Formative assessment

Question 1

A blood film contains macrovalocytes and hypersegmented neutrophils.

Which type of anaemia is these buzzwords referring to?

What is the cause?

Answer 1

Megaloblastic anaemia (a type of macrocytic anaemia)

Vitamin B12 / Folate deficiency

Question 2

Which autoimmune disease can cause B12 / Folate malabsorption?

Answer 2

Pernicious anaemia

Question 3

What are two blood film buzzwords for B12 / Folate deficiency?

Answer 3

Macrovalocytes

Hypersegmented neutrophils

Question 4

What is a blood film finding specific to acute myeloid leukaemia?

Answer 4

Auer rods

Question 5

A patient’s blood film contains Auer rods.

Which haematological malignancy is this referring to?

Answer 5

Acute myeloid leukaemia (AML)

Remember CML has its own buzzwords: Philadelphia chromosome (22) mutation, BCR-ABL1 positive, treated with imatinib

Question 6

What does a monocyte look like under the microscope?

Answer 6

Horseshoe nucleus

White vacuoles

Question 7

In which situations would you give a patient

a) iron tablets

b) iron injections?

Answer 7

a) Mild iron deficiency anaemia

b) Severe iron deficiency anaemia

Question 8

How do you treat autoimmune haemolytic anaemia?

Answer 8

Steroids

Question 9

How do you treat Waldenstrom’s (IgM) disease?

Answer 9

Cytotoxic drugs

Plasma electropharesis

Question 10

Which anticoagulant drugs target Factor Xa?

Answer 10

Rivaroxaban

Apixaban

Edoxaban

i.e all the novel anticoagulants with -xa- in their name

Question 11

Which type of blood cells express CD20 antigens?

Answer 11

B cells

Question 12

Which type of blood cells express CD30 antigens?

Answer 12

T cells

Question 13

Which drug targets CD20 and can therefore be used to target B cell lymphomas?

Answer 13

Rituximab

Question 14

Which drug targets BCR-ABL1 tyrosine kinase?

Which haematological malignancy is this enzyme associated with?

Answer 14

Imatinib

CML

Question 15

Which drug targets Factors II, VII, IX and X?

Answer 15

Warfarin

Question 16

Which disease is JAK2 mutation associated with?

Answer 16

Polycythaemia rubra vera

Question 17

Which drug potentiates the action of antithrombin?

Which types of this drug potentiate antithrombin’s action against

a) thrombin
b) factor Xa?

Answer 17

Heparin

a) Unfractionated heparin

b) LMWH e.g dalteparin

Question 18

Which drug inhibits platelet activation by inactivating cycloxygenase enzymes?

Answer 18

Aspirin

Question 19

Which drug inhibits primary haemostasis by antagonising ADP?

Answer 19

Clopidogrel

Ticagrelor

Question 20

Which NOAC directly inhibits thrombin?

Answer 20

Dabigatran

Question 21

Bence Jones proteins (light chains found in a urine sample) indicates which haematological malignancy?

Answer 21

Multiple myeloma

Question 22

Which drugs tend to cause a prolonged

a) PT / INR

b) APTT?

Answer 22

a) Warfarin

b) Heparin

Question 23

Which disease causes a drop in platelets and fibrinogen, plus prolonged clotting times?

Answer 23

Disseminated intravascular coagulation (DIC)

Treat with platelet transfusions and fresh frozen plasma

Treat underlying cause

Question 24

Which disease are you testing for with a JAK2 gene analysis?

Answer 24

Polycythaemia rubra vera

i.e primary polycythaemia

Question 25

What is the purpose of a **Coombs test**?

Answer 25

**To differentiate between an autoimmune and non-autoimmune cause of haemolytic anaemia** (Autoimmune HA is Coombs positive, other causes e.g Sickle cell are Coombs negative)

Question 26

What disease is associated with a **raised serum caeruloplasmin**?

Answer 26

**Wilson's disease**

Question 27

**Immunophenotyping** is used to differentiate between different kinds of **\_\_\_.**

Answer 27

**lymphoma**

Question 28

What is a **Kleihauer test** used to detect?

Answer 28

**Antepartum haemorrhage**

Question 29

Name **two tests** which can be used to detect **thalassaemia**.

Answer 29

**Osmotic fragility analysis** **Haemoglobin analysis** because this is a disease affecting globin chains

Question 30

Name a cause of **single factor deficiency**.

Answer 30

**Haemophilia A/B**

Question 31

Name some causes of **multiple factor deficiency**.

Answer 31

**DIC** **Liver failure**

Question 32

If an investigation references the **red cell membrane**, which disease does it likely involve?

Answer 32

**Hereditary spherocytosis** but you'd see this on a blood film???

Question 33

What is the (really simple) pathophysiology of **sickle cell anaemia**?

Answer 33

**_Point mutation in globin gene_ producing HbS instead of HbA**

Question 34

**Transfusions** can acutely injure which organs?

Answer 34

**Lungs**

Question 35

**Loss of central pallor** is a buzzword for which disease?

Answer 35

**Spherocytosis**

Question 36

What is a **sickle crisis**?

Answer 36

**Episodes of ischaemia (pain) caused by blockage of capillaries by sickle cells**

Question 37

**Antiphospholipid syndrome** is an **(inherited / acquired)** cause of **thrombophilia.**

Answer 37

**acquired** others, like Factor V Leiden & antithrombin, protein C & S deficiencies are usually INHERITED