 10 years)

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66
Q

Describe high grade non-hodgkins lymphoma

A

E.g. Diffuse Large B cell Lymphoma
Agressive
Nodal presentation
Often curable

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67
Q

Give an example of a very high grade Non-Hodgkin’s lymphoma

A

Burkitt’s lymphoma

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68
Q

Give 4 features of non-hodgkins lymphoma

A
  1. Lymphadenopathy - painless
  2. Extranodal involvement - skins, CNS
  3. Systemic symptoms - fever, weight loss, night sweats
  4. Pancytopenia - anaemia, thrombocytopenia and leukopenia due to BM involvement
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69
Q

What is the treatment for low grade non-hodgkins lymphoma?

A

If symptomless - do nothing

Radiotherapy, combination chemotherapy and monoclonal antibodies may be used if symptomatic

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70
Q

What is the treatment for high grade non-hodgkins lymphoma?

A 
Early = short course chemotherapy and radiotherapy 
Advanced = combination chemotherapy and monoclonal antibody (Rituximab)
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71
Q

What is anaemia?

A

A reduced RBC mass +/- reduced Hb concentration

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72
Q

What is the functions of Hb?

A

It carries and delivers oxygen to tissues

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73
Q

What are the normal Hb concentrations for:

a) Males
b) Females

A

a) Males = 131-166 g/L

b) Females = 110-147 g/L

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74
Q

What organs are responsible for the removal of RBCs?

A
  1. Spleen
  2. Liver
  3. Bone marrow
  4. Blood loss
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75
Q

What are the normal MCV values for:

a) Males
b) Females

A

a) Males = 81.8-96.3 fl

b) Females = 80.0-98.1 fl

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76
Q

Give 3 causes of microcytic anaemia

A
  1. Iron deficiency
  2. Chronic disease
  3. Thalassaemia
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77
Q

Give 3 causes of normocytic anaemia

A
  1. Acute blood loss
  2. Chronic disease
  3. Combined haematinic deficiency (iron and B12 deficiency)
78
Q

Give 3 causes of macrocytic anaemia

A
  1. B12/folate deficiency
  2. Alcohol excess –> liver disease
  3. Haemolytic anaemia
  4. Hypothyroid
79
Q

Briefly describe the pathophysiology of anaemia

A

Reduced O2 transport –> tissue hypoxia –> compensatory mechanism = increased tissue perfusion, increased O2 transfer to tissue, increase RBC production

80
Q

What pathological changes occur due to anaemia?

A
  1. Heart/liver fat change
  2. Ischaemia
  3. Skin/nail atrophy
  4. CNS death
  5. Aggravate angina and claudication
81
Q

What do reticulocytes show you?

A

Marker of balance between formation and removal of RBCs

82
Q

Give 4 symptoms of anaemia

A

Non-specific

  1. Fatigue
  2. Dyspnoea
  3. Headache
  4. Faintness
  5. Palpitations
  6. Anorexia
83
Q

Give 3 signs of anaemia

A
  1. Conjunctival pallor
  2. Hyper-dynamic circulation
  3. Tachycardia
  4. Systolic flow murmur
84
Q

What investigations might you do in someone with anaemia?

A
  1. FBC and Blood film
  2. Reticulocyte count
  3. B12, folate and ferritin levels
  4. U+E’s, LFT’s, TSH levels
85
Q

What is the treatment for anaemia?

A

Treat the underlying cause

86
Q

Give 3 causes of iron deficiency anaemia

A
  1. Blood loss
  2. Poor absorption
  3. Decreased intake in diet
  4. Increased demand - growth/pregnancy
  5. Hookworm
87
Q

Describe the pathophysiology of iron deficiency anaemia

A

Lack of iron –> no haem production –> lack of effective RBCs

88
Q

What would the results of investigations be for someone with iron deficiency anaemia?

A

MICROCYTIC HYPOCHROMIC ANAEMIA

Low ferritin, low reticulocyte

89
Q

How do you treat iron deficiency anaemia?

A 
Improve diet and treat cause 
Ferrous sulphate (iron supplement) - SE = black stool and constipation
90
Q

Describe the pathophysiology of B12 deficiency/pernicious anaemia

A

Lack of B12/intrinsic factor –> B12 not absorbed in terminal ileum –> big facile RBCs

91
Q

Give 2 causes of B12 deficiency/pernicious anaemia

A
  1. Autoimmune parietal cell destruction (pernicious)
  2. Poor diet
  3. Ileectomy
92
Q

What are 2 specific signs of B12 deficiency/pernicious anaemia?

A

Inflamed tongue

Neurological - paraesthesia, psychological problems

93
Q

What would the results of the investigations be for someone with B12 deficiency/pernicious anaemia?

A

MACROCYTIC NORMOCHROMIC ANAEMIA with polysegmented neutrophils
Autoantibodies = intrinsic factor and coeliac antibodies

94
Q

How would you treat B12 deficiency/pernicious anaemia ?

A

Treat cause

B12 replacement - hydroxocobalamin

95
Q

Describe the pathophysiology of folate deficiency

A

Lack of folate –> can’t be absorbed in upper intestine –> large fragile RBC
Macrocytic anaemia with low erythrocyte folate levels

96
Q

How do you treat folate deficiency?

A

Folic acid supplement

97
Q

Describe the pathophysiology of haemolytic anaemia

A

RBC destroyed before 120 day lifespan –> compensatory reticulocytes from BM –> RBC destruction

  • Extravascular
  • Intravascular
98
Q

Give 3 inherited causes of haemolytic anaemia

A
  1. RBC membrane defect
  2. Abnormal Hb - thalassaemia’s, sickle cell
  3. Enzyme defects - Glucose-6-phosphate dehydrogenase deficiency
99
Q

Give 3 acquired causes of haemolytic anaemia

A
  1. Autoimmune
  2. Drug induced
  3. Secondary to systemic disease
  4. Malaria
100
Q

What is the management for haemolytic anaemia

A

Dietary = folate and iron supplementation
AI cause = immunosuppression
Surgical = splenectomy

101
Q

Name the 3 broad categories of red cell disorders

A
  1. Haemoglobinopathies
  2. Membranopathies
  3. Enzymopathies
102
Q

What is normal adult haemoglobin made of?

A

2 alpha and 2 beta chains

103
Q

What is foetal haemoglobin made of?

A

2 alpha and 2 gamma chains

104
Q

What is haemoglobin S?

A

Variant haemoglobin arising because of a point mutation in the beta globin gene
Mutation leads to a single AA change, Glutamate –> Valine

105
Q

What two categories can haemoglobinopathies be divided in to?

A
  1. Disorders of quality - abnormal molecule or variant haemoglobin (sickle cell)
  2. Disorders of quantity - reduced production (thalassaemia’s)
106
Q

What is sickle cell disease?

A

A haemoglobin disorder of quality

HbS polymerises –> sickle shaped RBC

107
Q

What is the advantage of being a carrier of sickle cell disease?

A

Offers protection against falciparum malaria

They are symptom free

108
Q

Describe the inheritance pattern of sickle cell disease

A

Autosomal recessive

Homozygous SS

109
Q

If both parents are carries of the sickle trait, what is the chance of their first child having sickle cell disease?

A

25% chance of having sickle cell

50% chance of being a carrier

110
Q

How long do sickle cells last for?

111
Q

Give 3 acute complications of sick cell disease

A
  1. Painful crisis
  2. Sickle cell syndrome - blockage of blood vessels within bone leading to pain
  3. Strokes in children
  4. Infections
112
Q

Give 3 chronic complications of sickle cell disease

A
  1. Renal impairment
  2. Pulmonary hypertension
  3. Joint damage
113
Q

What investigations are done to confirm a diagnosis of sickle cell disease?

A

Neonatal screening = sickle cells on blood film

Hb electrophoresis confirms diagnosis

114
Q

Describe the treatment for sickle cell disease

A
  1. Transfusion
  2. Hydroxycarbamide
  3. Stem cell transplant
115
Q

What is thalassaemia?

A

A haemoglobin disorder of quantity

Reduced synthesis of one or more globin chain leading to a reduction in Hb –> anaemia

116
Q

If someone has beta thalassaemia, do they have more alpha or beta globing chains

A

Beta thalassaemia = reduced Beta chain synthesis

Very few beta chains, excess alpha chains

117
Q

What is the clinical classification of beta thalassaemia?

A
  1. Thalassaemia major
  2. Thalassaemia intermedia
  3. Thalassaemia carrier/heterozygote
118
Q

What clinical classification of Thalassaemia relies on regular transfusions?

A

Thalassaemia major

119
Q

What clinical classification of Thalassaemia relies is often asymptomatic?

A

Thalassaemia carrier/heterozygote

120
Q

When do people with beta Thalassaemia major usually present and why?

A

Present very young due to having severe anaemia and so a failure to feed and thrive

121
Q

What results would you see from investigations of someone with beta Thalassaemia major?

A

Hb 40-70 g/L
Blood film = large and small (irregular) very pale red cells
Hb F > 90% (neonatal sample)

122
Q

What is the treatment for beta Thalassaemia major?

A

Regular transfusions
Iron chelation
Endocrine supplementation
Fertility help

123
Q

Why is it important to monitor iron levels in someone with beta Thalassaemia major?

A

Risk of iron overload from the regular transfusion

Excess iron will be deposited in various organs (e.g. liver and spleen) and cause fibrosis

124
Q

What is the significance of parvovirus in someone with sickle cell disease?

A

Parvovirus is common infection in children

Leads to decreased RBC production and an cause a dramatic drop in Hb in patients who already have a reduced RBC lifespan

125
Q

Describe the inheritance pattern for membranoapthies

A

Autosomal dominant

126
Q

Name 2 common membrnaopathies

A
  1. Spherocytosis

2. Elliptocytosis

127
Q

Briefly describe the physiology of membranopathies

A

Deficiency in red cell membrane protein caused by genetic lesions

128
Q

What are enzymopathies?

A

Enzyme deficiencies lead to shortened RBC lifespan

129
Q

Name a common enzymopathy

A

G6PD deficiency

130
Q

Give 3 signs of G6PD deficiency

A

Crises characterised by:

  1. Haemolysis
  2. Jaundice
  3. Anaemia
131
Q

Name 3 things that can precipitate G6PD deficiency

A
  1. Broad beans
  2. Infection
  3. Drugs - Primaquine, sulphonamide, quinolones
132
Q

What is polycythaemia?

A

Too many RBC’s, increased Hb

Due to a JACK2 mutation

133
Q

What hormone is responsible for regulating RBC production?

A

Erythropoietin (EPO)

134
Q

What stimulates EPO?

A

Tissue hypoxia

135
Q

Name a primary cause of polycythaemia

A

Polycythaemia rubra vera - overactive bone marrow

136
Q

Give 3 secondary causes of polycythaemia

A
  1. Smoking
  2. Lung disease
  3. Cyanotic heart disease
  4. High altitude
  5. Excess EPO
137
Q

Give 3 signs of polycythaemia

A
  1. Hyper-viscosity - headaches, dizziness, visual disturbances
  2. Red face
  3. Splenomegaly
138
Q

What is the treatment for polycythaemia?

A
  1. Secondary cause = treat underlying causes
  2. Primary cause = aims to maintain a normal blood count and prevent complications
    - Aspirin
    - Venesection (in young)
    - Hydroxycarbamide (in old)
139
Q

Where are platelets produced?

A

In the bone marrow

They are fragments fo megakaryocytes

140
Q

What hormone regulated platelet production?

A

Thrombopoietin - produced mainly in the liver

141
Q

What is the lifespan of a platelet?

142
Q

What organ is responsible for platelet removal?

143
Q

What can cause platelet dysfunction?

A

Reduced platelet number (thrombocytopenia)

Reduced platelet function

144
Q

What can cause decreased platelet production?

A
  1. Congenital causes (e.g. malfunctioning megakaryocytes)
  2. Infiltration of bone marrow (e.g. leukaemia)
  3. Alcohol
  4. Infection (e.g. HIV/TB)
  5. Reduced TPO
  6. Aplastic anaemia
145
Q

What can cause increased platelet destruction?

A
  1. Autoimmune (e.g. ITP)
  2. Hypersplenism
  3. Drug related (e.g. heparin induced)
  4. DIC and TTP –> increased consumption
146
Q

What can cause reduced platelet function?

A
  1. Congenital abnormality
  2. Medications - aspirin
  3. VWF disease
  4. Uraemia
147
Q

Give 3 symptoms of platelet dysfunction

A
  1. Mucosal bleeding - epistaxis, gum bleeding, menorrhagia
  2. Easy bruising
  3. Petechiae/purpura
  4. Traumatic haematomas
148
Q

Give 4 causes of bleeding

A
  1. Trauma
  2. Platelet deficiency - thrombocytopenia
  3. Platelet dysfunction - aspirin induced
  4. Vascular disorders
149
Q

Give 3 things that can cause coagulation disorders

A
  1. Vitamin K deficiency
  2. Liver disease
  3. Congenital - haemophilia
150
Q

What is disseminated intravascular coagulation (DIC)?

A

Pathological activation of coagulation cascade –> fibrin in vessel walls
Platelet (thrombocytopenia) and coagulation factor consumption
Thrombin activated inappropriately –> excess diffuse clotting –> uncontrolled bleeding

151
Q

Give 3 causes of DIC

A
  1. Sepsis
  2. Malignancy
  3. Trauma
152
Q

What is the affect on thrombin time, prothrombin time and APTT in someone with DIC?

A

All increased

153
Q

What the effect on fibrinogen in someone with DIC?

154
Q

How do you treat DIC?

A
  1. Treat underlying condition
  2. Platelet transfusions
  3. FFP - contain clotting factors
  4. Cryoprecipitate - contains fibrinogen and some clotting factors
155
Q

What is thrombotic thrombocytopenia?

A

ADAMTS13 deficiency –> no vWF degradation –> widespread aggregation of platelets –> thrombosis in microvasculature or heart/lungs/brain

156
Q

Give 3 symptoms of thrombotic thrombocytopenia

A
  1. Renal/CNS/cardiac impairment
  2. Fever
  3. Haemolytic anaemia
157
Q

What is the treatment for thrombotic thrombocytopenia?

A 
Plasma exchange (removed ADAMTS13 autoantibodies)
Splenectomy
158
Q

What is immune thrombocytopenia?

A

Antibodies formed against platelet –> autoimmune platelet destruction via reticuloendothelial system

159
Q

Give 3 causes of immune thrombocytopenia

A 
Primary = viral infection (children)
Secondary (chronic, adults)
  - Autoimmune condition - SLE
  - Malignancies - CLL
  - Infections - HIV/Hep C
160
Q

Give 3 symptoms of immune thrombocytopenia

A
  1. Rapid purpura
  2. Epistaxis
  3. Easy bruising
161
Q

What is the management for immune thrombocytopenia?

A

Corticosteroid (prednisolone)

Splenectomy

162
Q

Give 4 casues of folate deficiency

A
  1. Dietary
  2. Malabsorption
  3. Increased requirement - pregnancy
  4. Folate antagonists - methotrexate
163
Q

Give 3 signs of haemolytic anaemia

A
  1. Pallor
  2. Jaundice
  3. Splenomegaly
164
Q

Give 2 specific symptoms of iron deficiency anaemia

A
  1. Koilonychia
  2. Brittle har and nails
  3. Atrophic glossitis
165
Q

What is neutrophilia?

A

Too many neutrophils

166
Q

Give 3 causes of neutrophilia

A
  1. Infection
  2. Inflammation
  3. Cancer
  4. CML = primary cause
167
Q

What is lymphocytosis?

A

Too many lymphocytes

168
Q

Give 3 causes of lymphocytosis

A
  1. Viral infection
  2. Inflammation
  3. Cancer
  4. CLL = primary cause
169
Q

What is thrombocytopenia?

A

Not enough platelets

170
Q

What is thrombocytosis?

A

Too many platelets

171
Q

Give 3 causes of thrombocytosis

A
  1. Infection
  2. Inflammation
  3. Cancer
  4. Essential thrombocythaemia = primary cause
172
Q

What is neutropenia?

A

Not enough neutrophils

173
Q

What is the major risk associated with being neutropenic?

A

Susceptible to infection

174
Q

Give 3 causes of neutropenia

A
  1. Underproduction = marrow failure, marrow infiltration, marrow toxicity (e.g. drugs)
  2. Increased removal = autoimmune, Felty’s syndrome, cyclical
175
Q

Give 2 causes of thrombocytopenia

A
  1. Production failure - marrow suppression, marrow failure

2. Increased removal - immune response (ITP), consumption (DIC), splenomegaly

176
Q

What is the definition of febrile neutropenia?

A

Temperature >38 degrees in a patient with neutrophil count <1x10^9/L

177
Q

Give 4 risk factors for febrile neutropenia

A
  1. If the patient had chemotherapy <6 weeks ago
  2. Any patient who has had a stem cell transplant <1 year ago
  3. Any haematological condition causing neutropenia
  4. Bone marrow infiltration
178
Q

Give a risk for spinal cord compression

A

Any malignancy that can cause compression - bone metastasis

179
Q

What is tumour lysis syndrome?

A

Breakdown of malignancy cells –> content release –> metabolic disturbances
Can cause hyperuricaemia, hyperkalaemia, hypocalcaemia

180
Q

Give 3 risk factors for tumour lysis syndrome

A
  1. High tumour burden
  2. Pre existing renal failure
  3. Increasing age
181
Q

What is hyper viscosity syndrome?

A

Increase in blood viscosity usually due to high levels of immunoglobulins

182
Q

Give 2 consequences of hyperviscosity syndrome

A
  1. Vascular stasis

2. Hypoperfusion

183
Q

What does rituximab target?

A

Targets CD20 on the surface of B cells

184
Q

What is the affect of sickle cell anaemia on reticulocyte count?

185
Q

What clotting factors depend on vitamin K?

A

2, 7, 9, 10

186
Q

Haemophilia A is due to deficiency of what clotting factor?

A

Factor 8 deficiency

187
Q

Haemophilia B is due to deficiency of what clotting factor?

A

Factor 9 deficiency

188
Q

How does warfarin work?

A

Antagonises vitamin K so reduction in clotting factors 2, 7, 9 and 10

189
Q

How does heparin work?

A

It activates antithrombin which then inhibits thrombin and factor Xa

190
Q

What 3 blood test values would be increased in someone with polycythaemia?

A
  1. Hb
  2. RCC
  3. PCV

PHASE 2A (16 decks)

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