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MRCP 2 > Haematology > Flashcards

Haematology Flashcards

1
Q

Myeloma prognostic markers

A

B2 microglobulin and Albumin

high and low respectively is bad prog

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2
Q

febrile and jaundiced 7 days after blood transfusion, management

A

Supportive mx unless symp anaemia

delayed transfusion reaction, typically 7-10 days post-tran
2ndary to sensitised from previous transfusions/preg; alloantibodies against red cell antigens

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3
Q

Patient w flu-like symptoms headache, GI symps, haemorrhagic fever

Been in bat cave in Uganda

A

Marbug virus

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4
Q

Auer rods seen it…

A

pathognomonic of Acute promyelocytic leukaemia M3
Assx w t(15;17)

M3 subtype of AML

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5
Q

Fever/chills after blood transfusion

A

As long as no hypotension, dyspnoea wheezing Angioedema, Abdo pain etc

Slow/stop transfusion, paracetamol and monitor
Likely non haemolytic febrile reaction

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6
Q

Blood film: schistocytes
Low platelets
High APTT and PT

A

DIC

Schistocytesdue to microangiopathic haemolytic anaemia

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7
Q

Commonest cause of chronic DIC in elderly

A

Prostate cancer

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8
Q

acquired factor VIII deficiency Vs Von willebrands

A

Both cause long APTT but in Vwb APTT corrects with addition of plasma

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9
Q

Most common cause of hyperviscocity syndrome

A

Waldenström’s macroglobulinaemia (most common cause).

Presents with neuro symps like headaches, visual disturbances, papilloedema, hypertension, bleeding.,.
Treat with plasmapharesis to rapidly reduce viscosity and reduced thromboembolic events

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10
Q

Patient with Waldenström’s macroglobulinaemia presents with headaches, visual disturbances, papilloedema, hypertension, bleeding.,.

A

Hyperviscocity syndrome

Treat with plasmapheresis

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11
Q

Management of heparin induced thrombocytopenia

A

Switch to direct thrombin inhibitors like Argatroban or danaparoid

remember: low platelets but is actually a prothrombotic condition
and HIT antibodies have a high false positive rate
Can use Warkentin probability scale

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12
Q

Treatment of atypical HUS

A

Eculizumab (a C5 inhibitor)

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13
Q

fever, anaemia, thrombocytopenia, renal failure and confusion post partum.
Fragmented red cells on blood film

A

Thrombotic thrombocytopenic purpura

overlaps with HUS, but HUS is classically after bloody diarrhoea (EColi0157:H7) and more severe AKI

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14
Q

Management of Granulomatosis with polyangiitis (Wegener’s granulomatosis)

A

Cyclophosphamide and steroids (90% response)

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15
Q

Complications of plasma exchange

A

Hypocalcaemia (due to citrate as anticoag)
Metabolic all
Coagulation depletion so bleeding risk

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16
Q

Reed-Sternberg cells

A

hodgkin’s

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17
Q

which hodgkin’s has worst prognosis?

A

Lymphocyte depleted (also rarest)

18
Q

which hodgkin’s has best prognosis?

A

Lymphocyte predominant

19
Q

alcohol-induced pain?

A

hodgkin’s lymphoma

20
Q

raised reticulocyte and LDH

A

Haemolysis

high reticulocyte count (medically known as reticulocytosis) can be found after blood loss due to injury, ulcers, or surgery

LDH is found intracellularly, so indicates damage…

21
Q

raised red cell count, platelets and splenomegaly

A

polycythaemia vera

Would usually have raised Hb but could be normal if co-existing IDA

22
Q

The most common cause of an isolated lymphocytosis in an adult

A

Chronic lymphocytic leukaemia (CLL)

Tx if constitutional symptoms
Anti-CD20 monoclonal antibody (e.g. obinutuzumab), chlorambucil or bendamustine

23
Q

red cell fragmentation

A

heart valves
TTP
DIC
HUS

24
Q

thrombotic thrombocytopenic purpura vs haemolytic uraemic syndrome

A

Overlap, but HUS is classically after bloody diarrhoea (EColi0157:H7) and more severe AKI

both can have fragmentation of red cells on blood film

DIC would have low platelets, prolonged APTT, PT

25
Q

ADAMTS13 deficiency

A

TTP

ADAMTS13 Deficiency (a metalloprotease enzyme) which cleaves large multimers of von Willebrand’s factor

26
Q

What is the deficiency in TTP

A

ADAMTS13

Which breakdowns large multimers of von Willebrand’s factor

27
Q

alternative description for Auer rods

A

needle-like elongated cytoplasmic inclusions

pathognomonic of acute myeloid leukaemia

28
Q

who do you screen for thrombophilia?

A

younger pt w spontaneous clotting events

don’t test during acute event though or on anticoag

29
Q

commonest thrombophilia

A

Factor V Leiden (heterozygous)
5%
x4risk

30
Q

most severe thrombophilia

A

Antithrombin III deficiency
rare 0.02%

x10-20 risk

31
Q

ITP vs TTP

A

ITP: autoimmune destruction of platelets and is managed with immunosuppression - the first line is usually prednisone, IgGlob

TTP platelets clump within vessels due to deficiency of ADAMTS13
Fluctuating neuro, AKI,
Raised LDH
Medical emergency
Plasma exchange.
32
Q

when do you treat Chronic lymphocytic leukaemia (CLL)?

A

B symps
worsening of anaemia and/or thrombocytopenia
>10 cm or progressive lymphadenopathy
>6 cm or progressive splenomegaly
lymphocytosis: > 50% increase over 2 months or lymphocyte doubling time < 6 months
autoimmune cytopaenias e.g. ITP

33
Q

commonest cause of amyloidosis in uk

A

plasma cell disorders (e.g. myeloma) are the commonest cause of amyloidosis in the UK and lead to primary (AL) amyloidosis

34
Q

old person w anaemia, neutropaenia, thrombocytopenia

A

myelodysplasia

35
Q 
25 yr old presents acutely unwell w recent weight loss, nosebleed, oozing from his cannula sites and non-blanching purpura over his arms and legs.
INR	8.5
PT	89 s (9-12)
APTT ratio 1.7 (0.8-1.2)
Platelets	43
A

DIC, in acute promyelocytic leukaemia (APML presents younger than other AML)
Tx Tretinoin AKA all-trans retinoic acid

HSP doesn’t have pancytopenia/bleeding
Aplastic anaemia wouldn’t have weight loss

36
Q

how do you assess for ?heparin induced thrombocytopenia

A

HIT antibodies have a high false positive rate
Can use Warkentin probability scale
4Ts Score
- Thrombocytopenia (30-50, >50)
- timing 5-10d, or <1d if 100d since exposure
- Thrombosis (thrombosis or skin necrosis)
- other cause for thrombocytopenia

37
Q

what is Berger disease aka

A

IgA nephropathy

38
Q

what is IgA nephropathy aka

A

Berger disease

39
Q

bloody diarrhoea then AKI and thrombocytopenia… what type of haemolytic anaemia?

A

microangiopathic haemolytic anaemia (MAHA) in the context of HUS-TTP

40
Q

immediate therapy for acute promyelocytic leukaemia

A

Tretinoin PO for 3/12
AKA all-trans retinoic acid (ATRA)

If diagnosed, one of the most treatable leukaemias, however, 1/3 present w catastrophic haemorrhage

41
Q

Prognosis with Philadelphia translocation t(9;22)

A

GOOD in CML (most commonly found)

BAD in AML + ALL

MRCP 2 (13 decks)

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