Haematology final one plz Flashcards
Contrast HUS and TTP:
HUS:
- bloody diarrhoea
- Microangiopathic haemolytic anaemia
- thrombocytopenia
- kidney failure
TTP:
- no diarrhoea
- Microangiopathic haemolytic anaemia
- Thrombocytopenia
- Kidney failure
- CNS involvement
- Fever
How does an amniotic embolism cause DIC?
Releases tissue factor which triggers the extrinsic pathway
Tissue factor is the triggering factor
What are some of the causes of DIC?
Sepsis
Obstetric complications
- especially amniotic embolisms
Acute pancreatitis
Haematological malignancy
- AML -M3
What is found in cryoprecipitate?
Von- Williebrand
Factor VIII
Fibrinogen
Useful for:
- Haemophilia A
- DIC
How is DIC management:
- *treat the underlying cause
- *contact haematology
- FFP
- platelets
- Cryoprecipitate (fibrinogen, von-Williebrand, VIII)
+/- - Heparin if coagulating
Which drug can cause haemolytic anaemia which is associated with coeliac disease?
Dapsone
- used for dermatitis herpatoformis
What is the diagnostic criteria for tumour lysis syndrome and how is it managed?
Clinical:
- AKI
- Cardiac arrhythmias
- Confusion/ weakness - hypocalcaemia
- Muscle cramps
Bloods;
- Hypocalcaemia
- Hyperuricemia
- Hyperphosphatemia
- Hyperkalaemia
Treatment: - IV fluids - Frusemide - Calcium gluconate (both replenish Ca2+ and protects for K+) - Phosphate binders - Rasburicase (anti- uricaemic) \+/- - Haemodialysis
In heparin induced thrombocytopenia - what would you expect the bleeding to be like?
There is a paradoxical increased risk of thrombosis
If requesting blood for a pregnant female - what do you ask for?
CMV - negative RBCs
*this is also required if neonate transfusion
What is the test to diagnose hereditary spherocytosis?
EMA binding test
Autosomal dominant
How is tranexamic acid delivered during an emergency?
IV bolus
followed by
IV infusion
Outline the major causes of Polycythaemia:
Polycythaemia Ruba Vera
- haematological malignancy
Relative polycythaemia
Secondary to COPD, high altitude
EPO producing tumour
- renal cell carcinoma
What are some of the signs of polycythaemia Ruba vera and list some complications:
Facial plethora
Itching
Headaches
Itchiness
Complications:
- Budd Chiari
- Stroke
- Cavernous sinus thrombosis
- Malignant transformation into AML
How would you manage a patient bleeding who has haemophilia A and those with haemophilia B?
Haemophilia A:
- Desmopressin
- Recombinant Factor VIII (can cause antibodies to them)
- Cryoprecipitate (contains VIII)
Haemophilia B:
- Recombinant IX
- FFP
- Prothrombin Complex Concentrate
In the setting of acute haemolytic reaction what two major bloods do you want? what else should should be done?
Two Major bloods:
Cross match
- repeat
Direct Coombs test
Other bloods:
- coagulation
- U&Es
Keep unit of blood and sent to haematology
Check all details
IV fluids and flush
If someone has Raised MCV anaemia with hypothyroidism - what may be causing the raised MCV?
Pernicious anaemia
What is the kidney disorder that can occur in sickle cell disease leading to AKI?
Renal Papillary necrosis
- due to ischemia
Avascular necrosis can also occur in the bone
Who get Hodgkin’s lymphoma? and What are the diagnostic investigations and what is the treatment?
Young people
Elderly
- bimodal disruption
Investigations: Bloods: - FBC - Blood film - LDH *prognosticator - HIV serology
CXR
ST for staging (Ann Arborr)
Lymph node biopsy *Reid Steinberg cells seen
Bone marrow aspiration with trephine
Treatment:
- radiotherapy
- Chemotherapy (ABVD)
- Autologous Stem cell transplant
What is the most common type of Hodgkin’s lymphoma? and what are some risk factors?
Nodular Sclerosing
Risk factors:
- EBV
- HIV
- Sarcoidosis
- Family history
What is the common translocation in CML? and what other leukaemia can this be present in and what does it suggest?
Philadelphia chromosome
- 9:22
It can also be associated with ALL which is a poor prognostic factor
What are the stages of CML?
Chronic phase
Accelerated phase
Blast phase
What would you expect to see on the blood film of CLL?
Smudge cells
What are the three phases of chemotherapy?
Remission induction
Remission consolidation
Remission Maintenance
How are leukaemia’s classified?
Morphology
Immunological
Cytogenetics
What are the poor prognostic factors for ALL?
Age <2 years, >10 years 9:22 translocation High B and T cell count Male sex >20 WCC
Name the notable causes for a massive splenomegaly:
Malaria
Myelofibrosis
CML
What is the immunological agent that can cure CML and how does it work?
Imatinib
BCR- ABL Tyrosine kinase inhibitor
What cells may you see on a blood film of someone with iron deficiency anaemia?
Anisocytosis - changes in cell sizes and shapes
Piokilocytosis
- irregular shaped
What are the clinical features of iron deficiency anaemia?
Symptoms:
- dizziness
- Palpitation
- Dyspnoea
- Reduced energy
- Headaches
- restless leg
Signs:
- Angulitis stomatitis
- atrophic glossitis
- Koilonychia
- Pale
- Oesophageal webs
What are the iron supplements that can be given?
When giving IV Iron supplementation what is an important aspect to be aware of?
Ferrous Fumarate
Ferrous gluconate
IV Iron will not cause a haematological response any quicker than PO, but does replenish iron stores slightly quicker.
If there is folate deficiency - what must you check before treating?
Must check B12 levels
- can worsen sub-acute combined spinal cord degeneration if not
What type of haemolysis is Hereditary spherocytosis and how is it managed long term?
Autosomal dominant.
Extravascular.
Diagnosed:
- EMA binding
Management:
- folate replacement
- Splenectomy
**can be a cause of haemolytic jaundice and splenomegaly
What are the general causes of aplastic anaemia?
Primary:
- idiopathic/ genetic related
Secondary:
- Virus induced - parvovirus B19
Iatrogenic: (including radiation)
Management:
- Blood transfusions
- Neutropenic sepsis management
<40 years:
- allogenic stem cell transplant
> 40 years:
- Anti-thymocyte drugs
What is the intervention done which removes plasma from the blood?
Plasmapheresis
*look at spelling!!
What tests should you order in multiple myeloma to establish an increase in paraprotein, and what test to distinguish exactly what it is?
Electrophoresis of the plasma:
- establishes high M protein
- is quantitative
Immunofixation of plasma:
- establish the type (IgG, IgM, Kappa, lamda)
- is Qualitative
What do bands on a blood film suggest?
The suggest granulocytes at different stages of maturation.
Very suggestive of CML as multiple neutrophils etc will be at different stages.
What is a D-Dimer?
Fibrin Degradation products
High light all the clinical signs/ symptoms you may see with someone who has myeloma:
Amaurosis Fagux
- high ESR
Bruising/ easy bleeding
Pathological fractures
Confusion
Constipation
Carpal tunnel
- secondary amyloidosis
Nephritis
- Amyloidosis
- tubular acidosis
- Direct toxicity of paraproteins
- NSAID use
Infections
What test is needed for the confirmation of myeloma?
Bone marrow aspiration
>10% blast cells
What is needed for a diagnosis of myeloma?
Blast cells >10% in bone marrow
Evidence of paraproteins
- in urine
or
- Blood
Evidence of CRAB
What is the treatment for myeloma?
Cancer:
- chemotherapy
- autologous stem cell transplant
Anaemia:
- Blood transfusions
- EPO
Infections:
- Prophylactic antibiotics
- Immunoglobulin transfusions
Bones:
- Bisphosphonates
- Analgesia
- Radiotherapy
- Vertebroplasty/ Kyphoplasty
Anti-thrombotic prevention
- risk of DVTs is high
Prognosis:
- smouldering disease
- 5 years - 50%
How should warfarin overdose be managed?
INR 5-8: with hold and start again when <5
INR >8: Withhold. IV vitamin K. Contact haematology
Any major bleed/ Intracranial bleed: Stop warfarin, IV vitamin K, Prothrombin complex concentrate
*prothrombin complex concentrate contains factors:
- II, V, IX, X
all which warfarin inhibits
What are you differentials for myeloma?
Monoclonal gammopathy of undetermined significance
Waldenstrom’s macroglobinaemia
Amyloidosis
Hodgkin’s
What clinical test can be done to help establish a DVT?
Dorsiflexion of the affected limp will often produce significant pain
Where does a P.E typically originate from?
Iliofemoral
