Haemotology, includes DVT anaemia and blood malignancies Flashcards
1
Q
Signs and sympotoms of DVT
A
signs- tenderness swelling, warm and discoloured
symptoms- pain
diagnoses is adied by histiory of risk factors
2
Q
Risk factors for DVT
A
Long haul flight Imobilisation surgery hip fracture smoking obesity 3rd trimester of pregnancy oral contraceptive pill family history
3
Q
Investigations for DVT
A
D Dimer test- used to rule out if they dont have DVT
compression ultrasound and venogram
4
Q
Treatment for DVT
A
LMWH
Warfarin INR 2-3
compression stalking
education
5
Q
signs and symptoms of PE
A
main3: Dyspnoea, tachypnoea pleuritic chest pain
others: Haemoptysis hypotension cough tachycardia
If severe hypotension and syncope
6
Q
Investigations for PE
A
CXR- normal ECG normal Blood gas show type 1 resp failure pattern CT pulmonary angiography is diagnostic very important to calculate wells score FBC shows thrombocytopenia
7
Q
What is WELLS criteria/ Geneva score
A
questionnaire to access likeliness of PE,
ask previous DVT or PE
risk factors Signs for DVT
tachycardia haemoptyis surgery
8
Q
Management of PE
A
Oxygen
Iv fluid for hypotension
anti coagulation
thrombolytic therapy- alteplase
9
Q
what does reticulocyte count test show
A
increased reticulocytes = increased turnover problem
low reticulocytes= reduced RBC production
10
Q
what is anaemia in general terms
A
low HB
11
Q
what does low HB cause in terms of vascular compensation
A
increased HR, BP and production of RBC
12
Q
signs and symptoms of anaemia
A
SOB fatigue lethargy palpitation tachycardia hypertension headache nail bed changes pallor exacerbate existing coronary conditions- angina
13
Q
General investigations to carry out in anaemia
A
FBC WCC Platelet Reticulocyte count ferratin Blood film- allows observation of apperance of RBC
14
Q
what is the commonest cause of anaemia
A
Iron deficiency anaemia
15
Q
what are the types of anaemia
A
microcytic
normocytic
macrocytic
16
Q
what are the features of microcytic anaemia
A
Low HB Low MCV
commonest cause is iron deficiency anaemia
other causes= anaemia of chronic disease or thalassemia
17
Q
what regulates iron absorption transfers it and stores it
A
Hepcidin absorbs in the duodenum
transferratin moves it
stored in ferratin in liver bone marrow, spleen and skeletal muscle
18
Q
what are the causes of iron deficiency anaemia
A
most commonly due to blood loss. menhorrea, or loss of blood from GI tract, ulcers or infection of GI tract or NSAID causing GI bleed
other causes include low iron in diet
decreased absorption (malabsorbtion)
increased demand from increased growth
19
Q
signs specific to iron deficiency anaemia
A
angular stomatitis
brittle nails or koilonychia, spoon shaped nails (indented)
atrophy of tounge papillae
20
Q
Investigations for ID Anaemia
A
FBC and film= Hb Low and MCV low microcytic
serum ferritin= also low- this can be diagnostic of ID
ferrittin is normal in Anaemia of Chronic disease
21
Q
Treatment for microcytic anaemia
A
Treat underlying cause and oral iron tablets
22
Q
anaemia of chronic disease
A
second commonest type. due to reduced production of EPO and RBCs due to chronic disease, TB Infection Rheumatoid malignancy renal failure
can be microcytic or normocytic
23
Q
features of normocytic anaemia
causes and treatment
A
low Hb MCV normal
due to secondary anaemia (of chronic disease, commonest) or acute blood loss or autoimmune disease. treat underlying condition
24
Q
features of macrocytic anaemai and its causes
A
Hb low MCV high B12 or folate deficency- caused by pernicious anaemia alcohol excess liver disease haemolysis chemotherapy
25
what is pernicious anaemia
autoimmune disease which destroys parietal cells, Gastric intrinsic factor and causes B12 deficiency
associated with thyroid disease and other autoimmune diseases
26
features of pernicious anaemia
mild jaundace due to excess HB breakdown
| macrocytic anemia
27
general investigations for macrocytic anaemia
FBC and film= HB low , MCV high due to reticulocytes
reticulocyte count= high
U&E LFT TSH B12 Folate Ferratin
if still nothing then bone marrow biopsy
28
Investigations of Pernicious anaemia
```
FBC and film
reticulocyte count
B12
Folate
other tests
bone marrow biopsy
GIT and parietal cells antibodies
```
29
Treatment for pernicous anaemia
B12 and folate in whichever is deficient
30
what is the principle pathology behind thalassemias
Imbalance between alpha and Beta Globulins, One globulin is more dominant than the other, causes RBC deformity and gets destroyed
31
what is the pathology genetically behind sickle cell anemia
SNP in B globulin causing sickle shaped RBCs
32
what type of inheritance is sickle cell anemia
autosomal recessive,
Carriers are asymptomatic and have Malaria protection
Asymptomatic unless at extreme altitude or dehydration
33
prevalence of sickle cell anemia
1 in 700 of those of african heritage
34
sickle cell pathophysiology
has normal shape when oxygenated but when deoxygenated, shape distorts and causes sickling.
sickles are more likely to get stuck and vaso occlude
sickling causes Intravascular haemolysis
35
Sickel cell signs and symptoms due to vaso occlusions
thrombus in Hands and feet causing Dactylitis
occurs in bone causing avascular necrosis and Pain crisis
occurs in CNS - Stroke or Seizures or cognitive decline
Occurs in renal causing haematuria and proteinuria
occurs in spleen causing spleen auto infarct which reduces immunity and more likely to be infected by H influenza S pneumonia N meningitis
acute chest syndromes- RBCs don't get oxygenated which causes Vasoconstriction so less get oxygenated
36
sickle cell symptoms due to Intravascular haemolysis
anemia - Increased Reticulocytes
New bone formation due to increased production demand - expansion of medullary cavities in skull, enlarged cheeks + Hair on end appearance on X ray
also extrameduallary hematopoiesis- Blood formed in liver causing Hepatomegaly
Increased turnover can cause jaundice, gallstones or scleral Icterus
37
Screening and diagnosis of Sickle cell anemia
Blood film
Protein electrophoresis
Newborn Blood Spot test
other investigations on assessing severity are cultures
X rays
FBC and reticulocyte count
38
complications of sickle cell anemia
```
Spleen autoinfarction
osteoarthritis
Avascular necrosis
Pulmonary hypertension (acute chest syndrome)
Joint damage
```
39
Management of sickle cell anemia
Opioids and analgesia for pain
Hypoxia dehydration and acidosis - Fluids and oxygen
chest syndrome - oxygen
Antibiotics
Blood transfusions if vaso occlusive events
Blood transfusion in chest syndrome
Hydroxycarbamide in chronic anemia - prevent recurrent crisis
40
What is leukaemia and its different types and origins
Haematological malignancy
can be acute or chronic
can originate from myeloid or lymphoid tissue
41
risk factors of leukemia
Radiation, Hiroshima nagasaki
genetic T21
drugs that has benzens
42
what chromosome is associated with leukemia
Philadelphia chromosome Chromosome 22 (CML and ALL)
43
which is the commonest Cancer in children
ALL,
All the other kids have A L L
AML CLL CML more common in adults
44
Presentation of acute lymphoblastic leukemia
Anemia - Fatigue SOB, Pallor
Thrombocytopenia- Bleeding Bruising Rash, Petechiae
neutropenia - Recurrent infections, Fever
Marrow infiltration - Bone Pain
Infiltration : hepatomegaly, splenomegaly
Orchidomegaly
Cranial nerve palsies and meningism, headache
45
Tests for ALL
FBC- low HB high WBC Platlet Low
bone marrow or Blood film- Blast cells on film (specific to ALL)
Bone marrow film and biopsy - diagnostic (presence of lymphoblasts)
CXR and CT to look for Lymphadenopathy
Lumbar puncture to look for CNS involvement
46
Management of ALL
Conservative/ supportive
Education on Infection prevention. prophylactic anti fungal, antiviral antibiotics.
IV antibiotics on first sign of infection
Blood and platelet transfusion for bleeding.
Intensive chemotherapy treatment (give allopurinol, since tumour lysis- increased urate levels)
counselings to them and family
marrow transplant once in remission (carry out HLA typing to identify which donor is eligible)
47
pathophysiology of ALL
| which cells does it originate from and what age group does it affect most commonly
occurs mainly 2 to 4
Malignancy of immature Lymphocytes, Lymphoblasts precursors to B cells in children
Lymphocytes Precursors for T cells In adults
48
pathophysiology of acute Myeloid leukemia
| Which cells does it originate from
affects myeloBlastic cells, these cells give rise to Basophils, Neutrophils and eosinophils
49
Presentation of AML
Neutropenia- Increased risk of infection, fever
Thrombocytopenia - reduced clotting, bleeding, purpura
Anemia, reduced Hb, pallor SOB, Fatigue, Gum Hypertrophy
Hepatomegaly and splenomegaly
Risk of DIC
50
AML investigations
WCC elevated, can be normal or low
Bone marrow biopsy and blood film: MyeloBlast cells
Microscopy Immunophenotyping and molecular methods
51
what is the bases of differentiating ALL from AML
Bone marrow aspirate and biopsy , film
| Microscopy, Immunophenotyping and molecular methods
52
Management for AML
Supportive therapy, Blood and platelet transfusion, IV fluids
Antibiotics, fungals and virals.
allopurinol for excess uric acid released by tumour lysis
chemotherapy
HLA typing to look for Marrow transplant
53
What is the microscopic feature of AML
Auer rods are diagnostic of AML
54
complications of Acute leukemia
Infection is largest one, especially in AML
55
pathophysiology of chronic lymphocytic anemia
| include risk and potential trigger
Proliferation of B lymphocytes, due to avoiding cell apoptosis
mutations and T21 increase risk of CLL
pneumonia may be a trigger
56
Symptoms of CLL
Mostly asymptomatic and discovered on routine test
If severe sweating, anorexia, Weight loss
anemic (SOB fatigue, Pallor) or infection prone
57
signs of CLL
Splenomegaly, hepatomegaly
| Enlarged rubbery non tender Lymph nodes, Lymphadenopathy
58
Investigations for CLL
```
Film= smudge cells (lymphocytes)
FBC= HB low, WCC Very high. Platelets low. end stage WBC also low
```
59
What is a film diagnostic feature of CLL
Smudge cells
60
Management of CLL
considering to treat, potentially just palliative care
```
Blood transfusion
Human Iv immunoglobulins
chemo or radiotherapy
Stem cell transplant
Rdex- Rituximab + dexamethasone
```
61
complications of CLL
autoimmune Haemolysis
main mortality is due to infection
Marrow failure
62
Progression of CLL
```
Stable for many years and may even regress
can advance very quickly
1/3 never progess
1/3 progress slowly
1/3 progressive rapidly
```
63
what is the commonest leukemia
CLL
64
which cancer is associated with trisomy
CLL
65
which cancer is most associated with Philadelphia chromosome, 22
CML
66
pathophysiology of Chronic myeloid leukemia
epidemiology
genetic association
```
Proliferation of myeloid cells
affects 40-60
a disease of the adults
more common in males
80% associated with philadelphia chromosome
```
67
Presentation of CML
```
anemia - SOB, Fatigue, Pallor
Splenomegaly, abd discomfort
weight loss
Fever and sweats in the absence of infection
thrombocytopenia- Bleeding
```
68
Diagnosis of CML
FBC- very high WCC, with neutrophil, basophil, eosinophil
platelet low
HB low
Bone marrow aspirate - Hypercellular
69
Management of CML
Tyrosine kinase inhibitor - Oral Imatinib
| stem cell transplant
70
what is hickman line
used in ALL and AML to give fluids faster
71
what is lymphoma
a malignant growth of WBc, causing abnormal proliferation in lymph nodes
split into hodgekin and non hodgkin
thought to be autoimmune disease
72
where does hodgkin lymphoma occur
Mostly in Lymph nodes
73
where does non hodgkin lymphoma
anywhere WBCs go
| Blood spleen liver bone marrow
74
differential for lump in the neck
MSK and anatomical
Reactive LN due to infection, bacterial or vial, Tb HIv. autoimmune
Primary- Malignancy: Lymphoid, Hodgkin, non H, CLL ALL.
metastatic, Secondary metastatic, Thyroid Laryngeal, Breast
75
Presentation of hodgkin lymphoma
Lymphadenopathy (lymph node enlargement). painless, rubbery, contagious spread
Pruritus
Hepatosplenomegaly- due to proliferation
Systemic B symptoms
Extranodal presentation (more common in non hodgkins) cough, SOB, G tract symptoms
76
what are systemic B symptoms
```
Symptoms assoistaed with lymphoma
fever
night sweats
weight loss
anorexia
fatigue
```
77
Investigations for Hodgkin's lymphoma
```
Blood film - abnormal cells
FBC Hb lwo, ESR CRP elevated
Lymph node biopsy - Reed Sternberg cells
Bone marrow Aspirate and biopsy
Ct, PET used for staging
```
Cytogenetics, Immunophenotyping
78
how is hodgkin's lymphoma staged
By using Xray CT, PET, +biopsy
79
what classification system is used for hodgkin's lymphoma
Ann arbor system
1 involves singular lymph node
2 involves lymph nodes but bly on one side of diaphragm
3 involves lymph nodes both sides of diaphragm
4 Spread beyond lymph nodes, in liver, bone marrow
```
A= no B symptoms, except pruritus
B= B symptoms present, poor prognostic factor
```
80
Management of hodgkin's lymphoma
stages 1 A t 2 A - short term chemo plus radiotherapy
| Stage 2B to 4b - Long term chemo
81
complications of chemotherapy
Infertility,
| myelosuppression alopecia nausea infection
82
complication of radiotherapy
Increase risk of ischemic heart Disease
83
Presentation of non hodgkin's lymphoma
Painless lymphadenopathy
Systemic B symptoms
extranodular symptoms - gi symptoms, cough breathlessness
hepatosplenomegaly
Pancytopenia- anemia, infection and bleeding
pancytopenia, deficiency in RBCs, WBCs and Platelets
84
Epidemiology and risk factors for Hodgkin's lymphoma
```
family history
SLE
Post transplant
obesity
Peaks in teenage years and elderly
```
85
chemotherapy used in hodgkin's lymphoma
```
ABVD
• ADRIAMYCIN
- BLEOMYCIN
• V - VINBLASTINE
• D - DACARBAZINE
```
86
causes of non hodgkin lymphoma
Immunodeficiency
HIV
H pylori
87
Investigations for non hodgkins
```
Bloods, FBC U and E
bone marrow biopsy and aspirate
lymph node biopsy -ve reed sternberg
Immunophenotyping- CD20 and surface Immunoglobulins.
PET, CT for staging
```
88
management of non hodgkin lymphoma
radiotherapy
| if not responding: Rituximab - targets CD20 on B cells
89
what is myeloma
Blood cancer, Malignant disease of bone marrow arising from plasma cells
90
Presentation of Myeloma
OLD CRAB
Old age
Calcium elevated due to bone destruction, increased risk of fractures and vertebral collapse - spinal cord compression
Renal Impairment
Recurrent infection
Anemia (neutropenia, Thrombocytopenia)
bone lytic lesions
91
pathophysiology of myeloma
Excess Plasma proteins- excess monoclonal antibodies, proliferation- Paraproteinemia, high protein in blood, leads to excretion of Light chain IG in urine
Increased osteoclast activity, no increase in osteoblast typical myeloma lesions
abnormality in P53
Hyperviscosity symptoms
92
Investigations in myeloma
Bloods, Hb low, Pancytopenia. ESR U and E Ca elevated
Blood film- (rouleaux formation) indication of increased proteins, paraproteinemia
Screening: serum and urine electrophoresis shows B2 microglobulin
Imaging- X Ray shows pepper pot skull, vertebral collapse. dexa shows osteoporosis, fractures
bone marrow aspirate and biopsy - shows infiltration of plasma cells
93
Diagnostic criteria for myeloma
has 2 of the following
Skeletal survey shows bone lesions (pepper pot skull)
bone marrow aspirate and biopsy shows increased plasma cells
24 hour serum or urine electrophoresis showing monoclonal antibodies (result of paraproteinemia)
Hypercalcemia, Renal failure, anemia
94
Management of myeloma
Supportive:
Treat bone pain with analgesia
alendronic acid plus adcal
correct anemia with blood and platelet transfusion
rehydrate and Iv Fluids
renal dialysis
Broad spectrum antibiotics for infection
Intensive chemotherapy
idea for stem cell transplant
dexamethasone
95
complications of myeloma
Hypercalcemia
spinal cord compression
hyperviscosity
Acute renal injury (cause of mortality)
96
What are hyperviscosity syndromes
triad of mucosal bleed
Visual disturbance
neurological symptoms
