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Medicine > Haematology > Flashcards

Haematology Flashcards

1
Q

Causes of MICROCYTIC ANAEMIA (10 causes)

A

IRON DEFICIENCY of varying cause:

  • Menorrhagia
  • Pregnancy
  • GI Malignancy
  • Oesophagitis
  • GORD
  • Coeliac Disease
  • Hookworm
  • THALASSAEMIA
  • SCHISTOSOMIASIS
  • Diet low in Iron
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2
Q

Causes of MACROCYTIC ANAEMIA (6 causes)

A

FAT RBC

  • FOLATE deficiency
  • Alcohol
  • Thyroid LOW
  • RETICULOCYTOSIS
  • B12 deficiency- Pernicious Anaemia
  • CYTOTOXIC drugs
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3
Q

Causes of NORMOCYTIC ANAEMIA (6 causes)

A

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)
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4
Q

Signs of Microcytic and Macrocytic Anaemia

A

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

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5
Q

Bloods in MICROCYTIC ANAEMIA

A 
LOW Hb
LOW MCV
LOW MCH
LOW Ferritin
LOW Iron

HIGH Total Iron Binding Capacity

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6
Q

Bloods in MACROCYTIC ANAEMIA

A 
LOW B12
LOW Folate
LOW RETICULOCYTES
LOW Platelets (If Severe)
LOW WCC (If Severe)

HIGH MCV

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7
Q

Bloods in NORMOCYTIC ANAEMIA

A

LOW Hb

NORMAL MCV
NORMAL or HIGH FERRITIN

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8
Q

Which anaemia increases risk of infection?

A

MICROCYTIC

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9
Q

Which anaemia can lead to SPLENOMEGALY and neuropsychiatric/ neurological complications?

A

MACROCYTIC

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10
Q

Treatment for Microcytic and Macrocytic Anaemia

A

TREAT CAUSE

Microcytic-
- Ferrous Sulphate

Macrocytic-
- HYDROXOCOBALAMIN INJECTIONS if Pernicious Anaemia

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11
Q

BLOODS in THALASSAEMIA

A

LOW HB
LOW MCV
LOW MCH

NORMAL Ferritin
NORMAL Iron

Hb electrophoresis- HIGH HbA2 and HIGH HbF

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12
Q

Treatment of THALASSAEMIA

A

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
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13
Q

Complications of THALASSAEMIA

A

SPLENOMEGALY

Iron overload

GALLSTONES

ARRHYTHMIAS

Bone abnormalities (CRANIAL BOSSING)

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14
Q

The four steps of CLOT FORMATION

A

1) Vessel construction
2) Platelet adhesion and aggregation
3) Blood coagulation
4) Fibrinolysis

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15
Q

Glanzmann’s thrombasthenia (DEFECT in STEP 2 of clot formation)

+ investigation

A
  • Platelets are deficient of Gp IIb/IIIa

Investigations- increased bleeding time

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16
Q

Treatment of Glanzmann’s thrombasthenia

A
  • Avoid ASPIRIN and NSAIDs
  • DESMOPRESSIN
  • Recombinant activated factor VII
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17
Q

Von Willebrand disease (DEFECT in STEP 2 of clot formation)

A
  • Defect in Von Willebrand factor- which binds GpIb on platelets to subendothelial collagen
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18
Q

Investigations in Von Willebrand disease

A

LOW VWF antigen
LOW factor VIIIc

NORMAL Prothrombin Time

INCREASED bleeding time
INCREASED activated PARTIAL THROMBOPLASTIN time

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19
Q

Treatment of Von Willebrand disease

A

Avoid ASPIRIN and NSAIDs

DESMOPRESSIN

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20
Q

Bernard Soulier Syndrome (DEFECT in STEP 2 of clot formation)

A

GpIb deficiency

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21
Q

Investigations in Bernard Soulier Syndrome

A

Increased bleeding time

NORMAL or LOW platelet

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22
Q

Treatment for Bernard Soulier Syndrome

A

DESMOPRESSIN

Recombinant activated factor VII

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23
Q

Haemophilia (DEFECT in STEP 3 of clot formation)

A

Two types-

Type A- lack of FACTOR VIII
Type B- lack of FATOR IX

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24
Q

Investigations in Haemophilia

A

INCREASED partial thromboplastin time

INCREASED prothrombin

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25
Q

Treatment in Haemophilia

A

Avoid ASPIRIN, NSAIDs, HEPARIN and WARFARIN

Replace the deficient clotting factor with regular infusion

  • FACTOR VIII in Type A
  • FACTOR IX in Type B
26
Q

Vitamin K Insufficiency (BLEEDING Disorder)

A

Decreased Vitamin K1 or K2

Results in-

  • DECREASED synthesis of factors II, VII, IX, X
  • DECREASED synthesis of PROTEINS C and S
27
Q

Causes of Vitamin K insufficiency (7 causes)

A

MMA DC3

  • Malnutrition
  • Malabsorption
  • Alcoholism
  • Drugs (WARFARIN)
  • CYSTIC FIBROSIS
  • CHRONIC KIDNEY INJURY
  • CHOLESTATIC DISEASE
28
Q

Bleeding disorders with increased PROTHROMBIN TIME

A

Vitamin K insufficiency

29
Q

Bleeding disorders with increased PARTIALTHROMBOPLASTIN TIME

A

Vitamin K insufficiency (may be NORMAL as well)

Haemophilia

Von Willebrand Disease

30
Q

Treatment of Vitamin K insufficiency

A

Dietary advice and Vitamin K supplements

31
Q

Symptoms in all four types of LEUKEMIA

A

NIGHT SWEATS
WEIGHT LOSS
BONE MARROW FAILURE
MALAISE

32
Q

Symptoms of Acute Lymphoblastic Leukemia (ALL)

A

NIGHT SWEATS
WEIGHT LOSS
BONE MARROW FAILURE
MALAISE

Purpura
Shortness of breath
Bruising

33
Q

Symptoms of Chronic Lymphoblastic Leukemia (CLL)

A

NIGHT SWEATS
WEIGHT LOSS
BONE MARROW FAILURE
MALAISE

HEPATOSPLENOMEGALY
Non-tender Lymphadenopathy
ASYMPTOMATIC

34
Q

Symptoms of Acute Myeloid Leukemia

nothing extra from standard leukemia symptoms

A

NIGHT SWEATS
WEIGHT LOSS
BONE MARROW FAILURE
MALAISE

35
Q

Symptoms of Chronic Myeloid Leukemia

A

NIGHT SWEATS
WEIGHT LOSS
BONE MARROW FAILURE
MALAISE

HEPATOSPLENOMEGALY

36
Q

Leukemias that lead to hepatosplenomegaly

A

CHRONIC myeloid and lymphoblastic leukemia

37
Q

Risk factors of Acute Myeloid Leukemia

A

Myeloproliferative disease
Alkylating agents
Ionising radiation exposure (also risk factor for CML)
Down’s Syndrome

38
Q

Which Leukemia is commonest in children and often spreads to CNS?

A

Acute Lymphoblastic Leukemia

39
Q

Which Leukemia usually affects adults over 60 years old?

A

Chronic Lymphoblastic Leukemia

40
Q

Which Leukemia is commonest in adults and has AUER RODS on microscopy?

A

Acute Myeloid Leukemia

41
Q

Treatment of ALL leukemia

A

To INDUCE REMISSION-

  • Dexamethasone
  • Anthracycline antibiotics
  • Cincristine
  • Vincristine

For MAINTENANCE-

  • METHOTREXATE
  • Mercaptopurine
  • CYTARABINE
  • HYDROCORTISONE
42
Q

Treatment of CLL leukemia

A

Chlorambucil

Fludarabine

Rituximab

Prednisolone

Cyclophosphamide

43
Q

Treatment of AML leukemia

A

Patient<60-

  • chemotherapy with ANTHRACYCLINE and CYTARABINE or METHOTREXATE

Patient>60-

  • Palliative, ANTHRACYCLINE, CYTARABINE or MITOXANTRONE
44
Q

Treatment of CML leukemia

A

IMATINIB

Stem cell transplantation possible for patients<60

Other treatments-

  • Alpha Interferon
  • Vincristine
  • Prednisolone
  • Cytarabine
  • Daunorubicin
45
Q

What is Hodgkin’s Lymphoma?

+ 4 common histological subtypes

A

Group of uncommon malignancies

1) Lymphocyte-predominant
2) Nodular sclerosing
3) Mixed cellularity
4) Lymphocyte-depleted

46
Q

Risk factors for Hodgkin’s Lymphoma

A

MALE

EBV infection

IMMUNOSUPPRESSION

Exotoxin exposure

47
Q

Signs and Symptoms of Hodgkin’s AND Non-Hodgkin’s Lymphoma

Kind of Similar to CLL

A
  • Painless Lymphadenopathy
  • Unintentional weight loss
  • Fever (>38C)
  • DYSPNOEA
  • HEPATOMEGALY
  • SPLENOMEGALY

Constitutional B symptoms= LYMPHOMA

  • FEVER >38C
  • Night Sweats
  • Weight loss
48
Q

INVESTIGATIONS in Hodgkin’s and Non-Hodgkin’s Lymphoma

A
  • LACTASE DEHYDROGENASE
  • CREATININE
  • ALKALINE PHOSPHATASE
  • CYTOKINE LEVELS
  • Look for REED-STERNBERG CELLS
49
Q

Treatment for Hodgkin’s Lymphoma

A

AVBD regimen (although it’s DVBD)-

  • Doxorubicin
  • Vinblastine
  • Bleomycin
  • Dacarbazine

BEACOPP regimen (although it’s BEDCVPP)

  • Bleomycin
  • Etoposide
  • Doxorubicin
  • Cyclophosphamide
  • Vincristine
  • Procarbazine
  • PREDNISOLONE
50
Q

What is Non-Hodgkin’s Lymphoma?

A

Group of malignancies that are either B cell or T cell in origin

51
Q

Non-Hodgkin’s B cell Lymphoma 4 examples

A

Burkitt’s Lymphoma- ASSOCIATED WITH EBV

Diffuse large B cell lymphoma

MANTLE CELL LYMPHOMA

Follicular LYMPHOMA

52
Q

Non-Hodgkin’s T cell Lymphoma 2 examples

A

Adult cell lymphoma (caused by Human T Lymphotrophic Virus 1)

Sezary

53
Q

Risk factors of Non-Hodgkin’s Lymphoma

A

Male sex

Infection with EBV, Helicobacter Pylori, Human Herpes Virus, Hepatitis C

Immunosuppression (HIV patients)

54
Q

Treatment of Non-Hodgkin’s Lymphoma

A

R-CHOP regimen (Although it’s actually RCHVP)

  • Rituximab
  • Cyclophosphamidde
  • Hydroxydaunomycin
  • Vincristine
  • Prednisolone

OTHER AGENTS-

  • Cisplatin
  • Etopside
  • Methotrexate
55
Q

What is a MYELOMA?

A

Malignant neoplasm of PLASMA CELLS

56
Q

Risk factors of Myeloma

A

Monoclonal gammopathy of unknown significance

PERNICIOUS ANAEEMIA

History of THYROID CANCER

Exposure to certain exotoxins (BENZENE, AGENT ORANGE)

Past history of radiation exposure

57
Q

Signs and Symptoms of Myeloma

HAIR FUV BP

A

HYPERCALCAEMIA
ANAEMIA
Infection
Renal Impairment

Fatigue
Unintentional weight loss
VERTEBRAL COLAPSE (may lead to spinal cord compression)

BRUISING
Pathological fractures

58
Q

Investigations in Myeloma

A
  • 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

59
Q

Treatment of Myeloma

A

<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

60
Q

Complications of Myeloma

A

ANAEMIA
HYPERCALCAEMIA
AKI
Pathological fracture

Medicine (15 decks)

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