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Phase 2a > Haematology conditions > Flashcards

Haematology conditions Flashcards

1
Q

What does a FBC test for? (5)

A
  • RBC volume
  • WBC volume
  • Platelet volume
  • Haemoglobin concentration
  • Mean Corpuscular Volume
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2
Q

What does a reticulocyte count show?

A
  • Shows how quickly the bone marrow is producing new RBCs
  • Reticulocytes are immature RBCs
  • Low = something preventing RBCs being produced
  • High = RBCs are being lost or destroyed (bleeding), RBCs are being produced to compensate
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3
Q

What does a serum ferritin test show?

A
  • Ferritin is iron storage protein
  • Measures iron levels
  • Can be falsely raised in inflammation and malignancy
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4
Q

What does a blood film show?

A
  • Smears put on slides and looked at under microscope
  • Thick = observes potential parasites
  • Thin = observes RBC morphology and parasites
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5
Q

Anaemia: Classification results

A
  • MCV <80 = Microcytic
  • MCV 80-100 = Normocytic
  • MCV >100 = Macrocytic
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6
Q

Anaemia: Symptoms (5)

A
  • Pale skin
  • Tachycardia
  • Fatigue
  • Headache
  • Palpitations
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7
Q

Iron Deficiency Anaemia: Pathology and type

A
  • Type of microcytic anaemia
  • Low iron → decreased haem synthesis → less haemoglobin → lack of effective RBCs → anaemia
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8
Q

Iron Deficiency Anaemia: Causes (4)

A
  • Low iron diet
  • Blood loss
  • Malabsorption
  • Pregnancy
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9
Q

Iron Deficiency Anaemia: Symptoms (4)

A
  • Brittle hair and nails
  • Atrophic glossitis (smooth and inflamed tongue)
  • Koilonychia (spoon shaped nails)
  • Angular Stomatitis (inflammation of corners of mouth)
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10
Q

Iron Deficiency Anaemia: Differential Diagnosis

A

Thalassaemia

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11
Q

Iron Deficiency Anaemia: Investigations (4)

A
  • FBC and blood film
  • Serum Ferritin - will be low
  • Reticulocyte count - reduced
  • Endoscopy and colonoscopy to look for bleeds
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12
Q

Iron Deficiency Anaemia: Treatement

A

Ferrous Sulphate (oral iron)

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13
Q

Pernicious Anaemia: Pathology

A
  • Autoimmune
  • Type of macrocytic anaemia
  • Intrinsic factor deficiency → reduced absorption of B12 in the terminal ilium
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14
Q

Pernicious Anaemia: Causes of B12 Deficiency (4)

A
  • Diet (vegan)
  • Gastrectomy
  • Crohn’s disease
  • Coeliac disease
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15
Q

Pernicious Anaemia: Symptoms (3)

A
  • General anaemia symptoms
  • Jaundice
  • Polyneuropathy
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16
Q

Pernicious Anaemia: Investigations (4)

A
  • FBC
  • Blood film - would show macrocytic RBCs
  • Autoantibody screen
  • Serum B12 - low
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17
Q

Pernicious Anaemia: Treatment

A

Vitamin B12 tablets (hydroxocobalamin)

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18
Q

Folate Deficiency Anaemia: Causes (4)

A
  • Diet (alcoholics, elderly)
  • Malabsorption (Crohn’s or Coeliac)
  • Pregnancy
  • Drugs
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19
Q

Folate Deficiency Anaemia: Symptoms

A
  • Anaemia symtpoms
  • No neuropathy (distinguishes between B12 and folate deficiency)
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20
Q

Folate Deficiency Anaemia: Investigations (3)

A
  • FBC
  • Blood film - macrocytic anaemia
  • Serum and erythrocyte folate levels
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21
Q

Folate Deficiency Anaemia: Treatment

A
  • Treat underlying cause
  • Folic acid supplementation (in pregnancy)
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22
Q

Haemolytic Anaemia: Pathology

A
  • RBCs are destroyed before their normal 120 day lifespan
  • Breakdown produces excess bilirubin
  • Can be intravascular (in blood vessels) or extravascular (most commonly in reticuloendothelial system)
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23
Q

Haemolytic Anaemia: Causes (6)

A
  • Sickle cell anaemia
  • Thalassaemia
  • Membranopathies
  • Glucose-6-phosphate deficiency
  • Autoimmune
  • Infections (malaria)
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24
Q

Haemolytic Anaemia: Symptoms (4)

A
  • Gallstones (excess bilirubin)
  • Jaundice (excess bilirubin)
  • Leg ulcers
  • Enlarged spleen
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25
Q

Haemolytic Anaemia: Investigations (5)

A
  • FBC - reduced haemoglobin
  • Blood film - schistocytes (RBC fragments)
  • High serum unconjugated bilirubin
  • High urinary urobilinogen
  • High faecal stercobilinogen
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26
Q

Haemolytic Anaemia: Treatment (3)

A
  • Folate and iron supplements
  • Immunosuppressives
  • Splenectomy
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27
Q

Aplastic Anaemia: Description

A

Reduction in number of pluripotent stem cells → lack of haemopoiesis (RBC and platelet production)

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28
Q

Aplastic Anaemia: Causes (5)

A
  • Congenital
  • Acquired
  • Chemotherapy
  • Infection
  • Pregnancy
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29
Q

Aplastic Anaemia: Symptoms (4)

A
  • Anaemia symptoms
  • Increased susceptibility to infection
  • Increased bruising
  • Increased bleeding
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30
Q

Aplastic Anaemia: Investigations (3)

A
  • FBC - pancytopenia (low levels of all blood cells)
  • Reticulocyte count - low or absent
  • Bone marrow biopsy - hypocellular with fat spaces
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31
Q

Aplastic Anaemia: Treatments (4)

A
  • Treat cause
  • Blood/platelet transfusion
  • BM transplant
  • Immunosuppressants (anti-thymocyte globulin and ciclosporin)
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32
Q

Sickle Cell Anaemia: Description

A

Autosomal recessive condition, more common in afro-caribbean. Protects from malaria

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33
Q

Sickle Cell Anaemia: Pathology

A
  • Mutation of B globin gene results in HbS variant
  • Under stress RBCs become deoxygenated and HbS polymerises causing cells to sickle
  • Sickling can cause destruction of RBCs and obstruction
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34
Q

Sickle Cell Anaemia: Symptoms (4)

A
  • Acute pain in hands and feet
  • Jaundice (Hb breakdown)
  • Anaemia symptoms (rare due to compensatory Hb production)
  • Acute chest pain (pulmonary vasculature obstruction)
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35
Q

Sickle Cell Anaemia: Investigations (3)

A
  • Blood/heel prick test (neonates)
  • FBC (low Hb, high reticulocyte)
  • Blood film (sickled erythrocytes)
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36
Q

Sickle Cell Anaemia: Treatment (5)

A
  • Folic acid
  • Opiates
  • Hydroxycarbamide (increases HbF conc)
  • Stem cell transplant
  • Antibiotics
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37
Q

Sickle Cell Anaemia: Complications

A
  • Acute - pain, mesenteric ischaemia
  • Chronic - renal impairment, pulmonary hypertension, joint damage
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38
Q

Thalassaemia: Description

A
  • Autosomal recessive
  • Decreased rate of production of one or more globin chains in red cell precursors causes reduced production and premature destruction of RBCs
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39
Q

Thalassaemia: α Thalassaemia description

A
  • Gene deletions in the 4 genes that control production of alpha globin chains
  • 2 deletions = mild microcytic anaemia
  • 3 = severe
  • 4 = stillborn
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40
Q

Thalassaemia: ß Thalassaemia pathology

A

Reduced beta chain production → excess alpha chain production → alpha chains bind with delta chains (HbA2) or gamma chains (HbF)

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41
Q

Thalassaemia: Investigations (2)

A
  • FBC and blood film - show mmicrocytic anaemia, irregular and pale RBCs, increased reticulocytes
  • Hb electrophoresis - shows increased HbF and low HbA (diagnostic)
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42
Q

Thalassaemia: Treatment (2)

A
  • Blood transfusion
  • Long term folic acid supplements
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43
Q

Glucose-6-Phosphate Dehydrogenase Deficiency: Description

A
  • G6PD maintains glutathione in reduce state
  • Glutathione protects RBCs from oxidative crisis
44
Q

Glucose-6-Phosphate Dehydrogenase Deficiency: Epidemiology

A
  • X-linked recessive (males)
  • Protects from malaria
45
Q

Glucose-6-Phosphate Dehydrogenase Deficiency: Symptoms (6)

A
  • Asymptomatic until exposed to oxidative stressor
  • Neonatal jaundice
  • Chronic haemolytic anaemia
  • Acute haemolysis
  • Back pain
  • Dark urine
46
Q

DVT: Definition

A

Occlusion in normal vessels (usually in leg)

47
Q

DVT: Causes (6)

A
  • Surgery
  • Immobility
  • Leg fracture
  • Oral contraceptive pill
  • Flights
  • Pregnancy
48
Q

DVT: Risk Factors (3)

A
  • Age
  • Obesity
  • Varicose veins
49
Q

DVT: Symptoms (5)

A
  • Calf pain and swelling
  • Calf warmth
  • Calf redness
  • Ankle oedema
  • Pitting oedema
50
Q

DVT: Investigations (3)

A
  • D dimer - coagulation screen (not diagnostic)
  • FBC
  • Angiography
  • Doppler/Compression ultrasound - if popliteal vein can’t be squashed = diagnostic
51
Q

DVT: Differential Diagnosis

A

Cellulitis

52
Q

DVT: Treatment (3)

A
  • LMW heparin - inactivates factor Xa
  • Warfarin
  • Direct acting Oral Anti-Coagulants (DOACs) e.g. apixaban
53
Q

ALL: Epidemiology

A

Most common malignancy of childhood, good survival

54
Q

ALL: Pathology

A

Mutation → clonal proliferation of lymphoblasts → divide uncontrollably → other blood cells in BM are crowded out → cytopenia (anaemia, thrombocytopenia and leukopenia)

55
Q

ALL: Symptoms (7)

A
  • Weight loss
  • Appetite loss
  • Fatigue (anaemia)
  • Bleeding and bruising (thrombocytopenia)
  • Infection (leukopenia)
  • Painful lymph nodes
  • Bone pain (BM expansion)
56
Q

ALL: Investigations (3)

A
  • FBC - anaemia and throbocytopenia
  • Blood film - shows excess lymphoblasts
  • BM biopsy - increased cellularity, increased lymphoblasts
57
Q

ALL: Treatment (4)

A
  • Chemo
  • BM transplant
  • Treat anaemia/thromboytopenia
  • IV antibiotics if infections
58
Q

AML: Epidemiology

A

Usually in older people, better survival if younger

59
Q

AML: Pathology

A

Mutation → clonal proliferation of myeloblasts → divide uncontrollably → other blood cells in BM are crowded out → cytopenia (anaemia, thrombocytopenia and leukopenia)

60
Q

AML: Symptoms (7)

A
  • Weight loss
  • Appetite loss
  • Fatigue (anaemia)
  • Bleeding and bruising (thrombocytopenia)
  • Infection (leukopenia)
  • Gum swelling (IMPORTANT differentiates ALL)
  • Bone pain (BM expansion)
61
Q

AML: Investigations (3)

A
  • FBC - anaemia and throbocytopenia
  • Blood film - shows excess myeloblasts
  • BM biopsy - increased cellularity, increased myeloblasts
62
Q

AML: Treatment (4)

A
  • Chemo
  • BM transplant
  • Treat anaemia/thromboytopenia
  • IV antibiotics if infections
63
Q

CLL: Epidemiology

A
  • Most common form
  • Incurable
  • Affects more older people
  • More white people
64
Q

CLL: Pathology

A

Uncontrolled proliferation and accumulation of mature B lymphocytes that didn’t apoptose → crowd out other cells in BM → cytopenia (anaemia, thrombocytopenia, leukopenia)

65
Q

CLL: Symptoms (4)

A
  • Early stages asymptomatic
  • Fatigue (anaemia)
  • Bleeding and bruising (thrombocytopenia)
  • Infections (leukopenia)
66
Q

CLL: Investigations (3)

A
  • FBC - Lots of lymphocytes, Hypogammaglobulinemia (as no plasma cells), anaemia, thrombocytopenia
  • Blood film - small mature lymphocytes with smear or smudge cells
  • Immunophenotyping - excludes reactive lymphocytosis
67
Q

CLL: Treatment (5)

A
  • Wait in early stage
  • Chemo in advanced stage
  • Radiotherapy
  • Splenectomy
  • BM transplant
68
Q

CML: Epidemiology

A
  • Middle aged people
  • Exposure to ionising radiation
69
Q

CML: Symptoms (5)

A
  • Asymptomatic
  • Fever
  • Weight loss
  • Sweating
  • Anaemia
70
Q

CML: Investigations (3)

A
  • FBC - leucocytosis (increased WBC), anaemia, normal/high platelets, Hb low
  • BM biopsy - hypercellular marrow, increased myeloid progenitors (take from iliac crest)
  • Genetic testing - for Philadelphia chromosome. Chromosome 9 and 22 are translocated to form this abnormality, causing an over-activation of tyrosine kinase
71
Q

CML: Treatment (5)

A
  • Imatinib - if Philadelphia chromosome positive
  • Wait
  • Chemo
  • Stem cell transplant
  • BM transplant
72
Q

Hodgkin’s Lymphoma: Description

A

Malignant proliferation of lymphocytes which accumulate in lymph nodes causing lymphadenopathy (swelling)

Has Reed-Sternberg cells!

73
Q

Hodgkin’s Lymphoma: Epidemiology

A
  • Young adults
  • Increased risk with history of Epstein-Barr Virus
74
Q

Hodgkin’s Lymphoma: Symptoms (2)

A
  • Painless lymphadenopathy
  • B symptoms - night sweats, weight loss, loss of appetite, fever
75
Q

Hodgkin’s Lymphoma: Investigations (3)

A
  • CT/MRI of chest, abdomen and pelvis (staging)
  • Lymph node biopsy - reed-sternberg cells
  • FBC - may be normal or show normochromic, normocytic anaemia
76
Q

Hodgkin’s Lymphoma: Staging

A
  • Ann Arbor system
  • Stage 1 - lymph nodes in one region
  • Stage 2 - 2 or more lymph node regions on the same side of the diaphragm
  • Stage 3 - lymph node regions on both sides of the diaphragm
  • Stage 4 - widespread outside of lymph nodes
  • Prefixed with A (no B symptoms) or B (with B symptoms)
77
Q

Hodgkin’s Lymphoma: Treatment

A
  • ABVD - Adriagmycin, Bleomycin, Vinblastine, Dacarbazine
  • Stage 1-2a - short course ABVD then radiotherapy
  • Stage 2b-4 - longer course ABVD
78
Q

Non-Hodgkin’s Lymphoma: Pathology

A

Malignant clonal expansion of lymphocytes occurs at different stages of lymphocyte development. Majority B cell. No reed-sternberg cells

79
Q

Non-Hodgkin’s Lymphoma: Symptoms (3)

A
  • Painless lymphadenopathy
  • B symptoms (night sweats, weight loss, loss of appetite, fever)
  • Extranodal involvement symptoms (more common in Hodgkin’s)
80
Q

Non-Hodgkin’s Lymphoma: Investigations (3)

A
  • CT - staging
  • Lymph node biopsy
  • FBC - anaemia, raised ESR (erythrocyte sedimention rate), elevated WBC or thrombocytopenia suggests B involvement
81
Q

Non-Hodgkin’s Lymphoma: Classification

A

Low grade:

  • Slow growing
  • Usually advanced presentation
  • Incurable
  • 9-11 years survival

High grade:

  • More severe but 30% cure rate
82
Q

Non-Hodgkin’s Lymphoma: Treatment (3)

A
  • R-CHOP - Rituximab, Cyclophosphamide, Hydroxy-daunorubicin, O-Vincristine, Prednisolone
  • Low grade - watch and wait, combination chemo, radiotherapy, BM transplant
  • High grade - early (sort course R-CHOP with radiotherapy), advanced (R-CHOP and monoclonal antobodies)
83
Q

Myeloma: Description

A

Cancer of plasma cells which usually produce antibodies

84
Q

Myeloma: Epidemiology

A
  • More men than women
  • Mostly present around 60
  • More common in Afro-Caribbeans
85
Q

Myeloma: Pathology

A

Clonal proliferation of plasma cells → produce excess of one immunoglobulin (usually IgG or IgA)

86
Q

Myeloma: Symptoms (4)

A

CRAB

  • Calcium raised, cancer symptoms, confusion
  • Renal failure
  • Anaemia (infections and bleeding)
  • Bone pain (increased osteoclast activity)
87
Q

Myeloma: Investigations (4)

A
  • Serum and urine electrophoresis - B2 microglobulin
  • Blood film - Rouleaux formation (aggregates of RBCs)
  • Urine - Bence Jones protein
  • X-ray - pepperpot skull
88
Q

Myeloma: Treatment (4)

A
  • Chemo
  • BM transplant
  • Bisphosphonates
  • Treat anaemia (RBC and erythropoietin transfusions)
89
Q

Malaria: Causes

A

Protozoa infection transmitted by female mosquitos

90
Q

Malaria: Stages

A
  • Exo-erythrocytic stage
  • Endo-erythrocytic stage
  • Hypnozoite stage
91
Q

Malaria: Pathology

A
  • Infection travels to liver → multiply in hepatocytes → rupture releasing merozoites into blood → taken up into erythrocytes → develop further → rupture causing anaemia and fever
  • Infected RBCs adhere to endothelium of small vessels → vascular occlusion → organ damage
92
Q

Malaria: Symptoms (6)

A
  • Fever
  • Chills and sweats
  • Jaundice
  • Anaemia
  • Fatigue
  • Black urine
93
Q

Malaria: Investigations (4)

A
  • Thick blood film - detects parasite
  • Thin blood film - identifies what parasite
  • Rapid Diagnostic Test - detects plasmodium antigens in blood
  • Fever + exotic travel = malaria until proven otherwise
94
Q

Malaria: Treatment (2)

A
  • Quinine (antimalarial)
  • Doxycycline (antibiotic)
95
Q

Polycythaemia: Pathology

A
  • Absolute - increased RBC mass
  • Secondary - hypoxia and high erythropoietin secretion
96
Q

Polycythaemia: Symptoms (6)

A
  • Headache
  • Itching
  • Fatigue
  • Tinnitus
  • Hypertension
  • Angina
97
Q

Polycythaemia: Investigations (3)

A
  • FBC - raised WBC count, platelets, haemoglobin
  • Genetic screening - JAK2 mutation (in 95%)
  • BM biopsy - proliferation of granulocytes and megakaryocytes
98
Q

Polycythaemia: Treatment (3)

A
  • No cure
  • Venesection (reduce RBCs)
  • Low dose aspirin
99
Q

Haemophilia: Types

A
  • A - factor 8 deficiency
  • B - factor 9 deficiency
100
Q

Haemophilia: Epidemiology

A
  • X-linked recessive disorder - men
  • A is more common
101
Q

Haemophilia: Symptoms (6)

A
  • Easy bruising
  • Haematomas
  • Excess bleeding
  • Plasma levels of factor 8/9 <1 - severe, bleeding into muscles and joints
  • Levels 1-5 - severe bleeding after injury
  • Levels >5 - mild, bleeding only with trauma or surgery
102
Q

Haemophilia: Investigation

A

Prolonged Activated Partial Thromboplastin Time (APTT) - factor 8/9 in intrinsic pathway. Shows longer time

103
Q

Haemophilia: Treatment (2)

A
  • IV recombinant factor 8/9
  • Synthetic vasopressin
104
Q

Over-anticoagulation: RFs, Symptoms, Investigations

A
  • Risk Factors - Vitamin K antagonists, DOACs
  • Symptoms - Bruising, bleeding, haematemesis (vomiting blood), haemoptysis (coughing blood)
  • Investigations - APTT and PTT
105
Q

Disseminated Intravascular Crisis: Description, causes, symptoms

A
  • Wide spread clotting and bleeding
  • Occurs when balance between forming new clots and breaking down clots goes to making clots → depleted clotting factors → bleeding
  • Causes - malignancy, septicaemia, trauma, infections
  • Symptoms - bleeding from IV sites, nose and mouth, bruising , haemoptysis
106
Q

Disseminated Intravascular Crisis: Investigations, treatment

A
  • Investigations - PTT and APTT, blood film shows fragmented RBCs
  • Treatment - treat underlying cause, transfusions, activated C protein
107
Q

Thrombocytopenia: Description

A
  • Platelet deficiency
  • Either Immune thrombocytopenic purpura (ITP) or Thrombotic thrombocytopenic purpura (TTP) - ITP more common

Phase 2a (15 decks)

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