Haematology Flashcards
What are your differentials for a platelet disorder?
Viral infection Drugs ITP DIC TTP
What are your differentials for coagulation disorders?
Haemophilia Type A=factor 8 Type B=factor 9 Von willebrands Warfarin Vitamin K deficiency Liver disease DIC
Which factors does APTT assess?
Intrinsic and common pathways
All factors apart from 7 but especially Factors 8, 9, 11 and 12
Which factors does Prothrombin ratio assess?
Extrinsic and common pathways
Factors 2, 5, 7 , 10, fibrinogen and prothrombin
How does chronic immune thrombocytopenic purpura present?
Bleeding, purpura, epistaxis, menorrhagia without splenomegaly
Management of ITP
If mild, just supportive Prednisolone Splenectomy cures 80% of relapses IV IG TPO-RAs
What is ALL associated with?
Children between 2 and 10.
Associated with Down’s Syndrome
Presentation of ALL
Marrow failure, bleeding, infection, lymphadenopathy, hepatosplenomegaly
Management of ALL
Blood/platelet transfusion Allopurinol (prevents tumour lysis syndrome) IV antibiotics if febrile neutropenia Chemotherapy Bone marrow transplant
Prognosis of ALL
90% cure rate in children
40% in adults
What is AML associated with?
Complication of radiotherapy/chemo
Commonest acute leukaemia in adults
What is CML associated with?
Philadelphia chromosome in 80% of cases-better prognosis
Splenomegaly
Investigations for CML
FBC
Bone marrow aspirate
Check for Philadelphia chromosome
Management of CML
Chemotherapy: imatinib
Stem cell transplant
How does CLL present?
Most common leukaemia
Often incidental finding on bloods
Painless lymphadenopathy
Investigations for CLL
FBC
Blood film
Bone marrow aspirate
Direct coomb’s test
Management of CLL
Watchful waiting if mild Steroids IVIG Transfusions Allogenic stem cell transplantation Fludarabine, cyclophosphamide and rituximab
Complications of CLL
Autoimmune haemolysis
Infections
Marrow failure
Key features of Hodgkin’s lymphoma
Reed-sternberg cells
FhX, EBV, sle
Young adults and elderly
Symptoms of lymphoma
Rubbery painless nodes fever, weight loss, fatigue Mediastinal involvement Extranodal disease Infection
Investigations for lymphoma
Lymph node biopsy
Bone marrow aspirate
CXR/CT/MRI
Bloods
Differentials for cervical lymph node enlargement
Infection: CMV,TB, EBV, HIV
Autoimmune: rheumatoid arthritis
Malignancy: Lymphoma, CLL, ALL, melanoma, thyroid cancer, stomach cancer, breast cancer
What is the staging for lymphoma?
Ann Arbor Staging System
I-confined to single lymph node
II-> 2 nodal areas, same side of the diaphragm
III-> 2 nodal areas, both sides of diaphragm
IV- spread beyond lymph nodes
Management for hodgkins lymphoma
80% 5 year survival
Radiotherapy and chemotherapy
ABVD chemo (adriamycin, bleomycin, vinblastine, decarbazine)
Management for non-hodgkin’s lymphoma
40% 5 year survival
Low grade-just radiotherapy
High grade- RCHOP: rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, prednisolone
What is the pathogenesis of multiple myeloma?
The malignant proliferation of plasma cells producing identical immunoglobulins
Presentation of multiple myeloma
CRAB hyperCalcemia Renal involvement Anemia Bone lesions/Back pain Plus increased infections
How to diagnose multiple myeloma
Monoclonal protein band on serum electrophoresis
Increased plasma cells on bone marrow biopsy
Evidence of end organ damage
Bence jones protein in urine
Investigations for multiple myeloma
Bloods: anemia, hypercalcemia, rouleaux formation
Electrophoresis
Skeletal survey
Bone marrow
Management of multiple myeloma
Analgesia Bisphosphonates Transfusions and erythropoietin IV immunoglobulin Chemotherapy 3-4 year survival
What is virchow’s triad
Hypercoagulability
Stasis of blood flow
Changes to blood flow wall
Pathogenesis of Factor V Leiden
Protein C cleaves Factor V molecule
Factor V Leiden is resistant to cleavage and so protein C cannot act as an anticoagulant
Causes of microcytic anaemia
Iron deficiency
Thalassemia
Sideroblastic anaemia
Iron deficiency: Serum ferritin is low, TIBC is up and iron is low
Causes of normocytic anaemia
Acute blood loss Anaemia of chronic disease Renal failure Pregnancy Bone marrow failure Hypothyroidism
Causes of macrocytic anaemia
B12/folate deficiency
Liver failure
Alcohol
Cytotoxic drugs
Lab results in anaemia of chronic disease
Serum ferritin: high
TIBC: low
Iron: low
What are the four myeloproliferative disorders?
Polycythaemia (RBC increased)
Chronic myeloid leukaemia (WBC increased)
Essential thrombocythaemia (platelets increased)
Myelofibrosis (fibroblasts increased)
Presentation of polycythemia rubra vera
Itch after bath/shower Facial redness Headaches DVT PVD JAK2 positive Massive splenomegaly
Management of polycythemia rubra vera
Venesection
Hydroxyurea/interferon
Low dose aspirin
Presentation of essential thrombocythaemia
Abnormal bleeding
Thromboembolism
Headaches
JAK2 -50%
Management of thrombocythaemia
Don’t treat if asymptomatic
Transexamic acid
Aspirin
Hydroxyurea/interferon
Presentation of myelofibrosis
Lethargy, weakness, weight loss, fever, easy bleeding
Investigations for myelofibrosis
Tear drop cells on blood film
Nucleated RBCs
Fibrosis on bone marrow trephine
Management of myelofibrosis
Bone marrow support-RBC and platelet transfusion
