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Year 6 > Haemotology > Flashcards

Haemotology Flashcards

1
Q

Causes of macrocytic anaemia

A

B12
Folate- methotrexate, phenytoin, ?nitro
Alcoholism
MM
Hypothyroid

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2
Q

Haemolytic anaemic serology features

A

Increased bilirubin
Increase urinary urobillinogen
Increased LDH
Reticulocytosis
Low haptoglobin

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3
Q

Types of haemolytic anaemia

A

Acquired
Immune- warm/cold- DAT positive
Mechanism- MAHA- DIC, HUS, TTP
Heart valve
Malaria

Hereditary
G6PD, Pyruvate
Hereditary spherocytosis
SCD, thalassaemia

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4
Q

Types of immune mediated haemolytic anaemia and features

A

DAT +
Warm- IgG- extravascular haemolysis- lymphoma, SLE

Cold- IgM, intravascular

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5
Q

Features of HUS

A

E coli- O157
Diarrhoea
MAHA
Thrombocytopenia
Renal failure

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6
Q

Features of TTP

A

Attacking ADAMTS 13- which usually breakdown vWF- causes plt aggregations
 Adult females
Pentad
 Fever
 CNS signs: confusion, seizures
 MAHA
 Thrombocytopenia
 Renal failure

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7
Q

Triggers for G6PD

A

Broad beans
Infections
Antimalarials
Sulphonamides, cipro, nitrofuratoin
Sulphylureas

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8
Q

Inheritance of G6PD, SCD,

A

G6PD- X linked- MALES

SCD- recessive

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9
Q

Pernicious anaemia features

A

AB against IF or parietal cells
Atrophic gastritis
B12 deficiency
Peripheral neuropathy
Anaemia
Lemon tinged skin

Associated with AI diseases

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10
Q

Causes of B12 deficiency

A

Vegan - low intake
Pernicious anaemia- low IF
Crohns - affects terminal ileum
Bacterial overgrowth

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11
Q

Presentation of sickle cell

A

Splenomegaly
Infarction
Crises
Kidney
Liver/Lung
Erection
Dactylics

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12
Q

Complication and Tx of SCD

A

Sequestarion crisis- shock and severe anemia- splenectomy

Acute chest crisis- pain, O2, Abs
Aplastic crisis

Painful crisis- analgesia, hydration, O2

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13
Q

Causes of DIC

A

Sepsis, malignancy, trauma

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14
Q

Tumour lysis syndrome Dx

A

Recent chemo
Increased K, P, low Ca
Raised creatinine

Seizure, arrhythmia

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15
Q

Indication of RBC transfusion

A

ACS- maintain >80
No ACS- >70

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16
Q

Indication of plt transfusion

A

Pre-procedure- >50 , 100 if eye
No bleeding- <10
Bleeding <30

CI if BM failure, TTP, Heparin induced T

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17
Q

Heparin induced thrombocytopenia features

A

AB induce plt activation

Low plt but prothrombotic

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18
Q

Who gets what in FFP transfusion

A

If A- A, AB
If B- B, AB
If AB- only AB
If O- All

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19
Q

Immediate Transfusion reactions

A

Haemolytic- ABO incompatible, fever, agitation,DIC shock- renal failure - stop

Bacterial- temp, shock- more common in platelet

Febrile non haemolytic- just high fever- slow and paracetamol

Allergic- urticaria, anaphylaxis

TACO- high HR, BP, low SpO2- fluid overload

TRALI- anti WBC abs- ARDS- cough, SOB, bilateral infiltrates- stop

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20
Q

Causes of thrombophilia

A

Increased clotting

Factor V leiden- increased likelihood to clot
Prothrombin mutation- increased chance
Protein C and S deficiency- C and S used to prevent clotting
Antithrombin III deficiency

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21
Q

Cause of increased bleeding

A

Thrombocytopaenia- TTP, DIC, HUS
VWD
Haemophilia A and B

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22
Q

Features of VWD

A

Increased bleeding
Mildly elevated APTT- due to reduced factor 8

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23
Q

Cause of Howell Jolly bodies

A

Hyposplensim - SCD, coeliac

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24
Q

Cause of hypersegmented neutrophils

A

B12/folate deficiency

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25
Q

Treatment of folate and B12 deficiency together

A

I 1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months, then oral folate when b12 normal

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26
Q

Prophylaxis of TLS

A

Allopurinol

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27
Q

Difference between aplastic and sequestration in SCD in bloods

A

Both anaemic
Low reticulocytes in aplastic
High in sequestration

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28
Q

Ann Arbor staging

A

I: single lymph node
II: 2 or more lymph nodes/regions on same side of the diaphragm
III: nodes on both sides of the diaphragm
IV: spread beyond lymph nodes

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29
Q

Causes of polycythaemia

A

Secondary- hypoxia- COPD, high altitiude
Primary- PRV, EPO producing tumour

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30
Q

Signs of ALL

A

Anaemic, petechiae, infections

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31
Q

High metHb meaning and Tx

A

Dysfunctional Hb- +3 state caused by nitrate
Treat with methylene blue if acquired

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32
Q

Imaging for suspected MM

A

Whole body MRI

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33
Q

Polycythaemia Tx

A

Venesection
Aspirin

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34
Q

ALL vs AML vs CLL vs CML

A

Acute- blasts
chronic- bands- different stages of maturation
Low lymph- myeloid
WBC >100- Chronic

AML- Auer rods

ALL- anaemia, neutropenia, lymphadenopathy

CLL- lymph,

CML- Phil +ve , all stages seen, splenomegaly

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35
Q

CML treatment

A

Imatinib

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36
Q

Poor prognosis of lymphoma

A

B symptoms

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37
Q

Factor V leiden pathology

A

Resistance to protein C

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38
Q

Blood clot results for haemophilia

A

APTT- incresase
PT- normal
Bleeding time- normal

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39
Q

Blood clot results for von Willebran disease

A

APTT- increase- F8
PT- normal
BT- increased

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40
Q

Vit K deficiency blood clot results

A

APTT- increased
PT- increased
BT- normal

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41
Q

APTT in antiphospholipid sx

A

Increased

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42
Q

Myelofibrosis features

A

Massive splenomegaly
Anaemia
High plt and WBC early- but can be pancytopenia
Tear drop- poikilocytosis

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43
Q

Myeloma Ca, P and ALP levels

A

Ca high
P high
Normal ALP

Infections

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44
Q

Mx of ITP

A

Oral prednisolone

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45
Q

Complication of hereditary spherocytosis

A

Aplastic crisis
Parvovirus

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46
Q

Aplastic crisis sx

A

Jaundice, fatigue, splenomegaly
Erythema infectiosum

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47
Q

Ix for G6PD deficiency

A

Enzyme assay at time and 3 months

48
Q

Glucocorticoids effect on neutrophils

A

Neutrophillia

49
Q

What is the use of irradiated blood

A

Depletes T cells
So useful for graft vs host disease

50
Q

CLL patient becomes suddenly unwell

A

Ritcher transformation into Non Hodgkin lymphoma

51
Q

Graft vs host disease sx

A

Painful Maculopapular rash
Jaundice
Diarrhoea
N+V

52
Q

Medical tx of TACO

A

Furosemide

53
Q

SE of chemotherapy

A

Asparagine- neuro
Cisplatin- ototoxic/nephro
Vincrinstine- nerve, blastine- bones
Doxorubicin- heart
Cyclophosphamide- bladder
Methotrexate- nephrotic

54
Q

Tx of ABO incompatibility

A

Stop and give fluids

55
Q

Most common Hodgkin lymphoma

A

Nodular sclerosino

56
Q

Best and worst prognosis of Hodgkin lymphoma

A

Lymph depleted - worst
Lymph predominant - best

57
Q

Plt level before surgery or invasive procedure

A

> 50
50-75 if high risk of bleeding
100 if critical site q

58
Q

Mx of DAT+ haemolytic anaemia

A

Steroids and rituximab

59
Q

Rituximab moa

A

CD20- B cells

60
Q

When to give irradiated blood

A

Immunodeficiency
Allogenic- 6 months
Auto- 3 months

61
Q

Guidelines for neutropenic sepsis

A

Known cause for neutropenia- recent cancer tx
Temp >38
RR >20

Do not delay ABx

62
Q

Order of tests in IDA

A

FBC
Then if low Hb and MCV check ferritin
But if infected- check iron status

If ferritin <15- colonoscopy and gastroscopy

63
Q

Dx of ABO incompatibility

A

Direct Coombs test

64
Q

Pigmented gallstones associated with

A

Sickle cell anaemia

65
Q

IDA vs ACD

A

TIBC is high in IDA and low/normal in ACD
Ferritin high in ACD

66
Q

Tx of hyper viscosity due to waldenstroms

A

Plasmaphoresis

67
Q

Dx of polycythaemia ruba

68
Q

Sx of thalassaemia

A

Mediterranean
Hepatosplenomegaly
Failure to thrive
Maxillary overgrowth

69
Q

Dx of thalassaemia

A

Electrophoresis

70
Q

Myelodysplasia features

A

Low myeloid cells
Progress to AML
Ring sideroblasts

71
Q

Features of lead poisoning

A

Sideroblastic anaemia
High iron and ferritin
Normal TIBC

72
Q

Common haemolytic anaemia in northern europue and fx

A

Hereditary spherocytosis
Splenomegaly
Jaundice

73
Q

Dx of HS

A

EMA binding- if HS will show less binding of EMA

74
Q

Features and diagnosis of Paroxysmal nocturnal haemaglobinuria

A

Dark urine in mornings
jaundice
Flow cytometry

75
Q

B12 deficiency with neuro deficits treatment

A

Hydroxycobalamin 1mg IM on alternate days for 1 weeks
Injections every 2 month lifelong

76
Q

AML Vs CML

A

AML- present within weeks, blasts
CML- months, WCC >100, all across germ line

77
Q

Blood results of beta thalassaemia

A

Microcytic anaemia
Absent HbA
Raised HbF and HbA2

78
Q

Main precipitate in Cryoprecipitate

79
Q

Tumour lysis syndrome prophylaxis tx

A

IV allopurinol or IV rasburicase
if high risk- high tumour burden

PO allopurinol if low risk

80
Q

When should cryoprecipitate be used

A

If fibrinogen is low

81
Q

Anaemia with epilepsy cause

A

Taking phenytoin- folate

82
Q

SLE anaemia blood results

A

High bilirubin
High LDH
Jaundice
DAT +

83
Q

Sideroblastic anaemia iron/blood results

A

Anaemic
High iron
Low TIBC
High ferritin

84
Q

Haptoglobin in haemolytic anaemia

A

Low since binds to haemoglobin

85
Q

Haptoglobin in haemolytic anaemia

A

Low since binds to haemoglobin

86
Q

Ix if new B symptoms in CLL

A

Lymph biopsy- pitcher transformation

87
Q

Ethnicity with neutropenia is common

A

Black afro carribean

88
Q

Sickle cell crisis management

A

Analgesia
Fluids

Exchange transfusion- if vaso occlusive or organ failure, splenic crisis

89
Q

Basophillic stipping of red cells

A

Sideroblastic anaemia

90
Q

Multiple myeloma x ray

A

Osteolytic lesions
Rain drop skull

91
Q

Acute haemolytic reaction Anti bodies

92
Q

Cryoprecipitate

A

VIII, fibrinogen, VWF, XIII

93
Q

Most common non Hodgkin lymphoma

A

Diffuse large B cell

94
Q

Mx of thala major

A

Transfusions
Chelation therpay- desferrioxamine

95
Q

Bite and blister cells on blood film

96
Q

Echinocytes on blood film

A

Pyruvate kinase deficiency

97
Q

Basophillic stippling causes

A

Pyrimidine 5’ nucleotidase deficiency

98
Q

Cold vs warm causes of Haemolytic anaemia

A

Cold- Myco, EBV, CMV- IgM

Warm- SLE, CLL, lymphoma- IgG

99
Q

How long should non urgent blood transfusions take

A

90-120 mins

100
Q

How long should urgent blood transfusions take

101
Q

Which conditions require pneumococcal vaccine and how often

A

COPD- 1 off
Sickle/hypospelnism- 5 years

102
Q

RBC results of alcoholic liver disease

A

Macrocytic anaemia
Low plt

103
Q

SE of EPO

A

Bone aches, flu-like symptoms and skin rashes

104
Q

Cause of Heinz body anaemia

A

Mesalazine

105
Q

TRALI vs acute haemolytic reaction

A

TRALI- crackles in bases

Acute- immediate- more systemic- vomiting, flushed, dark urine, pain in loin

106
Q

Tx of VWD

A

Desmopressin

107
Q

Starry sky dx

A

Burkitt lymphoma

108
Q

Feature of B thala trait

A

Slightly anaemic
Disproportiate microcytic
High A2

109
Q

Waldenstroms features

A

High IgM
Hypervisocity- causing strokes

110
Q

Red welts on abdomen whilst transfusion management

A

Temporarily stop
Antihistamine

111
Q

What increases risk of anaphylactic reaction to blood transfusions

A

IgA deficiency

112
Q

Iron deficiency anaemia before surgery mx

A

Oral iron works in 2-4 weeks

So if time interval is less - use IV

113
Q

Combination of azathioprine and allopurinol

A

Pancytopaenai

114
Q

TRALI sx

A

Fever, SOB, bilateral infiltrates, hypotension, hypoxia

115
Q

CML vs myelofibrosis

A

Both cause splenomegaly and low cell count

CML- high WBV vs low in MF

116
Q

Cause of massive splenomegaly

A

CML, MF, malaria and lymphoma

Year 6 (28 decks)

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