Clinical Topic 8: Haematology

Question 1

Coeliacs gives what classic anaemic picture?

Answer 1

Microcytic, hypochromic anaemia

Question 2

What is the most common inherited clotting disorder?

Answer 2

Von Willebrand Disease

Question 3

What is the inheritance pattern of Haemophilia? Which is the most common?

Answer 3

X-linked Reccessive

• Boys = symptomatic
• Girls = carriers

Most common: Haemophillia A

Question 4

Haemophillia A and B are affected by what clotting factors?

Answer 4

A - 8

B - 9

Question 5

What is the inheritance pattern of von Willebrand Disease?

Answer 5

Autosomal Dominant

Question 6

What are the blood test results for Haemophillia:
Bleeding time?
Prothrombin time?
APTT?

Answer 6

Bleeding time: Normal
Prothrombin time: Normal
APTT: Prolonged

Question 7

Prothrombin time reflects what pathway in haemostasis? What about APTT?

Answer 7

Prothrombin time: Intrinsic pathway

APTT: Extrinsic pathway

Question 8

How is Von Willebrand Disease different symptomatically from Haemophillia?

Answer 8

Von Willebrand: Bleeding into mucosa

Haemophillia: Beeding into joints

Question 9

Treatment for Haemophillia?

Answer 9

Injection of missing factor

Question 10

Ages of presentation:

ALL and AML?

Answer 10

ALL - Young children

AML - Any age, but typically older

Question 11

Philadelphia Chromosome / BCR-ABL is associated with which leukaemias?

Answer 11

CML and ALL

Question 12

Acute Promyelocytic Leukaemia is a subtype of what Leukaemia?

Answer 12

AML

Question 13

What blood cancer causes Disseminated Intravascular Coagulation?

Answer 13

Acute Promyelocytic Leukaemia

Question 14

What is found on a blood smear for Acute Myeloid Leukaemia?

Answer 14

Big nuclei
Scanty cytoplasm
High proportion of blast cells
Auer rods

Question 15

What is found on a blood smear for Acute Lymphoblastic Leukaemia?

Answer 15

Small nuclei
Coarse chromatin
Glycogen granules

Question 16

What may be seen on a FBC in patients with Leukaemia? What symptoms do these lead to?

What other symptoms might there be?

Answer 16

Anaemia - fatigue / tiredness
Thrombocytopenia - easy bruising
Leukopenia - infections

Other: Bone pain, hepatosplenomegaly

Question 17

CD10 is associated with what blood cancer?

Answer 17

B Lymphocyte ALL

Question 18

1/3rd of MDS cases can develop into what condition?

Answer 18

AML

Question 19

Chronic Lymphoid Leukaemia typically affects what cell types?
Chromic Myeloid Leukaemia typically affects what cell types?

Answer 19

CLL - B lymphocytes
CML - Granulocytes

Question 20

What is the most common mutation associated with CML?

Answer 20

Philadelphia chromosome, Bcr-Abl

Question 21

What is the treatment for CML?

Answer 21

Receptor tyrosine kinase inhibitors, i.e. Gleevac / Imatinib

Question 22

What is found on a blood smear for Chronic Myeloid Leukaemia?

Answer 22

Increased granulocytes

Increased monocytes

Question 23

What are the features of Chronic lymphocytic leukaemia

Answer 23

Warm haemolytic anaemia
Richter’s transformation (rare process of CLL → high grade B cell lymphoma)
Blood smear - Smudge cells which are aged WBCs

Question 24

What is Polycythaemia Vera? What mutation is it commonly associated with?

Answer 24

Proliferation of marrow stem cells, leading to increased red blood cells

JAK2 mutation

Question 25

What are the classic symptoms of Polycythaemia Vera?

Answer 25

- Itchiness after hot bath - Splenomegaly - Red flushed appearance

Question 26

What are the treatments for Polycythaemia Vera?

Answer 26

- Phlebotomy - Low dose Aspirin

Question 27

Which type of cell does Acute lymphoblastic leukaemia usually affect?

Answer 27

Excessive rapid production of B-lymphocytes

Question 28

Features of acute lymphoblastic leukaemia?

Answer 28

Associated with Down's syndrome FBC - Pancytopaenia Associated with Philadelphia chromosome

Question 29

Which type of cell does Acute lymphoblastic leukaemia usually affect?

Answer 29

Slow proliferation of B lymphocytes

Question 30

What process drives CML and ALL?

Answer 30

Philadelphia chromosome, an abnormal chromosome formed by translocation between Chromosome 9 and 22 leading to an abnormal gene sequence called BCR-ABL1 BCR-ABL1 codes for an abnormal tyrosine kinase enzyme which drives abnormal proliferation of cells

Question 31

TUMOUR LYSIS SYNDROME What is Tumour Lysis Syndrome? Features on blood tests? What are the complications? What is the management?

Answer 31

Destroyed cells from chemotherapy releasing chemicals leading to... - ↑ uric acid - hyperkalaemia - hyperphosphataemia - ↓ calcium secondary to hyperphosphataemia Complications: AKI secondary to ↑ uric acid, arrythmias secondary to hyperkalaemia Management: Allopurinol/rasburicase to suppress uric acid levels, prevent TLS with hydration before chemotherapy