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YR5 Haematology > Interactive Haematology > Flashcards

Interactive Haematology Flashcards

1
Q

Describe where you would see … myeloblasts
<5%
5-20%
>20%

A

<5%: Normal BM
5-20%: Myelodysplasia
>20%: Acute Myeloid Leukaemia (AML)

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2
Q

Where should myeloblasts never be seen?

A

Peripheral blood
Presence indicates AML or leucoerythroblastic picture

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3
Q

Which cells may contain Auer rods ?

A

Myeloblasts (though not all)

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4
Q

Describe where you would see … lymphoblasts
<5%
>20%

A

<5%: Normal BM
>20%: Acute Lymphoblastic Leukaemia

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5
Q

Give 2 causes of an MCV of 50-70

A

IDA
Thalassaemia

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6
Q

Give 3 causes of an MCV of 100-108

A

Hypothyroidism
Alcoholism
Combined Iron + Folate deficiency

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7
Q

Give 2 causes of an MCV of 115-125

A

B12 deficiency
Folate deficiency

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8
Q

Name 2 B cell markers and what they are epitopes for

A

CD19: CAR T cells
CD20: Rituximab MOAB

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9
Q

Name 4 T cell markers

A

CD3 (Mature)
CD4 (Helper)
CD8 (Cytotoxic)
CD5

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10
Q

Name a marker of lymphoid differentiation

A

TdT: marker of immature T + B lymphoblasts

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11
Q

Name a marker of mature B cells and plasma cells

A

Surface Immunoglobulini

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12
Q

Give 2 causes of raised globulins

A

Monoclonal rise due to lymphoid malignancy: Myeloma
Polyclonal rise as part of reactive response: Infection, SLE, untreated HIV

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13
Q

How does myeloma cause a rise in immunoglobulins?

A

Excess of clonal plasma cells
Plasma cells secrete immunoglobulins
Immune paresis: e.g. in IgG myeloma, massively raised IgG, so remaining IgA + IgM are suppressed

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14
Q

What patterns of abnormalities should you look for when interpreting bloods?

A

Isolated single lineage cytopenia (all other values normal)
Pancytopenia
Isolated single lineage raised (all other values normal)
Isolated single lineage raised (other values suppressed)

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15
Q

How should you look at blood values?

A
  1. As a “group”:
    Hb + MCV
    WBC + differential
    Platelets
  2. Pattern
  3. Morphology
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16
Q

Name 2 conditions in which spherocytes may be seen

A

AIHA
Hereditary spherocytosis

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17
Q

What test determines whether spherocytosis is inherited or acquired?

A

DAT

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18
Q

List 4 causes of hereditary haemolytic anaemia

A

Hereditary spherocytosis
G6PD deficiency
Sickle cell (structural Hb pathy)
Thaalassaemia major (globin chain imbalance)

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19
Q

Name 2 types of acquired immune haemolytic anaemia

A

Autoimmune: linked to other immune disease
Alloimmune: post-blood transfusion

20
Q

Name 4 causes of acquired non-immune haemolytic anaemia

A

Malaria
Drugs
Oxidant drugs
Snake venom

21
Q

List 4 features of haemolytic anaemia regardless of aetiology

A

Unconjugated hyperbilirubinaemia
Reticulocytosis
Raised LDH
Lowered haptoglobins (bind to free Hb, thus are consumed)

22
Q

What distinguishes anaemia of chronic disease from iron deficiency?

A

L Fe: confirms Fe deficiency
N/ H Fe: can be ACD (or Fe deficiency with inflammation)
L/N Transferrin/ TIBC: ACD
H Transferrin/ TIBC: Fe deficiency

23
Q

What is ACD?

A

Anaemia of inflammation, mediated by high hepcidin levels
Body stores Fe adequate but sequestered + unavailable for erythropoeisis

24
Q

How are iron stores sequestered in ACD?

A

Hepcidin is master regulator of Fe
Elevated hepcidin inhibits GI absorption of Fe + sequesters Fe in macrophage + kupffer cells

25
Q

Why are iron stores sequestered in inflammation?

A

Hepcidin is an antibacterial/ inflammatory response protein
Removing available Fe from blood circulation deprives invading bacteria of Fe required for rapid proliferation

26
Q

What can cause an isolated single lineage cytopenia with otherwise normal FBC?

A

Often peripheral destruction/ shortened survival
Less often failure of production

27
Q

What can cause peripheral destruction/ shortened survival resulting in isolated cytopenia?

A

Immune destruction
Non immune: Infections (malaria), mechanical (DIC), consumption sequestration (splenomegaly)

28
Q

What can cause failure of production resulting in isolated cytopenia?

A

Haematinics: Fe deficiency
Drugs causing isolated agranulocytosis

29
Q

What kind of cytopenia is caused by B12/ folate deficiency?

A

Pancytopenia
B12/ folate required for DNA synthesis
Failure in all 3 lineages coming out of BM
More marked in erythroid as more rapid turnover

30
Q

What cytopenia is generally seen with bone marrow disorders?

A

Pancytopenia
Suppression of all lineages

31
Q

Give 2 non malignant causes of pancytopenia

A

DNA synthesis failure (B12/ folate deficiency)
Aplastic anaemia (Chemo drugs, Idiosyncratic post hep C)

32
Q

Give 2 malignant causes of pancytopenia

A

Metastatic non-haematological cancer that has spread to the bone marrow
Haematological cancer infiltrating BM: Acute leukaemia, myelodysplasia, myeloma, lymphoma

33
Q

Name 5 cancers that metastasise to the bone

A

Breast
Prostate
Lung
Thyroid
Kidney

34
Q

What distinguishes non malignant from malignant causes of pancytopenia?

A

Malignant has leucoerythroblastic picture

35
Q

What is the sigle most useful test to confirm the likely haematological diagnosis?

A

BCR ABL 1 RT-PCR assay
for chronic myeloid leukaemia
Blood film: excess white cells, heterogenous, mainly myeloid

36
Q

What is the likely cause of massive splenomegaly +/- hepatomegaly?

A

Chronic myeloid leukaemia

37
Q

What is the likely cause of hepatosplenomegaly and lymphadenopathy?

A

Lymhoid disorders

38
Q

How can CML be monitored during treatment?

A

RT-PCR for % of cells with BCR-ABL fusion protein to get ratio of malignant: normal

39
Q

What is the most useful haematological test? What is the diagnosis?

A

Immunophenotyping for CD19/CD5/CD3
CLL
Blood film: mature normal lymphocytes, lots of smudges/ smear cells (rupture of fragile lymphocytes)

40
Q

Describe the normal expression of CD5 and CD19 in lymphocytes

A

T: CD5 +ve, CD19 -ve
B: CD19 +ve, CD5 -ve

41
Q

What is the worst cell based prognostic factor in CLL?

A

Chr 17p deletion +/- TP53 point mutation

42
Q

What are the clinical issues of CLL?

A

Increased risk of infection: non functional mature B cells + hypogammaglobulinaemia
BM failure: malignant cell proliferation
Lymphadenopathy +/- splenomegaly: spread
Transformation to high grade lymphoma
AI complications e.g. AIHA

43
Q

Name 3 tyrosine kinase inhibitors

A

Imatinib: ABL TK inhibitor
Ruxolotinib: JAK2 TK inhibitor
Ibrutinib: Bruton TK inhibitor

44
Q

What tyrosine kinase inhibitor can be used in the targeted treatment of CLL?

A

Ibrutinib
Deprive B cells of bruton TK to recreate phenotype of lacking B cells which is seen in Bruton’s X-linked agammaglobulinaemia

45
Q

Give 3 treatment options in CLL

A

BCR kinase inhibitors e.g. Ibrutinib
BCL2 inhibitors e.g. Venetoclax
Chimaeric Antigen Receptor T cells (CAR-T)

46
Q

What is the most common cause of renal failure in multiple myeloma?

A

Cast nephropathy
High serum free light chain levels
Can pass through BM in kidneys + precipitate in tubules

YR5 Haematology (20 decks)

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