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Hayders Phase 2A > Haemotology, includes DVT anaemia and blood malignancies > Flashcards

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

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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
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3
Q

Investigations for DVT

A

D Dimer test- used to rule out if they dont have DVT

compression ultrasound and venogram

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4
Q

Treatment for DVT

A

LMWH
Warfarin INR 2-3
compression stalking
education

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5
Q

signs and symptoms of PE

A

main3: Dyspnoea, tachypnoea pleuritic chest pain
others: Haemoptysis hypotension cough tachycardia
If severe hypotension and syncope

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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
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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

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8
Q

Management of PE

A

Oxygen
Iv fluid for hypotension
anti coagulation
thrombolytic therapy- alteplase

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9
Q

what does reticulocyte count test show

A

increased reticulocytes = increased turnover problem

low reticulocytes= reduced RBC production

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10
Q

what is anaemia in general terms

A

low HB

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11
Q

what does low HB cause in terms of vascular compensation

A

increased HR, BP and production of RBC

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12
Q

signs and symptoms of anaemia

A 
SOB 
fatigue lethargy 
palpitation
tachycardia 
hypertension 
headache
nail bed changes 
pallor
exacerbate existing coronary conditions- angina
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13
Q

General investigations to carry out in anaemia

A 
FBC
WCC
Platelet
Reticulocyte count
ferratin
Blood film- allows observation of apperance of RBC
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14
Q

what is the commonest cause of anaemia

A

Iron deficiency anaemia

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15
Q

what are the types of anaemia

A

microcytic
normocytic
macrocytic

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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

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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

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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

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19
Q

signs specific to iron deficiency anaemia

A

angular stomatitis
brittle nails or koilonychia, spoon shaped nails (indented)
atrophy of tounge papillae

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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

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21
Q

Treatment for microcytic anaemia

A

Treat underlying cause and oral iron tablets

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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

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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

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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
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25
Q

what is pernicious anaemia

A

autoimmune disease which destroys parietal cells, Gastric intrinsic factor and causes B12 deficiency
associated with thyroid disease and other autoimmune diseases

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26
Q

features of pernicious anaemia

A

mild jaundace due to excess HB breakdown

macrocytic anemia

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27
Q

general investigations for macrocytic anaemia

A

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

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28
Q

Investigations of Pernicious anaemia

A 
FBC and film 
reticulocyte count 
B12
Folate 
other tests 
bone marrow biopsy 
GIT and parietal cells antibodies
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29
Q

Treatment for pernicous anaemia

A

B12 and folate in whichever is deficient

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30
Q

what is the principle pathology behind thalassemias

A

Imbalance between alpha and Beta Globulins, One globulin is more dominant than the other, causes RBC deformity and gets destroyed

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31
Q

what is the pathology genetically behind sickle cell anemia

A

SNP in B globulin causing sickle shaped RBCs

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32
Q

what type of inheritance is sickle cell anemia

A

autosomal recessive,
Carriers are asymptomatic and have Malaria protection
Asymptomatic unless at extreme altitude or dehydration

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33
Q

prevalence of sickle cell anemia

A

1 in 700 of those of african heritage

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34
Q

sickle cell pathophysiology

A

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

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35
Q

Sickel cell signs and symptoms due to vaso occlusions

A

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

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36
Q

sickle cell symptoms due to Intravascular haemolysis

A

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

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37
Q

Screening and diagnosis of Sickle cell anemia

A

Blood film
Protein electrophoresis
Newborn Blood Spot test

other investigations on assessing severity are cultures
X rays
FBC and reticulocyte count

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38
Q

complications of sickle cell anemia

A 
Spleen autoinfarction 
osteoarthritis 
Avascular necrosis
Pulmonary hypertension (acute chest syndrome)
Joint damage
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39
Q

Management of sickle cell anemia

A

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
Q

What is leukaemia and its different types and origins

A

Haematological malignancy
can be acute or chronic
can originate from myeloid or lymphoid tissue

41
Q

risk factors of leukemia

A

Radiation, Hiroshima nagasaki
genetic T21
drugs that has benzens

42
Q

what chromosome is associated with leukemia

A

Philadelphia chromosome Chromosome 22 (CML and ALL)

43
Q

which is the commonest Cancer in children

A

ALL,

All the other kids have A L L

AML CLL CML more common in adults

44
Q

Presentation of acute lymphoblastic leukemia

A

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
Q

Tests for ALL

A

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
Q

Management of ALL

A

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
Q

pathophysiology of ALL

which cells does it originate from and what age group does it affect most commonly

A

occurs mainly 2 to 4
Malignancy of immature Lymphocytes, Lymphoblasts precursors to B cells in children
Lymphocytes Precursors for T cells In adults

48
Q

pathophysiology of acute Myeloid leukemia

Which cells does it originate from

A

affects myeloBlastic cells, these cells give rise to Basophils, Neutrophils and eosinophils

49
Q

Presentation of AML

A

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
Q

AML investigations

A

WCC elevated, can be normal or low
Bone marrow biopsy and blood film: MyeloBlast cells
Microscopy Immunophenotyping and molecular methods

51
Q

what is the bases of differentiating ALL from AML

A

Bone marrow aspirate and biopsy , film

Microscopy, Immunophenotyping and molecular methods

52
Q

Management for AML

A

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
Q

What is the microscopic feature of AML

A

Auer rods are diagnostic of AML

54
Q

complications of Acute leukemia

A

Infection is largest one, especially in AML

55
Q

pathophysiology of chronic lymphocytic anemia

include risk and potential trigger

A

Proliferation of B lymphocytes, due to avoiding cell apoptosis
mutations and T21 increase risk of CLL
pneumonia may be a trigger

56
Q

Symptoms of CLL

A

Mostly asymptomatic and discovered on routine test
If severe sweating, anorexia, Weight loss
anemic (SOB fatigue, Pallor) or infection prone

57
Q

signs of CLL

A

Splenomegaly, hepatomegaly

Enlarged rubbery non tender Lymph nodes, Lymphadenopathy

58
Q

Investigations for CLL

A 
Film= smudge cells (lymphocytes) 
FBC= HB low, WCC Very high. Platelets low. end stage WBC also low
59
Q

What is a film diagnostic feature of CLL

A

Smudge cells

60
Q

Management of CLL

A

considering to treat, potentially just palliative care

Blood transfusion 
Human Iv immunoglobulins 
chemo or radiotherapy 
Stem cell transplant 
Rdex- Rituximab + dexamethasone
61
Q

complications of CLL

A

autoimmune Haemolysis
main mortality is due to infection
Marrow failure

62
Q

Progression of CLL

A 
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
Q

what is the commonest leukemia

A

CLL

64
Q

which cancer is associated with trisomy

A

CLL

65
Q

which cancer is most associated with Philadelphia chromosome, 22

A

CML

66
Q

pathophysiology of Chronic myeloid leukemia
epidemiology
genetic association

A 
Proliferation of myeloid cells 
affects 40-60 
a disease of the adults 
more common in males
80% associated with philadelphia chromosome
67
Q

Presentation of CML

A 
anemia - SOB, Fatigue, Pallor 
Splenomegaly, abd discomfort 
weight loss 
Fever and sweats in the absence of infection 
thrombocytopenia- Bleeding
68
Q

Diagnosis of CML

A

FBC- very high WCC, with neutrophil, basophil, eosinophil
platelet low
HB low
Bone marrow aspirate - Hypercellular

69
Q

Management of CML

A

Tyrosine kinase inhibitor - Oral Imatinib

stem cell transplant

70
Q

what is hickman line

A

used in ALL and AML to give fluids faster

71
Q

what is lymphoma

A

a malignant growth of WBc, causing abnormal proliferation in lymph nodes
split into hodgekin and non hodgkin
thought to be autoimmune disease

72
Q

where does hodgkin lymphoma occur

A

Mostly in Lymph nodes

73
Q

where does non hodgkin lymphoma

A

anywhere WBCs go

Blood spleen liver bone marrow

74
Q

differential for lump in the neck

A

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
Q

Presentation of hodgkin lymphoma

A

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
Q

what are systemic B symptoms

A 
Symptoms assoistaed with lymphoma 
fever
night sweats
weight loss
anorexia 
fatigue
77
Q

Investigations for Hodgkin’s lymphoma

A 
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
Q

how is hodgkin’s lymphoma staged

A

By using Xray CT, PET, +biopsy

79
Q

what classification system is used for hodgkin’s lymphoma

A

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
Q

Management of hodgkin’s lymphoma

A

stages 1 A t 2 A - short term chemo plus radiotherapy

Stage 2B to 4b - Long term chemo

81
Q

complications of chemotherapy

A

Infertility,

myelosuppression alopecia nausea infection

82
Q

complication of radiotherapy

A

Increase risk of ischemic heart Disease

83
Q

Presentation of non hodgkin’s lymphoma

A

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
Q

Epidemiology and risk factors for Hodgkin’s lymphoma

A 
family history
SLE
Post transplant 
obesity 
Peaks in teenage years and elderly
85
Q

chemotherapy used in hodgkin’s lymphoma

A 
ABVD
• ADRIAMYCIN 
 - BLEOMYCIN
• V - VINBLASTINE
• D - DACARBAZINE
86
Q

causes of non hodgkin lymphoma

A

Immunodeficiency
HIV
H pylori

87
Q

Investigations for non hodgkins

A 
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
Q

management of non hodgkin lymphoma

A

radiotherapy

if not responding: Rituximab - targets CD20 on B cells

89
Q

what is myeloma

A

Blood cancer, Malignant disease of bone marrow arising from plasma cells

90
Q

Presentation of Myeloma

A

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
Q

pathophysiology of myeloma

A

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
Q

Investigations in myeloma

A

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
Q

Diagnostic criteria for myeloma

A

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
Q

Management of myeloma

A

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
Q

complications of myeloma

A

Hypercalcemia
spinal cord compression
hyperviscosity
Acute renal injury (cause of mortality)

96
Q

What are hyperviscosity syndromes

A

triad of mucosal bleed
Visual disturbance
neurological symptoms

Hayders Phase 2A (10 decks)

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