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Phase 3b > Haematology > Flashcards

Haematology Flashcards

1
Q

What might cause a insufficient erythropoiesis?

A 
EPO deficiency (renal failure, chronic disease)
Nutrient deficiency 
Marrow infiltration (leukemia, multiple myeloma)
Myelosuppression (chemo/radiotherapy)
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2
Q

What might cause ineffective erythropoiesis?

A

Thalassemia
Folate/B12 deficiency
Myelodysplastic syndrome
Sideroblastic anaemia

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3
Q

What might cause increased RBC destruction?

A

Inherited:
Membrane - hereditary spherocytosis
Metabolic - G6PD deficiency
Haemaglobinopathies - sickle cell or thalassaemia

Acquired:
Immune haemolytic anaemias (warm or cold)
Mechanical heart valve

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4
Q

What are the types of autoimmune haemolytic anaemias?

A

Warm (CLL, lymphoma, SLE, drugs) - IgG

Cold (mycoplasma pneumoniae, infectious mononucleosis) - IgM

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5
Q

Causes of microcytic hypochromic anaemia?

A

Iron-deficiency
Thalassaemia
Anaemia of chronic disease
Sideroblastic anaemia

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6
Q

Normocytic normochromic anaemia causes?

A

Anaemia of chronic disease
Renal failure
Blood loss

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7
Q

Macrocytic anaemia causes?

A

Megaloblastic: folate and B12 deficiency

Non-megaloblastic: alcoholism, hypothyroidism, drugs (azathioprine), liver disease

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8
Q

What are target cells and in whom would you see them?

A

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

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9
Q

What are spherocytes and in whom would you see them?

A

Round cells which have lost central pallor

Seen in patients with hereditary spherocytosis, autoimmune haemolytic anaemias

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10
Q

When would you consider a RBC transfusion in a patient with anaemia?

A

<70g/L Hg concentration
<80g/L with cardiovascular disease

Symptomatic suggests need for transfusion even if higher concentrations

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11
Q

Which patients with iron deficiency need to be investigated further and what would you do?

A

Male or female past menopause or not menstruating

Gastroscopy or colonoscopy

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12
Q

Secondary causes of thrombocytosis

A

Inflammation, Cancer, Bleeding

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13
Q

Oral iron dose

A

200mg once daily

Up to 3x per day but gives abdominal pain, bloating and diarrhoea

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14
Q

Haemophilia A or B investigations

A

Factor VIII or IX

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15
Q

Haemophilia A and B main presentation

A

Prolonged APTT

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16
Q

Haemophilia B treatment

A

Extended half life Factor IX concentrate

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17
Q

Haemophilia B inheritance?

A

X-linked recessive

If father is affected - 0% chance of son, 100% chance of daughter being carrier

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18
Q

Investigation for pernicious anaemia?

A

Intrinsic factor antibodies

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19
Q

Why do you not give a blood transfusion for B12 deficiency?

A

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

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20
Q

What cells will be low in severe B12/folate deficiency?

A

Haemoglobin
Platelets
WCC

PANCYTOPAENIA

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21
Q

Neurological signs of B12 deficiency?

A

Dementia

PERIPHERAL NEUROPATHY

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22
Q

Neurological signs of folate deficiency?

A

NONE

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23
Q

Blood components in a blood donation

A

Fresh frozen plasma
Red cells
Platelets
Cryoprecipitate

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24
Q

Complications of blood transfusion

A 
Circulatory overload 
Haemolytic reaction
ABO incompatability (most common cause of death)
Iron overload 
Anaphylaxis 
Rash 
Pyrexia
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25
Q

Three locations for DVT

A

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

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26
Q

Wells Score >= 2 what action?

A

Proximal leg vein ultrasound within 4 hours

Alternative: D-dimer and anti-coagulant and arrange US within 24 hours

27
Q

Wells Score <=1 what action?

A

D-dimer

If positive, proceed to proximal leg vein ultrasound

28
Q

Management if D-dimer positive but initial USS negative?

A

Stop anti-coagulation and offer repeat USS in 6-8 days in case distal DVT extended into proximal veins

29
Q

What medication would you use prior to confirmation of DVT (ie still waiting for USS results)?

A

Rivaroxaban or apixaban

30
Q

Management of DVT if renal impairment?

A

Cr/Cl <15ml/min offer LMWH or warfarin

31
Q

Management of DVT in patient with no co-morbidities

A

Apixaban/rivaroxaban or LMWH for 5 days followed by warfarin

32
Q

Duration of anti-coagulation following DVT

A

3 months if provoked

6 months if unprovoked or active cancer (more investigations to look for underlying thrombophilia)

33
Q

What is the main complication following DVT?

A

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
34
Q

Common DVT differentials

A

Ruptured baker’s cyst
Pre-patellar bursitis
Cellulitis
Gastronemius tear

35
Q

When would you give a patient platelet transfusions?

A

Clinically significant bleeding, platelets <30x10^9

No bleeding, platelets <10

36
Q

When is a platelet transfusion contraindicated?

A

Chronic bone marrow failure
Thrombotic thrombocytopaenic purpura
Thrombocytopenia (AI or heparin-induced)

37
Q

Graft versus host disease common features

A

Maculopapular rash of neck, palms and soles
Jaundice
Bloody diarrhoea
Deranged LFTs - cholestatic jaundice

38
Q

Graft versus host disease treatment

A

IV steroids

Anti-TNF

39
Q

von Willebrand’s features

A

Epistaxis, menorrhagia

Prolonged APTT

40
Q

Von Willebrand’s treatment

A

Mild bleeding: tranexamic acid

Factor VIII

Desmopressin

41
Q

Cryoprecipitate main component? Indications?

A

Factor VIII

Massive haemorrhage, uncontrolled bleeding due to haemophilia

42
Q

When do you admit a patient with sickle cell disease

A

Adult with mild-mod pain and temperature

Child with mild-mod pain

43
Q

Management of sickle cell crisis

A 
Opiates 
Rehydration 
Oxygen 
Abx if infection 
Blood transfusion
44
Q

Most common cause of isolated thrombocytopenia, and main features?

A

Idiopathic thrombocytopenic purpura

+ anaemia, purpura

45
Q

Causes of acquired haemophilia

A

Liver failure
Vit K deficiency
Autoimmunity against a clotting factor
Disseminated intravascular coagulation

46
Q

What are the investigations for haemophilia

A

Platelets - normal
Prothrombin time - normal
Partial thromboplastic time - RAISED (contains factors VIII and IX)

47
Q

Treatment of haemophilia

A

Injection of clotting factors (except in severe deficiency)

Desmopressin in A as it stimulates factor VIII and vWF release

Avoid contact sports

48
Q

Virus associated with Burkitt’s lymphoma

A

EBV

49
Q

Microscopic findings of Burkitt’s

A

Starry sky appearance

50
Q

What do you give with chemo in Burkitt’s to prevent tumour lysis syndrome?

A

Rasburicase

51
Q

Secondary causes of polycythaemia

A

COPD
Altitude
Obstructive sleep apnoea
Uterine fibroids

52
Q

Emergency reversal of warfarin if patient has head injury or severe haemorrhage?

A

Vitamin K

Prothrombin complex concentrate

53
Q

Hypo chromic microcytic anaemia with raised reticulocyte count?

A

B-Thalassaemia

54
Q

Myelofibrosis presentation

A

Elderly patient
tiredness, night sweats weight loss, splenomegaly
Tear drop appearance of RBC

55
Q

Treatment of CML

A

Imatinib

56
Q

CLL treatment

A

Young: stem cell transplant
Old and symptomatic: chemo
Old and asymptomatic: watch and wait

57
Q

Acute leukaemia bone biopsy

A

> 20% blast cells (lots of nucleus, not much cytoplasm)

58
Q

AML M3 treatment

A

Vitamin A (chemo if it is not M3)

59
Q

AML presentation

A

67 years old

Exposure to benzene, radiation or CML blast crisis

60
Q

Diagnosis of AML

A

Smear: neutrophils
Bone marrow biopsy >20% blast cells
+ve myeloperoxidase

61
Q

What is seen in blast cells in M3 variant of AML?

A

Auer rods

62
Q

What would you see in ALL bone marrow biopsy?

A

cALLa

Tdt

63
Q

How do you treat ALL?

A

Chemo and CNS prophylaxis (ARA-C +/- radiation)

64
Q

CML bone marrow biopsy?

A

Philadelphia, t(9,22), BCR-ABL

Phase 3b (18 decks)

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