Haemotology Conditions A Flashcards
1
Q
Deep Vein Thrombosis - Description
A
blood clot in deep veins (esp. legs)
2
Q
Deep Vein Thrombosis - Risk Factors (Change in Blood Flow) (4)
A
circulatory stasis
1) surgery
2) leg fracture —> plaster of Paris
3) long haul flight
4) obesity
3
Q
Deep Vein Thrombosis - Risk Factors (Change in Blood Vessel) (2)
A
endothelial damage
1) smoking
2) hypertension
4
Q
Deep Vein Thrombosis - Risk Factors (Change in Blood Constituents) (6)
A
1) pregnancy
2) oral contraceptive
3) hormone replacement therapy
4) dehydration
5) polycythaemia
6) inherited thrombophilia
5
Q
Deep Vein Thrombosis - Signs (6)
A
1) calf warmth (calor)
2) calf tenderness (dolor)
3) calf erythema (rubor)
4) calf swelling (tumor)
5) fever (mild)
6) pitting oedema
6
Q
Deep Vein Thrombosis - Complications (1)
A
1) pulmonary embolism
8
Q
Deep Vein Thrombosis - Diagnosis (Well’s Score) (9)
A
≥2 DVT likely —> imaging, <2 DVT unlikely —> D-dimer
1) active cancer
2) differential calf swelling (>3cm)
3) swelling of entire leg
4) pitting oedema
5) prominent superficial veins
6) localised deep venous system pain
7) paralysis, paresis, recent cast immobility
8) recent bed rest >3 days or major surgery with 12 weeks
9) previous DVT
9
Q
Deep Vein Thrombosis - Management (2/3/0)
A
conservative 1) compression stockings 2) physical activity medical 1) treat underlying cause 2) LMW heparin 3) warfarin
10
Q
Malaria - Description
A
infection by Plasmodium genus
11
Q
Malaria - Causes (5)
A
1) Plasmodium falciparum
2) Plasmodium ovale
3) Plasmodium vivas
4) Plasmodium malariae
5) Plasmodium knowlesi
12
Q
Malaria - Symptoms (7)
A
1) fever (inc. rigor)*
2) headache
3) myalgia
4) fatigue
5) abdominal pain
6) vomiting
7) diarrhoea
13
Q
Malaria - Signs (4)
A
1) hepatomegaly
2) splenomegaly
3) jaundice
4) dark urine (black water fever)
14
Q
Malaria - Complications (Severe Falciparum) (5)
A
1) sepsis
2) anaemia
3) cerebral pathology
4) acute respiratory distress syndrome
5) acute kidney injury
15
Q
Malaria - Investigations (2/0)
A
initial
1) blood smear microscopy (Giemsa stain)
2) parasite antigen rapid diagnostic test
16
Q
Malaria - Management (3/2/0)
A
conservative 1) insect repellent 2) bed nets 3) long-sleeved clothes medical 1) chloroquine 2) artesunate (severe falciparum)
17
Q
Anaemia - General Description
A
decreased blood haemoglobin concentration
18
Q
Anaemia - Causes (Microcytic) (2)
A
1) iron deficiency (most common)
2) thalassaemia
19
Q
Anaemia - Causes (Normocytic) (6)
A
1) chronic disease (2nd most common)
2) combined haemanitic deficiency (Fe + B9)
3) pregnancy
4) blood loss
5) kidney disease
6) sickle cell disease
20
Q
Anaemia - Causes (Macrocytic) (6)
A
1) B9 deficiency
2) B12 deficiency (inc. pernicious)
3) liver disease (inc. alcohol)
4) hypothyroidism
5) bone marrow failure
6) chemotherapy
21
Q
Anaemia - General Symptoms (7)
A
1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication
22
Q
Anaemia - General Signs (3)
A
may be absent even if severe
1) pallor
2) tachycardia
3) functional systolic ejection murmur
23
Q
Anaemia - General Investigations (8)
A
1) FBC
2) B9
3) B12
4) ferritin
5) U&E
6) LFT
7) TSH
8) blood film
24
Q
Anaemia - General Complications (2)
A
1) heart failure
2) infection risk
25
Q
Anaemia - General Management (0/1/0)
A
medical
1) treat underlying cause
26
Iron Deficiency Anaemia - Description
decreased blood haemoglobin concentration due to iron deficiency
27
Iron Deficiency Anaemia - Causes (6)
1) poor dietary intake
2) malabsorption (e.g. Coeliac disease, Crohn’s disease)
3) GI bleed
4) menorrhagia
5) pregnancy
6) hookworm (most common WW)
28
Iron Deficiency Anaemia - Symptoms (7)
1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication
29
Iron Deficiency Anaemia - Signs (8)
may be absent even if severe
1) pallor
2) tachycardia
3) functional systolic ejection murmur
4) brittle hair
5) brittle nails
6) koilonychia (spoon shaped nails)
7) atrophic glossitis (tongue papillae atrophy, i.e. smooth tongue)
8) angular cheilitis (mouth corner ulcers)
30
Iron Deficiency Anaemia - Complications (3)
1) heart failure
2) infection risk
3) pregnancy problems
31
Iron Deficiency Anaemia - Investigations (2/0)
initial
1) FBC (microcytic anaemia)
2) iron studies (low iron, low ferritin)
32
Iron Deficiency Anaemia - Management (1/3/1)
```
conservative
1) high dietary iron (e.g. red meat, spinach)
medical
1) treat underlying cause
2) ferrous sulphate (PO —> IV)
3) ascorbic acid (increases absorption)
surgery
1) red cell transfusion (2nd line)
```
33
Folate Deficiency Anaemia - Description
decreased blood haemoglobin concentration due to folate deficiency
34
Folate Deficiency Anaemia - Causes (5)
1) poor dietary intake (poverty, alcohol, elderly)
2) malabsorption (e.g. Coeliac disease, Crohn’s disease)
3) pregnancy
4) increased cell turnover (e.g. malignancy, inflammatory disease, haemolysis, dialysis)
5) antifolate drugs (e.g. methotrexate, trimethoprim)
35
Folate Deficiency Anaemia - Risk Factors (5)
1) poverty
2) Coeliac disease, Crohn’s disease
3) alcohol
4) pregnancy
5) elderly
36
Folate Deficiency Anaemia - Symptoms (7)
1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication
37
Folate Deficiency Anaemia - Signs (4)
may be absent even if severe
1) pallor
2) tachycardia
3) functional systolic ejection murmur
4) atrophic glossitis (tongue papillae atrophy, i.e. smooth tongue)
38
Folate Deficiency Anaemia - Complications (3)
1) heart failure
2) infection risk
3) pregnancy problems (spina bifida)
39
Folate Deficiency Anaemia - Investigations (2/3)
initial
1) FBC (macrocytic anaemia)
2) blood film (hypersegemented neutrophils)
consider
1) serum folate (low)
2) erythrocyte folate (low)
3) bone marrow biopsy (megaloblastic marrow)
40
Folate Deficiency Anaemia - Management (0/3/0)
medical
1) treat underlying cause
2) folic acid + B12 supplement (4 months)
3) prophylactic folic acid (pregnancy)
41
Haemolytic Anaemia - Description
decreased blood haemoglobin concentration due to erythrocyte haemolysis
42
Haemolytic Anaemia - Causes (6)
1) hereditary spherocytosis (most common in Northern Europeans)
2) glucose-6-phosphate dehydrogenase deficiency
3) α thalassaemia
4) β thalassaemia
5) sickle cell disease
6) autoimmune haemolytic anaemia
43
Haemolytic Anaemia - Pathophysiology (5)
1) premature breakdown of erythrocytes
2) increased erythropoesis by bone marrow to compensate (up to 6-8 times)
3) premature reticulocytes are released by bone marrow
4) premature breakdown of erythrocytes exceed compensation
5) anaemia
44
Haemolytic Anaemia - Symptoms (7)
1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication
45
Haemolytic Anaemia - Signs (3)
may be absent even if severe
1) pallor
2) tachycardia
3) functional systolic ejection murmur
46
Haemolytic Anaemia - Complications (4)
1) heart failure
2) infection risk
3) cholelithiasis
4) jaundice
47
Haemolytic Anaemia - Investigations (5/0)
initial
1) FBC (macrocytic anaemia, reticulocytosis)
2) blood film
3) LFT (high unconjugated bilirubin)
4) urine urobilinogen (high)
5) stool stercobilinogen (high)
48
Haemolytic Anaemia - Management (0/1/0)
medical
| 1) treat underlying cause
49
Acute Lymphoblastic Leukaemia - Description
malignant proliferation of lymphoblasts
50
Acute Lymphoblastic Leukaemia - Risk Factors (5)
1) <6 years old
2) radiation exposure (inc. radiotherapy)
3) chemotherapy
4) Down’s syndrome
5) Klinefelter’s syndrome
51
Acute Lymphoblastic Leukaemia - Pathophysiology (4)
1) malignant proliferation of lymphoblasts
2) decreased space and energy for proliferation of other cells in bone marrow (bone marrow failure)
3) decreased functional blood cells in blood
4) increased non-functional blast cells in blood
52
Acute Lymphoblastic Leukaemia - Symptoms (7)
1) fatigue
2) fever
3) headache
4) palpitations
5) dyspnoea
6) epistaxis
7) menorrhagia
53
Acute Lymphoblastic Leukaemia - Signs (6)
1) lymphadenopathy
2) hepatomegaly
3) splenomegaly
4) pallor
5) petechiae/purpura/ecchymoses
6) mouth ulcers
54
Acute Lymphoblastic Leukaemia - Complications (2)
1) pancytopenia
| 2) cranial nerve palsy
55
Acute Lymphoblastic Leukaemia - Investigations (2/1)
initial
1) FBC (anaemia, leucocytosis, neutropenia, thrombocytopenia)
2) blood film (lymphoblasts)
consider
1) bone marrow biopsy* (>20% lymphoblasts)
56
Acute Lymphoblastic Leukaemia - Management (1/3/3)
conservative
1) Hickman line (permanent cannula in main vessel to easily take blood and administer drugs and fluids)
medical
1) prophylactic antibiotics, antivirals, antifungals
2) chemotherapy
3) allopurinol (prevent tumour lysis syndrome)
surgery
1) red cell transfusion
2) platelet transfusion
3) bone marrow stem cell transplant (after 1st remission)
57
Chronic Lymphocytic Leukaemia - Description
malignant proliferation of B lymphocytes
58
Chronic Lymphocytic Leukaemia - Risk Factors (3)
1) >60 years old
2) radiation exposure (inc. radiotherapy)
3) male
59
Chronic Lymphocytic Leukaemia - Pathophysiology (4)
1) malignant proliferation of B lymphocytes
2) decreased space and energy for proliferation of other cells in bone marrow (bone marrow failure)
3) decreased functional blood cells in blood
4) increased non-functional blast cells in blood
60
Chronic Lymphocytic Leukaemia - Symptoms (6)
```
1) asymptomatic (often incidental FBC finding)
severe
2) fatigue*
3) dyspnoea*
4) fatigue (inc. rigor, sweats)
5) anorexia
6) weight loss
```
61
Chronic Lymphocytic Leukaemia - Signs (3)
1) lymphadenopathy
2) hepatomegaly
3) splenomegaly
62
Chronic Lymphocytic Leukaemia - Complications (3)
1) pancytopenia
2) hypogammaglobulinaemia —> infection risk
3) autoimmune haemolytic anaemia
63
Chronic Lymphocytic Leukaemia - Investigations (2/0)
initial
1) FBC (anaemia, leucocytosis, lymphocytosis, neutropenia, thrombocytopenia)
2) blood film (smudge cells)
64
Chronic Lymphocytic Leukaemia - Management (0/2/2)
```
medical
1) IV IgG
2) chemotherapy/radiotherapy
surgery
1) blood transfusion
2) bone marrow stem cell transplant
```
65
Acute Myeloid Leukaemia - Description
malignant proliferation of common myeloid progenitors/myeloblasts
66
Acute Myeloid Leukaemia - Risk Factors (5)
1) >65 years old
2) radiation exposure (inc. radiotherapy)
3) chemotherapy
4) Down’s syndrome
5) Klinefelter’s syndrome
67
Acute Myeloid Leukaemia - Pathophysiology (4)
1) malignant proliferation of common myeloid progenitors/myeloblasts
2) decreased space and energy for proliferation of other cells in bone marrow (bone marrow failure)
3) decreased functional blood cells in blood
4) increased non-functional blast cells in blood
68
Acute Myeloid Leukaemia - Symptoms (7)
1) fatigue
2) fever
3) headache
4) palpitations
5) dyspnoea
6) epistaxis
7) menorrhagia
69
Acute Myeloid Leukaemia - Signs (6)
1) lymphadenopathy
2) hepatomegaly
3) splenomegaly
4) pallor
5) petechiae/purpura/ecchymoses
6) mouth ulcers
70
Acute Myeloid Leukaemia - Complications (3)
1) pancytopenia
2) infection risk
3) disseminated intravascular coagulation
71
Acute Myeloid Leukaemia - Investigations (2/1)
initial
1) FBC (anaemia, leucocytosis, neutropenia)
2) blood film (Aurer rod blast cells)
consider
1) bone marrow biopsy* (>20% blast cell infiltration)
72
Acute Myeloid Leukaemia - Management (1/3/3)
conservative
1) Hickman line (permanent catheter in main vessel to easily take bloods and administer drugs and fluids)
medical
1) prophylactic antibiotics, antivirals, antifungals
2) chemotherapy
3) allopurinol (prevent tumour lysis syndrome)
surgery
1) red cell transfusion
2) platelet transfusion
3) bone marrow stem cell biopsy
73
Chronic Myeloid Leukaemia - Description
malignant proliferation of basophils/eosinophils/neutrophils
74
Chronic Myeloid Leukaemia - Risk Factors (3)
1) 65-74 years old
2) radiation exposure (inc. radiotherapy)
3) male
75
Chronic Myeloid Leukaemia - Pathophysiology (4)
1) malignant proliferation of basophils/eosinophils/neutrophils
2) decreased space and energy for proliferation of other cells in bone marrow (bone marrow failure
3) decreased functional blood cells in blood
4) increased non-functional blast cells in blood
76
Chronic Myeloid Leukaemia - Symptoms (3)
1) fatigue
2) fever (inc. rigor, sweats)
3) weight loss
77
Chronic Myeloid Leukaemia - Signs (1)
1) splenomegaly
78
Chronic Myeloid Leukaemia - Complications (1)
1) pancytopenia
79
Chronic Myeloid Leukaemia - Investigations (2/1)
initial
1) FBC (anaemia, leucocytosis, thrombocytosis/penia)
2) blood film (almost all maturing/mature myeloid cells)
consider
1) bone marrow biopsy* (granulocytic hyperplasia)
80
Chronic Myeloid Leukaemia - Management (0/1/1)
medical
1) chemotherapy (PO imatinib)
surgery
1) bone marrow stem cell transplant
81
Hodgkin’s Lymphoma - Description
malignant proliferation of lymphocytes
82
Hodgkin’s Lymphoma - Types (2)
1) classical Hodgkin’s lymphoma (95%, Reed-Sternberg cells)
| 2) nodular lymphocyte predominant Hodgkin’s lymphoma (5%, popcorn cells)
83
Deep Vein Thrombosis - Investigations (2/1)
```
initial
1) LFTs (normal)
2) D-dimer (Wells’<2, negative excludes)
consider
1) proximal duplex ultrasound* (Wells’≥2 or positive D-dimer)
```
84
Hodgkin’s Lymphoma - Risk Factors (7)
1) 13-19 years old
2) >65 years old
3) male
4) family history (esp. siblings)
5) Epstein-Barr virus
6) autoimmune (e.g. SLE)
7) immunocompromised
85
Hodgkin’s Lymphoma - Symptoms (2)
1) weight loss
| 2) fever (inc. night sweats)
86
Hodgkin’s Lymphoma - Signs (3)
1) lymphadenopathy
2) hepatomegaly
3) splenomegaly
87
Hodgkin’s Lymphoma - Complications (4)
chemotherapy/radiotherapy complications
1) secondary malignancy
2) thyroid pathology (e.g. hypothyroidism)
3) heart pathology (e.g. ischaemic heart disease)
4) lung pathology (e.g. lung fibrosis)
88
Hodgkin’s Lymphoma - Investigations (1/5)
initial
1) lymph node biopsy* (Reed-Sternberg/popcorn cells)
consider
1) bone marrow biopsy (Reed-Sternberg/popcorn cells)
2) FBC (anaemia, worse prognosis)
3) serum lactate dehydrogenase (high)
4) high CRP + ESR
5) chest, abdomen, pelvis CT (Ann Arbor classification)
89
Hodgkin’s Lymphoma - Classification (Ann Arbor) (6)
I) one lymph node group
II) multiple lymph node groups same side of diaphragm
III) multiple lymph node groups either side of diaphragm
IV) spread beyond lymph nodes (e.g. liver, bone marrow)
A) no B symptoms (except pruritus)
B) B symptoms (e.g. weight loss, fever, night sweats)
90
Hodgkin’s Lymphoma - Management (0/5/0)
```
medical
medical
1) radiotherapy
chemotherapy (ABVD)
2) adriamycin
3) bleomycin
4) vinblastine
5) dacarbazine
```
91
Non-Hodgkin’s Lymphoma - Description
malignant proliferation of lymphocytes
92
Non-Hodgkin’s Lymphoma - Risk Factors (7)
1) >50 years old
2) male
3) family history
4) Epstein-Barr virus
5) hepatitis C
6) Helicobacter pylori
7) immunocompromised
93
Non-Hodgkin’s Lymphoma - Symptoms (2)
1) weight loss
| 2) fever (inc. night sweats)
94
Non-Hodgkin’s Lymphoma - Signs (3)
1) lymphadenopathy
2) hepatomegaly
3) splenomegaly
95
Non-Hodgkin’s Lymphoma - Complications (2)
1) chemotherapy/radiotherapy complications (e.g. secondary malignancy)
2) tumour lysis syndrome (Burkitt’s lymphoma)
96
Non-Hodgkin’s Lymphoma - Investigations (1/5)
initial
1) lymph node biopsy* (non-Reed-Sternberg cells)
consider
1) bone marrow biopsy (non-Reed-Sternberg cells)
2) FBC (anaemia, worse prognosis)
3) serum lactate dehydrogenase (high)
4) high CRP + ESR
5) chest, abdomen, thorax CT (Ann Arbor classification)
97
Non-Hodgkin’s Lymphoma - Classification (Ann Arbor) (6)
I) one lymph node group
II) multiple lymph node groups same side of diaphragm
III) multiple lymph node groups either side of diaphragm
IV) spread beyond lymph node groups (e.g. liver, bone marrow)
A) no B symptoms (except pruritus)
B) B symptoms (e.g. weight loss, fever, night sweats)
98
Non-Hodgkin’s Lymphoma - Management (0/6/0)
```
medical
1) radiotherapy
chemotherapy (R-CHOP)
2) rituximab
3) cyclophosphamide
4) hydroxy-daunorubicin
5) oncovin
6) prednisolone
```
99
Non-Hodgkin’s Lymphoma - Management (Course) (6)
```
low grade
1) none may be needed
2) radiotherapy
high grade (early)
3) chemotherapy (3 months R-CHOP)
4) radiotherapy
high grade (late)
5) chemotherapy (6 months R-CHOP)
6) radiotherapy
```
100
Myeloma - Description
malignant proliferation of plasma cells
101
Myeloma - Risk Factors (3)
1) old (peak 70 years old)
2) Afro-Caribbean
3) family history
102
Myeloma - Symptoms (3)
1) fatigue
2) weight loss
3) bone pain
103
Myeloma - Complications (7)
1) pancytopenia
2) anaemia (normocytic)
3) chronic kidney disease
4) hypercalcaemia
5) osteopenia
6) fractures
7) spinal cord compression
104
Myeloma - Investigations (4/5)
```
initial
1) serum/urine electrophoresis*
2) FBC (anaemia)
3) U&E (high urea, high creatinine)
4) serum Ca2+ (high)
consider
1) bone marrow biopsy* (plasma cell infiltration)
2) blood film (Rouleux formation)
3) β2-microglobulin (high, worse prognosis)
4) x-ray (‘punched-out’ lytic lesions)
5) Bence-Jones proteins
```
105
Myeloma - Management (1/4/1)
```
conservative
1) high fluid intake (3L/day)
medical
1) analgesia (bone pain, avoid NSAIDs (CKD))
2) bisphosphonates (bone pain, reduce fractures)
3) prophylactic antibiotics
4) chemotherapy
surgery
1) haemodialysis (CKD)
```
106
Myeloma - Management (Chemotherapy) (6)
```
fit - VAD 6 cycles
1) vanblastine
2) adriamycin
3) dexamethasone
unfit - CTD 8 cycles
4) cyclophosphamide
5) thalidomide
6) dexamethasone
```
107
Hodgkin’s Lymphoma - Management (Course) (2)
1) I-A to II-A —> short course
| 2) II-B to IV-B —> long course
