Haematology + oncology Flashcards
causes of microcytic anaemia
Iron deficiency (hypochromic microcytic)
Thalassaemia
Anaemia of chronic disease (rarely)
causes of normocytic anaemic
Acute bleeding Haemolysis - congenital - acquired Aplastic anaemia Anaemia of chronic disease
causes of macrocytic anaemia
Vitamin B12 deficiency, folate deficiency = both may cause pancytopenia
Macrocytosis without anaemia:
- liver disease
- hypothyroidism
- alcohol
acute leukaemia is due to…
failed differentiation of cells, leads to large numbers of malignant precursor cells in the bone marrow
chronic leukaemia is due to…
chronic leukaemia is the result of excessive proliferation of mature malignant cells
acute lymphoblastic leukaemia features
abnormal clinical proliferation of lymphoid progenitor cells
- typically affects children
- bone marrow failure: anaemia, leukopenia, thrombocytopenia
- organ infiltration: lymphadenopathy, hepatosplenomegaly, bone pain, CNS involvement (eg. nerve palsy), testicular swelling
- high blast cells
differentiating ALL from AML
blood film shows different precursor cells
AML cells have Auer rods on microscopy
features of acute myeloid leukaemia
abnormal clinical proliferation of myeloid progenitor cells
- typically affects adults + elderly
- associated with myelodysplastic syndromes
- bone marrow failure: anaemia, leukopenia, thrombocytopenia
- organ infiltration: hepatosplenomegaly, bone pain, gum hypertrophy
- high blast cells
features of myelodysplastic syndrome
“Premalignant” condition of haematopoietic precursors
- affects elderly
- may present with anaemia, thrombocytopenia, pancytopenia, may be asymptomatic
- may become acute myeloid leukaemia
features of chronic myeloid leukaemia
- typically affects middle-aged patients (men more commonly)
- usually associated with Philadelphia chromosome
- symptomatic anaemia eg. SOB, fatigue
- weight loss
- massive splenomegaly
- bleeding/bruising
investigations for chronic myeloid leukaemia
- leukocytosis (high neutrophils/basophils/eosinophils/monocytes)
- Philadelphia chromosome (t9:22)
management of chronic myeloid leukaemia
- presence of Philadelphia chromosome = imitanib
- chemotherapy
features of chronic lymphocytic leukaemia
proliferation of functionally incompetent malignant B cells
- most common in male patients over the age of 60
- often asymptomatic
- may have symptoms of
> bone marrow failure eg. anaemia, infection prone, bleeding
> cancer: weight loss, night sweats
> infiltration: hepatosplenomegaly, lymophadenopathy
investigations for chronic lymphocytic leukaemia
FBC: lymphocytosis, anaemia
blood film: smudge cells
immunophenotyping
features of Hodgkin’s lymphoma
- typically young adults
- painless lymphadenopathy
- B symptoms: night sweats, weight loss, fever
- may be pain on drinking alcohol
- peaks at 15-35yrs and >55
- Reed-Sternberg cell diagnostic on biopsy of lymph node
RFs for Hodgkin’s lymphoma
- Epstein-Barr Virus
- HIV
- immunosuppression
- smoking
types of Non-Hodgkin’s lymphoma
- indolent or low grade eg. follicular lymphoma
> gradual onset, usually advanced at presentation
> may be asymptomatic
> incurable but treatable (use for watchful waiting), median survival 10 years - aggressive or high grade eg diffuse large B cell lymphoma
> rapidly progressive
> usually symptomatic: painless lymphadenopathy, B symptoms, extranodal (gastric, bone marrow, CNS symptoms)
> potentially curable
management of lymphoma
manage symptoms
- chemotherapy
- radiotherapy
- stem cell transplantation
associations with non-Hodgkin’s lymphoma
- Helicobacter pylori with gastric MALT (mucosa-associated lymphoma tissue)
- Epstein Barr virus with Burkitt’s lymphoma and AIDS-related CNS lymphoma
- Hepatitis C virus with diffuse large B-cell lymphoma and splenic marginal zone lymphoma
- Human T cell lymphotropic virus type 1 with T-cell lymphoma
poor prognostic markers of lymphoma
low haemoglobin and raised LDH (high red cell turnover)
blood markers of tumour lysis syndrome
- U&E:
> high: potassium, phosphate, uric acid, creatinine
> low: calcium - ECG may have arrhythmias related to hyperkalaemia
prophylaxis of tumour lysis syndrome
- IV allopurinol
- OR IV rasburicase
- if TLS develops:
> fluids
> electrolyte balance
> supportive
features of multiple myeloma
CRABBI Calcium (hypercalcaemia) Renal failure (high creatinine and urea) Anaemia Bone lesions (lytic) Bleeding Infections
markers of multiple myeloma
- Bence Jones proteins (in urine)
- monoclonal IgA/G in serum
- raised monoclonal plasma cells on bone marrow biopsy
- blood film = rouleaux formation
- whole body MRI done to check for bone lesions (pepperpot skull)
management of multiple myeloma
- stem cell transplant in young/few comorbidities
- chemotherapy
- supportive
> analgesia, bisophosphonates, surgery/physiotherapy for bone disease, EPO for anaemia
diagnosis of amyloid
rectal tissue biopsy and apple-green birefringence when stained with Congo red and viewed under polarised light
normal haemostasis
- localized vasoconstriction at the site of injury
- adhesion of platelets to damaged vessel wall and
formation of a platelet aggregate or plug - activation of the coagulation cascade leading to fibrin formation, reinforcing the platelet plug
- activation of the fibrinolytic system which digests the
haemostatic plug, re-establishing vascular patency
management of thrombosis
Arterial thrombosis – Antiplatelet drugs
Venous thrombosis – Anticoagulant drugs
causes of DIC
- sepsis
- obstetric
- malignancy
- trauma
management of DIC
treat underlying cause
- plasma and platelets if bleeding
warfarin acts on:
Vit K antagonist
- factors X IX VII II remember as 1972
symptoms of ITP (immune thrombocytopenia)
- petichae, purpura
- bleeding (e.g. epistaxis)
management of ITP (immune thrombocytopenia)
- oral prednisolone
- IVIG
- splenectomy in refractive
features of TTP (thrombotic thrombocytopenic purpura)
deficiency of ADAMTS13 leads to vWF causing clumping of platelets
- fever
- fluctuating neuro signs (microemboli)
- microangiopathic haemolytic anaemia
- thrombocytopenia
- renal failure
mutation in polycythaemia rubra vera
JAK2
constituents of haemoglobin
HbA = 2α + 2β HbA2 = 2α + 2𝛿 HbF = 2α + 2γ
management of sickle cell crisis
- high flow oxygen
- IV fluids
- analgesia
- top-up transfusions may be required in severe cases
long term sickle cell anaemia management
- hydroxycarbamide: increases the HbF levels and is used in the prophylactic management of sickle cell anaemia to prevent painful episodes
- pneumococcal vaccine every 5 years
iron deficiency further investigations
if unexplained (eg. men and post-menopausal women), endoscopy and colonoscopy required (gastro referral within 2 weeks if Hb <100 in women or <110 in men
management of iron deficiency anaemia with no findings on further investigations
- PO ferrous sulfate (until normal Hb then for 3 months beyond)
- iron-rich diet
management of von Willebrand’s disease
- desmopressin (DESMOnd von Willebrand): raises levels of vWF
- factor VIII concentrate
- tranexamic acid for mild bleed
aplastic anaemia features
typically in young people ~30yrs
- pancytopenia and a hypoplastic bone marrow
- normochromic, normocytic anaemia
- leukopenia, with lymphocytes relatively spared
- thrombocytopenia
features of pernicious anaemia
antibodies to intrinsic factor +/- gastric parietal cells leads to B12 deficiency
- anaemia: lethargy, pallor, dyspnoea
- neurological: peripheral neuropathy, numbness, degeneration of the spinal cord (progressive weakness, ataxia and paresthesias that may progress to spasticity and paraplegia)
- neuropsychiatric features: memory loss, poor concentration, confusion, depression
- other features: mild jaundice: combined with pallor results in a ‘lemon tinge’, glossitis
management of pernicious anaemia
IM B12 supplementation
