Revision Flashcards
What antibody may be seen in antiphospholipid syndrome?
Anticardiolipin antibodies
What are anti-Ro antibodies seen in?
Sjogren’s syndrome
Why can WCC be low in ALL?
As the damaged bone marrow produces defective white cells that don’t contribute towards the WCC (this is also why they get infections etc), hence the neutropaenia.
What are the most common causes of massively splenomegaly in UK?
1) CML
2) Myelofibrosis
In what cancers is tumiur lysis syndrome most common?
In cancers with a high WCC, especially following aggressive chemo.
E.g. Burkitt’s lymphoma
What cancer is the most common cause of tumour lysis syndrome?
Burkitt’s lymphoma
What medication is used in ombination with conventional chemotherapy regimes for a variety of types of non-HL?
Rituximab
What should all patients be screened for prior to treatment with rituximab?
hepatitis B –> retuximab can cause reactivation
What cancer can myelodysplasia progress to?
AML
What genetic change is Burkitt’s lymphoma associated with?
C-myc gene translocation
This leads to overexpression of the c-myc protein, which promotes cell growth and proliferation - key features of malignancy.
Does HL cause an increase in the lymphocytes on blood tests?
No
But it can cause normocytic anaemia and eosinophilia.
Non-HL is associated with exposure to what chemical?
Pesticides
What gender is a poor prognostic factor for ALL?
Male
What is a characteristic blood film finding of CLL?
Smear/smudge cells –> these are the result of abnormally fragile lymphocytes in CLL.
What is a characteristic blood film finding of multiple myeloma?
Rouleaux formation
What do Auer rods on a blood film indicate?
AML
TIBC in anaemia of chronic disease vs iron def anaemia?
Anaemic of chronic disease –> low/normal TIBC
Iron def anaemia –> raised TIBC
Rituximab is used in combination with chemotherapy for a variety of types of non-Hodgkin’s lymphoma.
What receptor does this monoclonal antibody drug act against?
CD20 receptor (B lymphocyte antigen receptor)
1st line mx of warm autoimmune haemolytic anaemia?
Steroids +/- rituximab
What triad is seen in Felty’s syndrome?
1) RA
2) Splenomegaly
3) Low WCC (neutropenia)
This is an extra-articular manifestation of RA.
What is a pepperpot skull a characteristic X-ray finding of?
Hyperparathyroidism (due to increased osteoclast activity).
Also myeloma.
How can myeloma cause strokes?
Due to hyperviscosity (due to hyperparaproteinaemia)
FBC results in CML?
an increase in granulocytes at different stages of maturation +/- thrombocytosis
What condition is associated with ‘tear drop’ poikilocytes on blood film?
Myelofibrosis
How do steroids affect WCC?
Cause neutrophilia
Give 3 haematological causes of pyoderma gangrensoum
1) myeloproliferative disorders
2) lymphoma
3) myeloid leukaemias
PT & APTT in APS?
PT - normal
APTT - prolonged
Reticulocytes in beta-thalassaemia?
Raised
HbA2 in beta thalassaemia trait?
Raised (>3.5%)
What type of Hodgkin’s lymphoma carries the worst prognosis?
Lymphocyte depleted
What can cause pancytopaenia 5 years post-chemotherapy/radiotherapy?
Myelodysplastic syndrome (MDS)
What medications can exacerbate plaque psoriasis?
- beta blockers
- lithium
- antimalarials (chloroquine and hydroxychloroquine)
- NSAIDs
- ACE inhibitors
- infliximab
Iron def anaemia vs anaemia of chronic disease:
1) serum iron
2) TIBC
3) serum ferritin
iron def:
1) decreased
2) raised
3) decreased
anaemia of chronic disease:
1) decreased
2) low/normal
3) normal/increased
What can mixed anaemia (co-presentation of iron deficiency anaemia and B12 deficiency anaemia) cause?
Normocytic anaemia
What is polychromasia?
There are more immature RBCs than what’s considered normal.
It’s a finding a peripheral blood smear.
Usually, it’s a sign that RBCs are being destroyed more quickly than the body can replace them (haemolytic anemia).
Mx of acute pain crisis in sickle cell?
Morphine
1st line mx of superficial thrombophlebitis?
NSAIDs
Cautery vs anterior packing in epistaxis?
Minor bleeding from an accessible site can be treated with cautery using a silver nitrate stick or electrocautery.
Anterior pack is for profuse bleeding with site difficult to localise.
What is the most common type of myeloma?
IgG kappa
The myeloma cells produce an immunoglobulin made from two IgG heavy chains bound to two kappa light chains
What is seen on serum electrophoresis in IgG kappa myeloma?
Monoclonal Ig kappa peak
What is seen on bone marrow biopsy in myeloma?
Abnormally high % of plasma cells (>10%)
When is a platelet transfusion indicated?
Patients with a platelet count <30 x 10^9 and clinically significant bleeding.
What type of anaemia is associated with CLL?
Warm autoimmune haemolytic anaemia
What investigation is required to confirm a diagnosis of G6PD deficiency?
G6PD enzyme assay at the time of presentation AND after 3 months –> to avoid false negatives.
Mx of children and young people (0-24 y/o) with:
a) unexplained petechiae
b) hepatosplenomegaly
Immediate referral for specialist assessment –> rule out leukaemia
1st line mx of ITP?
Oral prednisolone
What is seen on a blood film in hyposplenism (e.g. post-splenectomy, coeliac disease)?
- Howell-Jolly bodies
- Target cells
What is seen on a blood film in iron deficiency anaemia?
- Target cells
- ‘Pencil’ poikilocytes
What is seen on a blood film in myelofibrosis?
‘Tear-drop’ poikilocytes
What is seen on a blood film in intravascular haemolysis?
Schistocytes
What is seen on a blood film in megaloblastic anaemia?
Hypersegmented neutrophils
What is the most common type of lymphoma in the UK?
Diffuse large B cell lymphoma (type of non-Hodgkin lymphoma)
What is the most common inherited clotting disorder?
Factor V Leiden –> results in activated protein C resistance
What does the presence of haemolysis with blister cells on a blood film indicate?
G6PD deficiency
FBC results in EBV?
Can cause increased lymphocytes but decreased neutrophils.
DIC typical blood picture?
- reduced platelets
- reduced fibrinogen
- raised PT & APTT
- raised fibrinogen degradation products
What is the 1st line imaging in suspected multiple myeloma?
Whole body MRI –> identifies both focal and diffusion bone marrow infiltration.
1st line investigation in those aged ≥60 y/o with hypercalcaemia or leukopenia and a presentation that is consistent with myeloma?
Very urgent (<48h) protein electrophoresis and Bence Jones protein testing.
What are mirror image nuclei?
Reed-Sternberg cells
