Haematology and Oncology Flashcards
1
Q
Source of energy in RBC
A
Glucose
2
Q
How glucose is used in RBCs
A
90% glycolysis, 10% HMP shunt
3
Q
How do RBCs transport CO2?
A
Use Cl/HCO3 transporter
4
Q
Anisocytosis
A
varying sizes
5
Q
Poikilocytosis
A
varying shapes
6
Q
Lifespan of thrombocyte
A
8-10 days
7
Q
Dense granules of thrombocytes
A
ADP, Ca
8
Q
alpha granules of thrombocytes
A
vWF, fibrinogen, fibronectin
9
Q
What proportion of platelets are stored in the spleen?
A
1/3
10
Q
vWB receptor
A
GpIb
11
Q
Fibrinogen receptor
A
GpIIb/IIIa
12
Q
Granulocytes
A
neutrophil, eosinophil, basophil (BEN)
13
Q
Mononuclear cells
A
Monocytes, lymphocytes
14
Q
Order of WBCs from most to least pneumonic
A
Neutrophils Like Making Everything Better
15
Q
Multilobed nucleus, leukocyte alkaline phosphatase, lysozyme, lactoferrin
A
Neutrophil
16
Q
Lysosome =
A
azurophilic granules
17
Q
lysosomes in neutrophils contain
A
proteinases, acid phosphatase, myeloperoxidase, B-glucuronidase
18
Q
Hypersegmented neutrophil
A
B12/ folate deficiency
19
Q
Band cell
A
immature neutrophil
20
Q
Neutrophil chemotaxis agents
A
C5a, IL-8, LTB4, kallikrein, PAF
21
Q
Frosted glass cytoplasm
A
monocyte
22
Q
Activation of monocyte –> mpg
A
gamma-interferon
23
Q
Mpg as antigen presenting
A
MHC II
24
Q
Initiation of septic shock
A
Lipid A from bacterial LPS binds CD14
25
bilobate nucleus
eosinophil
26
what are eosinophils good for?
antigen-antibody complexes
27
produes histaminase + major basic protein
eosinophils
28
Causes of eosinophilia
NAACP
| Neoplasia, asthma, allergy, chronic adrenal insufficiency, parasites
29
Mediates allergic reaction
basophil
30
WBC containing heparin and histamine
basophil
31
leukotrienes
basophils
32
job of mast cells
allergic reaction in local tissues
33
what do mast cells contain?
basophilic granules
34
Binds Fc of IgE to membrane
Mast cell
35
WBC involved in type I hypersensitivity
Mast cell
36
What prevents mast cell degranulation?
cromolyn sodium
37
What does mast cell degranulation release?
histamine, heparin, tryptase, eosinophil chemotactic factors
38
Link between innate and adaptive immune systems
dendritic cell
39
Dendritic cells express
MHC class II
40
Dendritic cell on the skin
Langerhans cells
41
Adaptive immunity
B and T cells
42
NK cells as part of the
innate immune presonse
43
round densely staining nucleus with small amount of pale cytoplasm
lymphocyte
44
Antigen presenting using B cell
MHC II
45
cytotoxic T cells
express CD8, MHC I
46
helper T cells
express CD4, MHC II
47
Regulatory T cells express
CD28
48
clock face refers to
plasma cell chromatin
49
eccentric nucleus, abundant RER, well developed golgi
plasma cells
50
erythropoesis yolk sac
yolk sac - 3 - 8 weeks
liver - 6 weeks-birth
spleen - 10-28 weeks
marrow - 18 weeks on
51
embryonic globin
zeta and epsilon
52
HbF
a2y2
53
Why does HbF have a higher affinity for O2?
less avid binding of 2,3-BPG
54
Universal RBC recipient
AB
55
Universal RBC donor
O
56
Rh hemolytic disease of the newborn
Maternal anti-D Rh IgG molecules
57
erythroblastosis fetalis
haemolytic disease of the newborn
58
Why would a woman have anti-D IgG?
previously exposed to Rh+ve blood
59
Rx haemolytic disease of the newborn
anti-D IgG in 3rd trimester
60
ABO hemolytic disease of the newborn presents as
Early jaundice
61
When does ABO haemolytic disease of the newborn occur?
Type O mother with type A, B or AB fetus
62
Hb electrophoresis direction
+ve to -ve
63
Hb electrophoresis positions
Animal food seems classy
| Adult, fetus, sickle, HbC
64
action of bradykinin
vasodilation, permeability, pain
65
stimulation of bradykinin
HMWK from factor XII activation
66
extrinsic pathway
VII
67
Intrinsic pathway
XII, XI, IX, VIII
68
Factor I
fibrinogen
69
Factor II
prothrombin
70
active vitamin K
reduced
71
vitamin K deficiency
II, VII, IX, X, protein C, protein S
72
what does activated protien C do?
cleaves and inactivates Va and VIIIa
73
what does plasminogen do?
fibrinolysis
74
How does factor V leiden work?
factor V is resistant to protein C
75
how does heparin work?
enhances the activity of antithrombin
76
weibel-palade bodies of endothelial cells
vWF (also a-granules of platelets)
77
what coagulation factor is released by platelets?
TXA2
78
how does aspirin work?
inhibits TXA2 synthesis by inhibiting cyclooxygenase
79
how to clopidogrel, prasugrel and ticlopidine work?
inhibit ADP-induced expression of GpIIb, IIIa
80
How do abciximab, eptifibatide and tirofiban work?
Inhibit GpIIb/IIIa
81
Ristocetin failure
vWF disease, Bernard-Soulier syndrome
82
spur cell
liver disease, abetalipoproteinemia
83
basophilic stippling
lead poisoning, sideroblastic anaemia, myelodysplastic syndromes
84
teardrop cell =
dacrocyte
85
bite cell =
degmacyte
86
Burr cell/ echinocyte
end stage renal disease, liver disease, pyruvate kinase deficiency
87
heireditary elliptocytosis
mutation in RBC membrane proteins
88
macro-ovalocyte
megaloblastic anaemia, marrow failure
89
Ring sideroblast from
excess iron in mt
90
schistocyte
think shit has hit the fan
| DIC, TTP/HUS, HELLP, mechanical haemolysis
91
spherocyte
drug and infection induced haemolytic anaemia
92
target cell
HALT
| HbC disease, asplenia, liver disease, thalasaemia
93
Heinz bodies due to
oxidation of -SH to S-S
94
Howell-Jolly bodies
asplenia/ hyposplenia
95
what are howell-jolly bodies?
basophilic nuclear remnants
96
Microcytic anaemia
Iron deficiency, ACD, thalassemia, lead poisoning, sideroblastic anaemia
97
Normocytic anaemia - non haemolytic
iron deficiency, ACD, aplastic, CKD
98
Normocytic anaemia - haemolytic, intrinsic
RBC membrane defect, enzyme deficiency, HbC disease, paroxysmal nocturnal haemoglobinuria, sickle cell
99
Normocytic anaemia - haemolytic, extrinsic
autoimmune, microangiopathic, macroangiopathic, infection
100
macrocytic anaemia - megaloblastic
folate, B12, orotic aciduria
101
macrocytic anaemia - non-megaloblastic
liver disaese, alcohol, diamond-blackfan anaemia
102
hydrops fetalis
Hb Barts (4 gamma chains)
103
inhibits ferrochelatase and ALA dehydratase
Lead
104
symptoms of Lead poisoning
Lead lines
Encephalopathy, erythrocyte basophilic stippling
Abdo colic, sideroblastic anaemia
Drop of wrist and foot
105
Rx lead poisoning
dimercaprol
| EDTA
106
X linked defect delta-ALA gene
sideroblastic anaemia
107
sideroblastic anaemia
defect in haem synthesis
108
acquired sideroblastic anaemia
alcohol, lead, B6 deficiency, copper deficiency, isoniazid
109
Rx sideroblastic anaemia
B6
110
cause of megaloblastic anaemia
impaired DNA synthesis - nucleus and cytoplasm mature at different rates
111
drugs causing folate deficiency
methotrexate, trimethoprim, phenytoin
112
diphyllobothrium lactum
fish tapeworm
| B12 deficiency
113
Schilling test
B12 deficiency
114
raised homocysteine, methylmalonic acid
B12 deficiency
115
Orotic aciduria
can't convert orotic acid to UMP
116
Rx orotic aciduria
uridine monophosphate
117
Diamod-Blackfan anaemia
defect in erythroid progenitor cell
118
triphalangeal thumbs
Diamond-Blackfan anaemia
119
Difference between megaloblastic and non megaloblastic
nonmegaloblastic will have NO hypersegmented neutrophils
120
how to tell if hemolysis is intra or extra vascular
only intravascular decreases haptoglobins
121
anaemia of chronic disease
hepcidin binds ferroportin inhibiting iron transport
122
where is ferroportin found?
mucosal cells, mpgs
123
decreased iron + TIBC, increased ferritin
anaemia of chronic disease
124
aplastic anaemia
destruction/ failure of myeloid stem cells
125
viruses causing aplastic anaemia
B19, EBV, HIV, hepatitis
126
Fanconi anaemia
DNA repair defect --> marrow failure
127
cafe-au-lait spots, short, thumb/ radial defects
Fanconi anaemia
128
splenomegaly, aplastic crisis
hereditary spherocytosis
129
back pain, hemoglobulinuria after stress
G6PDH deficiency
130
hemolytic anaemia in the newborn
pyruvate kinase deficiency
131
HbC mutation
glutamic acid --> lysine
132
complement mediated intravascular RBC lysis
Paroxysmal nocturnal haemoglobulinuria (PNH)
133
coombs negative haemolytic anaemia, pancytopaenia, venous thrombosis
PNH
134
Rx PNH
eculizumab
135
proportion of african americans carrying HbS allele
8%
136
Warm autoimmune hemolytic anaemia
IgG
137
Warm anaemia causes
SLE, CLL, methyldopa
138
Cold autoimmune haemolytic anaemia
IgM and complement
139
Cold anaemia causes
CLL, m.pneumoniae infections, mono
140
Coombs +ve
autoimmune hemolytic anaemia
141
Microangiopathic anemia is
damaged RBCs from passing through obstructed/ narrow vessel
142
causes of microangiopathic anaemia
DIC, TTP/HUS, SLE, malignant htn
143
macroangiopathic anemia
mechanical RBC destruction
144
TIBC
Transferrin
145
Ferritin
primary iron storage protein
146
neutropenia value
< 1500
147
severe neutropenia
< 500
148
lymphopenia
<1500
| < 3000 kids
149
eosinopenia
< 30
150
lymphopaenia
HIV, DiGeorge, SCID, SLE, GCs, radiation, sepsis, post-op
151
neutropenia
sepsis, chemo, aplastic anaemia, SLE, radiation
152
eosinopenia
cushing syndrome, GCs
153
leukoerythroblastic reaction
more immature RBCs due to severe anaemia, marrow response
154
porphyrias
condition of defective heme synthesis
155
Porphobilinogen deaminase
Acute intermittent porphyria
156
Abdo pain, port wine urine, polyneuropathy, psych disturbance
acute intermittent porphyria
157
drugs precipitating acute intermittent porphyria
cytochrome p-450 inducers, alcohol starvation
158
Rx acute intermittent porphyria
glucose + heme
159
uroporphyrinogen decarboxylase
porphyria cutanea tarda
160
tea coloured urine
porphyria cutanea tarda
161
blistering cutaneous photosensitivity
porphyria cutanea tarda
162
nausea, vomiting, gastric bleed, lethargy, scarring --> GI obstruction
Fe poisoning
163
Iron chelation agents
Deforoxamine, defasirox
164
PT
extrinsic
165
INR calculated from
PT
166
Haemophilia B
IX
167
Rx haemophilia
desmopressin + factor concentrate
168
low GpIIb/IIIa
Glanzmann thrombasthenia
169
Bernard-Soulier syndrome
large plt, low GpIb, platelets don't bind to vWF
170
thrombocytopenia, microangiopathic hemolytic anemia, acute renal failure
HUS
171
Rx HUS
plasmaphoresis
172
Immune thrombocytopenia
anti-GpIIb/IIIa
| viral
173
Rx immune thrombocytopenia
steroids, IVIG, splenectomy
174
inhibition of ADAMTS 13
TTP
175
neuro and renal symptoms, fever, thrombocytopenia, microangiopathic hemolytic anemia
TTP
176
Rx TTP
plasmapheresis, steroids
177
how does desmopression affect coagulation?
releases vWF from endothelial stores
178
Causes of DIC
Sepsis, trauma, obstetric, pancreatitis, malignancy, nephrotic syndrome, transfusion
179
Protein C/S deficiency
can't inactivate Va and VIIIa (vWB)
180
antithrombin
inhibits factors IIa and Xa
181
acquired antithrombin deficiency
renal failure, nephrotic syndrome
182
Reed-Sternberg cells
| origin
Hodgkins
Owl eyes/ avocado
CD15 + CD30 + B cell
183
lymphoma > 55yr male
Hodgkin
184
lymphoma associated with EBV
Hodgkins, Burkitt's
185
which lymphomas have B symptoms?
Hodgkins
186
lymphoma associated with HIV and autoimmune
Non-Hodgkins
187
t(8:14)
Burkitt's
188
starry sky, tingible body mpg
Burkitt's
189
lymphoma endemic in Africa
Burkitt's
190
Most common adult NHL
Diffuse large B cell
191
t(14:18) is, affects
Follicular
| Bcl-2
192
waxing and waning lymphadenopathy
follicular lymphoma
193
t(11:14) - called, is, affects
mantle cell, cyclin D1 Ig heavy chain, adult males
194
Lymphoma associated with HIV/AIDS
primary central nervous system lymphoma
195
HTLV
T cell lymphoma
196
HTLV populations
Japan, West Africa, Caribbean
197
T cell lymphoma presentation
lytic bone lesions, hypercalcaemia
198
skin plaques in adults
Mycosis fungoides
199
Multiple myeloma normally procudes
IgG or IgA
200
Multiple myeloma epectrophoresis
M spike at Beta and gamma
201
Rouleaux
Myeloma
202
hypercalcaemia, renal issue, anaemia, bone lytic lesions
myeloma
203
What apart from myeloma has an M spike?
Waldenstrom macroglobulinaemia
204
Pseudo-Pelger-Huet anomaly
| when is it seen?
neutrophils with biolbed nuclei
| post chemo
205
T cell ALL presentation
medaistinal mass
206
ALL associated with
Down's syndrome
207
TdT
pre-T and B cells
208
CD10
pre-B cells
209
t(12;21)
good in ALL
210
CLL think
crushed little lymphocytes
211
Richter transformation
CLL --> diffuse large b cell lymphoma
212
Hairy cell leukaemia is, who gets it
mature B cell tumour
| adult males
213
Rx Hairy cell leukaemia
cladribine, pentostatin
214
Auer rods
AML
215
myeloperoxidase +ve
AML
216
RF for AML
chemo, radiation, myeloproliferative disorders, Down's syndome
217
t(15:17)
AML associated with Down's syndrome
218
t(9:22)
CML
219
blast crisis
CML --> AML/ALL
220
Rx CML
tyrosine kinase inhibitors - imatinib
221
child with lytic bone lesions, skin rash, recurring otitis media
langerhans cell histiocytosis
222
S-100 expression, CD1a
Langerhans cell histiocytosis
223
Birbeck granules
Langerhans cell histiocytosis
224
JAK2 mutation
chronic myeloproliferative disorders
225
polycythaemia
increased hematocrit
226
severe itching after warm water
polycythaemia rubra vera
227
polycythaemia Rx
aspirin
228
proliferation of megakaryocytes and platelets
essential thrombocythemia
229
mechanism of heparin
lowers activity of thrombin and factor Xa
230
S.E heparin
bleeding, thrombocytopaenia, osteoporosis, drug-drug interactions
231
protamine sulfate
heparin antidote
232
LMW-heparin
enoxaparin, fondaparinux
233
enoxaparin benefit
longer half life, better bioavailability
234
heparin induced thrombocytopenia
IgG antibodies against Plt factor 4
235
Bivalirudin
| is, use, s.e
direct thrombin inhibitor
AF, VTE
bleeding
236
S.E Warfarin
bleeding, tetarogenic, tissue necrosis, drug inteactions,
237
Rivaroxaban
Bind directly to Xa
238
Alteplase, streptokinase
conversion of plasminogen to plasmin
239
reversal of thrombolytics
aminocaproic acid
240
clopidogrel, ticagrelor, riclopidine
Block ADP receptors, prevent GpIIb/IIIa expression
241
Cilostazol, dipyridamole is, use, s.e
phosphodiesterase III inhibitor, inhibits plt addregation
intermittent claudication, angina, stroke/TIA prevention
headache, facial flushing, hOtn, abdo pain
242
S.E. ticlopidine
neutropenia
243
s.e. abciximab
bleeding, thrombocytopaenia
244
Azathioprine is
purine analog
245
metabolite of azathioprine
6-MP
246
Azathioprine use
preventing organ rejection, RA, IBD, SLE
247
Careful when prescribing azahtioprine with
allopurinol or febuxostat (xanthine oxidase)
248
Cladribine is, use, s.e
purine analog - inhibits DNA polymerase, DNA strand breaks
ahiry cell
myelosupression, nephrotoxicity, neurotoxicity
249
Cytarbine
pyramidine analog
| inhibits DNA polymerase
250
Rx with cytarabine
AML, lymphoma
| s.e myelosuppession with megaloblastic anaemia
251
use of 5-flurouracil
colcon ca, oancreatic ca, basal cell ca
252
careful use of 5-flurouracil
leucovorin (folinic acid)
253
methotrexate
folic acid analog
254
use of methotrexate
ALL, lymphoma, choriocarcinoma, sarcoma, ectopic pregnancy, abortion, RA, psoriasis, IBD, vasculitis
255
s.e. methotrexate
myelosupression, hepatotoxicity, mucositis, pulmoary fibrosis
256
reversal of methotrexate myelosupressoin
leucovorin
257
bleomycin is, use, s.e
breaks DNA strands
testicular ca., HL
pulmonary fibrosis, skin hyperpigmentation
258
dactinomycin is, use
intercalates in DNA
| wilms tumour, ewing sarcoma, rhabdomyosarcoma
259
doxorubicin use, s.e
generates free radicals breaking DNA
solid tumours, leukaemia, lymphoma
dilated cardiomyopathy, alopecia
260
how can cardiotoxicity with doxorubicin be stopped?
dexrazozane - iron chelation
261
busulfan is, use, s.e.
cross links DNA
CML, ablates bone marrow
pumlonary fibrosis, hyperpigmentation, myelosupression
262
Cyclophosphamide, ifosfamide
gross links DNA at guanine N-7
263
use ifosfamide s.e
solid tumours, leukaemia, lymphoma
| haemorrhagic cystitis
264
how to prevent haemorrhagic cystitis
mensa
265
nitrosoureas
carmustine, lomustine, semustine, streptozocin
266
what is different about nitrosoureas?
cross link DNA in the CNS
267
S.E nitrosoureas
cns toxicity
268
paclitaxel is, use, s.e
stops anaphase
ovarian + breast ca
neuropathy, hypersensitivity
269
vincristine, vinblastine
prevent mitotic spindles
270
use vincristine
solid tumours, leukaemia, NHL
271
vinblastine
solid tumours, leukaemia, HL
272
vincristine s.e.
neurotoxicity, constipation
273
cisplatin is, use, s.e.
cross links DNA
testicular, bladder, ovary ,lung carcinoma
nephrotoxicity, peripheral neuropathy, ototoxicity
274
give with cisplatin
amifostine, chloride
275
etoposide is, use, s.e
inhibits topoisomerase II
solid tumours - testicular, small cell, leukaemia, lymphoma
alopecia
276
irinotecan, is, use, s.e.
inhibit topoisomerase I
colon ca., ovarian, small cell
diarrhoea
277
hydroxyurea does, for
inhibits ribonucleotide reductase
| melanoma, CML, sickle cell
278
general s.e. of cancer drugs
myelosupression
279
bevacizumab
mab against VEGF
280
use bevacizumab, s.e
colorectal, renal carcinoma
| hemorrhage, blood clots, impaired wound healing
281
erlotinib is, use, s.e
EGFR tyrosine kinase inhibitor
non-small cell
rash
282
cetuximab, is, use, s.e
ECGF
IV colon ca (KRAS), head and neck ca
rash, elevated LFTs, diarrhoea
283
imatinib use, s.e
CML, GI stromal tumours
| fluid retention
284
rituximab is, use, s.e.
against CD20
NHL, CLL, ITP, RA
multifocal leukoencephalopathy
285
Tamoxifen, raloxifene
E R modulator
286
use raolxifene
prevent OP, breast ca
287
tamoxifen s.e.
risk of endometrial ca, hot flashes, PE, DVT
288
raolxefine s.e.
PE, DVT
289
Herceptin is, use, s.e.
trastuzumab
breast/gastric ca
cardiotoxicity
290
vemurafenib, is, use
inhibits BRAF oncogene
| metastatic melanoma
291
hydroxyurea in sickle cell
increases HbF
| used in a crisis
292
sickle cell increases infection from
encapsulated organisms - s.pneumoniae
293
salmonella osteomyelitis
sickle cell
294
cerebriform nuclei
Mycosis fungoides
295
Mycosis fungoides
cutaneous T cell lymphoma from CD4+ cells
296
nosebleeds + petichiae
immune thrombocytopaenic purpura
297
venous thrombosis + anaemia + pancytopaenia
Paroxysmal nocturnal haematuria
298
what type of anaemia is seen in paroxysmal nocturnal haematuria?
coombs negative autoimmune haemolytic anaemia
299
deficiency in CD59 and CD55
PNH - haemolysis by complement
