Medicine - Haematology Flashcards
What tests should you order when querying IDA in a sick vs healthy patient?
No illness: Ferritin
Illness: TIBC, TF, iron
Why? Ferritin is an acute phase protein
What markers will be raised in iron deficiency anaemia?
LDH, haptoglobins, uBR
Differentiate the class of immunoglobulin associated with warm vs cold AIHA?
Warm: IgG
Cold: IgM
How is warm AIHA managed?
Steroids, splenectomy
Recall some causes of warm AIHA
Lymphoma
CLL
Drug allergy
SLE
Recall some causes of cold AIHA
Myclopasma pneumoniae
EBV
CMV
What abnormality would be seen on blood film in warm AIHA?
Spherocytes
What test is used to identify paroxysmal nocturnal haemoglobinuria?
Ham’s test
If warm AIHA and hereditory spherocytosis both have spherocytes, what test can be used to differentiate them?
Coomb’s/DAT test
Positive in AIHA
Neg in HS
Recall 3 possible causes of MAHA
HUS
TTP
Adenocarcinoma
Recall 3 electrolyte abnormalities seen in tumour lysis syndrome
Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia
How should tumour lysis syndrome be managed?
Allopurinol
IV if high risk
PO if low risk
What Hb level indicates packed RBC transfusion?
No ACS: <70g/L
ACS: <80g/L
Recall 4 contraindications for platelet transfusion
Chronic BM failure
Heparin-induced thrombocytopaenia
ITP
TTP
Which inherited thrombophilia increases the relative risk of DVT the most?
Antithrombin III deficiency
What is the prevalence of Factor V Leiden?
5%
What is the most common inherited bleeding disorder?
Von Willebrand
What is the aetiology (broadly) of heparin-induced thrombocytopaenia?
Antibodies form against heparin and platelet factor 4 –> platelet activation via various mechanisms –> PROTHROMBOTIC state (even though it’s a thrombocytopaenia)
Which blood group antigens are most likely to cause a delayed transfusion reaction?
Duffy
Kidd
What % of the population are Rh pos?
85%
What sort of transfusion reaction does Rhesus incompatability cause?
Delayed haemolytic
Recall the storage conditions for RBCs, platelets and FFP
RBCs: 4C for 35 days
Platelets: 22C for 7 days
FFP: frozen
How long does FFP need to thaw?
20-30 mins
How long can RBCs be out of the fridge?
4 hours
Most of the heritable haem disease information
is in the path decks
Recall the parameters of each class of blood loss (depending on % volume lost)
Type 1: 0-15% lost, HR <100, BP normal, cap refill normal
Type 2: 15-30% lost, tachycardic, BP normal, cap refil >2s
Type 3: 30-40% lost, + tachycardic, BP reduced, cap refil >2s
Type 4: >40% lost, ++ tachycardic, BP reduced, cap refil undetectable, anuric
What investigation is required to confirm the diagnosis of ITP?
Blood film
What is the risk of replacing folate without B12 in a patient who is both B12 and folate deficient?
Subacute combined degeneration of the cord
What are the 4 key electrolyte derangements in tumour lysis syndrome?
Hyperkalaemia, hyperuricaemia, hyperphosphataemia,
Hypocalcaemia
How should tumour lysis syndrome be managed?
Rasburicase (allopurinol = prophylaxis)
What sort of cancer does pernicious anaemia predispose to?
Gastric carcinoma
What is the mechanism of action of dabigatran?
Dirent thrombin inhibitor
What does irradiation do to red cells?
Reduces the number of T lymphocytes to reduce the risk of GvHD in people who’ve received lots of blood transfusions
What are the 2 main constituents of cryoprecipitate?
Factor VIII and fibrinogen
What is the first line treatment of ITP?
Oral prednisolone
Main signs of Chronic Myeloid leukaemia
splenomegaly
increased granulocytes
thrombocytosis
treat with Imatinib
Tranmission of what type of infection for platelet transfusion
Bacteria - room temperature
Features of blood product transfusion complications
Non - haemolytic febrile - fever, chills - stop transfusion and give paracetamol
Minor allergic reaction - pruritus - temporailiy stop, give anti-histamine
Anaphylaxis - obvious (IgA def can cause)
Acute haemolytic - ABO incompatible - fever with hypotension - stop, confrim patient, coombs test, cross match - fluid resus - RBC destroyed by IgM antibodies
TACO - pulmonary oedema and hypertension, fast transfusion - stop - IV loop diuretic
TRALI - Non cardiogenic PO, hypotension, pulmonary infilitraes on Xray - stop and give oxygen
What is post-thrombotic syndrome and how is it treated?
venous obstruction and insufficiency as a result of chronic venous hypertension
- pain, pruritus, swelling, varicose and ulceration
Compression stockings once developed
Everything for Hodgkin’s lymphoma
Reed-sternberg - eosinophilic nucleoli (owls eye)
RF: HIV / EBV
Features: Lymphadenpathy, alcohol lymph node pain, B symptoms
Ix: normocytic anaemia, eosinophilia, LDH up and biopsy
Features and treatment for anti-phospholipid syndrome
think recurrent miscarriage etc
low dose aspirin + LMWH once a fetal heart sound seen
Main causes of massive splenomegaly
Myelofibrosis
CML
Visceral leishmaniasis
malaria
gauchers syndrome
Features of G6PD
Neonatal jaundice
heinz - bite and blister cells
check levels 3 months after hemolysis
What drugs can trigger haemolysis in g6pd deficiency?
Anti-malarials - primaquine
ciprofloxacin
sulph - e.g. phonamides
why are irrdiated blood products given?
Avoid transfusion - associated graft versus host disease by destroying T cells
Features of neutropenic sepsis
complication of cancer therapy (7-14 days after)
0.5> neutrophils
high temperautre
staph epidermis most common
fluoroquinolone prophylaxis
ABs immediately - tazocin
if febrile after 48 hrs - vancomycin
Combination of high reticulocyte count and severe anaemia indicate
Sickle cell anaemia
What are the sickle cell crises?
Thrombotic - infection, dehydration, deoxygenation, clinical, infarct other organs
Acute chest syndrome - pulmonary vasculature, dyspnoea, chest pain, pulmonary infilitrates lowpO2 - pain relief
Aplastic - infection parvovirus, sudden hb fall, bone marrow supression = low reticulocyte count
Sequestration crises = pooling of blood, increased reticulotcyte count
Investigation results for VWD
prolonged bleeding time
APTT prolonged
tranexamic acid / desmopression treatment
Features of Beta=thalassaemia major
first yr
microcytic anaemia
HbA2 and HbF raised
HbA absent
transfusion, iron chelation therapy may be needed (desferrioxamine)
Which type of hodgkins gives the worst and best prognosis
lymphocyte predominant - best
depleted - worst
Cancer patients with VTE
6 months of DOAC
1st line imaging for multiple myeloma
whole body MRI
Reversal agent for dabigatran
Idarucizumab
