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Medicine Notes Haematology Notes

Lymphomas Notes

Updated Lymphomas Notes

Haematology Notes

Haematology

Approximately 20 pages

Clinically relevant notes covering the main subjects within Haematology including malignancies, anaemias and pre-malignant disorders. Concise but with enough depth to answer SAQs for Finals. I have also included some notes on history and examination of a haematology patient - very useful for OSCEs.
These notes greatly aided me in passing my final exams with distinction. The notes were made using information from a variety of text books, lecture notes and workbooks. Each topic is colour-coded....

The following is a more accessible plain text extract of the PDF sample above, taken from our Haematology Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Lymphomas

Malignant disorder of lymphoid tissue

Hodgkin’s Lymphoma

Reed-Sternberg cells present

Epidemiology

  • Two peaks in incidence

    • 20-30yrs

    • > 50yrs

Clinical features

  • Asymmetrical painless lymphadenopathy

  • Most often cervical lymph nodes (feel rubbery)

  • Hepatosplenomegaly

  • 20-30% also have systemic features

    • Fever

    • Night sweats

    • Weight loss

    • Pruritis

    • Fatigue

    • Alcohol-induced pain

Staging

  • Ann Arbor system

    • 1 = nodal involvement restricted to 1 region

    • II – 2 or more lymph nodes regions on the same side of diaphragm

    • III – nodal involvement on both sides of diaphragm or splenic involvement

    • IVa – extra-nodal disease – liver/bone no systemic symptoms

    • IVb – extra-nodal disease – liver/bone plus systemic symptoms

      • Unexplained fever > 38 degrees

      • Drenching night sweats

      • Loss of >10% body weight in 6 months

Investigations

  • Blood count (FBC, LDH, ESR/PV)

    • Mild normochromic anaemia

    • Eosinophilia

  • BM aspirate and trephine

    • Can show infiltration

  • FNA of lymph nodes (excision biopsy of node preferred)

  • CXR

  • CT (of neck,chest, abdo, pelvis)

Management

  • In early stages, can be cured by radiotherapy

  • In advanced stages the main treatment is chemotherapy

    • + Radiotherapy

    • + Autologous stem cell transplant

Prognosis

  • Good curative rates

  • Risk of secondary malignancies in long-term survivors

  • Poor prognostic factors

Non-Hodgkin’s Lymphoma

Absence of Reed-Sternberg cells

Epidemiology

  • Commonest haematological malignancy

  • Most common age of presentation = 50yrs

Aetiology

  • Varies depending on type

    • Genetic mutations

    • Viruses

Classification

  • Can be classified with REAL system

  • Usually divided into

    • High grade = large poorly differentiated lymphoid cells, aggressive course but often curable

    • Low grade = smaller, better differentiated lymphoid cells, slower clinical course but relapse common

Clinical presentation

  • Nodal involvement causes painless rubbery lymphadenopathy

  • Commonest in cervical nodes

  • Extra-nodal involvement

    • Intestinal – abdo. pain, dysphagia

    • CNS – headache, CN palsies, cord compression

    • Skin – mycosis fungoides

    • BM – pancytopenia

  • Systemic features less common

Diagnosis

  • Depends on tissue biopsy for histology

  • CT (staging)

  • BM aspirate

Staging

  • As for Hodgkins lymphoma – less use in management and...

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