Haematology - Anaemia and the Leukaemias Flashcards
anaemia
decreased o2 delivery to metabolising tissues
leads to tiredness, sob and palpitations etc
Normal Hb levels 130g/l male, 120g/l female
which of these are the primary red cell indices
a.Hb, HCt, RBC
b.MCV,MCH.MCHC
a.Hb, HCt, RBC
which of these are the secondary red cell indices
a.Hb, HCt, RBC
b.MCV,MCH.MCHC
b.MCV,MCH.MCHC
what type of anaemia does thalassaemia cause
a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic
a.microcytic hypochromic
what type of anaemia does early iron deficiency cause
a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic
c.normocytic, normochromic
what type of anaemia does acute/subacute bleeding cause
a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic
c.normocytic, normochromic
what type of anaemia does renal failure cause
a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic
c.normocytic, normochromic
what type of anaemia does anaemia of chronic disease cause
a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic
c.normocytic, normochromic
what type of anaemia does lead poisoning cause
a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic
c.normocytic, normochromic
what type of anaemia do primary bone marrow disorders and leukaemias cause
a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic
c.normocytic, normochromic
what type of anaemia do b12 and folate deficiency cause
a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic
b.macrocytic
what type of anaemia does alcohol deficiency cause
a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic
b.macrocytic
what type of anaemia does red cell aplasia cause
a.microcytic hypochromic
b.macrocytic
c.normocytic, normochromic
d.microcytic, normochromic
c.normocytic, normochromic
with reduced reticulocytes
2 main causes of anaemia
REDUCED RBC PRODUCTION
I) DEFICIENCY
B12,folate,Fe deficiency
decreased erythropoietin 2 to ckd
II) BONE MARROW SURPRESSION
drug induced
infiltrate (malignancy)
thalassameia
aplasia
INCREASED RBC DESTRUCTION
I)BLOOD LOSS
II)REDUCED RBC SURVIVAL
haemolytic anaemias (increase LDH, decreased haptoglobin) eg….
autoimmune
hereditary spherocytosis
G6PD deficiency
sickle cell disease
unstable haemoglobin
hypersplenism (increased reticulocytes)
symptoms of haematological malignancy
non specific
tiredness
weight loss
recent night sweats and bone pain
bleeding and bruising
petechiae
lymph node swelling
petechiae are ..
a.blanching
b.non blanching
b.non blanching
trauma to vessel - leakage of blood into skin from vessels , cannot go back in so doesn’t blanch
appear around weight bearing parts eg ankles
appear under areas of tight clothing
what is the first investigation for suspected haematological cancer
a.fbc
b.blood film
c.bone marrow aspirate and trophine
d.flow cytometry
e.cytogenetics
b.blood film
presence of abnormal cells
increased BLAST cells (early white cell precursors, not normally present in peripheral blood should be present in bone marrow only
what is trephine
biopsy of bone marrow tissue examined for pathology
cwhat is first in the pathway of diagnosis of haematological malignancy
a.morphological exam of aspirate
b.immunophenotyping with flow cytometry
c.cytogenetics
d.molecular diagnosis
a.morphological exam of aspirate
what is second in the pathway of diagnosis of haematological malignancy
a.morphological exam of aspirate
b.immunophenotyping with flow cytometry
c.cytogenetics
d.molecular diagnosis
b.immunophenotyping with flow cytometry
what is third in the pathway of diagnosis of haematological malignancy
a.morphological exam of aspirate
b.immunophenotyping with flow cytometry
c.cytogenetics
d.molecular diagnosis
c.cytogenetics
what is fourth in the pathway of diagnosis of haematological malignancy
a.morphological exam of aspirate
b.immunophenotyping with flow cytometry
c.cytogenetics
d.molecular diagnosis
d.molecular diagnosis
in which part of haematological cancer diagnosis are a mix of antibodies used to identify antigens on pt cells in order to deduce the cells present in the aspirate
a.morphological exam
b.flow cytometry
c.cytogenetics
d.molecular diagnosis
b.flow cytometry
can tell if myeloid or lymphoid
in which part of haematological cancer diagnosis are bone marrow cells grown in culture to analyse the chromosomal arrangement in cells
a.morphological exam
b.flow cytometry
c.cytogenetics
d.molecular diagnosis
c.cytogenetics
in leukaemia cells there is an acquired abnormality with chromosomal rearrangement in all cells
PML/RARA fuse due to rearrangement of chromosomes 15 and 17
fusion protein drives disease and continued production of leukaemia cells
leads to acute myelocytic leukaemia
in which part of haematological cancer diagnosis is per used to assess size of genes present in the cells
a.morphological exam
b.flow cytometry
c.cytogenetics
d.molecular diagnosis
d.molecular diagnosis
fusion genes different size
blast cells are usually found in ……….. numbers in the bone marrow
a.small
b.large
a.small
blast cells are found in large numbers in the bone marrow when there is a malignant change in which cell type
a.pluripotent stem cell
b.haematopoetic stem cell
c.common myeloid progenitor
d.common lymphoid progenitor
b.haematopoetic stem cell
blast cells that form from this are abnormal so don’t differentiate into abc and remain in large numbers in bone marrow
leukaemia
acquired series of events leading to expansion of abnormal clone of cells that accumulate in the bone marrow and blood leading to blood cancer
4 types of leukaemia
ACUTE - lymphoid and myeloid (usually aggressive)
CHRONIC- lymphoid and myeloid (more mature and aggressive)
first line treatment for either acute leukaemia
a.supportive treatment , anti emetic, antibiotics allopurinol and fluids to prevent tumour lysis
b.chemotherapy
c.CNS directed therapy
d.stem cell transplant
a.supportive treatment , anti emetic, antibiotics allopurinol and fluids to prevent tumour lysis
then chemo
then transplant
cons directed therapy needed in lymphoblastic
what match is required with a donor for stem cells
a.HLA
b.HRE
c.Philadelphia gene
a.HLA
main side effect of stem cell transplant
a.graft vs host disease
b.infection
c.rejection
d.post transplant lymphoproliferative disorder
a.graft vs host disease
if Philadelphia positive ALL then transplant should ..
a.be done
b.not be done
a.be done
higher chance of relapse
stem cell transplants are directed at those in…
a.first remission
b.second remission
a.first remission
patient with symptoms of leukaemia, bloods show increased WCC, increased neutrophils, basophils and eosinophils which most likely
a.ALL
b.AML
c.CLL
d.CML
d.CML
chronic myeloid
chronic as cells that are present are further along in development pathway
neut, baso.eosin all come from the myeloid progenitor so myeloid
the bone marrow in chronic myeloid leukaemia is
a.hypocellular
b.hypercellular
b.hypercellular
large number of myeloid precursors
all have Philadelphia chromosome (small chromosome 22)
leads to BCR-ABL fusion gene driving disease
management for chronic myeloid leukaemia
a.tyrosine kinase inhibitors (-inib)
b.supportive therapy
c.stem cell transplant
d.chemotherapy and steroids
a.tyrosine kinase inhibitors (-inib)
BCR-ABL makes a tyrosine kinase protein long term inhibitor given with monitoring of bar all levels
slow growing cancer of the immune cells (b lymphocytes) arising as an immune response to infection that does not switch off and eventually becomes malignant
a.ALL
b.AML
c.CLL
d.CML
c.CLL
suspected chronic leukaemia blood shows increased lymphocytes , anaemia and thrombocytopenia what is most likely
a.ALL
b.AML
c.CLL
d.CML
c.CLL
treatment for cll
depends on stage and aggression
some never need treatment
young with aggressively progressive disease - stem cell transplant - curative
