Haematology

Question 1

What are the symptoms of iron deficiency anaemia?

Answer 1

Dyspnoea
Fatigue
Headaches
Restless legs
Cognitive impairment

Question 2

What is classed as severe anaemia?

Answer 2

haemoglobin less than 70g/L

Question 3

What is the definition of anaemia?

Answer 3

In men aged over 15 years — Hb below 130 g/L.
In non-pregnant women aged over 15 years — Hb below 120 g/L.
In children aged 12–14 years of age — Hb below 120 g/L.

Question 4

What are some tests to identify a source for IDA?

Answer 4

FIT
Coeliac testing
Urine in blood

Question 5

What are the signs of DVT?

Answer 5

Unilateral localised pain
Tenderness.
Skin changes, which include oedema, redness, and warmth.
Vein distension.

Question 6

How should a suspected DVT be initially investigated?

Answer 6

Assess leg and thigh swelling — measure the circumference of the leg 10 cm below the tibial tuberosity and compare with the asymptomatic leg. A difference of more than 3 cm between the extremities increases the probability of DVT.

Well’s score

Question 7

How should most people with DVT be managed?

Answer 7

Anticoagulation therapy

Question 8

How should a pregnant woman with DVT be managed?

Answer 8

Refer immediately for same-day assessment and management if deep vein thrombosis (DVT) is suspected in a woman who is pregnant or has given birth within the past 6 weeks.

Question 9

What are some risk factors or associated factors for DVT?

Answer 9

Active cancer (treatment ongoing, within the last 6 months, or palliative).
Paralysis, paresis, or recent plaster immobilization of the legs.
Recently bedridden for 3 days or more, or major surgery within the last 12 weeks requiring general or regional anaesthesia.
Localized tenderness along the distribution of the deep venous system (such as the back of the calf).
Entire leg is swollen.
Calf swelling by more than 3 cm compared with the asymptomatic leg.
Pitting oedema confined to the symptomatic leg.
Collateral superficial veins (non-varicose).
Previously documented DVT.

Question 10

Explain how DIC is managed

Answer 10

Question 11

What are the risk factors for DIC?

Answer 11

Question 12

What are some questions to ask in a patient with epitaxis?

Answer 12

When the bleeding started and from which nostril.
How much blood has been lost.
Whether a temporary pack (such as cotton wool) has been used
About any previous episodes of epistaxis and how they were treated.

Question 13

What should be avoided after a nosebleed has occured?

Answer 13

Blowing or picking the nose.
Heavy lifting.
Strenuous exercise.
Lying flat.
Drinking alcohol or hot drinks.

Question 14

What are some risk factors to consider for epistaxis?>

Answer 14

Trauma
Cancer
Allergies

Question 15

What are some symptoms of polycythaemia?

Answer 15

Question 16

What are some underlying causes of secondary polycythaemia?

Answer 16

Cardiac and respiratory symptoms or disease, smoking, and potential exposure to carbon monoxide.

Excessive daytime sleepiness, snoring, sleep disturbances, and observed night-time episodes of apnoea (particularly in people who are obese or with other respiratory conditions).

Previous renal transplantation.

Performance enhancing drug use (testosterone, anabolic steroids or erythropoietin).

Question 17

What are some clinical findings of polycythaemia vera?

Answer 17

Ruddy complexion
Conjunctival plethora (indicative of erythrocytosis) is present.
Splenomegaly, which can be indicative of polycythaemia vera
Abdominal masses. Benign and malignant uterine, renal, and hepatic tumours, which may be palpable, can secrete erythropoietin, leading to secondary erythrocytosis.

Question 18

How is polycythaemia vera managed?

Answer 18

An explanation of the risks and implications of the condition. A patient information leaflet, such as that provided by MacMillan Cancer Support, may be helpful.

Venesection to maintain the haematocrit at less than 0.45.
The volume of blood removed and frequency of venesection are adjusted depending on the person’s size and tolerability to venesection.

Prescription of aspirin 75 mg daily (unless this is contraindicated)

High risk or >60 = + The first-line drug is usually hydroxycarbamide

Question 19

What might lead to further investigation for polycythaemia?

Answer 19

One-off values of elevated Hct (>0.6 in males and >0.56 in females) indicate an absolute erythrocytosis and require additional investigations.

Question 20

What are the features of multiple myeloma?

Answer 20

The median age at presentation is 70 years old.

Use the mnemonic CRABBI + HANC:
Calcium

Renal

Anaemia

Bleeding

Bones

Infection

hyperviscosity
amyloidosis e.g. macroglossia
neuropathy
carpal tunnel syndrome

Question 21

What are the features of acute haemolytic reaction?

Answer 21

Fever, abdominal pain, hypotension

Question 22

How is acute haemolytic reaction managed?

Answer 22

Stop transfusion

Confirm diagnosis
check the identity of patient/name on blood product
send blood for direct Coombs test, repeat typing and cross-matching

Supportive care
fluid resuscitation

Question 23

What are the features of TRALI?

Answer 23

Hypoxia, pulmonary infiltrates on chest x-ray, fever, hypotension

Question 24

How is TRALI managed>

Answer 24

Stop the transfusion

Oxygen and supportive care

Question 25

T or F, G6PD enzyme assays should be repeated around 3 months after acute haemolytic episodes to avoid false negatives

Answer 25

T