Hematology Flashcards
Disproportionate Microcytic hypochromic anaemia = Hb=slightly less(110) + MCV = a lot lesser ( 60s) + Fatigue/Asymptomatic+ Raised HbA2 + basophilic stipling and target cells.Dx:
B thalasemia Trait.
B thalasemia Trait.
Disproportionate Microcytic hypochromic anaemia = Hb=slightly less(110) + MCV = a lot lesser ( 60s) + Fatigue/Asymptomatic.
Basophilic stippling with occasional target cells
Electrophoresis result in B thalasemia trait ?
Raised HBA2.
Blood film/ type of cells in B thalasemia trait ?
Basophilic stipling and occasional target cells.
Diagnostic test of B thalasemia trait ?
Haemoglobin electrophoresis = Raised HBA2.
Which mutation in Polycythemia Rudra Vera ?
JAK 2 Mutation.
Pruritis after bath + epistaxis + recurrent infection + splenomegaly+
Stroke history
JAK 2 mutation + all 3 : hb , tlc, platelet: all increased. Think :
Polycythemia Rubra Vera.
Polycythemia rubra Vera can lead to which condition :
AML and Myelofibrosis.
C/o SOB+ Lethargy+ night sweats+ Bone pain + H/o Polycythemia Rubra Vera. Which cancer most likely /
Acute Myeloid leukemia.
Marked spherocytosis + DAT= negative. Dx:
Hereditary Spherocytosis.
Marked spherocytosis + DAT=Positive. Dx:
Autoimmune Hemolytic Anaemia.
( AIHA)
Diagnostic test in Hereditary Spherocytosis :
EMA binding test.
H/O Hereditary Spherocytosis + Now : viral infection—Presents with weakness and lethargy.
Hemolytic crisis secondary to hereditary Spherocytosis.
Rx: Folic acid + - Fluids, Supportive Rx
Rx for Hemolytic crisis secondary to H.Spherocytosis : Rx:
Folic acid.
What genotype is associated with a milder form of sickle cell ?
HBSc.
Which UTI meds can lead to pancytopenia ?
Trimoethoprim.
Most common symptom of Myelofibrosis :
Fatigue.
What type of cells in Myelofibrosis :
Tear drop cells.
What is increased in Myelofibrosis, indicating high turnover ?
Urea and LDH.
What is increased in early stage of Myelofibrosis ?
High WBC and High Platelet count.
What indicates Dry tap in Myelofibrosis ?
Unable to take bone marrow sample.
Elderly + Basophilia + Massive splenomegaly. Dx:
Chronic Myeloid Leukemia.
Mutation In CML ?
BCR- ABL ( Tyrosine Kinase pathway)
Rx in CML ?
Tyrosine Kinase Inhibitor ( Imatinib)
Poor prognosis in CLL :
Deletion of 17p13 region.
K/C/O Sickle cell + Throbbing pain in leg. Dx and Investigation to diagnose :
Dx: Vaso occlusive crisis.
Ix: No Ix required. Dx is clinical.
Transfusion—SOB+ Decrease in BP. Dx and Rx?
Transfusion related acute lung injury. ( TRALI)
Rx: IV fluids + oxygen + escalation of care.
20-30 year old + low in IgA, IgG, IgM+ Recurrent chest infection. Dx:
Common variable immunodeficiency syndrome.
Lethargy + Splenomegaly +JAK 2 + High Urea and LDH + WBC and Platelets : slightly Raised. Dx and blood film :
Myelofibrosis
Tear drop cells
Dapsone + Dyspnoea =
Methhaemoglobinaemia.
Neutropenic sepsis is caused by :
Staphylococcus epidermidis.
Staphylococcus epidermidis is gram ?
Gram Positive , coagulase negative.
mechanism of action of DDAVP in von Willebrand’s disease?
Induces release of von Willebrand’s factor from endothelial cells
Antibiotic which causes hemolysis in G6PD?
Ciprofloxacin, sulphamethaxole, co trimoxazole.
Acute myeloid leukaemia - poor prognosis:
Deletion of chromosome 5 or 7
TTP features and Rx:
Terrible Pentad : Fever + Neuro. + Anaemia+ Decrease in Platelets + AKI= Increase in Urea and Creat.
Rx: Plasma Exchange.
TTP deficiency of what:
Inhibition or deficiency of ADAM TS 13 = leads to failure to cleave VWF multimers.
In TTP, The deficiency of ADAM TS 13 leads to what :
Leads to failure to cleave VWF multimers.
Wiscot Aldrich syndrome, features and mnemonic :
WATER:
WA:Wiscot Aldrich, WASP gene mutation.
T: Thrombocytopenia: Decrease in platelets
E: Eczema
R: Recurrent pyogenic infection.
Both B and T cell deficiency :
Wash your B and Ts:
Wiscot
Ataxia Telangiectasia
SCID
Hyper IgM syndrome.
B cell deficiency :
ABC:
A: IgA deificiency
B : Brutons
C: Common variable immunodeficiency
Recurrent bruising + Recurrent infection + eczema + low platelet + anaemia
Wiscot Aldrich syndrome.
Most common type of lung cancer in non smokers:
Lung Adenocarcinoma.
Rabiscurase MOA:
Converts uric acid to allantoin.
Most common symptom of Superior vena cava obstruction :
Dyspnoea.
Hodkin’s Lymphoma poor prognosis
Fever
Weight loss
Night sweats
The universal donor of fresh frozen plasma is :
AB RhD negative blood
Myelofibrosis: High or Low LAP ?
High LAP score.
Haemophilia A , which factor ?
Factor 8 ( Aight)
Haemophiila B , which factor ?
Factor 9
Haemophilia clinical features ?
Haemarthroses.
Haematomas.
Prolonged Bleeding after surgery.
Anaphylactic reaction to bee sting, First line Ix:
Radio allergosorbent assay. ( RAST)
In Acute myeloid leukaemia. What is the single most important test in determining his prognosis?
Cytogenetics.
Cytogenetics detects chromosomal abnormalities—which has biggest effect on AML prognosis.
Cytogenetics detects what ?
C=C= Chromosomal Abnormalities.
Neutropenic sepsis Rx?
Filgrastim.
K/c/O cancer= Hodkins + Recent chemo+ C/o : Fever+ Neutrophils= < 0.5 10^9. Dx:
Neutropenic Sepsis.
Aetio of Neutropenic Sepsis:
Staph epidermidis.
Gm + cocci, Coagulase Negative.
In Hemolysis, Haptoglobin: Increase or Decrease ?
Haptoglobin decreases.
As Haptoglobin binds to free haemoglobin.
1 adrenaline
2 adrenaline
>2 adrenaline . Admit for how many hours ?
1 Adrenaline= Admit for 2 hours.
2 Adrenaline= Admit for 6 Hours.
>2 Adrenaline = Admit for 12 hours.
Aprepitant MOA:
Antiemetic which Binds to NK1 receptor( Chef wearing Apron , Nikon Camera)
Which products are used to avoid transfusion-associated graft versus host disease?
Irradiated Blood products.
Acute myeloid leukaemia - good prognosis:
good prognosis: t(15;17)
Woman with bone metastases- most likely to originate in the :
Breast
Isolated neutropenia in which ethnicity ?
Black Afro Caribbean.
Gallstones is common in which blood disorder ?
Hereditary Spherocytosis.
Philadelphia chromosome good or bad prognosis in ALL ?
Bad prognosis
VIT B12 absorption ?
Active transport in terminal ileum
Taxanes MOA:
Prevents micro tubules polymerisation.
T(9:22)
Philadelphia chromosome in CML.
Transmission of which type of infection is most likely to occur following a platelet transfusion?
Bacterial.
What is the single most important factor in determining whether cryoprecipitate should be given?
Low fibrinogen.
Pt on warfarin—Trauma—#ge—blood transfusion—which blood product to give additionally?
Prothrombin complex concentrate.
Best Prognosis in Hodkins:
Lymphocyte Rich ( Rich ppl have better bank accounts)
Worst Prognosis in Hodkins :
Lymphocyte Depleted ( Poor ppl have depleted bank accounts )
The oncologist recommends starting a medication which can specifically target this type of breast cancer in post-menopausal women only
Aromatase inhibitor- Azoles.
CKD is the most common cause of Which clotting factor deficiency ?
Anti thrombin 3.
Anterior mediastinal mass + symptoms of myasthenia = Dx and Ix of choice:
Thymoma.
Ix of choice : CT scan of chest.
Thymoma clinical features.:
Anterior mediastinal mass + symptoms of myasthenia = thymoma
Prostrate cancer—new onset back pain+ Peri anal numbness + leg weakness. Dx and Rx:
Neoplastic spinal cord compression.
Rx: high dose dexamethasone orally immediately.
Painless neck lump + B symptoms. Dx and Translocation:
Follicular Lymphoma.
Translocation: t( 14, 18)
Transfusion + now—fever chills rigors. Dx and Cause:
Dx: Transfusion related infection
Cause: platelets
Screening for Hereditary angioedema?
C4 levels
What is not involved in patho of hereditary angioedema?
Histamine.
Isolated thrombocytopenia +Increase in bleeding time. Easy bruising + Epistaxis. Dx and Rx?
ITP
Rx: oral prednisolone.
ITP Rx:
Oral prednisolone.
In ITP antibodies are against :
Glycoprotein 2b/3a complex.
Cells seen in DIC:
Schistocyte.
DIC mnemonic and features:
Damn I am clotting.
Decreased Fibrinogen + Increased D dimer.
Decreased Fibrinogen + Increased D dimer. Dx?
DIC
CML , LAP score , high or low ?
Low.
Family H/o + Abd pain + Neuro symptoms- hallucinations , agitation , change of mood + reduced sensation of foot +
Acute intermittent porphyria.
Dx of Acute intermittent porphyria :
Porphobilinogen.
Rx for Acute intermittent porphyria :
Heme.
Bombesin is a tumour marker in
Small cell lung cancer
Small cell lung cancer tumour marker:
Bombesin.
Tumour lysis syndrome. Rx:
Rasburicase + IV Fluids.
Tumour lysis syndrome mnemonic and electrolytes :
UKPc: Increase in urea, creat, phosphate,
Decrease in calcium.
H/o Breast cancer + Osteosarcoma. Most likely Dx:
Li Fraumeni syndrome.
Tumour marker in Li Fraumeni :
P53.
Difference bw TRALI and TACO:
No Hypotension in TRALI.
Post splenectomy which types of cells are seen ?
Howel Jolly bodies.
Which diabetic drugs causes hemolysis in G6PD?
Sulphonamides- Glimepiride.
Biguinide- Metformin.
Which bodies are seen in Leukamoid reaction:
Dohle bodies.
Leukamoid reaction features:
High LAP score
Dohle Bodies
Left shift of neutrophils.
which direction of shift of neutroohils in Leukamoid reaction ?
Left direction shift.
Heparin binds which clotting factor ?
Antithrombin 3.
Which one of the following causes of thrombophilia is associated with resistance to heparin?
Antithrombin 3 deficiency.
Which urine test in lead poisoning ?
Increase in urinary coproporphyrin.
Blood picture in lead poisoning
Microcytic anaemia plus basophilic stipling.
Pt started on warfarin+ Now develops necrotic skin condition : Dx
Protein c deficiency.
Protein c deficiency= Hypercoaguable state + warfarin= blood thinner= this imbalance leads to necrotic skin condition.
Thymoma assn :
Myasthenia gravis
Red cell aplasia.
Dermatomyositis
SIADH
Food allergy test:
Skin prick test.
JAK 2 + isolated increase in platelets. Dx:
Essential Thrombocytosis.
Rx: Hydroxyurea ( Hydroxycarbamide)
Essential thrombocytosis. Rx
Hydroxycarbamide.
Coeliacs causes which type of spleen issues ? And causes which type of cells to appear /
Hyposplenism.
Howell jolly bodies.
Diagnostic test in anaphylaxis
Serum tryptase.
Cyclophosphamide Adverse and its prevention :
Haemorhagic cystitis
Prevention: MESNA
H/o Sickle cell disease. Hb, WBC, Platelet : all three decreased. C/o fever cough myalgia. Dx:
Aplastic crisis
Raynauds + waldernstrom. Dx: which type ?
Type 1 cryoglobulinaemia.
Hepatitis c + Waldenstriom, which type ?
Type 3 cryoglobulinaemia.
_____is the empirical antibiotic of choice for neutropenic sepsis
Piperacillin with tazobactam (Tazocin)
Dyspnoea + Normal PO2+ Decreased SPO2. Dx:
Methhaemoglobinaemia.
Rx:IV methylthioninium chloride (methylene blue) if acquired
Rx of Methhaemoglobinaemia.
IV methylthioninium chloride (methylene blue) if acquired
PE+ Recurrent DVT- unprovoked. DX:
Activated protein c resistance( Factor 5 Leiden)
Which antibiotics causes Methhaemoglobinaemia ?
Sulphamethaxzole—Co-trimoxazole.
Which infection ass with MALT= gastric lymphoma
H.Pylori.
Cisplatin MOA:
Cross linking in DNA.
Methaemoglobinaemia Patho :
oxidation of Fe2+ in haemoglobin to Fe3+
Intravascular hemolysis mnemonic :
MRCGP
Mismatch blood transfusion
Red cell fragmentation- heart valves,TTP
G6PD
Paroxysmal nocturnal haemoglobinaemia.
Paroxysmal nocturnal haemoglobinaemia diagnostic investigation :
Cytometry- To detect low levels of CD55 and CD59.
Most common type of Hodkins lymphoma :
Nodular Sclerosing.
Acute intermittent porphyria is deficiency due to :
Porphobilinogen deaminase
Anaphylaxis - serum tryptase reach peak at :
Serum tryptase reach peak at one hour.
SVC obstruction Rx:
Dexamethasone.
Hodkins lymphoma- spread to other organs. Which stage ?
Stage 4
Which mutation is associated with prostate cancer in men?
BRACA 2
BRAC-2 in men mnemonic :
BP2:
Breast
Prostrate
Pancreas.
Hodkins = both sides of diaphragm , which stage ?
Stage 3
Abd pain + red coloured urine+ rapid weakness in legs. Dx :
Acute intermittent porphyria.
Sickle cell patients should be started____ to reduce the incidence of complications and acute crises
started on long term hydroxycarbamide/hydroxyurea.
most common primary tumour that metastasises to the bone in men :
Prostrate cancer.
Patients starting rituximab should be screened for__
Hepatitis B before starting treatment
Hereditary angioedema is caused by deficiency of___
C1 esterase inhibitor
Baseline haemoglobin of 110g/L: sudden drop of Hb—H/o Sickle cell. Dx:
Aplastic Crisis.
Sideroblastic anaemia causes and mnemonic :
MALT:
Myelodysplasia.
Alcohol.
Lead
Anti TB drugs.
Anti TB drugs causes which type of anaemia ?
Sideroblastic anaemia.
Which stain in Sideroblastic anaemia ?
Pearl’s stain.
Rx of Sideroblastic anaemia :
Pyridoxine.
Burkits lymphoma Translocation:
T(8,14)
Which gene in Burkits lymphoma?
C-Myc.
Which virus in Burkits lymphoma ?
Epstein Barr virus.
Biopsy findings in Burkits lymphoma ?
Starry sky appearance.
Growth in Jaw + Starry sky appearance. Dx:
Burkits lymphoma.
ESR value in polycythemia Rubra Vera :
Low
Rx for hairy cell leukemia:
Interferon alpha.
H/o h.spherocytosis + Episodic upper abdomen pain. Dx:
Billiary colic.
How is capecitabine Administered ?
Orally.
Which sex is a good prognosis in CLL ?
Female sex.
most common inherited bleeding disorder:
Von WIllebrand disease.
most useful marker of prognosis in myeloma?
B2 Microglobulin.
Which is not a treatment modality in ITP ?
Plasma exchange.
Alpha thalasemia on which chromosome ?
Chromosome 16.
Olanzapine, an atypical antipsychotic Ass with increased risk of :
VTE.
primary immunodeficiency is due to a defect in neutrophil function?
Chronic Granulomatous disease.
Common variable immunodeficiency Is due to defect in which primary immunodeficiency ?
B cell function.
Mnemonic- ABC
A- IgA deficiency
B- Brutons agammaglobulinaemia
C- common variable immunodeficiency anaemia
Ovarian cancer tumour marker :
CA 125.
Peritoneal cancer tumour marker :
CA 125.
Pancreatic cancer tumour marker
CA 19 9
Breast cancer tumour marker :
CA 15 3
H/o Polycythemia rubra + petechia + gingival bleeding+ DIC picture. Dx:
Acute Promyelocytic leukemia
Which of the following chemotherapy agents is most likelcy responsible for hypomagnesemia ?
cisplatin.
Aromatase inhibitors common side effects in post menopausal women ?
Osteoporosis
The presence of haemolysis with blister cells on the blood film is highly suggestive of____
G6PD deficiency
Blood smear of G6PD:
Heinz bodies
Bite cells
Blister cells.
Anti malarials causes hemolysis in :
G6PD
Translocation of Acute promyelocytic leukaemia :
t(15;17)
T(15;17)
Acute Promyelocytic leukaemia.
irinotecan MOA:
Inhibition of topoisomerase 1.
Methhaemoglobinaemia. Po2 and spo2 level :
Normal PO2 and low Spo2( low oxygen saturation)
Recurrent pancreatitis + Recurrent parotitis. Dx:
IgG4 disease.
which gene proliferation in follicular lymphoma ?
Increases BCL2 transcription
Hereditary angioedema mode of inheritance ?
Autosomal Dominant.
Doxorubicin Adverse:
Cardiomyopathy
Vincristine Adverse :
Peripheral neuropathy.
Imatinib MOA:
Tyrosine kinase inhibitors
Ototoxicity is caused by which Anti cancer drugs ?
Cisplatin.
Cisplatin adverse :
Hypomagnesemia
Ototoxicity
Peripheral neuropathy
Acute Promyelocytic leukemia Rx:
All-trans retinoic acid (ATRA)
Abdomen pain, diarrhoea and progressive weakness and pain in the limbs. She looks low in mood and tearful at times. You ask for a urine sample and leaves it standing near the window. 20 minutes later, you notice that the urine has become darker.
Acute intermittent porphyria
M protein > 30 g/l + monoclonal plasma cell infiltrate.
▪︎No CRAB features. Dx and Rx:
Smouldering Multiple Myeloma.
Rx: Observe and Monitor.
Cyclophosphamide - MOA:
Causes cross-linking in DNA
HTLV1 association :
Adult T cell leukemia
Do fungal infection cause eosinophilia ?
No
IgG paraprotein level in MGUS?
<30 g/L
4 year old + Splenomegaly + clinically anaemic+ H/o Sickle Cell :
Sequestration crisis.
IV drug user + hep C + Rheumatoid arthritis +Purpuric Rash + low C4. Dx:
Cryoglobulinaemia.
Megaloblastic Anaemia Rx
Intramuscular vitamin B12 + start oral folic acid when vitamin B12 levels are normal
Congenital cause of Methhaemoglobinaemia :
NADH methaemoglobin reductase deficiency
H/o H Spherocytosis—C/o- Lethargy. Hb low , Retic=low. Dx:
Parvo virus infection.
In Hemolytic anaemia, retic count is high. It’s Low here.
Most useful follow-up investigation(s) to detect disease recurrence in testicular cancer.
Alpha-fetoprotein + beta-HCG.
weight loss, anaemia, splenomegaly, + Leucocyte with all stage of maturation. Dx:
CML
T(11,14):
Mantle Cell Lymphoma.
What chemical mediator is mainly responsible for the tissue oedema seen in patients in hereditary angioedema?
Bradykinin.
Does penicillin cause G6PD?
No.
Treatment of hereditary angioedema?
Anabolic steroids.
Is dermatomyositis ass with Thymoma ?
yes
Is motor neuron disease ass with Thymoma ?
No.
Which two anaemias are seen in PNH ?
hemolytic anaemia and aplastic anaemia.
Which test is positive in PNH ?
Positive Ham test.
Is hemearthosis a feature of PNH ?
No. its seen in haemophilias.
Lead poisoning mnemonic and features:
LEADS
L- lead lines on gingival
E- encephalopathy
A- Abdomen colic
D- wrist drop- peripheral neuropathy.
Type of cell seen in lead poisoning:
Microcytic Anaemia + basophilic stipling.
Mode of inheritance in Wiscot :
X linked recessive( water down)
SVC obstruction is caused by primary malignancy or metastatic malignancy ?
Primary malignancy.
Stoke + isolated increase in platelets. Dx and Mutation :
Dx: Essential thrombocytosis.
Mutation : JAK 2 mutation.
Mutations seen in essential thrombocytosis:
JAK 2 mutation and CALR
Which toxin leads to hepatocellular cancer ?
Aflatoxin
Elderly + Increase in Lymphocytes + which cancer ?
Chronic Lyphocytic Leukemia.
Investigation of choice in CLL :
Flow Cytometry/Immunophytic - detects Antibodies on the surface
Deletion of which chromosome in
Deletion of Long arm chromosome 13.
Unusual taste in mouth is a classical feature of :
LEAD poisoning.
Abdominal pain, constipation, neuropsychiatric features, basophilic stippling
Lead poisoning.
itchiness in her mouth and at the back of her throat after consuming peaches on several occasions with some mild swelling which settles down over time + Seasonal Variation:
Oral allergy syndrome.
Which of the following has a role in monitoring disease activity in colorectal cancer?
CEA
Difference between H. Angioedema and anaphylaxis :
H.angioedema has painful macular rash.
Skin manifestation in anaphylaxis is : urticaria.
Methotrexate MOA:
inhibits dihydrofolate reductase and thymidylate synthesis
Urinary findings in Acute Intermittent Porphyria.
Increased urinary porphobilinogen between acute attacks
Imp Adverse of SERM:
DVT
DVT in pregnancy. Rx:
Low molecular Weight Heparin.
(Heparin helps in pregnancy )
Rituximab acts against :
CD 20 and B cells
What to screen before giving Rituximab?
Patients starting rituximab should be screened for hepatitis B before starting treatment
Is Haemochromatosis ass with Polycythemia?
No.
Is dehydration ass with Polycythemia ?
Yes
Common causes of polycythemia ?
Polycythemia Rubra Vera.
COPD.
Stress/ Dehydration.
Fibroids.
Hypernephroma.
If allergy to latex, then allergy to which food ?
Banana
Hypodiploidy : Good or Bad prognosis In ALL ?
Bad prognosis
Epistaxis + Bleeding Gum+ Bilobed large nuclear cells. Dx:
Acute myeloid leukemia.
K/C/O Sickle + Fever + Dyspnoea + low spo2 + CXR= opacification.
Dx: Acute chest syndrome
Rx: Oxygen, IV FLuids, Incentive spirometry.
CLL - treatment:
Fludarabine, Cyclophosphamide and Rituximab (FCR)
MGUS+ Organomegaly + No bone lesions. think :
Waldenstorm
Headache+ epistaxis + hepatospleomegaly + Pancytopenia + IgM peak. Dx:
Waldernsotrm.
Which peak in waldenstorm ?
IgM Peak
Blood picture in Waldensorm :
Pancytopenia
What type of blood cells in Waldenstorm ?
B lymphocytes + Plasma cells
DVT plus IgM peak. Dx?
Waldenstorm.
DVT= Hyperviscocity syndrome
CLL is due to :
Monoclonal Proliferation of B lymphocytes.
Complications developed in Waldenstorm :
Hyperviscocity complications ( Headache, DVT)
Cancer patients with VTE Rx:
Continue DOAC for 6 months.
Provoked VTE Rx:
DOAC for 3 Months
Unprovoked VTE Rx:
DOAC for 6 Months
Elderly + Absolute Lymphocytosis. Dx:
CLL
Type of cells in CLL :
Smudge cells.
Diagnostic test for CLL.
Flow Cytometry/ Immunophenotyping : to detect antibodies.
Warm autoimmune Hemolytic anaemia is ass with Ig?
IgG
It’s warm in G=Ghana( Outside Uk)
Cold autoimmune Hemolytic anaemia is ass with ig?
IgM
It’s miserable in Manchester.
Coombs test ( DAT test) in warm autoimmune Hemolytic ?
Coombs or DAAT : Positive.
Recurrent infection in CLL is due to :
hypogammaglobulinaemia
Which type of anaemia occurs in CLL as complication:
Warm autoimmune haemolytic anaemia
Common complication in warm autoimmune Hemolytic anaemia ?
Lymphoma.
Raynauds+ Spherocytosis. Dx and First line Ix?
Next line Ix: Direct antiglobulin test (DAT)
Dx: Autoimmune Hemolytic anaemia.
