Ha - Leukaemia Cases & Quiz

Question 1

how is a haematalogical diagnosis made

Answer 1

clinical sx
blood film
immunophenotyping
imaging

Question 2

5 year old indian boy with lymphadenopathy & mediastinal mass on CXR.
High WCC, low Hb, low platelets. Dx?

Answer 2

ALL

Question 3

5 year old indian boy with lymphadenopathy & mediastinal mass on CXR.
High WCC, low Hb, low platelets. what is the mediastinal mass?

Answer 3

thymus enlargement due to ALL

Question 4

how is a diagnosis of ALL confirmed?

Answer 4

Immunophenotyping

Question 5

is a high WCC in ALL good or bad?

Answer 5

BAD indicator for prognosis

Question 6

48 year old with bleeding gums, haematuria and bruises. No hepatospelenomegaly. Low Hb and platelets. Dx?

Answer 6

acute promyelotic leukaemia –> DIC

Question 7

48 year old with bleeding gums, haematuria and bruises. No hepatospelenomegaly. Most likely Ix to give Dx?

Answer 7

blood count, film and coagulation screen

Question 8

Is APTT and PT long or short in DIC?

Answer 8

APTT is short
PT is normal

Question 9

how do you identify myeloid and lymphoid cells?

Answer 9

granules suggest myeloid

Question 10

how do you confirm diagnosis of acute promyelocytic anaemia

Answer 10

cytogenic analysis /FISH /molecular genetic analysis

all the cells look the same as they stopped at same stage of differentiation

Question 11

what is CD117 a marker of

Answer 11

leukaemia

Question 12

68 year old with gradual fatigue, lethargy, exertional syncope. pallor, oedema. low neutrophils, low anaemia. Dx?

Answer 12

myelodysplastic syndrome

Question 13

68 year old with gradual fatigue, lethargy, exertional syncope. pallor, oedema. which is the most important Ix to diagnose?

Answer 13

blood film

Question 14

what cell is seen in myelodysplastic syndrome

Answer 14

ring sideroblasts
blast cells

Question 15

72 year old indian woman, veggie, t total. SoB on exertion, fatigue, painful gums/tongue, unable to eat spicy food. pallor. macrocytic anaemia. best Ix?

Answer 15

vitamin b12 and folate

Question 16

what cell type is classic of pernicious anaemia / megaloblastic anaemia

Answer 16

hypersegmented neurtrophils
tear drop poikilocytes
macrocytes inc oval macrocytes

Question 17

72 year old indian woman, veggie, t total. SoB on exertion, fatigue, painful gums/tongue, unable to eat spicy food. pallor. macrocytic anaemia. Dx?

Answer 17

megaloblastic anaemia

Question 18

giant metamyelocyte and megaloblast in BM. Hypersegmented neutrophils. Dx?

Answer 18

pernicious anaemia

Question 19

70 year old woman with gangrenous toes. No DM, smoker with breathlessness. large spleen. Ix?

Answer 19

blood gas
FBC

Question 20

70 year old woman with gangrenous toes. No DM, smoker with breathlessness. large spleen. high platelet, high Hb. Dx?

Answer 20

polycythaemia vera

Question 21

Ix to diagnose polycythaemia vera

Answer 21

molecular analysis for JAK2 mutation

Question 22

Tx of polycythaemia vera

Answer 22

venesection plus hydroxycarbamide

Question 23

cause of lymphocytosis in elderly man with no Sx or abnormal blood findings. Dx?

Answer 23

CLL

Question 24

high RBC, HB and HCt. Dx?

Answer 24

polycythaemia

Question 25

when polycythmaemia is diagnosed, what question needs to be asked and how is this done?

Answer 25

is this a true or pseudo PC? check if theres hypoxia / blood loss which can drive up HCt or bone marrow disease

Question 26

most likely cause of high WCC in an ICU pt ?

Answer 26

reactive neutrophilia

Question 27

spanish woman in her 60s with high WCC, normal Hb and splenomegaly. Dx?

Answer 27

CML

Question 28

spanish woman in her 60s with high WCC, normal Hb and splenomegaly. why is this not AML?

Answer 28

because of normal Hb

Question 29

elderly man in haematology OPD with bruising and bleeding. low plts, normal everything else. Dx?

Answer 29

immune thrombocytopenia

Question 30

pale, bruised child. DDx?

Answer 30

NAI thrombocytopaenia - ALL, immune haemophillia

Question 31

causes of microcytosis

Answer 31

iron def thalassaemia

Question 32

beta thalassaemia trait blood film results

Answer 32

normal Hb increased RCC low MCV

Question 33

what is a good initial test for ?iron def

Answer 33

ferritin

Question 34

what blood results are seen in rheumatoid arthritis

Answer 34

anaemia of chronic disease low neutrophils / platelets due to drug toxicity felty syndrome increased ESR

Question 35

10 year old girl with R painful swollen knee after knocking it. prev fever but afebrile now. High WCC and CRP. DDx?

Answer 35

osteomyelitis

Question 36

1 year old boy with pain and swelling of joint after minor injury. most likely Dx?

Answer 36

haemophilia

Question 37

what Ix would you do for haemophilia?

Answer 37

coagulation screen - PT, APTT

Question 38

coagulation screen results of haemophilia

Answer 38

normal PT long APTT

Question 39

red cell fragments microangiopathic haemolytic anaemia Dx?

Answer 39

TTP

Question 40

TTP pentad

Answer 40

microangiopathich haemolytic anaemia thrombocytopenia fever neurological abnormalities renal impairment

Question 41

what is the defect in TTP

Answer 41

deficiency of von willebrand factor cleaving protease (ADAMTS13)