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HaemPath > Haematology of systemic disease > Flashcards

Haematology of systemic disease Flashcards

1
Q
  1. List some ways in which lymphoma can cause jaundice.
A

Direct liver involvement
Compression of the bile duct
Causing autoimmune haemolytic anaemia

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2
Q
  1. Which types of anaemia can be caused by cancer?
A

Iron deficiency
Anaemia of chronic disease
Haemolytic anaemia
Leucoerythroblastic anaemia

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3
Q
  1. Which types of cancer are associated with causing secondary polycythaemia?
A

Renal cell carcinoma
Liver cancer
Due to the production of EPO

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4
Q
  1. What is the most common cause of iron deficiency anaemia?
A

Occult blood loss (e.g. GI cancers, urinary tract cancers)

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5
Q
  1. What are the typical laboratory findings of iron deficiency anaemia?
A

Low ferritin
Low transferrin saturation
High TIBC

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6
Q
  1. What is leucoerythroblastic anaemia?
A

Anaemia characterised by the presence of red and white cell precursors

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7
Q
  1. What are the morphological features of leucoerythroblastic anaemia seen on blood film?
A

Tear drop red blood cells (aniso- and poikilocytosis)
Nucleated RBCs
Immature myeloid cells

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8
Q
  1. What does leucoerythroblastic anaemia tend to be caused by?
A

Bone marrow infiltration (leukaemia, lymphoma, myeloma, solid tumours, myelofibrosis, military TB, severe fungal infection)

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9
Q
  1. Define haemolytic anaemia.
A

Anaemia caused by reduced red blood cell survival

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10
Q
  1. List some key laboratory findings in haemolytic anaemia.
A 
Anaemia
Raised reticulocytes 
Raised unconjugated bilirubin
Raised LDH 
Low haptoglobins
NOTE: LDH is an intracellular enzyme that is released when RBCs are destroyed
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11
Q
  1. What are the two main groups of haemolytic anaemia? List some examples.
A

Inherited (defects with the cell)
• Hereditary spherocytosis (membrane problem)
• G6PD deficiency (enzyme problem)
• Sickle cell disease, thalassemia (haemoglobin problem)
Acquired (defects with the environment)
• Immune-mediated
• Non-immune mediated

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12
Q
  1. Which test distinguishes immune-mediated and non-immune mediated haemolytic anaemia?
A

DAT or Coombs’ test

DAT +ve means that the haemolytic anaemia is mediated through immune destruction of red cells

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13
Q
  1. What morphological change is seen on the blood film of patients with autoimmune haemolytic anaemia?
A

Spherocytes

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14
Q
  1. List some systemic diseases that can cause autoimmune haemolytic anaemia.
A

Cancer involving the immune system (e.g. lymphoma)
Disease of the immune system (e.g. SLE)
Infections (disturbs the immune system)

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15
Q
  1. List some causes of non-immune haemolytic anaemia.
A

Infection (e.g. malaria)

Microangiopathic haemolytic anaemia (MAHA)

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16
Q
  1. List some key features of MAHA.
A

Usually caused by underlying adenocarcinoma
Red cell fragments
Low platelets
DIC/bleeding

17
Q
  1. Outline the mechanism of MAHA.
A

An underlying adenocarcinoma produces procoagulant cytokines that activate the coagulation cascade
This leads to DIC and the formation of fibrin strands in various parts of the microvasculature
Red cells will be pushed through these fibrin strands and fragment
NOTE: always consider underlying adenocarcinoma in any patient presenting with MAHA

18
Q
  1. List some causes of secondary polycythaemia.
A

Cancer (renal, hepatocellular, bronchial)
High altitude
Hypoxic lung disease
Congenital cyanotic heart disease

19
Q
  1. What is the main difference seen in the blood film of patients with acute and chronic leukaemia?
A

Chronic – mature white cells are raised

Acute – immature blast cells are raised

20
Q
  1. List some causes of neutrophilia.
A 
Corticosteroids (due to demargination)
Underlying neoplasia
Tissue inflammation (e.g. colitis, pancreatitis)
Myeloproliferative/leukaemia disorder 
Infection
21
Q
  1. List some infections that characteristically do not cause neutrophilia.
A

Brucella
Typhoid
Many viral diseases

22
Q
  1. List some key features of a reactive neutrophilia on a blood film.
A

Band cells (presence of immature neutrophils (band cells) show that the bone marrow has been signalled to release more WBCs)
Toxic granulation
Clinical signs of infection/inflammation

23
Q
  1. What are some key blood film and clinical features suggestive of a myeloproliferative disorder?
A 
Neutrophilia
Basophilia 
Immature myelocytes
Splenomegaly
NOTE: you may see raised Hb and raised platelets in CML if it affects those lineages
24
Q
  1. What are some key blood film features suggestive of AML?
A

Neutrophilia

Myeloblasts

25
Q
  1. List some causes of monocytosis.
A

Bacteria: TB, Brucella, typhoid
Viral: CMV, VZV
Sarcoidosis
Chronic myelomonocytic leukaemia

26
Q
  1. List some causes of reactive eosinophilia.
A

Parasitic infection
Allergy (e.g. asthma, rheumatoid arthritis)
Underlying neoplasms (e.g. Hodgkin’s lymphoma, T cell lymphoma, NHL)
Drug reaction (e.g. erythema multiforme) DRESS

27
Q

FIP1L1-PDGFRa fusion gene

A
  1. Which gene mutation causes chronic eosinophilic leukaemia?
28
Q
  1. Which type of virus typically causes basophilia?
A

Pox viruses

29
Q
  1. What investigations are typically used when investigating lymphocytosis?
A 
Clinical examination
FBC 
Light microscopy
Flow cytometry (identify lineage and stage of differentiation)
Molecular genetics (TCR or Ig gene)
30
Q
  1. List some causes of reactive lymphocytosis.
A 
Infection (EBV, CMV, toxoplasmosis, rubella, HSV)
Autoimmune diseases (NOTE: these are more likely to cause lymphopaenia)
Sarcoidosis
31
Q
  1. How would the lymphocytes seen on a blood film due to a viral infection be different from leukaemia/lymphoma?
A

Viral infection: reactive or atypical lymphocytes (EBV)

CLL or NHL: small lymphocytes and smear cells

32
Q
  1. Outline how flow cytometry is used to identify cell types.
A

Fluorescently labelled monoclonal antibodies targeted at different antigens are washed over the cells
Cells are passed through the flow cytometer and the fluorescence is recorded
Dependent on the antigens present on the cells, you can identify the stage of maturation

33
Q
  1. What is light chain restriction?
A

An individual B cell will either express kappa or lambda light chains (not both)
In response to an infection, you will get a polyclonal B cell response so there will be a roughly even mixture of kappa and lambda light chains
In lymphoproliferative disorders, monoclonal proliferation of a B cell expressing only one type of light chain (e.g. kappa) will mean that the proportion of kappa relative to lambda will increase (e.g. showing an overwhelming majority of kappa)

HaemPath (8 decks)

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