Q's I got wrong Flashcards
In the management of B12 and Folate deficiency, which should be replaced treated first and why?
B12
- To avoid subacute degeneration of the spinal cord.
What is Paroxysmal Nocturnal Haemoglobinuria?
A rare type of haemolytic anaemia associated with aplastic anaemia in which the Complement system targets and destroys RBC’s.
What types of signs would a patient with Paroxysmal Nocturnal Haemoglobinuria displpay?
Patients complain of Dark urine (especially in morning due to higher concentration of urine in morning)
- Symptoms of anaemia
- Erectile dysfunction
- Dysphagia
What type of mutation causes Paroxysmal Nocturnal Haemoglobinuria?
A mutation in the PIG-A gene of Haematopoietic stem cells leading to a deficiency of Glycosyl-Phospatidylinositol anchor proteins.
What are Auer rods common in?
AML
What would VWD show on APTT and PT?
Decreased factor VIII leads to prolonged APTT and but normal PT.
What drug can cause heamolytic crisis in G6PD?
Nitrofurantoin.
What is Aplastic Anaemia?
A type of Anaemia characterisedby a deficiency of all types of blood cells due to failure of the bone marrow to produce them. (pancytopenia on blood film)
What are some causes of Aplastic Anaemia?
Radiation, Chemotherapy, Certain medications, Autoimmune disorders.
What would Anaemia of Chronic disease do to serum Iron and Serum Ferritin?
Cause a Low Serum Iron and Normal / High serum ferritin.
What are Non-Hodgkins lymphomas?
A group of malignancies that affect the lymphoid system.
How are Non-hodgkins lymphomas distinguishable from other lymphomas?
The Absence of Reed-Seternberg cells in Non-Hodgkins.
How do Non-hodgkins Lymphomas usually present?
Painless, Symmetrical Lymphadenopathy associated with B symptoms (fever, Night sweats, and weight loss)
What blood tests are important in a non-hodgkins lymphoma?
LDH is the most important - an elevated LDH is a poor prognostic indicator.
(reflects greater red cell turnover)
- Blood tests
- Blood film
Increased marrow involvement and turnover in particularly high-grade cancers Blood films may show characteristic left shift, what does this mean?
Left shift refers to the presence of early white blood cell precursors (not yet fully matured neutrophils and such)
What test is required to define the subtype of non-hodgkins lymphoma?
Biopsy
what is a smear blood test?
A laboratory technique used to examine blood cells under a microscope which involves spreading a drop of blood thinly on a glass slide, fixing it, staining it then viewing it.
What are smear cells and when are they seen?
Smear cells, also known as smudge cells or basket cells, are a type of abnormal finding observed on a peripheral blood smear. These cells appear as fragmented or ruptured lymphocytes or monocytes that have been disrupted during the preparation of the blood smear.
- commonly seen in CLL as the delicate lymphocytes are damaged.
In which Haematological Malignancy is Splenomegaly most common?
CML
What drugs are used in anti-parasitic therapy? (of Taeniasis / tapeworm)
Praziquantel and Niclosamide.
How is Tapeworm contracted?
By eating uncooked pork or beef as the eggs are laid in meat.
What should you think when a patient described “grapefruit seeds” in their stool?
These are Proglottids - Tape worm segments
What is a Wells score used to calculate the risk of?
DVT
What is the range of a wells score and at what score is DVT likely?
-2 to 10
DVT likely with a score of 2 or more.
What should be done first in a suspected DVT with a wells score of 2, US doppler or Anticoagulation?
A Score of ≥ 2 means DVT is likely.
NICE recommends a proximal vein US should be carried out within 4 hrs of a suspected lower limb DVT and Wells score of ≥ 2.
Anticoagulation should only be done if there is a delay of > 4 hrs for D/Dimer / US Doppler.
What should be done US Doppler or D-Dimer in a patient with suspected Lower limb DVT and Well’s score of 1 or less?
D Dimer within 4 hours.
If there is going to be a delay of > 4 hrs for this then Anticoagulation should be commenced.
What anticoagulation should be started in Patients with suspected DVT if its indicated?
DOACs are generally preferred.
(Apixaban)
In a Patient with a Disproportionally low MCV to Hb Microcytic anaemia, what would be the likely cause?
Thalassaemia
- Beta thalassaemia trait and alpha thalassaemia minor may present with a normal/low Hb with a disproportionately low MCV
What is Cold Autoimmune Haemolytic Anaemia (AIHA)?
An IgM-Mediated autoimmune condition characterised by the production of autoantibodies against erythrocytes that bind at temperatures colder than body temperature.
What are some common causes of Cold AIHA?
Infection, Malignancy or Idiopathic.
SLE is more commonly assoc w Warm AIHA.
What is Warm AHIA?
A condition characterised by the production of IgG autoantibodies against erythrocytes.
Presents as a Normocytic anaemia and patient may have certain risk factors… e.g. SLE or Lymphoma.
In warm AIHA Haemolysis occurs at body temperature.
What should be given to a patient with an INR of 3.4 (2.0-3.0) before emergency surgery which cannot be delayed for 6-12 hrs?
IV vitamin K and Prothrombin complex concentrate!
What should be given to a patient with an INR of 3.4 (2.0-3.0) before emergency surgery which can be delayed for 6-12 hrs?
IV Vitamin K and recheck INR in 6-12 hrs.
What INR value is usually considered safe for surgery?
<1.5
What medication can reduce the frequency and severity of vaso-occlusive crises in sickle cell disease?
Hydroxyurea aka (hydroxycarbamide)
- Increased Foetal Hb (which is resistant to sickling)
What are some indications to commence a patient on Hydroxyurea (aka Hydroxycarbamide)?
If a patient has three or more painful crises in one year.
If a patient has pain which interferes with daily activities or affects their QoL.
What type of medication is Desferrioxamine?
An Iron Chelator which can be used to Tx iron overload, for e.g. due to repeated blood transfusions in pateints with beta thalassaemia.
Which marker measures the extrinsic pathway in haemostasis?
Prothrombin Time. (and the INR which is derived from the PT)
Which marker measures the intrinsic clotting pathway in haemostasis?
Activated partial Thromboplastin Time (APTT)
When is the intrinsic pathway of Haemostasis initiated?
When blood comes into contact with collagen on the injured vessel wall.
When is the Extrinsic pathway of Haemostasis initiated?
When blood comes into contact with the products of damaged tissue (tissue factor)
What is the target action of Rituximab?
CD20
- Rituximab is a monoclonal antibody targeting CD20, which is important in the maturation of B cells into plasma cells.
What is vWF produced by?
The endothelium and Megakaryocytes.
What is the main function of vWF?
It Functions by binding to platelets to promote agglutination.
