haem

Question 1

mx of post-thrombotic syndrome

Answer 1

compression stockings

Question 2

when does post-thrombotic syndrome occur

Answer 2

6 months to 2 years after a DVT

Question 3

causes of petechiae in adults

Answer 3

ITP
bone marrow failure (secondary to leukaemias, myelodysplasia or bone mets)
senile purpura
drugs
nutritional deficiencies

Question 4

non-emergency mx of ITP in adults

Answer 4

platelet count >30 - observe

platelet count <30 - oral prednisolone

Question 5

ix for polycythaemia vera (after FBC)

Answer 5

JAK2 mutation screen

Question 6

sickle cell with high reticulocyte

Answer 6

sequestration crisis

Question 7

sickle cell with low reticulocytes

Answer 7

aplastic anaemia caused by Parvovirus

Question 8

diagnostic criteria for tumour lysis syndrome (TLS)

Answer 8

positive laboratory TLS (raised uric acid, hyperkalaemia, hyperphosphataemia or hypocalcaemia)
AND
positive clinical TLS (increased creatinine, cardiac arrhythmia or seizure)

Question 9

ABX for neutropenic sepsis

Answer 9

IV Tazobactam and Piperacillan (Tazocin)

Question 10

what can myelodysplasia transform into?

Answer 10

AML

Question 11

what can CML transform into?

Answer 11

AML or ALL

Question 12

what can CLL transform into?

Answer 12

non-Hodgkin’s lymphoma (Richter’s transformation)

Question 13

CML bloods

Answer 13

increase in granulocytes at different stages of maturation

anaemia

Question 14

CLL bloods

Answer 14

lymphocytosis
anaemia
smudge cells

Question 15

transfusion threshold NO ACS

Answer 15

70 g/L

Question 16

transfusion threshold ACS

Answer 16

80 g/L

Question 17

features of TTP (thrombotic thrombocytopenic purpura)

Answer 17

FAT RN 
Fever
Anaemia
Thrombocytopenia
Renal failure
Neuro features

Question 18

myeloma bloods

Answer 18

raised Ca
normal/high phosphate
normal ALP

Question 19

mx of antiphospholipid syndrome

Answer 19

primary thromboprophylaxis - low dose aspirin
secondary thromboprophylaxis - lifelong warfarin
- initial VTE - target INR of 2-3
- recurrent VTE - target INR of 3-4 (if occurred whilst taking warfarin then consider adding low-dose aspirin)
- arterial thrombosis - target INR 2-3

Question 20

features of multiple myeloma

CRABBI

Answer 20

Calcium raised
Renal failure
Anaemia
Bone lesions
Bleeding (thrombocytopenia)
Infection

Question 21

FBC in beta thalassaemia trait

Answer 21

Microcytosis disproportionate to anaemia

Question 22

what are acute haemolytic transfusion reactions the result of

Answer 22

RBC destruction by IgM antibodies

Question 23

features of tumour lysis syndrome

Answer 23

hyperkalaemia
hyperphosphataemia
hypocalcaemia

Question 24

mx of tumour lysis syndrome

Answer 24

Allopurinol

Question 25

which leukaemia may polycythaemia rubra vera transform into

Answer 25

AML

Question 26

ITP in adults

Answer 26

thrombocytopenia | any of: purpura, epistaxis or major haemorrhage (e.g. intracranial)

Question 27

universal donor of fresh frozen plasma

Answer 27

AB RhD negative blood

Question 28

inheritance pattern of G6PD deficiency

Answer 28

X-linked

Question 29

direct Coombs test

Answer 29

autoimmune haemolytic anaemia

Question 30

blood film findings in AML

Answer 30

Auer rods

Question 31

dx for painful vaso-occlusive crisis in sickle cell

Answer 31

clinical - no additional tests will confirm this

Question 32

when to think about autoimmune haemolytic anaemia

Answer 32

anaemia in Mycoplasma infection with raised LDH and raised unconjugated bilirubin

Question 33

antibodies to measure in macrocytic anaemia

Answer 33

INTRINSIC FACTOR

Question 34

blood film findings of G6PD deficiency

Answer 34

bite and blister cells

Question 35

bloods in DIC

Answer 35

low platelets and fibrinogen | prolonged PT, APTT and bleeding time

Question 36

bloods in alcoholic liver disease

Answer 36

macrocytic anaemia | thrombocytopenia

Question 37

when to transfuse platelets

Answer 37

platelet count <30x10^9 and clinically significant bleeding | platelet count <10x10^9 if no active bleeding

Question 38

bloods in von Willebrand disease

Answer 38

normal platelets prolonged bleeding time prolonged APTT

Question 39

bloods in anaemia of chronic disease

Answer 39

normocytic anaemia low serum iron low TIBC raised ferritin