Haematology Flashcards
What might cause a insufficient erythropoiesis?
EPO deficiency (renal failure, chronic disease) Nutrient deficiency Marrow infiltration (leukemia, multiple myeloma) Myelosuppression (chemo/radiotherapy)
What might cause ineffective erythropoiesis?
Thalassemia
Folate/B12 deficiency
Myelodysplastic syndrome
Sideroblastic anaemia
What might cause increased RBC destruction?
Inherited:
Membrane - hereditary spherocytosis
Metabolic - G6PD deficiency
Haemaglobinopathies - sickle cell or thalassaemia
Acquired:
Immune haemolytic anaemias (warm or cold)
Mechanical heart valve
What are the types of autoimmune haemolytic anaemias?
Warm (CLL, lymphoma, SLE, drugs) - IgG
Cold (mycoplasma pneumoniae, infectious mononucleosis) - IgM
Causes of microcytic hypochromic anaemia?
Iron-deficiency
Thalassaemia
Anaemia of chronic disease
Sideroblastic anaemia
Normocytic normochromic anaemia causes?
Anaemia of chronic disease
Renal failure
Blood loss
Macrocytic anaemia causes?
Megaloblastic: folate and B12 deficiency
Non-megaloblastic: alcoholism, hypothyroidism, drugs (azathioprine), liver disease
What are target cells and in whom would you see them?
Due to excess cell membrane, look like a target with a dark centre
Seen in patients post-splenectomy, or those with thalassaemia, sickle cell, iron-deficiency or hyposplenism
What are spherocytes and in whom would you see them?
Round cells which have lost central pallor
Seen in patients with hereditary spherocytosis, autoimmune haemolytic anaemias
When would you consider a RBC transfusion in a patient with anaemia?
<70g/L Hg concentration
<80g/L with cardiovascular disease
Symptomatic suggests need for transfusion even if higher concentrations
Which patients with iron deficiency need to be investigated further and what would you do?
Male or female past menopause or not menstruating
Gastroscopy or colonoscopy
Secondary causes of thrombocytosis
Inflammation, Cancer, Bleeding
Oral iron dose
200mg once daily
Up to 3x per day but gives abdominal pain, bloating and diarrhoea
Haemophilia A or B investigations
Factor VIII or IX
Haemophilia A and B main presentation
Prolonged APTT
Haemophilia B treatment
Extended half life Factor IX concentrate
Haemophilia B inheritance?
X-linked recessive
If father is affected - 0% chance of son, 100% chance of daughter being carrier
Investigation for pernicious anaemia?
Intrinsic factor antibodies
Why do you not give a blood transfusion for B12 deficiency?
It’s chronic and the blood volume has increased to adapt, so giving transfusion can tip them into heart failure
Instead just give them B12
What cells will be low in severe B12/folate deficiency?
Haemoglobin
Platelets
WCC
PANCYTOPAENIA
Neurological signs of B12 deficiency?
Dementia
PERIPHERAL NEUROPATHY
Neurological signs of folate deficiency?
NONE
Blood components in a blood donation
Fresh frozen plasma
Red cells
Platelets
Cryoprecipitate
Complications of blood transfusion
Circulatory overload Haemolytic reaction ABO incompatability (most common cause of death) Iron overload Anaphylaxis Rash Pyrexia
Three locations for DVT
Distal: below popliteal trifurcation, most likely to resolve spontaneously without symptoms
Proximal: above popliteal trifurcation (popliteal, femoral or iliac veins), 50% of symptomatic develop PE in 3 months
Other: e.g. upper limb or portal vein
Wells Score >= 2 what action?
Proximal leg vein ultrasound within 4 hours
Alternative: D-dimer and anti-coagulant and arrange US within 24 hours
Wells Score <=1 what action?
D-dimer
If positive, proceed to proximal leg vein ultrasound
Management if D-dimer positive but initial USS negative?
Stop anti-coagulation and offer repeat USS in 6-8 days in case distal DVT extended into proximal veins
What medication would you use prior to confirmation of DVT (ie still waiting for USS results)?
Rivaroxaban or apixaban
Management of DVT if renal impairment?
Cr/Cl <15ml/min offer LMWH or warfarin
Management of DVT in patient with no co-morbidities
Apixaban/rivaroxaban or LMWH for 5 days followed by warfarin
Duration of anti-coagulation following DVT
3 months if provoked
6 months if unprovoked or active cancer (more investigations to look for underlying thrombophilia)
What is the main complication following DVT?
PE (most worrying)
Post-thrombotic syndrome (within 2 years)
- Result of chronic venous HTN leading to swelling, pain and skin changes
- Can lead to gangrene and ulcers
Common DVT differentials
Ruptured baker’s cyst
Pre-patellar bursitis
Cellulitis
Gastronemius tear
When would you give a patient platelet transfusions?
Clinically significant bleeding, platelets <30x10^9
No bleeding, platelets <10
When is a platelet transfusion contraindicated?
Chronic bone marrow failure
Thrombotic thrombocytopaenic purpura
Thrombocytopenia (AI or heparin-induced)
Graft versus host disease common features
Maculopapular rash of neck, palms and soles
Jaundice
Bloody diarrhoea
Deranged LFTs - cholestatic jaundice
Graft versus host disease treatment
IV steroids
Anti-TNF
von Willebrand’s features
Epistaxis, menorrhagia
Prolonged APTT
Von Willebrand’s treatment
Mild bleeding: tranexamic acid
Factor VIII
Desmopressin
Cryoprecipitate main component? Indications?
Factor VIII
Massive haemorrhage, uncontrolled bleeding due to haemophilia
When do you admit a patient with sickle cell disease
Adult with mild-mod pain and temperature
Child with mild-mod pain
Management of sickle cell crisis
Opiates Rehydration Oxygen Abx if infection Blood transfusion
Most common cause of isolated thrombocytopenia, and main features?
Idiopathic thrombocytopenic purpura
+ anaemia, purpura
Causes of acquired haemophilia
Liver failure
Vit K deficiency
Autoimmunity against a clotting factor
Disseminated intravascular coagulation
What are the investigations for haemophilia
Platelets - normal
Prothrombin time - normal
Partial thromboplastic time - RAISED (contains factors VIII and IX)
Treatment of haemophilia
Injection of clotting factors (except in severe deficiency)
Desmopressin in A as it stimulates factor VIII and vWF release
Avoid contact sports
Virus associated with Burkitt’s lymphoma
EBV
Microscopic findings of Burkitt’s
Starry sky appearance
What do you give with chemo in Burkitt’s to prevent tumour lysis syndrome?
Rasburicase
Secondary causes of polycythaemia
COPD
Altitude
Obstructive sleep apnoea
Uterine fibroids
Emergency reversal of warfarin if patient has head injury or severe haemorrhage?
Vitamin K
Prothrombin complex concentrate
Hypo chromic microcytic anaemia with raised reticulocyte count?
B-Thalassaemia
Myelofibrosis presentation
Elderly patient
tiredness, night sweats weight loss, splenomegaly
Tear drop appearance of RBC
Treatment of CML
Imatinib
CLL treatment
Young: stem cell transplant
Old and symptomatic: chemo
Old and asymptomatic: watch and wait
Acute leukaemia bone biopsy
> 20% blast cells (lots of nucleus, not much cytoplasm)
AML M3 treatment
Vitamin A (chemo if it is not M3)
AML presentation
67 years old
Exposure to benzene, radiation or CML blast crisis
Diagnosis of AML
Smear: neutrophils
Bone marrow biopsy >20% blast cells
+ve myeloperoxidase
What is seen in blast cells in M3 variant of AML?
Auer rods
What would you see in ALL bone marrow biopsy?
cALLa
Tdt
How do you treat ALL?
Chemo and CNS prophylaxis (ARA-C +/- radiation)
CML bone marrow biopsy?
Philadelphia, t(9,22), BCR-ABL
