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  <head>
    <title>039-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="White-cell disorders and haematological malignancy">
      <outline text="Orientation and haematopoiesis">
        <outline text="Counts reflect production, release, destruction, clonality">
          <outline text="A count is not a diagnosis"/>
          <outline text="Morphology, lineage, tempo, molecular findings"/>
        </outline>
        <outline text="Stem cells balance self-renewal and differentiation">
          <outline text="Niches of stroma, matrix, vessels, cytokines"/>
        </outline>
        <outline text="Growth factors drive red-cell, platelet, granulocyte lines"/>
        <outline text="Clonal haematopoiesis rises with age">
          <outline text="Raises blood-cancer and cardiovascular risk"/>
          <outline text="Leukaemia is not inevitable"/>
        </outline>
      </outline>
      <outline text="Interpreting white-cell counts">
        <outline text="Use absolute counts, not percentages alone"/>
        <outline text="Neutrophilia: infection, inflammation, steroids, neoplasia">
          <outline text="Left shift means more immature granulocytes"/>
          <outline text="Toxic granulation and vacuoles support reaction"/>
          <outline text="Demargination raises count without production"/>
        </outline>
        <outline text="Lymphocytosis: reactive versus monomorphic clone"/>
        <outline text="Leukopenia: suppression, destruction, drugs, spleen">
          <outline text="Trends show one lineage or whole marrow"/>
        </outline>
      </outline>
      <outline text="Neutropenia and febrile neutropenia">
        <outline text="Risk rises with depth and duration">
          <outline text="Barrier, device, cellular-immune defects add risk"/>
        </outline>
        <outline text="Serious infection without pus, signs, or fever"/>
        <outline text="Fever in neutropenia is an emergency">
          <outline text="Cultures and site assessment"/>
          <outline text="Prompt broad antipseudomonal antibiotics"/>
          <outline text="Avoid rectal procedures"/>
        </outline>
        <outline text="Persistent fever prompts reassessment"/>
        <outline text="Colony-stimulating factor shortens treatment neutropenia">
          <outline text="Not a substitute in established sepsis"/>
        </outline>
      </outline>
      <outline text="Bone-marrow failure">
        <outline text="Aplastic anaemia: hypocellular pancytopenia">
          <outline text="Immune destruction of stem cells common"/>
          <outline text="No major nodes or spleen"/>
        </outline>
        <outline text="Transplantation cures selected patients">
          <outline text="Alloimmunisation from transfusion complicates it"/>
        </outline>
        <outline text="Immunosuppression with thrombopoietic support"/>
        <outline text="Aspirate gives cellular detail and flow cytometry"/>
        <outline text="Trephine shows architecture, fibrosis, infiltration"/>
      </outline>
      <outline text="Myelodysplastic and myeloproliferative neoplasms">
        <outline text="Myelodysplasia: ineffective dysplastic haematopoiesis">
          <outline text="Cytopenias and risk of acute myeloid leukaemia"/>
          <outline text="Exclude nutritional, toxic, drug, infectious mimics"/>
        </outline>
        <outline text="Myeloproliferative: excess mature myeloid cells">
          <outline text="Polycythaemia vera: thrombosis, itch, splenomegaly"/>
          <outline text="Essential thrombocythaemia: clot or bleed"/>
          <outline text="Myelofibrosis: fibrosis, leukoerythroblastic film"/>
        </outline>
        <outline text="Driver mutations activate growth signalling"/>
        <outline text="A high count alone does not set risk"/>
      </outline>
      <outline text="Acute leukaemia">
        <outline text="Blasts suppress marrow and infiltrate tissues">
          <outline text="Fatigue, infection, bleeding, bone pain"/>
        </outline>
        <outline text="Lineage and genotype set therapy and prognosis"/>
        <outline text="Promyelocytic leukaemia: severe coagulopathy">
          <outline text="Differentiation therapy on suspicion"/>
        </outline>
        <outline text="Induction, consolidation, transplantation by risk"/>
        <outline text="Hyperleukocytosis impairs microvascular flow">
          <outline text="Brain and lung symptoms need cytoreduction"/>
          <outline text="Red-cell transfusion raises viscosity"/>
        </outline>
      </outline>
      <outline text="Chronic leukaemias">
        <outline text="Chronic myeloid: translocation fusion kinase">
          <outline text="Chronic phase can progress to blast crisis"/>
          <outline text="Kinase inhibitors need response monitoring"/>
        </outline>
        <outline text="Chronic lymphocytic: clonal mature B cells">
          <outline text="Hypogammaglobulinaemia, autoimmune cytopenias"/>
          <outline text="Treat active indications, not count"/>
        </outline>
      </outline>
      <outline text="Lymphoma">
        <outline text="Hodgkin: malignant cells in reactive background">
          <outline text="Often spreads contiguously"/>
        </outline>
        <outline text="Non-Hodgkin: indolent and aggressive B, T, NK"/>
        <outline text="Persistent nodes, sweats, weight loss prompt assessment"/>
        <outline text="Excision or core biopsy preserves architecture">
          <outline text="Fine-needle aspiration often cannot classify"/>
        </outline>
        <outline text="Subtype and molecular risk outweigh stage"/>
      </outline>
      <outline text="Plasma-cell disorders">
        <outline text="Monoclonal immunoglobulin or light chain"/>
        <outline text="MGUS lacks organ injury but can progress"/>
        <outline text="Myeloma: bone, anaemia, kidney, calcium, infection"/>
        <outline text="Small clones can still damage organs"/>
        <outline text="Protein studies, light chains, marrow, imaging"/>
      </outline>
      <outline text="Emergencies and care principles">
        <outline text="Tumour lysis releases potassium, phosphate, nucleic acid">
          <outline text="Arrhythmia, seizure, urate kidney injury"/>
          <outline text="Prevent: fluid, monitoring, urate lowering"/>
        </outline>
        <outline text="Cord compression, vena-cava obstruction, airway"/>
        <outline text="Never dismiss persistent abnormality without trend"/>
        <outline text="Decisions weigh curability, frailty, goals"/>
        <outline text="Survivorship: vaccination, second cancers, fertility"/>
      </outline>
    </outline>
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