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MSRA > Haematology > Flashcards

Haematology Flashcards

1
Q

Microcytic anaemia causes (5)

A
  1. Iron deficiency
  2. Thalassaemia
  3. Lead poisoning
  4. Anaemia of chronic disease (more commonly normocytic, normochromic picture)
  5. Congenital sideroblastic anaemia

TAILS

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2
Q

most common cause in pre-menopausal women

most common cause in men

A 
Menorrhagia 
GI bleed (think colon cancer)
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3
Q

Ix iron deficiency anaemia
Findings on bloods:
TIBC low or high
Blood film - name two types

A

TIBC = high

Blood film = target cells, ‘pencil’ poikilocytes

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4
Q

Causes of normocytic anaemia

A
  1. Anaemia of chronic disease
  2. CKD
  3. Aplastic anaemia
  4. Acute blood loss
  5. Haemolytic anaemia

AAACH

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5
Q

Causes of macrocytic anaemia
Megaloblastic (2)
Normocytic (6)

A 
Megalo
1. B12 deficiency 
2. Folate deficiency 
Normo
3. Alcohol
4. Liver disease
5. Hypothyroid
6. Pregnancy 
7. Reticulocytosis 
8. Myleodysplasia
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6
Q 
abdominal pain
peripheral neuropathy (mainly motor)
fatigue
constipation
blue lines on gum margin
=
A

Lead poisoning

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7
Q

Lead poisoning

Mx (2)

A
  1. dimercaptosuccinic acid (DMSA)

2. D-penicillamine

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8
Q

Raised
- delta aminolaevulinic acid
- urinary coproporphyrin
=

A

Lead poisoning

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9
Q 
target cells
Howell-Jolly bodies
Pappenheimer bodies
siderotic granules
acanthocytes
A

Hyposplenism e.g. post-splenectomy, coeliac disease

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10
Q

‘tear-drop’ poikilocytes

A

Myelofibrosis

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11
Q

schistocytes

A

Intravascular haemolysis

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12
Q

hypersegmented neutrophils

A

Megaloblastic anaemia

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13
Q

Blood film
anisopoikilocytosis (red blood cells of different sizes and shapes)
target cells
‘pencil’ poikilocytes

A

iron deficiency anaemia

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14
Q

Blood film:

basophilic stippling and clover-leaf morphology

A

lead poisoning

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15
Q

Blood film findings:

Myelofibrosis

A

‘tear-drop’ poikilocytes

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16
Q

Blood film findings:

Megaloblastic anaemia

A

hypersegmented neutrophils

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17
Q

Blood film findings:

Haemolysis

A

schistocytes

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18
Q

Blood film findings:

Hyposplenism (5)

A 
target cells
Howell-Jolly bodies
Pappenheimer bodies
siderotic granules
acanthocytes

TAPSH

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19
Q

Spherocytes on blood film

Name two conditions

A

Hereditary spherocytosis

Autoimmune hemolytic anaemia

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20
Q

Basophilic stapling

Name four conditions

A

Lead poisoning
Thalassaemia
Sideroblastic anaemia
Myelodysplasia

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21
Q

Heinz bodies

Name two conditions

A

G6PD deficiency

Alpha-thalassaemia

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22
Q

Schistocytes

Name three conditions

A

Haemolysis
Mechanical heart valve
Disseminated intravascular coagulation

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23
Q

Target cells

Name four conditions

A

Sickle-cell/thalassaemia
Iron-deficiency anaemia
Hyposplenism
Liver disease

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24
Q

positive direct antiglobulin test (Coombs’ test) =

A

Automimmune haemolytic anaemia

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25
Q

Warm autoimmune haemolytic anaemia
What causes haemolysis
Where does haemolysis tend to occur?
Mx

A

IgG
haemolysis tends to occur in extravascular sites, for example the spleen
steroids, immunosuppression and splenectomy

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26
Q 
Cold autoimmune haemolytic anaemia
What causes haemolysis
Where does haemolysis tend to occur? 
Features (2) 
Mx
A

IgM
Haemolysis is mediated by complement and is more commonly intravascular.
Features may include symptoms of Raynaud’s and acrocynaosis. Patients respond less well to steroids

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27
Q

Hereditary spherocytosis
AD/AR
Features (4)

A

AD

  1. failure to thrive
  2. jaundice, gallstones
  3. splenomegaly
  4. aplastic crisis precipitated by parvovirus infection
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28
Q

Hereditary spherocytosis
AD/AR
Features (5)

A

AD

  1. failure to thrive
  2. jaundice, gallstones
  3. splenomegaly
  4. aplastic crisis precipitated by parvovirus infection
  5. MCHC elevated
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29
Q

Hereditary spherocytosis

Dx

A

Clinical - if equivocal
cryohaemolysis test and EMA binding test
for atypical presentations for electrophoresis

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30
Q

Spherocytosis

Mx

A 
acute haemolytic crisis:
1. supportive
2. transfusion if necessary
longer term treatment:
1. folate replacement
2. splenectomy
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31
Q

Difference between G6PD deficiency and spherocytosis

Country
Blood film
Genetics
Haemoylsis location

A

G6PD African + Mediterranean, Heinz bodies, X linked, intravascular heamolysis
Spherocytosis Northern european, AD, extravascular haemolysis

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32
Q

Drugs that can cause haemolysis (3)

A
  1. anti-malarials: primaquine
  2. ciprofloxacin
  3. sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas
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33
Q

Medications that increase VTE risk (4)

A
  1. Antipsychotics
  2. COCP
  3. HRT
  4. Tamoxifen
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34
Q

Direct thrombin inhibitor medication (1) –> reversal (1)

Direct factor Xa inhibitor (2) –> reversal (1)

A

Dabigatran –> Idarucizumab

Apixaban + rivaroxaban –> adnexanet

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35
Q 
Examples of myeloproliferative disorders
RBC
WBC
Platelets 
Fibroblasts
A

Polycythaemia rubra vera (PRV)
CML
Essential thrombocythaemia
Myelofibrosis

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36
Q

Auer rods

DIC or thrombocytopenia often at presentation

A

ApML

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37
Q

Philadelphia chromosome =
Due to a translocation between the long arm of chromosome 9 and 22

Mx (4)

A

CML

  1. imatinib is now considered first-line treatment
  2. hydroxyurea
  3. interferon-alpha
  4. allogenic bone marrow transplant
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38
Q

blood film: smudge cells (also known as smear cells) =

A

CLL

39
Q

CLL

Ix:

A

immunophenotyping

40
Q

CLL

Complications (4)

A

anaemia
hypogammaglobulinaemia leading to recurrent infections (low IgG)
warm autoimmune haemolytic anaemia in 10-15% of patients
transformation to high-grade lymphoma (Richter’s transformation)

41
Q

What is Richter’s transformation?

A

leukaemia cells enter the lymph node and change into a high-grade, fast-growing non-Hodgkin’s lymphoma

42
Q

Features of Richter’s transformation?

A 
lymph node swelling
fever without infection
weight loss
night sweats
nausea
abdominal pain
43
Q

Massive splenomegaly causes (5)

A
  1. myelofibrosis
  2. leukaemia
  3. leishmaniasis
  4. malaria
  5. Gaucher’s syndrome
44
Q

leukaemia cells enter the lymph node and change into a high-grade, fast-growing non-Hodgkin’s lymphoma occurs in which leukemia

A

CLL

45
Q

What is ITP?

A

an immune-mediated reduction in the platelet count. Antibodies are directed against the glycoprotein IIb/IIIa or Ib-V-IX complex.

46
Q

ITP Mx

A

Management

  1. oral prednisolone
  2. pooled normal human immunoglobulin (IVIG)
47
Q

What is thrombocytosis?

Mx (3)

A

High platelets

  1. hydroxyurea
  2. interferon-α
  3. low-dose aspirin to reduce the thrombotic risk
48
Q

Essential thrombocytosis

Features (4)

A
  1. platelet count > 600
  2. both thrombosis and haemorrhage can be seen
  3. burning sensation in the hands
  4. JAK2 mutation is found in around 50% of patients =
49
Q

Well score interpretation

A

=>2 –> DVT likely
If likely then for USS within 4 hours if +ve for rx
If negative then for d-dimer, if negative scan and negative d dimer –> unlikely, and consider alt dx

If scan cannot be done within 4 hours, then for d dimer and interim anticoag with DOAC, USS to be done within 24 hours

If scan negative but d-dimer +ve, stop DOAC and repeat scan in 1 week

If DVT unlikely 1 or less, for d-dimer within 4 hours, if not for interim DOAC. If +ve dimer then for USS within 4 hours. If unable to do within 24 hours then for interim DOAC

50
Q

When to not use DOAC

A

CKD eGFR<15
Antiphospholipid syndrome
TO use LMWH or unfractionated heparin

51
Q

platelet count > 600 * 109/l
both thrombosis and haemorrhage can be seen
burning sensation in the hands
JAK2 mutation is found in around 50% of patients =

A

Essential thrombocytosis

52
Q

Types of Burkitt’s lymphoma and locations

Which virus is associated with the first type?

A
  1. Endemic –> maxilla + mandible –> assoc with EBV

2. Sporadic form –> abdominal (e.g. ileo-caecal) tumours, common in pt’s with HIV

53
Q

Burkitt’s lymphoma miscroscopy findings?
Mx
Name of medication given before mx to prevent which condition?

A

‘starry sky’ appearance
Chemo
Rasburicase given prior to chemo to prevent tumour lysis syndrome

54
Q

Which condition?
bone disease: bone pain, osteoporosis + pathological fractures, osteolytic lesions
lethargy
infection
hypercalcaemia
renal failure
other features: amyloidosis e.g. Macroglossia, carpal tunnel syndrome; neuropathy; hyperviscosity

A

Multiple myeloma

55
Q

What is multiple myeloma?

A

Neoplasm of increased plasma cells

56
Q

Multiple myeloma Ix
Bloods (2)
Scan (1)
Xray finding?

A
  1. monoclonal proteins (usually IgG or IgA) in the serum and urine (Bence Jones proteins)
  2. Whole body MRI
  3. ‘rain-drop skull’
57
Q

Diagnostic criteria for multiple myeloma

A

one major and one minor criteria OR
three minor criteria

Major criteria
Plasmacytoma (as demonstrated on evaluation of biopsy specimen)
30% plasma cells in a bone marrow sample
Elevated levels of M protein in the blood or urine

Minor criteria
10% to 30% plasma cells in a bone marrow sample.
Minor elevations in the level of M protein in the blood or urine.
Osteolytic lesions (as demonstrated on imaging studies).
Low levels of antibodies (not produced by the cancer cells) in the blood.

58
Q

What is Factor V Leiden?

A

Most common thrombophillia secondary to activated protein C resistance
Increased risk of VTE

59
Q

What is Von Willebrand’s disease?
AD/AR?
Sx

A

Most common inherited bleeding disorder
AD
epistaxis and menorrhagia

60
Q

Von Willebrand

Ix (4)

A

prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin

61
Q

Von Willebrand

Mx

A

tranexamic acid for mild bleeding
desmopressin (DDAVP): raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells
factor VIII concentrate

62
Q

HbA2 raised (> 3.5%) =

A

Beta thalassemia

63
Q

Hepatitis C is associated with?

A

cryoglobulinaemia

64
Q

Type 1 cryoglobulinaemia examples

A

monoclonal - IgG or IgM

multiple myeloma, Waldenstrom macroglobulinaemia

65
Q

Type 2 cryoglobulinaemia examples

A

mixed monoclonal and polyclonal: usually with rheumatoid factor
hepatitis C, rheumatoid arthritis, Sjogren’s, lymphoma

66
Q

Raynaud’s only seen in which type of cryoglobulinaemia?

A

Type 1

67
Q

Haemophilia genetics

Haemophilia A and B which factors?

A

X linked recessive disorder of coagulation

VIII and IX

68
Q

prolonged APTT only =

A

Haemophillia

69
Q

usually asymptomatic

lower level of paraproteinaemia than myeloma

A

Monoclonal gammopathy of undetermined significance

70
Q

C1 1NH deficiency =

A

Hereditory angioedema

71
Q

attacks may be proceeded by painful macular rash
painless, non-pruritic swelling of subcutaneous/submucosal tissues
may affect upper airways, skin or abdominal organs (can occasionally present as abdominal pain due to visceral oedema)
urticaria is not usually a feature
=

A

Hereditory angioedema

72
Q

What is Waldenstrom macroglobulinemia?

A

type of non-Hodgkin lymphoma

73
Q

What is Paroxysmal nocturnal haemoglobinuria

A

acquired disorder leading to haemolysis caused by a lack of glycoprotein glycosyl-phosphatidylinositol (GPI)

Increased risk of VTE

74
Q

Dark-coloured urine, haemolytic anaemia, thrombosis =

A

Paroxysmal nocturnal haemoglobinuria

75
Q

Paroxysmal nocturnal haemoglobinuria
Ix
Mx (2)

A

flow cytometry of blood to detect low levels of CD59 and CD55

blood product replacement
anticoagulation

76
Q

Secondary causes of polycythaemia (4)

A

COPD
altitude
obstructive sleep apnoea
excessive EPO: cerebellar haemangioma, hypernephroma, hepatoma, uterine fibroids*

77
Q 
JAK2 mutation 
hyperviscosity
pruritus, typically after a hot bath
splenomegaly
haemorrhage (secondary to abnormal platelet function)
plethoric appearance
hypertension in a third of patients
low ESR =
A

polycythaemia

78
Q

low ESR and a raised leukocyte alkaline phosphatase =

A

polycythaemia

79
Q

Polycythaemia

Mx (3)

A

aspirin
venesection - first line treatment
hydroxyurea -slight increased risk of secondary leukaemia

80
Q

definitive Ix of sickle cell disease =

A

haemoglobin electrophoresis

81
Q

Name the crises sickle cell

sickling within organs such as the spleen or lungs causes pooling of blood with worsening of the anaemia

A

Sequestration

82
Q

Name the crises sickle cell
dyspnoea, chest pain, pulmonary infiltrates, low pO2
the most common cause of death after childhood

A

Acute chest syndrome

83
Q

Name the crises sickle cell
caused by infection with parvovirus
sudden fall in haemoglobin

A

Aplastic

84
Q

Name the crises sickle cell

fall in haemoglobin due an increased rate of haemolysis

A

Haemolytic

85
Q

Name the crises sickle cell
also known as painful crises or vaso-occlusive crises
precipitated by infection, dehydration, deoxygenation

A

Thrombotic

86
Q

Most common cause of thrombophillia =

Second most common cause

A

factor V Leiden

prothrombin gene mutation

87
Q

vit B12 deficiency is most commonly caused by?

A

pernicious anaemia

88
Q

Causes of vit b12 deficiency (5)

A 
pernicious anaemia
post gastrectomy
vegan/ poor diet
disorders/surgery of terminal ileum (site of absorption)
e.g Crohn's
metformin (rare)
89
Q

What does B12 use to be absorbed?
Where is this secreted from?
Where is it absorbed?

A

intrinsic factor (secreted from parietal cells in the stomach) and is actively absorbed in the terminal ileum.

90
Q

Mx B12

A

if no neuro 1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then every 3 months

if also deficient in folic acid then to treat B12 deficiency first to avoid precipitating subacute combined degeneration of the cord

91
Q

Sx B12 deficiency (4)

type of anaemia

A
  1. macrocytic anaemia
  2. sore tongue and mouth
  3. neurological symptoms
    the dorsal column is usually affected first (joint position, vibration) prior to distal paraesthesia
  4. neuropsychiatric symptoms: e.g. mood disturbances
92
Q

Which haemophillia accounts for 90% of cases?

A

A

93
Q

What is the antidote for heparin

A

protamine sulfate

94
Q

HbA2 raised (> 3.5%) =

A

beta thalassemia trait

MSRA (22 decks)

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