Haematology-Oncology
Anaemias & Red Cell Disorders · Haematological Malignancies · Bleeding, Clotting & Thrombosis · Oncology & Oncological Emergencies · Palliative Care · Immunology & Miscellaneous
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Anaemias & Red Cell Disorders
- Autoimmune Haemolytic Anaemia — Autoimmune haemolytic anaemia (AIHA) is divided into 'warm' and 'cold' types, according to the temperature at which the
- Vitamin B12 Deficiency — Vitamin B12 is mainly used in the body for red blood cell development and also maintenance of the nervous system.
- Acute Intermittent Porphyria — Acute intermittent porphyria (AIP) is a rare autosomal dominant condition caused by a defect in porphobilinogen deaminas
- Hereditary Spherocytosis — most common hereditary haemolytic anaemia in people of northern European descent
- Haemolytic Anaemias: by Site — In intravascular haemolysis free haemoglobin is released which binds to haptoglobin. As haptoglobin becomes saturated ha
- Macrocytic Anaemia — Macrocytic anaemia can be divided into causes associated with a megaloblastic bone marrow and those with a normoblastic
- Sideroblastic Anaemia — Sideroblastic anaemia is a condition where red cells fail to completely form haem, whose biosynthesis takes place partly
- G6PD Deficiency — Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the commonest red blood cell enzyme defect. It is more common in
- Lead Poisoning — Along with acute intermittent porphyria, lead poisoning should be considered in questions giving a combination of abdomi
- Sickle-Cell Crises — Sickle cell anaemia is characterised by periods of good health with intervening crises A number of types of crises are r
- Beta-Thalassaemia Major — absence of beta chains
- Iron Deficiency Anaemia — Features: atrophic glossitis, post-cricoid webs (Plummer-Vinson syndrome), angular stomatitis
- Beta-Thalassaemia Trait — The thalassaemias are genetic disorders characterised by reduced production of alpha or beta globin chains
- Methaemoglobinaemia — Methaemoglobinaemia describes haemoglobin which has been oxidised from Fe2+ to Fe3+. This is normally regulated by NADH
- Paroxysmal Nocturnal Haemoglobinuria — Paroxysmal nocturnal haemoglobinuria (PNH) is an acquired disorder leading to haemolysis (mainly intravascular) of haema
- Drug-Induced Pancytopaenia — Drug causes of pancytopaenia
- Porphyrias — abnormality in enzymes responsible for the biosynthesis of haem
- Aplastic Anaemia: Management — Supportive care: blood products (irradiated, to avoid alloimmunisation and transfusion-associated GVHD) and prevention/treatment of infection.
Haematological Malignancies
- Myeloma: Features — Multiple myeloma is a neoplasm of the bone marrow plasma cells. The peak incidence is patients aged 60-70 years. Clinica
- Lymphadenopathy — There are many causes of generalised lymphadenopathy Infective
- Hodgkin's Lymphoma: Staging — Hodgkin's lymphoma is a malignant proliferation of lymphocytes characterised by the presence of the Reed- Sternberg cell
- Myeloma: Prognosis — B2-microglobulin is a useful prognostic marker in myeloma — raised levels imply a poorer prognosis
- Acute Myeloid Leukaemia — Acute myeloid leukaemia is the more common form of acute leukaemia in adults. It may occur as a primary disease or follo
- Polycythaemia Vera: Management — PV: myeloproliferative disorder — clonal marrow stem-cell proliferation → ↑ red cell mass (± neutrophils/platelets); pea
- Polycythaemia Vera: Features — Polycythaemia vera (previously called polycythaemia rubra vera) is a myeloproliferative disorder caused by clonal prolif
- Hodgkin's Lymphoma: Histological Classification and Prognosis — Hodgkin's lymphoma is a malignant proliferation of lymphocytes characterised by the presence of the Reed- Sternberg cell
- Burkitt's Lymphoma — Burkitt's lymphoma is a high-grade B-cell neoplasm. There are two major forms:
- Haematological Malignancies: Genetics — Below is a brief summary of the common translocations associated with haematological malignancies t(9;22) - Philadelphia
- Hodgkin's Lymphoma: Staging — Hodgkin's lymphoma is a malignant proliferation of lymphocytes characterised by the presence of the Reed- Sternberg cell
- Haematological Malignancies: Infections — EBV: associated with Hodgkin's and Burkitt's lymphoma, and nasopharyngeal carcinoma
- Waldenstrom's Macroglobulinaemia — Waldenstrom's macroglobulinaemia is an uncommon condition seen in older men. It is a lymphoplasmacytoid malignancy chara
- Hairy Cell Leukaemia — Hairy cell leukaemia is a rare malignant proliferation disorder of B cells. It is more common in males (4:1) Features
- Chronic Lymphocytic Leukaemia — Chronic lymphocytic leukaemia (CLL) is caused by a monoclonal proliferation of well-differentiated lymphocytes which are
- Acute Lymphoblastic Leukaemia: Prognostic Features — Acute lymphoblastic leukaemia is a malignancy of lymphoid progenitor cells (B or T lineage) causing arrested maturation
- Polycythaemia — Polycythaemia may be relative, primary (polycythaemia rubra vera) or secondary Relative causes
- Chronic Myeloid Leukaemia — The Philadelphia chromosome is present in more than 95% of patients with chronic myeloid leukaemia (CML). It is due to a
- Chronic Lymphocytic Leukaemia: Management — Not all CLL needs treatment — asymptomatic early-stage disease is monitored ('watch and wait'). The iwCLL indications below define when to treat.
- Chronic Lymphocytic Leukaemia: Prognostic Factors — Poor prognostic factors (median survival 3-5 years)
- Myelofibrosis — a myeloproliferative disorder
- Acute Promyelocytic Leukaemia — You are not normally expected to be able to differentiate the different subtypes of acute myeloid leukaemia (AML) for th
Bleeding, Clotting & Thrombosis
- Thrombocytosis — Thrombocytosis is an abnormally high platelet count, usually > 400 * 109/l. Causes of thrombocytosis
- Von Willebrand's Disease — Von Willebrand's disease is the most common inherited bleeding disorder. The majority of cases are inherited in an autos
- Factor V Leiden — Factor V Leiden (activated protein C resistance) is the most common inherited thrombophilia, present in around 5% of the
- Blood Product Transfusion Complications — Blood product transfusion complications may be broadly classified into the following:
- Antiphospholipid Syndrome: Pregnancy — Antiphospholipid syndrome is an acquired disorder characterised by a predisposition to both venous and arterial thrombos
- Deep Vein Thrombosis: Diagnosis and Management — NICE NG158: two-level DVT Wells score first — DVT likely ≥ 2 points, unlikely ≤ 1. A Wells score alone cannot exclude DV
- Immune Thrombocytopenia (ITP) in Adults — Immune (or idiopathic) thrombocytopenic purpura (ITP) is an immune-mediated reduction in the platelet count. Antibodies
- Thrombotic Thrombocytopenic Purpura — TTP is a thrombotic microangiopathy caused by severe deficiency of ADAMTS13 (the protease that cleaves von Willebrand factor), so ultra-large vWF multimers drive platelet-rich microthrombi. Usually acquired/immune (anti-ADAMTS13 antibodies); rarely congenital.
- Haemophilia — Haemophilia is an X-linked recessive coagulation disorder (haemophilia A: factor VIII deficiency; haemophilia B: factor
- Antithrombin Iii Deficiency — Antithrombin III deficiency is an inherited cause of thrombophilia occurring in approximately 1:3,000 of the population.
- ITP: Investigation and Management — ITP: immune-mediated platelet destruction — autoantibodies (usually IgG) against platelet glycoprotein IIb/IIIa or Ib complex, plus impaired platelet production.
- Pregnancy: DVT/PE — pregnancy is a hypercoagulable state
- Venous Thromboembolism: Risk Factors — Common predisposing factors include malignancy, pregnancy and the period following an operation. The comprehensive list
- Thrombotic Thrombocytopenic Purpura: Management — TTP is a thrombotic microangiopathy caused by severe deficiency of ADAMTS13 (the protease that cleaves von Willebrand factor), so ultra-large vWF multimers drive platelet-rich microthrombi. Usually acquired/immune (anti-ADAMTS13 antibodies); rarely congenital.
- Prothrombin Complex — NICE published guidelines on the use of Supportive care: blood products (irradiated, to avoid alloimmunisation and transfusion-associated GVHD) and prevention/treatment of infection. in 2015. Fresh frozen plasma (FFP)
- Thrombophilia: Causes — Inherited Gain of function polymorphisms
- Protein C Deficiency — Protein C deficiency is an autosomal codominant condition which causes an increased risk of thrombosis Features
- Blood Products: CMV Negative and Irradiated Blood — Cytomegalovirus (CMV) is transmitted in leucocytes; as most Supportive care: blood products (irradiated, to avoid alloimmunisation and transfusion-associated GVHD) and prevention/treatment of infection. (except granulocyte transfusions) are now leu
Oncology & Oncological Emergencies
- Cytotoxic Agents — Summary of mechanism of action and major adverse effects of commonly used cytotoxic agents
- Neutropenic Sepsis — Definition: neutrophils < 0.5 × 10⁹/l during anticancer treatment + temperature > 38ºC or other signs of significant sep
- Tumour Markers — Tumour markers are broadly divided into monoclonal antibodies, tumour antigens, enzymes, and hormones
- Chemotherapy Side-Effects: Nausea and Vomiting — Nausea and vomiting are common side-effects of chemotherapy. Risk factors for the development of symptoms include:
- Superior Vena Cava Obstruction — Oncological emergency; most commonly lung cancer (NSCLC, lymphoma; also metastatic seminoma, Kaposi's, breast).
- Positron Emission Tomography (PET) — Positron emission tomography (PET) uses fluorodeoxyglucose (FDG) as a radiotracer to generate a 3D image of metabolic ac
- Spinal Cord Compression — Oncological emergency affecting up to 5% of cancer patients; mostly extradural (vertebral metastases) — lung, breast, pr
- Thymoma — Thymomas are the most common tumour of the anterior mediastinum and is usually detected between the sixth and seventh de
- Tumour Lysis Syndrome — TLS: massive tumour-cell breakdown — usually triggered by combination chemotherapy for high-grade lymphomas/leukaemias (
- Cervical Cancer: Human Papilloma Virus Infection — Human papilloma virus (HPV) infection is the most important risk factor for developing cervical cancer; subtypes 16, 18
- Carcinogens — Aflatoxin (produced by Aspergillus): associated with liver (hepatocellular) carcinoma
- Cancer in the Uk — Most common cancers in the UK by incidence (descending order): breast, lung, colorectal, prostate, bladder, non-Hodgkin'
- Lung Cancer: Non-Small Cell — There are three main subtypes of non-small cell lung cancer: Squamous cell cancer
- Cyclophosphamide — Cyclophosphamide is an alkylating agent used in the management of cancer and autoimmune conditions. It works by causing
- ECOG Score — The ECOG score is a performance status scale used to assess a patient's functional status and suitability for further on
- Bone Metastases — Most common tumour causing bone metastases (in descending order)
- Spinal Metastases — Patients may present with spinal metastases before developing metastatic spinal cord compression. It is, therefore, impo
Palliative Care
- Palliative Care Prescribing: Pain — NICE guidelines In 2012 NICE published guidelines on the use of opioids in palliative care. Selected points are listed b
- Palliative Care Prescribing: Agitation and Confusion — Underlying causes of confusion/agitation should be sought and treated where possible — e.g. hypercalcaemia, infection, u
- Palliative Care Prescribing: Hiccups — Management of intractable hiccups
Immunology & Miscellaneous
- Hereditary Angioedema — Hereditary angioedema is an autosomal dominant condition associated with low plasma levels of the C1 inhibitor (C1-INH)
- Leucocyte Alkaline Phosphatase — myelofibrosis
- Wiskott-Aldrich Syndrome — Wiskott-Aldrich syndrome causes primary immunodeficiency due to combined B- and T-cell dysfunction
- (Aiha) — Note: the original source text for this chapter was an incomplete clinical vignette that cut off mid-sentence, with no s
- Eosinophilia — Causes of eosinophilia may be divided into pulmonary, infective and other Pulmonary causes
- C1-Inhibitor Deficiency — C1 esterase inhibitor (C1-INH) deficiency causes hereditary angioedema — see the Hereditary Angioedema chapter for full
- Primary Immunodeficiency — Primary immunodeficiency disorders may be classified according to which component of the immune system they affect
- HCV PCR — Hepatitis C infection is associated with type II (mixed) cryoglobulinaemia
- Cryoglobulinaemia — Immunoglobulins which undergo reversible precipitation at 4 deg C, dissolve when warmed to 37 deg C. One-third of cases
- Blood Films: Pathological Cell Forms — Target cells: sickle-cell/thalassaemia, iron-deficiency anaemia, hyposplenism, liver disease
- Leukaemoid Reaction — The leukaemoid reaction describes the presence of immature cells (myeloblasts, promyelocytes, nucleated red cells) in th
- Hyposplenism — coeliac disease, dermatitis herpetiformis
- Blood Films: Typical Pictures — Hyposplenism e.g. post-splenectomy