Haematology Flashcards
Causes of MICROCYTIC ANAEMIA (10 causes)
IRON DEFICIENCY of varying cause:
- Menorrhagia
- Pregnancy
- GI Malignancy
- Oesophagitis
- GORD
- Coeliac Disease
- Hookworm
- THALASSAEMIA
- SCHISTOSOMIASIS
- Diet low in Iron
Causes of MACROCYTIC ANAEMIA (6 causes)
FAT RBC
- FOLATE deficiency
- Alcohol
- Thyroid LOW
- RETICULOCYTOSIS
- B12 deficiency- Pernicious Anaemia
- CYTOTOXIC drugs
Causes of NORMOCYTIC ANAEMIA (6 causes)
HAEMOLYTIC ANAEMIA of varying cause-
- Glucose-6-phosphate dehydrogenase deficiency
- Sickle Cell disease
- Hereditary SPHEROCYTOSIS
- ERYTHROBLASTOSIS FETALIS
- Warm antibody AUTOIMMUNE haemolytic anaemia and cold agglutin disease
- Anaemia of chronic disease (Rheumatoid Arthritis, Aplastic Anaemia)
Signs of Microcytic and Macrocytic Anaemia
Pallor
Angular Cheilitis- (inflammation on corners of mouth)
Atrophic Glossitis- (lack of white stuff on tongue)
MICROCYTIC ONLY- Koilynychia
MACROCYTIC ONLY- Paraesthesiae and Subacute degeneration of SPINAL CORD
Bloods in MICROCYTIC ANAEMIA
LOW Hb LOW MCV LOW MCH LOW Ferritin LOW Iron
HIGH Total Iron Binding Capacity
Bloods in MACROCYTIC ANAEMIA
LOW B12 LOW Folate LOW RETICULOCYTES LOW Platelets (If Severe) LOW WCC (If Severe)
HIGH MCV
Bloods in NORMOCYTIC ANAEMIA
LOW Hb
NORMAL MCV
NORMAL or HIGH FERRITIN
Which anaemia increases risk of infection?
MICROCYTIC
Which anaemia can lead to SPLENOMEGALY and neuropsychiatric/ neurological complications?
MACROCYTIC
Treatment for Microcytic and Macrocytic Anaemia
TREAT CAUSE
Microcytic-
- Ferrous Sulphate
Macrocytic-
- HYDROXOCOBALAMIN INJECTIONS if Pernicious Anaemia
BLOODS in THALASSAEMIA
LOW HB
LOW MCV
LOW MCH
NORMAL Ferritin
NORMAL Iron
Hb electrophoresis- HIGH HbA2 and HIGH HbF
Treatment of THALASSAEMIA
Transfusions are required when Hb<7g/dL or when patient is HIGHLY SYMPTOMATIC
Patients who have repeated transfusions regularly are at risk of HAEMOCHROMATOSIS and require IRON CHELATION THERAPY (like DESFERROXAMINE)
Surgical:
- Stem cell transplant
- Splenectomy
Complications of THALASSAEMIA
SPLENOMEGALY
Iron overload
GALLSTONES
ARRHYTHMIAS
Bone abnormalities (CRANIAL BOSSING)
The four steps of CLOT FORMATION
1) Vessel construction
2) Platelet adhesion and aggregation
3) Blood coagulation
4) Fibrinolysis
Glanzmann’s thrombasthenia (DEFECT in STEP 2 of clot formation)
+ investigation
- Platelets are deficient of Gp IIb/IIIa
Investigations- increased bleeding time
Treatment of Glanzmann’s thrombasthenia
- Avoid ASPIRIN and NSAIDs
- DESMOPRESSIN
- Recombinant activated factor VII
Von Willebrand disease (DEFECT in STEP 2 of clot formation)
- Defect in Von Willebrand factor- which binds GpIb on platelets to subendothelial collagen
Investigations in Von Willebrand disease
LOW VWF antigen
LOW factor VIIIc
NORMAL Prothrombin Time
INCREASED bleeding time
INCREASED activated PARTIAL THROMBOPLASTIN time
Treatment of Von Willebrand disease
Avoid ASPIRIN and NSAIDs
DESMOPRESSIN
Bernard Soulier Syndrome (DEFECT in STEP 2 of clot formation)
GpIb deficiency
Investigations in Bernard Soulier Syndrome
Increased bleeding time
NORMAL or LOW platelet
Treatment for Bernard Soulier Syndrome
DESMOPRESSIN
Recombinant activated factor VII
Haemophilia (DEFECT in STEP 3 of clot formation)
Two types-
Type A- lack of FACTOR VIII
Type B- lack of FATOR IX
Investigations in Haemophilia
INCREASED partial thromboplastin time
INCREASED prothrombin
Treatment in Haemophilia
Avoid ASPIRIN, NSAIDs, HEPARIN and WARFARIN
Replace the deficient clotting factor with regular infusion
- FACTOR VIII in Type A
- FACTOR IX in Type B
Vitamin K Insufficiency (BLEEDING Disorder)
Decreased Vitamin K1 or K2
Results in-
- DECREASED synthesis of factors II, VII, IX, X
- DECREASED synthesis of PROTEINS C and S
Causes of Vitamin K insufficiency (7 causes)
MMA DC3
- Malnutrition
- Malabsorption
- Alcoholism
- Drugs (WARFARIN)
- CYSTIC FIBROSIS
- CHRONIC KIDNEY INJURY
- CHOLESTATIC DISEASE
Bleeding disorders with increased PROTHROMBIN TIME
Vitamin K insufficiency
Bleeding disorders with increased PARTIALTHROMBOPLASTIN TIME
Vitamin K insufficiency (may be NORMAL as well)
Haemophilia
Von Willebrand Disease
Treatment of Vitamin K insufficiency
Dietary advice and Vitamin K supplements
Symptoms in all four types of LEUKEMIA
NIGHT SWEATS
WEIGHT LOSS
BONE MARROW FAILURE
MALAISE
Symptoms of Acute Lymphoblastic Leukemia (ALL)
NIGHT SWEATS
WEIGHT LOSS
BONE MARROW FAILURE
MALAISE
Purpura
Shortness of breath
Bruising
Symptoms of Chronic Lymphoblastic Leukemia (CLL)
NIGHT SWEATS
WEIGHT LOSS
BONE MARROW FAILURE
MALAISE
HEPATOSPLENOMEGALY
Non-tender Lymphadenopathy
ASYMPTOMATIC
Symptoms of Acute Myeloid Leukemia
nothing extra from standard leukemia symptoms
NIGHT SWEATS
WEIGHT LOSS
BONE MARROW FAILURE
MALAISE
Symptoms of Chronic Myeloid Leukemia
NIGHT SWEATS
WEIGHT LOSS
BONE MARROW FAILURE
MALAISE
HEPATOSPLENOMEGALY
Leukemias that lead to hepatosplenomegaly
CHRONIC myeloid and lymphoblastic leukemia
Risk factors of Acute Myeloid Leukemia
Myeloproliferative disease
Alkylating agents
Ionising radiation exposure (also risk factor for CML)
Down’s Syndrome
Which Leukemia is commonest in children and often spreads to CNS?
Acute Lymphoblastic Leukemia
Which Leukemia usually affects adults over 60 years old?
Chronic Lymphoblastic Leukemia
Which Leukemia is commonest in adults and has AUER RODS on microscopy?
Acute Myeloid Leukemia
Treatment of ALL leukemia
To INDUCE REMISSION-
- Dexamethasone
- Anthracycline antibiotics
- Cincristine
- Vincristine
For MAINTENANCE-
- METHOTREXATE
- Mercaptopurine
- CYTARABINE
- HYDROCORTISONE
Treatment of CLL leukemia
Chlorambucil
Fludarabine
Rituximab
Prednisolone
Cyclophosphamide
Treatment of AML leukemia
Patient<60-
- chemotherapy with ANTHRACYCLINE and CYTARABINE or METHOTREXATE
Patient>60-
- Palliative, ANTHRACYCLINE, CYTARABINE or MITOXANTRONE
Treatment of CML leukemia
IMATINIB
Stem cell transplantation possible for patients<60
Other treatments-
- Alpha Interferon
- Vincristine
- Prednisolone
- Cytarabine
- Daunorubicin
What is Hodgkin’s Lymphoma?
+ 4 common histological subtypes
Group of uncommon malignancies
1) Lymphocyte-predominant
2) Nodular sclerosing
3) Mixed cellularity
4) Lymphocyte-depleted
Risk factors for Hodgkin’s Lymphoma
MALE
EBV infection
IMMUNOSUPPRESSION
Exotoxin exposure
Signs and Symptoms of Hodgkin’s AND Non-Hodgkin’s Lymphoma
Kind of Similar to CLL
- Painless Lymphadenopathy
- Unintentional weight loss
- Fever (>38C)
- DYSPNOEA
- HEPATOMEGALY
- SPLENOMEGALY
Constitutional B symptoms= LYMPHOMA
- FEVER >38C
- Night Sweats
- Weight loss
INVESTIGATIONS in Hodgkin’s and Non-Hodgkin’s Lymphoma
- LACTASE DEHYDROGENASE
- CREATININE
- ALKALINE PHOSPHATASE
- CYTOKINE LEVELS
- Look for REED-STERNBERG CELLS
Treatment for Hodgkin’s Lymphoma
AVBD regimen (although it’s DVBD)-
- Doxorubicin
- Vinblastine
- Bleomycin
- Dacarbazine
BEACOPP regimen (although it’s BEDCVPP)
- Bleomycin
- Etoposide
- Doxorubicin
- Cyclophosphamide
- Vincristine
- Procarbazine
- PREDNISOLONE
What is Non-Hodgkin’s Lymphoma?
Group of malignancies that are either B cell or T cell in origin
Non-Hodgkin’s B cell Lymphoma 4 examples
Burkitt’s Lymphoma- ASSOCIATED WITH EBV
Diffuse large B cell lymphoma
MANTLE CELL LYMPHOMA
Follicular LYMPHOMA
Non-Hodgkin’s T cell Lymphoma 2 examples
Adult cell lymphoma (caused by Human T Lymphotrophic Virus 1)
Sezary
Risk factors of Non-Hodgkin’s Lymphoma
Male sex
Infection with EBV, Helicobacter Pylori, Human Herpes Virus, Hepatitis C
Immunosuppression (HIV patients)
Treatment of Non-Hodgkin’s Lymphoma
R-CHOP regimen (Although it’s actually RCHVP)
- Rituximab
- Cyclophosphamidde
- Hydroxydaunomycin
- Vincristine
- Prednisolone
OTHER AGENTS-
- Cisplatin
- Etopside
- Methotrexate
What is a MYELOMA?
Malignant neoplasm of PLASMA CELLS
Risk factors of Myeloma
Monoclonal gammopathy of unknown significance
PERNICIOUS ANAEEMIA
History of THYROID CANCER
Exposure to certain exotoxins (BENZENE, AGENT ORANGE)
Past history of radiation exposure
Signs and Symptoms of Myeloma
HAIR FUV BP
HYPERCALCAEMIA
ANAEMIA
Infection
Renal Impairment
Fatigue Unintentional weight loss VERTEBRAL COLAPSE (may lead to spinal cord compression)
BRUISING
Pathological fractures
Investigations in Myeloma
- Alkaline phosphatase
- Beta-2 Microglobulin
Blood film- ROULEUX formation
Serum and urine electrophoresis-
- Paraprotein (M) protein
- Bence Jones proteinuria
X-ray for BONE DEFORMITIES- generalised skeletal OSTEOPAENIA
Treatment of Myeloma
<70 years old and without comorbidities- BONE MARROW TRANSPLANT
- USE VAD regimen
- Vincristine
- Adriamycin
- Dexamethasone
After transplant- long term therapy with MELPHALAN
If NOT eligible for bone marrow transplant- MELPHALAN and PREDNISOLONE
Radiotherapy may be needed for bone pain and spinal cord compression
Surgical- KYPHOPLASTY
Complications of Myeloma
ANAEMIA
HYPERCALCAEMIA
AKI
Pathological fracture
