Haematology Cases AS Flashcards
What abnormalities can you get with these?
Hb/Plt/WCC
Hb - anaemia, polycythaemia
Plt - thrombocytopenia(e.g. in chronic liver disease because of pooling in the spleen), thrombocytosis
WCC - infection, malignancy
What causes low MCV anaemia?
normal - 80-100
- Iron deficiency (low ferritin) - from diet, blood loss (GI, UG)
- Beta thalassaemia heterozygosity
What causes normal MCV anaemia?
Chronic disease e.g. rheumatoid arthritis, normal/high ferritin( e.g. haemochromatosis- excessive iron absorption in GI tract)
What causes desaturation on exercise(?)
PCV
What investigation would you request in beta thalassaemia?
Hb electrophoresis
What are the causes of macrocytic anaemia?
Alcohol
Myelodysplasia
Hypothyroidism
Liver disease
Folate/B12 deficiency
Alcoholics May Have Liver Disease
How does polycythaemia present?
- Headache
- Pruritus after hot bath
- Blurred viison
- Tinnitus
- Thrombosis (stroke, DVT)
- Gangrene
- Choreiform movements
What are some crises which occur in sickle cell anaemia? Summarise their management.
- Acute painful crises - analgesia, oxygen, IV fluids, antibiotics
- Stroke - exchange blood transfusion
- Sequestration crises (lung (SOB) spleen (exacerbation anaemia) - splenectomy for repeated episodes of splenic sequestation
- Gall stones, cholecystitis - cholecystectomy
What is the menmonic for myltiple myeloma?
- Calcium
- Renal failure
- Anaemia
- Bone (pain, osteopororsis)
- Infection
- Cord compression
Presentation: polyuria, polydispsia, constipation, Ur + Cr, FBC, fracture bone pain, DXA.
What do you test for in urine in multiple myeloma?
Bence Jones proteins in urine
What is the significance of ALP in malignancy/multiple myeloma?
ALP is a marker of bone formation
Give examples of situations where you would have reduced or increased reticulocyte counts.
Anaemia with increased reticulocyte count - haemolytic crises, Ddx
Reduced - parvovirus B19 infection, aplastic crises in sickle cell, blood transfusion
What is the diabetes range for fasting/random? Why is this so?
Diabetes - fasting >7, random >11.1. Above these ranges people start getting retinopathy so this is diabetes.
Impaired glucose tolerance (IGT) - 75 OGTT, 2 hour glucose 7.8-11
How does type 1 diabetes present? (3)
Weight loss, ketones, acidosis.
45 year old with lthargy, ,fatigue, polyuria, polydipsia, urinalysis shows no ketones and high glc. Random glc is 12. What treatment would you give?
Start with metformin and then add sulfonylurea (e.g. gliptin)
Diabetes complications?
Micro - retino/nephro/neuropathy
Macro - MI/stroke/PVD
Metabolic - DKA/HHS/hypoglycaemia/hyperosmolar state(?)
What is the sliding scale?
If pt unwell or nor eating this is prescribed for diabetics
Give a diagnosis:
- Weight loss
- Good appetite
- Irritability
- Palpitaions
- Irregular periods
- O/E tremor/proptosis/smooth goitre/pretibial myxoedema.
- Free T4: 30(10-20)
- TSH <0.05
TSH receptor antibody attacks thyroid - Graves’ disease
What will nuclear medicine scan show in graves?
Diffuse increased uptake
What investigations would you do for thyroid cancer?
USS
FNAC (uptake scan: cold nodule)
MDT
What are the types of thyroid cancer? (4)
- papillary
- follicular
- medullary
- anaplastic
What are the risk factors for thyroid cancer?
Radiation
FHx
Rapid enlargement/compression symptoms e.g. swallowing, coughing
Lymphadenopathy
When does bitemporal hemianopia commonly occur?
Pituitary tumour compressing optic chiasm
Describe a common presentation of prolactinoma in a female patient.
- Amenorrhoea
- Galactorrhoea
- Bitemporal hemianopia
- Milk
- Irregular periods
- Sexual dysfunction
Why do men with prolactinomas present later?
No periods
Will complain once bitemporal hemianopia occurs
What is the treatment for prolactinoma?
Cabergoline (only operate if unresponsive to treatment)
50 yr old
headache, sweating
snoring, poor sleep
tingling in fingers (carpal tunnel syndrome)
What is the first test?
Oral glucose tolerance test (OGTT)
Acromegaly
Describe the results of OGTT.
Glucose will not suppress IGF-1 if there is a pituitary tumour
- 40yr old woman
- wt gain
- depressed
- fatigue
- cental adiposity
What is the diagnosis?
Can’t tell - this is probably NOT Cushing’s
These are very common features in the population
What are the discriminatory signs in Cushing’s/when would you start testing for Cushing’s?
- Bruising, thin skin
- Myopathy
- Purple striae, >1cm wide
- DM, HTN, osteoporosis at young age
Amenorrhoea/oligomenorrhoea - differential diagnosis?
- Pregnancy - urine BHCG
- Hypothalamus - excessive exercise, low BMI
- Pituitary - excess prolactin, low LH/FSH
- Thyroid (hyper/hypo)- TFTs
- Ovaries - PCOS/ovarian failure- excess androgens (or hirsutism), high FSH
Give a common presentation of hypokalaemia. (3)
Weakness/arrhythmia/polyuria
Polyuria because of nephrogenic diabetes insipidus
Which endocrine condition can cause hypokalaemia?
A third of hypokalaemias are caused by Conn’s
Describe the osmolality of blood/urine in hyponatraemia.
plasma osmolality low in blood in hyponatraemia and high in urine
When can you get a high urine osmolality?
dehydration (ederly, children)
hyperosmolar hyperglycaemic state (T2DM)
What biochem picture is suggestive of Vit D deficiency?
low ca, low phosphate, high PTH
(PTH goes up in low Ca/phosphate)
How do you distinguish between hyperparathyroidism and vit D deficiency?
high PTH in hyperparathyroidism and high Ca, low phophate (phosphate trashing hormone)
high ca, normal phosphate, low PTH?
Malignancy
Low Ca, high phosphate, low PTH?
hypoparathyroidism
Low Ca, high phosphate, high PTH?
Renal failure - Vit D needs to be activated in kidney/liver. If it is not activated then low Ca because low Vit D. PTH will be high due to low negative feedback
Causes of AKI?
- Pre-renal - hypovolaemia/sepsis
- Renal - drugs/ active urine sediment (blood and protein in urine e.g. glomerulonephritis)
- Post renal - obstruction (e.g. large prostate/malignancy)
Renal artery stenosis - what are the features? What investigation would you do?
Asymmetrical kidneys
MRA
Deterioration of renal function with ACE inhibition
What can you deduce from CO2 and bicarbonate in aBG?
CO2 and bicarbonate should always go in the same direction
Always look at pH first then CO2 (if CO2 is low then respiratory cause)
If they are going in opposite directions then there is a “mixed picture”
What is sarcoilitis?
Arthritis affecting the DIP joints
Distal oligarthritis - rheumatoid is symmetric polyarthropathy
