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[EDITED] ICSM Year 6 + edits > Medicine - Haematology > Flashcards

Medicine - Haematology Flashcards

1
Q

What tests should you order when querying IDA in a sick vs healthy patient?

A

No illness: Ferritin

Illness: TIBC, TF, iron

Why? Ferritin is an acute phase protein

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2
Q

What markers will be raised in iron deficiency anaemia?

A

LDH, haptoglobins, uBR

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3
Q

Differentiate the class of immunoglobulin associated with warm vs cold AIHA?

A

Warm: IgG

Cold: IgM

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4
Q

How is warm AIHA managed?

A

Steroids, splenectomy

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5
Q

Recall some causes of warm AIHA

A

Lymphoma
CLL
Drug allergy
SLE

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6
Q

Recall some causes of cold AIHA

A

Myclopasma pneumoniae
EBV
CMV

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7
Q

What abnormality would be seen on blood film in warm AIHA?

A

Spherocytes

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8
Q

What test is used to identify paroxysmal nocturnal haemoglobinuria?

A

Ham’s test

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9
Q

If warm AIHA and hereditory spherocytosis both have spherocytes, what test can be used to differentiate them?

A

Coomb’s/DAT test
Positive in AIHA
Neg in HS

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10
Q

Recall 3 possible causes of MAHA

A

HUS
TTP
Adenocarcinoma

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11
Q

Recall 3 electrolyte abnormalities seen in tumour lysis syndrome

A

Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia

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12
Q

How should tumour lysis syndrome be managed?

A

Allopurinol
IV if high risk
PO if low risk

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13
Q

What Hb level indicates packed RBC transfusion?

A

No ACS: <70g/L

ACS: <80g/L

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14
Q

Recall 4 contraindications for platelet transfusion

A

Chronic BM failure
Heparin-induced thrombocytopaenia
ITP
TTP

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15
Q

Which inherited thrombophilia increases the relative risk of DVT the most?

A

Antithrombin III deficiency

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16
Q

What is the prevalence of Factor V Leiden?

A

5%

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17
Q

What is the most common inherited bleeding disorder?

A

Von Willebrand

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18
Q

What is the aetiology (broadly) of heparin-induced thrombocytopaenia?

A

Antibodies form against heparin and platelet factor 4 –> platelet activation via various mechanisms –> PROTHROMBOTIC state (even though it’s a thrombocytopaenia)

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19
Q

Which blood group antigens are most likely to cause a delayed transfusion reaction?

A

Duffy

Kidd

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20
Q

What % of the population are Rh pos?

A

85%

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21
Q

What sort of transfusion reaction does Rhesus incompatability cause?

A

Delayed haemolytic

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22
Q

Recall the storage conditions for RBCs, platelets and FFP

A

RBCs: 4C for 35 days
Platelets: 22C for 7 days
FFP: frozen

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23
Q

How long does FFP need to thaw?

A

20-30 mins

24
Q

How long can RBCs be out of the fridge?

A

4 hours

25
Q

Most of the heritable haem disease information

A

is in the path decks

26
Q

Recall the parameters of each class of blood loss (depending on % volume lost)

A

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

27
Q

What investigation is required to confirm the diagnosis of ITP?

A

Blood film

28
Q

What is the risk of replacing folate without B12 in a patient who is both B12 and folate deficient?

A

Subacute combined degeneration of the cord

29
Q

What are the 4 key electrolyte derangements in tumour lysis syndrome?

A

Hyperkalaemia, hyperuricaemia, hyperphosphataemia,

Hypocalcaemia

30
Q

How should tumour lysis syndrome be managed?

A

Rasburicase (allopurinol = prophylaxis)

31
Q

What sort of cancer does pernicious anaemia predispose to?

A

Gastric carcinoma

32
Q

What is the mechanism of action of dabigatran?

A

Dirent thrombin inhibitor

33
Q

What does irradiation do to red cells?

A

Reduces the number of T lymphocytes to reduce the risk of GvHD in people who’ve received lots of blood transfusions

34
Q

What are the 2 main constituents of cryoprecipitate?

A

Factor VIII and fibrinogen

35
Q

What is the first line treatment of ITP?

A

Oral prednisolone

36
Q

Main signs of Chronic Myeloid leukaemia

A

splenomegaly
increased granulocytes
thrombocytosis

treat with Imatinib

37
Q

Tranmission of what type of infection for platelet transfusion

A

Bacteria - room temperature

38
Q

Features of blood product transfusion complications

A

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

39
Q

What is post-thrombotic syndrome and how is it treated?

A

venous obstruction and insufficiency as a result of chronic venous hypertension
- pain, pruritus, swelling, varicose and ulceration

Compression stockings once developed

40
Q

Everything for Hodgkin’s lymphoma

A

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

41
Q

Features and treatment for anti-phospholipid syndrome

A

think recurrent miscarriage etc
low dose aspirin + LMWH once a fetal heart sound seen

42
Q

Main causes of massive splenomegaly

A

Myelofibrosis
CML
Visceral leishmaniasis
malaria
gauchers syndrome

43
Q

Features of G6PD

A

Neonatal jaundice
heinz - bite and blister cells

check levels 3 months after hemolysis

44
Q

What drugs can trigger haemolysis in g6pd deficiency?

A

Anti-malarials - primaquine
ciprofloxacin
sulph - e.g. phonamides

45
Q

why are irrdiated blood products given?

A

Avoid transfusion - associated graft versus host disease by destroying T cells

46
Q

Features of neutropenic sepsis

A

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

47
Q

Combination of high reticulocyte count and severe anaemia indicate

A

Sickle cell anaemia

48
Q

What are the sickle cell crises?

A

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

49
Q

Investigation results for VWD

A

prolonged bleeding time
APTT prolonged

tranexamic acid / desmopression treatment

50
Q

Features of Beta=thalassaemia major

A

first yr
microcytic anaemia
HbA2 and HbF raised
HbA absent

transfusion, iron chelation therapy may be needed (desferrioxamine)

51
Q

Which type of hodgkins gives the worst and best prognosis

A

lymphocyte predominant - best
depleted - worst

52
Q

Cancer patients with VTE

A

6 months of DOAC

53
Q

1st line imaging for multiple myeloma

A

whole body MRI

54
Q

Reversal agent for dabigatran

A

Idarucizumab

55
Q
A

[EDITED] ICSM Year 6 + edits (28 decks)

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