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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
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
26
Wells Score >= 2 what action?
Proximal leg vein ultrasound within 4 hours Alternative: D-dimer and anti-coagulant and arrange US within 24 hours
27
Wells Score <=1 what action?
D-dimer | If positive, proceed to proximal leg vein ultrasound
28
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
29
What medication would you use prior to confirmation of DVT (ie still waiting for USS results)?
Rivaroxaban or apixaban
30
Management of DVT if renal impairment?
Cr/Cl <15ml/min offer LMWH or warfarin
31
Management of DVT in patient with no co-morbidities
Apixaban/rivaroxaban or LMWH for 5 days followed by warfarin
32
Duration of anti-coagulation following DVT
3 months if provoked | 6 months if unprovoked or active cancer (more investigations to look for underlying thrombophilia)
33
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
34
Common DVT differentials
Ruptured baker's cyst Pre-patellar bursitis Cellulitis Gastronemius tear
35
When would you give a patient platelet transfusions?
Clinically significant bleeding, platelets <30x10^9 No bleeding, platelets <10
36
When is a platelet transfusion contraindicated?
Chronic bone marrow failure Thrombotic thrombocytopaenic purpura Thrombocytopenia (AI or heparin-induced)
37
Graft versus host disease common features
Maculopapular rash of neck, palms and soles Jaundice Bloody diarrhoea Deranged LFTs - cholestatic jaundice
38
Graft versus host disease treatment
IV steroids Anti-TNF
39
von Willebrand's features
Epistaxis, menorrhagia Prolonged APTT
40
Von Willebrand's treatment
Mild bleeding: tranexamic acid Factor VIII Desmopressin
41
Cryoprecipitate main component? Indications?
Factor VIII Massive haemorrhage, uncontrolled bleeding due to haemophilia
42
When do you admit a patient with sickle cell disease
Adult with mild-mod pain and temperature | Child with mild-mod pain
43
Management of sickle cell crisis
``` Opiates Rehydration Oxygen Abx if infection Blood transfusion ```
44
Most common cause of isolated thrombocytopenia, and main features?
Idiopathic thrombocytopenic purpura + anaemia, purpura
45
Causes of acquired haemophilia
Liver failure Vit K deficiency Autoimmunity against a clotting factor Disseminated intravascular coagulation
46
What are the investigations for haemophilia
Platelets - normal Prothrombin time - normal Partial thromboplastic time - RAISED (contains factors VIII and IX)
47
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
48
Virus associated with Burkitt's lymphoma
EBV
49
Microscopic findings of Burkitt's
Starry sky appearance
50
What do you give with chemo in Burkitt's to prevent tumour lysis syndrome?
Rasburicase
51
Secondary causes of polycythaemia
COPD Altitude Obstructive sleep apnoea Uterine fibroids
52
Emergency reversal of warfarin if patient has head injury or severe haemorrhage?
Vitamin K | Prothrombin complex concentrate
53
Hypo chromic microcytic anaemia with raised reticulocyte count?
B-Thalassaemia
54
Myelofibrosis presentation
Elderly patient tiredness, night sweats weight loss, splenomegaly Tear drop appearance of RBC
55
Treatment of CML
Imatinib
56
CLL treatment
Young: stem cell transplant Old and symptomatic: chemo Old and asymptomatic: watch and wait
57
Acute leukaemia bone biopsy
>20% blast cells (lots of nucleus, not much cytoplasm)
58
AML M3 treatment
Vitamin A (chemo if it is not M3)
59
AML presentation
67 years old | Exposure to benzene, radiation or CML blast crisis
60
Diagnosis of AML
Smear: neutrophils Bone marrow biopsy >20% blast cells +ve myeloperoxidase
61
What is seen in blast cells in M3 variant of AML?
Auer rods
62
What would you see in ALL bone marrow biopsy?
cALLa | Tdt
63
How do you treat ALL?
Chemo and CNS prophylaxis (ARA-C +/- radiation)
64
CML bone marrow biopsy?
Philadelphia, t(9,22), BCR-ABL

Phase 3b (18 decks)

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