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haematology Flashcards

1
Q

What is anaemia

A

low haemoglobin due to decreased red cell mass

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2
Q

what are the three types of anaemia

A

microcytic
normocytic
macrocytic

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3
Q

What are symptoms of anaemia

A
  • tiredness
  • dyspnoea
  • pallor
  • palpitations
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4
Q

What are signs of anaemia

A
  • pallor (conjunctival)
  • tachycardia
  • heart failure
  • retinal haemorrhages
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5
Q

When should you suspect haemolytic anaemia

A

reticulocytosis and elevated bilirubin

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6
Q

What are types of microcytic anaemia

A
  • IDA
  • thalassaemias
  • sideroblastic anaemia
  • anaemia of chronic disease
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7
Q

What is the most common type of anaemia

A

iron deficiency anaemia

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8
Q

What are possible causes of IDA

A

poor intake eg vegetarian

malabsorption eg IBD

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9
Q

What is treatment for IDA

A

iron supplements

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10
Q

What is treatment for thalassaemia

A

Nothing or transfusions with iron chelating agents

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11
Q

What are causes of normocytic anaemia?

A
  • acute blood loss
  • bone marrow failure
  • renal failure
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12
Q

normocytic anaemia with low WCC and low platelets should make you suspect ___?

A

bone marrow failure

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13
Q

What treatment can be given for anaemia caused by renal failure

A

EPO

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14
Q

What are causes of macrocytic anaemia

A
  • myelodysplastic anaemia
  • haemolytic anaemia
  • B12/folate deficiency
  • liver disease
  • alcohol excess
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15
Q

How would you treat B12 deficiency macrocytic anaemia

A

oral B12 or IM B12 if malabsorptive

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16
Q

Why would B12/folate deficiency cause macrocytic anaemia?

A

impaired DNA synthesis of RBCs

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17
Q

what type of patient is particularly susceptible to folate deficiency?

A

pregnant women

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18
Q

What can severe anaemia cause

A

tachycardia and heart failure

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19
Q

what are the two types of causes of haemolytic anaemia

A

acquired and hereditary

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20
Q

What are some acquired causes of haemolytic anaemia

A
  • malaria
  • hepatitis
  • autoimmune haemolytic anaemia
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21
Q

reticulocytosis, normo/microcytic anaemia, and elevated bilirubin should make you suspect ____

A

haemolytic anaemia

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22
Q

What are some causes of hereditary anaemia

A
  • sickle cell disease
  • G6PD deficiency
  • hereditary spherocytosis
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23
Q

What is pancytopenia

A

decrease in all major blood cell types

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24
Q

What is treatment for bone marrow failure

A

bone marrow transplant

transfusion regimen

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25
what are the types of causes of pancytopenia
* bone marrow failure * bone marrow infiltration * ineffective haematopoiesis * peripheral pooling/destruction
26
What are causes of bone marrow failure
* viral * drugs * aplastic anaemia
27
What are causes of bone marrow infiltration
* acute leukaemia * myeloma * lymphoma * myelodysplastic syndromes
28
What causes ineffective haematopoiesis
megaloblastic anaemia | AIDS
29
What are causes of peripheral destruction causing pancytopenia
* hypersplenism | * SLE
30
What are the classifications of bleeding disorders
* vascular causes * platelet disorders * coagulation disorders * mixed
31
What are the vascular causes of bleeding disorders
* connective tissue disorders eg Ehlers Danlos | * osler-weber-rendu (arteriovenus malformations)
32
What are platelet causes of bleeding disorders
PLATELET DESTRUCTION * immune thrombocytopenic purpura * other immune conditions, eg SLE * sequestration * DIC REDUCED PRODUCTION * bone marrow failure/infiltration * aplastic/megaloblastic anaemia MALFORMATION * eg myelodysplastic syndromes
33
How are platelet disorders treated
transfusions or treat cause
34
What are coagulopathy causes of bleeding disorders
INHERITED * haemophilia A * haemophilia B * von willebrand disease ACQUIRED * antiplatelet drugs (eg heparin) * liver disease * vitamin K deficiency
35
What are the mixed bleeding disorders
* DIC | * von willebrand disease
36
What is DIC
disseminated intravascular coagulation is increased clot formation causing organ ischaemia but also loss of clotting factors and platelets causing bleeding
37
What is purpura and easy bruising with epistaxis consistent with?
vascular and platelet disorders
38
What is haemarthrosis consistent with
coagulopathies
39
What blood results would indicate DIC
* long PT and PTT * thrombocytopenia * elevated d-dimer
40
What are some causes of DIC
sepsis, malignancy
41
What clotting factor is affected in haemophilia A
factor VIII (8)
42
What clotting factor is affected in haemophilia B
Factor IX (9)
43
What is given in haemophilia A
desmopressin + factor VIII
44
What is myeloma
abnormal proliferation of B-lymphocytes (plasma cells)
45
What are paraproteins
the light chains produced by abnormal plasma cells in myeloma
46
What are symptoms of myeloma
* symptoms of hypercalcaemia * bone pain * pathological fractures * AKI * symptoms of hyperviscosity (eg confusion, visual disturbances) * fatigue due to anaemia * infections
47
What investigations do you do for myeloma? what results would you expect
* Bence-Jones positive in urine and serum electrophoresis * anaemia on FBC * raised ESR * raised urea and creatinine * lytic lesions on x ray * hypercalcaemia
48
What is treatment for myeloma
* chemo * analgesia for bone pain * transufion + EPO for anaemia/pancytopenia * IV fluid for hypercalcaemia and AKI * bisphosphonates
49
What is thrombophilia?
Increased predisposition to clotting
50
When should you screen for thrombophilia?
* more than 1 episode of DVT * DVT at a young age * DVT in unusual location * recurrent miscarriages
51
What are the types of inherited thrombophilia
* factor V Leiden * protein C + S deficiency * prothrombin gene mutation * antithrombin deficienct
52
What is the most common acquired thrombophilia
antiphospholipid antibody syndrome
53
What condition is associated with antiphospholipid antibody syndrome
SLE
54
What is the most common inherited thrombophilia
Factor V Leiden
55
What is factor V Leiden
factor V is resistant to the antithrombin action of protein C, causing increased clot formation
56
What causes warfarin induced skin necrosis
protein C + S have a shorter half life than the clotting factors so they are depleted first when starting warfarin, so there is a short window of hypercoagulability after starting warfarin regimen
57
What are myelodysplastic syndromes
a group of clonal disorders of the bone marrow
58
30% of myelodysplastic disorders transform into ___
acute leukaemia
59
How do myelodysplastic syndromes present
with bone marrow failure, infection and bleeding
60
What is treatment for myelodysplastic syndromes?
* blood transfusions * platelets * iron chelation possibly
61
What are the myeloproliferative disorders
* polycythaemia rubra vera * essential thrombocythaemia * myelofibrosis
62
What is polycythaemia rubra vera
malignant proliferatino of a clone derived from one pluripotent marrow stem cell there is excess proliferation of RBCs, WBCs and platelets, leading to hyperviscosity and thrombosis
63
What are the symptoms of polycythaemia rubra vera
hyperviscosity signs * tinnitus * visual disturbances * headaches * confusion venous or arterial thrombosis splenomegaly common gout may occur due to increased RBC turnover (and therefore increased urate)
64
What might polycythaemia rubra vera transform into
myelofibrosis
65
What is essential thrombocythaemia
clonal proliferation of megakaryocytes that leads to persistently raised platelets with abnormal function
66
How does essential thrombocythaemia present
with bleeding or arterial/venous thrombosis or microvascular occlusion (headache, light headedness, atypical chest pain)
67
How is essential thrombocythaemia treated
low dose aspirin
68
What is myelofibrosis
hyperplasia of megakaryocytes which produce platelet-derived growth factor, leading to intense marrow fibrosis and myeloid metaplasia (haemopoiesis in the spleen and liver)
69
What does myelofibrosis present with
hypermetabolic symptoms: * night sweats, fever, weight loss hepatosplenomegaly (and therefor possible abdo discomfort) may present with bone marrow failure
70
What is the treatment for myelofibrosis
bone marrow support or stem cell transplant in young people
71
What is leukaemia
a type of cancer caused by unregulated proliferation of a clone of immature blood cells derived from mutant haematopoietic stem cells
72
broadly, what is the difference between leukaemia and lymphoma?
leukaemia cells accumulate in the blood and bone marrow, whereas in lymphoma they form solid tumour masses in the lymphatics and spleen
73
What are the four types of leukaemia
ALL, AML, CML, CLL
74
What are the main dangers to consider as a junior doctor with leukaemia
* tumour lysis syndrome * DIC * preventing sepsis
75
What blood results indicate tumour lysis syndrome?
* hyperkalaemia * high urate levels * AKI
76
How is tumour lysis syndrome prevented
fluids and allopurinol
77
What is the broad difference between cells found in acute leukaemia and chronic?
In acute, the cells are less mature blast cells, and in chronic, the cells are immature but resemble mature cells while not retaining their function
78
what is ALL?
Acute lymphoblastic leukaemia is a malignancy of lymphoid cells; B or T lymphocytes
79
Which genetic syndrome is an important association for leukaemia
Down's syndrome
80
What are the main symptoms of acute lymphocytic leukaemia
Symptoms due to marrow failure: * anaemia * bleeding * infection Symptoms due to infiltration: * hepatosplenomegaly * lymphadenopathy * CNS involvement
81
ALL is typically seen in which age group?
children
82
Mediastinal lymph node mass is typical of which leukaemia?
T-cell ALL
83
What investigations should you order in suspicion of ALL?
* FBC * blood film * coag * bone marrow biopsy * CXR (look for mediastinal and abdominal lymphadenopathy)
84
What % of blast cells indicates leukaemia in the bone marrow biopsy
>20%
85
What is acute myeloid leukaemia
proliferation of blast cells derived from marrow myeloid elements
86
What condition can become AML
myelodysplastic syndromes
87
What treatment might AML be a long-term complication of
chemotherapy
88
What are symptoms of AML
symptoms of bone marrow failure symptoms of infiltration * hepatosplenomegaly * gum hypertrophy * skin involvement
89
What is treatment for ALL
* chemotherapy * bone marrow support * infection control * bone marrow transplant
90
What is treatment for AML
* chemotherapy * bone marrow support * infection control * bone marrow transplant
91
What is CML
uncontrolled proliferation of myeloid cells | It is a myeloproliferative disorder
92
What age do patients typically present with CML
40-60
93
What mutation is commonly seen in CML
Philadelphia chromosome (chr22) BCR-ABL
94
What are symptoms of CML
* abdominal discomfort due to splenomegaly * bleeding * weight loss, tiredness, fatigue, fever, sweats
95
How is chronic myeloid leukaemia treated
with imatinib if philadelphia chromosome positive
96
What is CLL
accumulation of mature B cells
97
What is the common presentation of CLL
often an incidental finding may be anaemic or infection-prone, or have weight loss and sweats
98
What are signs of CLL
* enlarged, rubbery, non-tender nodes * splenomegaly * hepatomegaly
99
What are complications of chronic lymphocytic leukaemia
antibodies produced by the B-cells may cause immune thrombocytosis or autoimmune haemolytic anaemia may also cause infection and bone marrow failure
100
What leukaemia are 'auer rods' typical of
AML
101
Which cells are classic in Hodgkin's lymphoma
Reed-Sternberg cells
102
What is the most common cell lineage in Non-Hodgkin Lymphoma
B-cell lymphoma
103
What is the most common type of NHL
large b-cell lymphoma
104
enlarged cervical lymph nodes are typical of (HL/NHL)
hodgkins' lymphoma
105
What are symptoms of HL
* enlarged, rubbery, non-tender lymph nodes * constitutional symptoms: sweats, fever, weight loss * sometimes splenomegaly
106
How do patients with non-hodgkin lymphoma present
consitutional symptoms + pancytopenia + symptoms specific to organ involvement eg T-cell lymphomas may specifically affect the skin
107
What % of patients present with NHL with nodal disease
75%
108
What are the two peaks of incidence in hodgkin lymphoma
young adults and the elderly
109
What is the difference between hodgkin lymphoma and NHL
* Reed-Sternberg cells not present in NHL | * NHL can spread to extra-nodal sites like the skin, GI tract, bones, lung and brain

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