haematology Flashcards
Multiple myeloma - key features in presentation
- wide consellation of symptoms including
“CRAB”: - Calcium elevated (bones, moans, stones, groans)
- Renal failure/impairment (+ Creatinine, +/- Ur)
- Anaemia (TATT, fatigue, SOBOE, exertional angina)
- Bony pain, pathological # (lytic bony lesions, sclerotic picture xr, multiple vertebral compression #)
+/- recurrent bacterial infections >2 in 6/12
Suspected Multiple myeloma - Initial ix
FBC blood film - rouleaux UEC Ca LFT ESR
Multiple myeloma - Ix
serum protein electrophoresis - monoclonal paraproteins
24hr urine protein + electrophoresis
serum light chain analysis (kappa/lambda)
skeletal survey xray
Multiple myeloma - Mx
referral to haematology for bone marrow biopsy and ongoing management
Fatigue/TATT - most likely ddx
stress/anxiety/depression
post + viral infection
sleep related disorders
lifestyle factors
Fatigue/TATT - serious/not to miss ddx
Thyroid DMT2 CKD malignancy cardiac arrhythmia anaemias haemochromatosis CCF HIV/Chronic Hepatitis C
Fatigue/TATT - red flag features
new onset fatigue in previously well older patient
unintentional wt loss
abnormal bleeding
SOB
lymphadenopathy
fever
recent onset or progression of cvd, rheum, neuro, git symptoms
Fatigue/TATT - hx key features
onset, duration, severity assocuated symptoms social hx - snap, drugs, sleep occupation hx medications red flags - constitutional symptoms
Fatigue/TATT - examination
vitals ht wt BMI Pallor, jaundice, skin pigmentation Thyroid exam Abdo - hepatosplenomegaly, Lymphaednopathy CVS/Resp exam MSE
Fatigue/TATT - mx
Office tests - urine dipstick, BSL, +/- ECG
No red flags/disease unlikely - lifestyle advice
watch and wait, review in 4 weeks
Fatigue/TATT - Initial Ix
FBC ESR BSL TSH \+/- Iron studies \+/- LFTs \+/- UEC
Thrombocytopenia - aetiology/broad categories (4)
1. Increased destruction (immune): Immune mediated thrombocytopenia (ITP) Drug induced thrombocytopenia Viral induced thrombocytopenia 2. Increased destruction (non-immune): DIC TTP-HUS 3. decreased production: malignancy, HIV, vit b12 deficiency 4. splenic sequestration
Thrombocytopenia - key features in hx
Alcohol intake Bleeding bruising PMHx - thyroid, CTX, malignancy Medications Possible HIV/HCV exposure Recent illness - sore throat Rashes
Thrombocytopenia - key features in ex
Lymphadenopathy
splenomegaly
Stigmata of CLD - hepatomegaly, jaundice ascites
Sepsis - HR, Temp, BP