Haemotology Conditions A Flashcards
Deep Vein Thrombosis - Description
blood clot in deep veins (esp. legs)
Deep Vein Thrombosis - Risk Factors (Change in Blood Flow) (4)
circulatory stasis
1) surgery
2) leg fracture —> plaster of Paris
3) long haul flight
4) obesity
Deep Vein Thrombosis - Risk Factors (Change in Blood Vessel) (2)
endothelial damage
1) smoking
2) hypertension
Deep Vein Thrombosis - Risk Factors (Change in Blood Constituents) (6)
1) pregnancy
2) oral contraceptive
3) hormone replacement therapy
4) dehydration
5) polycythaemia
6) inherited thrombophilia
Deep Vein Thrombosis - Signs (6)
1) calf warmth (calor)
2) calf tenderness (dolor)
3) calf erythema (rubor)
4) calf swelling (tumor)
5) fever (mild)
6) pitting oedema
Deep Vein Thrombosis - Complications (1)
1) pulmonary embolism
Deep Vein Thrombosis - Diagnosis (Well’s Score) (9)
≥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
Deep Vein Thrombosis - Management (2/3/0)
conservative 1) compression stockings 2) physical activity medical 1) treat underlying cause 2) LMW heparin 3) warfarin
Malaria - Description
infection by Plasmodium genus
Malaria - Causes (5)
1) Plasmodium falciparum
2) Plasmodium ovale
3) Plasmodium vivas
4) Plasmodium malariae
5) Plasmodium knowlesi
Malaria - Symptoms (7)
1) fever (inc. rigor)*
2) headache
3) myalgia
4) fatigue
5) abdominal pain
6) vomiting
7) diarrhoea
Malaria - Signs (4)
1) hepatomegaly
2) splenomegaly
3) jaundice
4) dark urine (black water fever)
Malaria - Complications (Severe Falciparum) (5)
1) sepsis
2) anaemia
3) cerebral pathology
4) acute respiratory distress syndrome
5) acute kidney injury
Malaria - Investigations (2/0)
initial
1) blood smear microscopy (Giemsa stain)
2) parasite antigen rapid diagnostic test
Malaria - Management (3/2/0)
conservative 1) insect repellent 2) bed nets 3) long-sleeved clothes medical 1) chloroquine 2) artesunate (severe falciparum)
Anaemia - General Description
decreased blood haemoglobin concentration
Anaemia - Causes (Microcytic) (2)
1) iron deficiency (most common)
2) thalassaemia
Anaemia - Causes (Normocytic) (6)
1) chronic disease (2nd most common)
2) combined haemanitic deficiency (Fe + B9)
3) pregnancy
4) blood loss
5) kidney disease
6) sickle cell disease
Anaemia - Causes (Macrocytic) (6)
1) B9 deficiency
2) B12 deficiency (inc. pernicious)
3) liver disease (inc. alcohol)
4) hypothyroidism
5) bone marrow failure
6) chemotherapy
Anaemia - General Symptoms (7)
1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication
Anaemia - General Signs (3)
may be absent even if severe
1) pallor
2) tachycardia
3) functional systolic ejection murmur
Anaemia - General Investigations (8)
1) FBC
2) B9
3) B12
4) ferritin
5) U&E
6) LFT
7) TSH
8) blood film
Anaemia - General Complications (2)
1) heart failure
2) infection risk
Anaemia - General Management (0/1/0)
medical
1) treat underlying cause
Iron Deficiency Anaemia - Description
decreased blood haemoglobin concentration due to iron deficiency
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)
Iron Deficiency Anaemia - Symptoms (7)
1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication
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)
Iron Deficiency Anaemia - Complications (3)
1) heart failure
2) infection risk
3) pregnancy problems
Iron Deficiency Anaemia - Investigations (2/0)
initial
1) FBC (microcytic anaemia)
2) iron studies (low iron, low ferritin)
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)
Folate Deficiency Anaemia - Description
decreased blood haemoglobin concentration due to folate deficiency
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)
Folate Deficiency Anaemia - Risk Factors (5)
1) poverty
2) Coeliac disease, Crohn’s disease
3) alcohol
4) pregnancy
5) elderly
Folate Deficiency Anaemia - Symptoms (7)
1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication
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)
Folate Deficiency Anaemia - Complications (3)
1) heart failure
2) infection risk
3) pregnancy problems (spina bifida)
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)
Folate Deficiency Anaemia - Management (0/3/0)
medical
1) treat underlying cause
2) folic acid + B12 supplement (4 months)
3) prophylactic folic acid (pregnancy)
Haemolytic Anaemia - Description
decreased blood haemoglobin concentration due to erythrocyte haemolysis
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
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
Haemolytic Anaemia - Symptoms (7)
1) fatigue
2) headache
3) angina
4) palpitations
5) dyspnoea
6) anorexia
7) claudication
Haemolytic Anaemia - Signs (3)
may be absent even if severe
1) pallor
2) tachycardia
3) functional systolic ejection murmur
Haemolytic Anaemia - Complications (4)
1) heart failure
2) infection risk
3) cholelithiasis
4) jaundice
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)
Haemolytic Anaemia - Management (0/1/0)
medical
1) treat underlying cause
Acute Lymphoblastic Leukaemia - Description
malignant proliferation of lymphoblasts
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
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
Acute Lymphoblastic Leukaemia - Symptoms (7)
1) fatigue
2) fever
3) headache
4) palpitations
5) dyspnoea
6) epistaxis
7) menorrhagia
Acute Lymphoblastic Leukaemia - Signs (6)
1) lymphadenopathy
2) hepatomegaly
3) splenomegaly
4) pallor
5) petechiae/purpura/ecchymoses
6) mouth ulcers
Acute Lymphoblastic Leukaemia - Complications (2)
1) pancytopenia
2) cranial nerve palsy
Acute Lymphoblastic Leukaemia - Investigations (2/1)
initial
1) FBC (anaemia, leucocytosis, neutropenia, thrombocytopenia)
2) blood film (lymphoblasts)
consider
1) bone marrow biopsy* (>20% lymphoblasts)
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)
Chronic Lymphocytic Leukaemia - Description
malignant proliferation of B lymphocytes
Chronic Lymphocytic Leukaemia - Risk Factors (3)
1) >60 years old
2) radiation exposure (inc. radiotherapy)
3) male
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
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
Chronic Lymphocytic Leukaemia - Signs (3)
1) lymphadenopathy
2) hepatomegaly
3) splenomegaly
Chronic Lymphocytic Leukaemia - Complications (3)
1) pancytopenia
2) hypogammaglobulinaemia —> infection risk
3) autoimmune haemolytic anaemia
Chronic Lymphocytic Leukaemia - Investigations (2/0)
initial
1) FBC (anaemia, leucocytosis, lymphocytosis, neutropenia, thrombocytopenia)
2) blood film (smudge cells)
Chronic Lymphocytic Leukaemia - Management (0/2/2)
medical 1) IV IgG 2) chemotherapy/radiotherapy surgery 1) blood transfusion 2) bone marrow stem cell transplant
Acute Myeloid Leukaemia - Description
malignant proliferation of common myeloid progenitors/myeloblasts
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
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
Acute Myeloid Leukaemia - Symptoms (7)
1) fatigue
2) fever
3) headache
4) palpitations
5) dyspnoea
6) epistaxis
7) menorrhagia
Acute Myeloid Leukaemia - Signs (6)
1) lymphadenopathy
2) hepatomegaly
3) splenomegaly
4) pallor
5) petechiae/purpura/ecchymoses
6) mouth ulcers
Acute Myeloid Leukaemia - Complications (3)
1) pancytopenia
2) infection risk
3) disseminated intravascular coagulation
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)
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
Chronic Myeloid Leukaemia - Description
malignant proliferation of basophils/eosinophils/neutrophils
Chronic Myeloid Leukaemia - Risk Factors (3)
1) 65-74 years old
2) radiation exposure (inc. radiotherapy)
3) male
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
Chronic Myeloid Leukaemia - Symptoms (3)
1) fatigue
2) fever (inc. rigor, sweats)
3) weight loss
Chronic Myeloid Leukaemia - Signs (1)
1) splenomegaly
Chronic Myeloid Leukaemia - Complications (1)
1) pancytopenia
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)
Chronic Myeloid Leukaemia - Management (0/1/1)
medical
1) chemotherapy (PO imatinib)
surgery
1) bone marrow stem cell transplant
Hodgkin’s Lymphoma - Description
malignant proliferation of lymphocytes
Hodgkin’s Lymphoma - Types (2)
1) classical Hodgkin’s lymphoma (95%, Reed-Sternberg cells)
2) nodular lymphocyte predominant Hodgkin’s lymphoma (5%, popcorn cells)
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)
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
Hodgkin’s Lymphoma - Symptoms (2)
1) weight loss
2) fever (inc. night sweats)
Hodgkin’s Lymphoma - Signs (3)
1) lymphadenopathy
2) hepatomegaly
3) splenomegaly
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)
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)
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)
Hodgkin’s Lymphoma - Management (0/5/0)
medical medical 1) radiotherapy chemotherapy (ABVD) 2) adriamycin 3) bleomycin 4) vinblastine 5) dacarbazine
Non-Hodgkin’s Lymphoma - Description
malignant proliferation of lymphocytes
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
Non-Hodgkin’s Lymphoma - Symptoms (2)
1) weight loss
2) fever (inc. night sweats)
Non-Hodgkin’s Lymphoma - Signs (3)
1) lymphadenopathy
2) hepatomegaly
3) splenomegaly
Non-Hodgkin’s Lymphoma - Complications (2)
1) chemotherapy/radiotherapy complications (e.g. secondary malignancy)
2) tumour lysis syndrome (Burkitt’s lymphoma)
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)
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)
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
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
Myeloma - Description
malignant proliferation of plasma cells
Myeloma - Risk Factors (3)
1) old (peak 70 years old)
2) Afro-Caribbean
3) family history
Myeloma - Symptoms (3)
1) fatigue
2) weight loss
3) bone pain
Myeloma - Complications (7)
1) pancytopenia
2) anaemia (normocytic)
3) chronic kidney disease
4) hypercalcaemia
5) osteopenia
6) fractures
7) spinal cord compression
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
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)
Myeloma - Management (Chemotherapy) (6)
fit - VAD 6 cycles 1) vanblastine 2) adriamycin 3) dexamethasone unfit - CTD 8 cycles 4) cyclophosphamide 5) thalidomide 6) dexamethasone
Hodgkin’s Lymphoma - Management (Course) (2)
1) I-A to II-A —> short course
2) II-B to IV-B —> long course
