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Yr 5 conditions > Haematology > Flashcards

Haematology Flashcards

1
Q

What are the 3 broad causes of iron deficiency anaemia?

A 
Dietray insufficiency (most common cause in kids)
Increased loss of iron (e.g. menorrhagia)
Inadequate absorption (e.g. in coeliac or Crohn's disease)
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2
Q

What blood tests are required to diagnose an iron deficiency anaemia?

A

FBC - will show low Hb, low MCV, low MCH
Serum Ferritin - low (if doing full iron studies, Total Iron Binding Capacity will be high)
Blood film shows hypochromic, microcytic red blood cells with anisocytosis (unequal size) and poikilocytosis (abnormal shape - >10%)

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3
Q

Once someone has been diagnosed with iron deficiency anaemia, what further tests should be carried out?

A

All should get a coeliac disease screen (α-gliadin transglutaminase and anti-endomycsial antibody).
Consider OGD and colonoscopy if symptoms suggestive of GI bleeding
Consider H. pylori testing
Urine dip to check for haematuria

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4
Q

What is the management of iron deficiency anaemia?

A

Treat the underlying cause
Increase iron intake with red meat, legumes, green veg etc
Oral iron supplementation with Ferrous sulphate 200mg TDS taken with food
If PO route ineffective/impossible, consider IV iron

Monitor response to iron therapy with blood tests

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5
Q

What side effects should patients be warned about before starting Iron supplementation?

A

Nausea, abdo discomfort, constipation, black stools (harmless)

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6
Q

What are the possible signs and symptoms of a blood-transfusion reaction?

A

Feeling of apprehension, flushing, chills, pain at venepuncture site, myalgia, nausea, abdo/chest/flank pain, dyspnoea, fever, hypotension/hypertension, tachycardia, respiratory distress, oozing from venepuncture site, heamoglobinaemia, haemoglobinuria

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7
Q

What are the features of Transfusion-Related Acute Lung Injury?

A

It is a form of ARDS brought on by the presence of antileucocyte antibodies in the donor plasma producing symptoms of prominent nonproductive cough, breathlessness, hypoxia and frothy sputum. HR and JVP will be raised. Bibasal inspiratory creps on auscultation.

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8
Q

What will a CXR show in TRALI?

A

Either multiple perihilar nodules with infiltration of the lower lung fields; or white-out.

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9
Q

What is the management of TRALI?

A 
•	STOP TRANSFUSION
•	15L NRBM
•	Sit patient upright
•	Furosemide 40mg IV STAT
•	Catheterise – monitor output
•	Monitor Obs – haemodynamic stability
•	ABG – hypoxaemia
•	ECG
Call senior if no improvement
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10
Q

What are the 2 subtypes of macrocytic anaemias?

A

Megaloblastic - low B12 and/or folate deficiency
Non-megaloblastic - other causes (e.g. alcoholism, hypothyroidism, liver disease, myelodisplastic syndromes, drugs e.g. azathioprine)

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11
Q

The presence of reticulocytes on blood film indicates what type of macrocytic anaemia?

A

Megaloblastic anaemia (due to B12 or folate deficiency)

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12
Q

The presence of which type of cells on blood film indicates a non-megaloblatic macrocytic anaemia?

A

Target cells

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13
Q

How is pernicious anaemia/B12 deficiency managed?

A

Vitamin B12 IM injection every 3 months

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14
Q

How is folate deficiency managed?

A

Folic acid 5mg PO every day for 4 months

If B12 and folate deficiency occur concurrently you MUST treat the B12 deficiency first

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15
Q

What are the 3 features of destruction of red blood cells?

A

Anaemia, splenomegaly, jaundice

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16
Q

What investigations should be carried out in suspected haemolytic anaemia?

A

FBC - shows a normocytic anaemia
Blood film - shows schistocytes (fragments of red blood cells)
Direct Coombs test - positive in autoimmune haemolytic anaemia

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17
Q

What is the most common cause of inherited haemolytic anaemia in northern Europeans?

A

Hereditary spherocytosis

Other inherited causes include hereditary elliptocytosis, thalassaemia, sickle Cell Anaemia, G6PD Deficiency

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18
Q

What is seen on blood film for G6PD deficiency?

A

Heinz body

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19
Q

Red urine in the morning (containing haemolgobin and haemosiderin) is the classical presentation of which rare condition?

A

Paroxysmal Nocturnal Haemoglobinuria

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20
Q

What are the peak ages of onset of Hodgkin’s Lymphoma?

A

Around 20 and 75

Bimodal age distribution

21
Q

What is the characterisitic description of the enlarged lymph nodes seen in Hodgkin’s lymphoma?

A

Non-tender, rubbery feel

Tend to be in the cervical region

22
Q

Pain in lymph nodes when drinking alcohol should prompt investigation for which condition?

A

Hodgkin’s lymphoma

23
Q

What type of cell is seen on biopsy in Hodgkin Lymphoma?

A

Reed-Sternberg cells - abnormally large B cells that have multiple nuclei that have nucleoli inside them. This can give them the appearance of the face of an owl with large eyes

24
Q

What is the staging system used for lymphomas?

A

Ann-Arbor staging system

25
Q

What is the 2nd most common haematological malignancy?

A

Multiple myeloma

26
Q

What is the classical presentation of Multiple Myeloma?

A 
C - calcium elevated (hypercalcaemia Sx)
R - Renal impairment
A - Anaemia
B - Bone pain (especially back)
B - Bleeding
I - Infection (increased susceptibility)
27
Q

What is the spectrum of myeloma?

A

Monoclonal gammopathy of undetermined significance (MGUS)
Smouldering myeloma
Multiple myeloma

28
Q

What is present in the urine of someone with multiple myeloma?

A

Bence-Jones Protein

29
Q

What investigations should be performed in suspected multiple myeloma?

A

B – Bence–Jones protein (request urine electrophoresis)
L – Serum‑free Light‑chain assay
I – Serum Immunoglobulins
P – Serum Protein electrophoresis

Bone marrow biopsy
Imaging (whole body MRI) to assess for bony lesions

30
Q

What will an X-ray of the skull show in multiple myeloma?

A

“Raindrop skull” - caused by many punched out (lytic) lesions throughout the skull that give the appearance of raindrops splashing on a surface

31
Q

What drug can be used in sickle cell disease to stimulate production of fetal haemoglobin?

A

Hydroxycarbamide

32
Q

What are some common triggers for sickle cell crises?

A

Can occur spontaneously or stresses such as cold, infection, dehydration or significant life events

33
Q

How are sickle cell crises managed?

A

Supportive management.

  • Have a low threshold for admission to hospital
  • Treat any infection
  • Keep warm
  • Keep well hydrated (IV fluids may be required)
  • Simple analgesia such as paracetamol and ibuprofen
  • Penile aspiration in priapism
34
Q

What factor is deficient in haemophilia A?

A

Factor VIII

35
Q

What factor is deficient in haemophilia B (aka Christmas disease)?

A

Factor IX

36
Q

What is the inheritance pattern of haemophilias?

A

X-linked recessive

37
Q

In haemophilia, what will the clotting blood tests show?

A

Prolonged APTT

Bleeding time, thrombin time, prothrombin time normal

38
Q

What is the inheritence pattern of thalassaemias?

A

Autosomal recessive

39
Q

What are the potential features of a child with thalassaemia?

A

Microcytic anaemia (low mean corpuscular volume)
Fatigue - due to more RBC breakdown
Pallor - due to more RBC breakdown
Jaundice - due to more RBC breakdown
Gallstones
Splenomegaly - spleen swells with destroyed RBCs
Poor growth and development
Pronounced forehead and malar eminences - overcompensation by the bone marrow to produce more RBCs

40
Q

Investigations for thalassaemia?

A

Full blood count - shows a microcytic anaemia.
Haemoglobin electrophoresis - used to diagnose globin abnormalities.
DNA testing - can be used to look for the genetic abnormality

41
Q

What complication of thalasseamia (and its treatment) must be regularly monitored for with a blood test?

A

Iron overload - due to faulty creation of red blood cells, recurrent transfusions and increased absorption of iron in response to the anaemia.
Regular serum ferritin monitoring

42
Q

What type of cells are seen on blood film in Acute Lymphoblastic Leukaemia?

A

Blast cells

43
Q

What is the mnemonic to rememeber which age groups get which haematological malignancies?

A

ALL CeLLmates have CoMmon AMbitions
Under 5 and over 45 – acute lymphoblastic leukaemia (ALL)
Over 55 – chronic lymphocytic leukaemia (CeLLmates)
Over 65 – chronic myeloid leukaemia (CoMmon)
Over 75 – acute myeloid leukaemia (AMbitions)

44
Q

Which haematological malignancy is associated with Down’s syndrome?

A

Acute lymphoblastic leukamias

45
Q

Which haematological malignancy is most strongly associated with the Philadelphia chromosome - t(9:22)?

A

Chronic myeloid leukaemia

46
Q

What distinguishing feature will be seen on blood film in Acute Myeloid Leukaemia?

A

Auer rods - rods in the cytoplasm of blast cells

47
Q

What is the most common cause of thrombophilia?

A

Factor V Leiden (activated protein C resistance) - impaired breakdown of clots

48
Q

What are some ‘acquired’ causes of thrombophilia?

A

Antiphospholipid syndrome

Drugs - e.g. COCP

49
Q

What level platelet count is a particular worry for spontaneous bleeds e.g. intracranial haemorrhage or GI bleeds?

A

Platelet count < 10 x 10’9/L

Yr 5 conditions (16 decks)

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