Medgems 27/05/24 Flashcards
PT has beta thalassaemia
pre transfusion bloods show a raised WCC and low haemoglobin
clinically well
apyrexial
what blood test do you need?
why?
reticulocyte count
ribosomes in immature RBC stain darkly as they are basophilic
so can appear as WCC
need to differentiate to know what is happening especially as a she has beta thalassaemia
reticulocytes can be misread as neutrophils
what is tumour lysis syndrome?
what complications can arise?
rapid destruction of tumour cells = intracellular release
renal failure
arrythmia
death
what does the cairo bishop score ?
potassium >6
phosphate >1.125
calcium <1.75
urate >475umol/l
TLS
how to manage TLY
IV allopurinol
rasburicase
pre treatment
monitoring is mainstay
Man presents to his out of hours GP with the following symptoms
nausea with vomiting
lack of appetite and palpitations
these came on in the last hour
he had just got home from his chemo appointment
tumour lysis syndrome
what is low in vWF disease?
APTT prolonged
low factor 8
and prolonged bleeding time
what is the link between vWF and factor 8
factor 8 is bound to vWF so in vWF disease factor 8 is rapidly degraded
affects aptt
why does haemophilia not prolong bleeding time?
it is a clotting disorder
bleeding is determined by platelets and vWF which are normal in haemophila
A- factor8
B-9
can a 20 year old girl have haemophilia A?
haemophilia is x-linked
so must have a copy from both dad and mum
t(8;14)
burkitt’s
cmyc
BCR-ABL fusion gene is which transloctaion?
9;22
t(14;18)
follicular lymphoma
BCL-2
what is relevance of myc gene?
put’s it next to a immunoglobulin making gene
myc causes division
sheets of large lymphocytes
diffuse
macrophages clearly contain apoptotic lymphocyte would be?
what is this appearance described as on microscopy?
starry sky
phagocytosed lymphocytes
c-MYC gene translocation 8;14
hereditary elliptocytosis
autosomal dominant
unexplained IDA should be investigated how?
OGD
colonoscopy
urine dip and Ix for coeliac
IDA in developing world?
hookworm
fibrin degredation product blood test?
D dimer
haptoglobin measures?
normally binds free Hb released from RBC during haemolysis
to tag it to be cleared by reticuloendothelial system
low haptoglobin means haemolysis is happening faster than haptoglobin can bind to free haemoglobin
pencil cell other names?
cigar
helmet
can suggest schistocyte
genetic condition that affects the synthesis of haem molecule; haemoglobin, peroxidase , p450
porphyria
cytochrome p450 enzymes
thrombocytosis in a smoker is a reason for urgent 2ww referral for suspected lung cancer?
T/F
true
DVT in upper limb consider extrinisic compression of upper limb venous return
also think malignancy if upper limb DVT ; d dimer and platelet high
as hypercoagulable blood in malignancy
Rivaroxaban is a ?
reversal agent?
DOAC
andexanet alfa
