Haem Flashcards
(133 cards)
1
Q
27F. Menorrhagia, anaemia.
What kind of anaemia does she have, and what is the treatment?
A
Iron deficiency anaemia.
Ferrous sulphate
2
Q
19M, university student. Presents to A&E with headache and breathlessness. Family lives in Nigeria.
Investigations show severe anaemia, reticulocytosis, bite cells.
Recent prescription of nitrofurantoin for a UTI.
Most likely cause of symptoms?
A
Oxidative crisis due to G6PD deficiency
3
Q
GS investigation for DVT
A
Doppler US
4
Q
Which of these is not a cause of thrombocytopenia?
A. Chronickidneydisease
B. HIV
C. Excessive alcohol consumption
D. Myeloma
E. Heparin
A
Heparin
5
Q
A 3 year-old is a patient on the oncology ward following severe anaemia, recurrent infection, and pain in her bones. Most likely diagnosis?
A
ALL
6
Q
What is the diagnostic test for sickle cell anaemia?
A
Hb electrophoresis
7
Q
Most appropriate treatment for CML?
A
Imatinib (tyrosine kinase inhibitor)
8
Q
What is the pathophysiology of hereditary spherocytosis?
A
It is caused by defects in the red cell membrane, resulting in them having an increased permeability to sodium
9
Q
What is the infective stage of the malaria parasite?
A
Sporozite
10
Q
What are you most likely to see on a blood smear in suspected ALL?
A
Blast cells
11
Q
What malignancy is Philadelphia Chromosome associated with?
A
CML
12
Q
Explain the mechanism of action of Imatinib
A
Tyrosine kinase inhibitor
13
Q
A 74 year old gentleman is investigated for multiple myeloma following a fragility fracture he sustained at home.
Which of these findings on a series of blood tests would NOT be suggestive of myeloma?
A. Anaemia
B. Hypocalcemia
C. Raised Creatinine
D. Raised Urea
E. Monoclonal proteins in Serum
A
Hypocalcaemia
HypER rather than hypOcalcemia is seen in myeloma
14
Q
What would you expect to see on a blood film for a patient with multiple myeloma?
A
Rouleaux formation. RBCs look like a stack of coins
15
Q
DVT.
What is the duration of treatment with Apixaban?
A
6 months
16
Q
68M. Thirst, constipation, confusion. Osteoarthritis had returned, severe back pain in the thoracic region. FBC shows anaemia.
Most likely diagnosis?
A
Multiple myeloma
17
Q
Haemophilia A is inherited in a X linked recessive pattern. In this case, the Father has the disease and the mother is a carrier.
What is the chance of their daughter also having the disease?
A
50%
X* X
X* XX X*X
Y X*Y XY
18
Q
48M. Alcoholic.
What type of anaemia would be seen on FBC?
A
Chronic alcoholism anaemia causes Macrocytic anaemia
19
Q
68F. Lower back pain, numbness and weakness in fingers.
Weight loss (unintentional), hypercalcaemia, anaemia.
What is the most likely diagnosis and which gene is associated with it?
A
Multiple Myeloma.
MGUS
20
Q
You suspect a haematological disorder, so perform a blood film. It shows blast cells with Auer rods.
What is your diagnosis?
A
AML
21
Q
What protein is deficient in Haemophilia A?
A
Factor VIII
22
Q
5month old baby, south-east Asian origin.
Weak, swollen abdo, dark urine. Small size, facial deformities.
Blood smear: microcytic, hypochromic anaemia, with target cells.
Low Hb, high iron.
Most likely diagnosis and the result of Hb electrophoresis that would confirm it?
A
Thallasemia
Decreased HbA, increased HbA2, present HbF
23
Q
List 4 causes of microcytic anaemia
A
- iron deficiency
- β thalassaemia
- anaemia of chronic disease
- lead poisoning
24
Q
List 4 causes of macrocytic anaemia
A
- B12 deficiency
- folate deficiency
- alcohol access
- myelodysplastic neoplasm
- hypothyroidism
- pregnancy
- methotrexate
- reticulocytosis
25
List 4 causes of normocytic anaemia
- anaemia of chronic disease
- CKD
- anaemia of traumatic blood loss
- combined (iron and B12 deficiencies for example)
- inflammatory disease
26
Describe the mechanism of absorption of vitamins B12
B12 binds to intrinsic factor, which is produced by parietal cells in the stomach. It is then actively absorbed in the terminal ileum
27
List 3 causes of B12 deficiency. Which is most common?
Most common = pernicious anaemia
- vegan / poor diet
- disorder of the terminal ileum e.g. Crohn’s, ileocaecal resection
28
What is the treatment of B12 deficiency anaemia ?
- B12 replacement
- IM hydroxocobalamin
29
What is the management for hereditary spherocytosis?
Splenectomy
30
What finding on blood film would confirm a diagnosis of multiple myeloma?
Rouleaux formation
31
The most severe form of the disease malaria with the highest rate of mortality in humans is caused by which species of mosquito?
Plasmodium falciparum
32
List 3 protective factors for malaria
- sickle cell trait
- G6PD deficiency
- HLA-B53
33
What does complicated malaria entail?
Vascular occlusion
Can cause raised ICP, seizure, coma
34
Ann Arbor Classification:
Describe class Ia
One nodal area, no systemic symptoms
35
Ann Arbor Classification:
Describe class IIa
Two or more nodal areas on the same side of the diaphragm
No systemic symptoms
36
Ann Arbor Classification:
Describe class IIb
Two or more nodal areas on the same side of the diaphragm
Systemic symtoms
37
Ann Arbor Classification:
Describe class IIIa
Nodal areas on both sides of the diaphragm
No systemic symptoms
38
Ann Arbor Classification:
Describe class IIIb
Nodes on both sides of the diaphragm
Systemic symptoms
39
Describe the Pathophysiology of Hereditary Spherocytosis
- autosomal dominant defect of the red blood cell cytoskeleton
- increased permeability to Na+ (therefore more water drawn in)
- normal biconcave disc shape replaced by sphere shape
- unable to pass through spleen without being destroyed
40
How is hereditary spherocytosis diagnosed?
Mostly family history and clinical picture.
BLood film will show spherocytes
41
Describe the Pathophysiology of thrombotic thrombocytopenic purpura
ADAMTS13 deficiency causes Von Willebrand’s factor to form thromboses
The body breaks these down, causing haemolytic anaemia and raised bilirubin
42
Describe the pathology and give two causes of relative polycythaemia
Fluid loss causing highly concentrated blood
- dehydration
- stress
43
Describe the pathology of secondary polycythaemia and give two examples of causes
Chronic hypoxia stimulated erythropoietin production in the kidney
- high altitude
- COPD
44
Describe the pathology of polycythaemia rubra Vera
Primary polycythaemia
JAK2 mutation -> bone marrow stem cell proliferation -> overproduction of RBCs, neutrophils, platelets -> increased clotting risk
45
What is Virchow’s triad?
Risk of DVT / PE
- stasis of blood flow
- hypercoagubility
- endothelial injury
46
What is the difference between ITP in children and adults?
- children = acute (primary)
- adults = chronic (secondary)
47
Name 3 signs / symtoms of immune thrombocytopenia
- easy bruising
- epistaxis
- menorrhagia
- purpura
- gum bleeding
48
How is ITP diagnosed?
FBC: isolated thrombocytopenia
49
What is the first line management of ITP?
Corticosteroids (Prednisolone)
IV IgG
50
Which causative organisms of malaria can cause relapses?
Plasmodium vivas
Plasmodium ovale
51
What signs would you expect to see in a patient when diagnosing malaria?
- fever, often >39
- sweats / chills
- headache
- myalgia
- fatigue
- diarrhoea
- vomiting
- abdominal discomfort
52
Name 3 signs you might see on examination of a patients’ face, skin, and nails that are associated with iron deficiency anaemia
- brittle nails
- koilonychia
- subconjuctival pallor
- pallor
- atrophic glossitis
- angular stomatitis
53
List the diagnostic criteria of multiple myeloma
- osteolytic lesions on imagine
- elevated plasma cells in bone marrow
- monoclonal protein in serum or urine
54
Which chromosomal abnormalities are assisted with multiple myeloma?
T(11;14)
55
50M presenting with recurrent infections, weight loss, hepatosplenomegaly, gum hypertrophy. Most likely diagnosis?
Acute Myeloid Leukaemia
56
What would be expected on bone marrow biopsy in AML?
Auer rods
57
What 2 things are associated with AML?
Down syndrome
Radiation
58
What 3 treatments are commonly used in AML?
- blood transfusion
- chemotherapy
- bone marrow transplant
- steroids
- IV antibiotics
- Allopurinol (to prevent tumour lysis)
59
Pt with CLL. What age do you expect them to be?
Over 70
60
What is expected on clinical examination of someone with CLL?
- anorexia
- non-tender lymphadenopathy
61
What treatments are commonly used in CLL?
- Chemotherapy,
- Rituximab (monoclonal antibody)
- Ibrutinib (bruton kinase inhibitor)
62
What is a complication of CLL that you should be aware of?
Richter’s transformation
(Progression to aggressive leukaemia)
63
Alcohol induced painful lymph nodes?
Hodgkin’s lymphoma
64
What investigation are done to diagnose Hodgkin’s lymphoma and what are the results?
FBC: normocytic anaemia
CXR: wide mediastinum
Blood film: Reed sternberg cells
65
What is the treatment plan for Hodgkin’s lymphoma?
Chemotherapy ABVD treatment
Bone marrow transplant
66
What would be seen on blood film in G6PD deficiency?
Heinz bodies
Bite cells
Reticulocytes
67
What antibiotic is contraindicated in G6PD deficiency?
Nitrofurantoin
68
What are the 6Ps ?
Pain
Pallor
Perishingly cold
Pulselessness
Paralysis
Paraesthesia
69
What is the scoring system used in DVT diagnosis?
Well’s score
70
List the factors of the Well’s score
Clinical signs / symptoms of DVT or PE
No alternative diagnosis
Heart rate >100bpm
Immobilisation for at least 3 days
Past history of DVT or PE
Haemoptosis
Malignancy with active treatment in the last 6 months or palliative management
71
What is the first line investigation of DVT?
D-dimer
72
Explain the Pathophysiology of disseminated intravascular coagulation
Simultaneous coagulation and haemorrhage caused by the initial formation of thrombi containing clotting factors and platelets, causing more bleeding
73
List 3 features of DIC
- clinically bleeding
- bruising
- ischaemia
- organ failure
74
List 3 causes of DIC
- infection
- malignancy
- trauma - burns, shock, surgery
- liver disease
- obstetric complications
75
What would the blood tests in DIC show?
Increased bleeding time
Low platelets
Low fibrinogen
Increased fibrin degradation products
76
Haemophilia A: genetic inheritance and deficiency
X linked recessive
Factor VIII
77
Haemophilia B: genetic inheritance and deficiency
X linked recessive
Factor IX
78
Haemophilia C: genetic inheritance and deficiency
Autosomal recessive
Factor XI
79
define bleeding time
Assessment of platelet function
Superficial puncture would, measure time taken for bleeding to stop (bleeding site turns glassy)
80
Define d-dimer
D-dimer is the degradation product of crosslinked (by factor XIII) fibrin. It reflects ongoing activation of the hemostatic system.
81
What plasma protein transports iron in the blood to the bone marrow?
Transferrin
82
What is ferritin?
Storage molecule of iron
83
Give 2 features of microcytic anaemia that would be seen on blood film?
- small red blood cells
- pale red blood cells (hypochromic)
- variation in RBC shape
84
Name 2 blood tests that would be carried out to diagnose microcytic anaemia
- serum ferritin
- serum iron
- reticulocyte count
85
What’s the pharmacological treatment of iron deficiency anaemia ?
Oral iron e.g. ferrous sulphate
86
Give 2 SEs of ferrous sulphate
- nausea
- abdominal discomfort
- black stools
87
What cells would you expect to find on microscopy of a Hodgkin’s lymphoma?
Reed stern berg cells
88
What lymphocyte is most likely affected in non-Hodgkin’s lymphoma?
B-lymphocyte
89
What virus is strongly associated with non-Hodgkin’s lymphoma?
Epstein Barr virus
90
What are the B symptoms?
Fever, weight loss, night sweats
91
Define pancytopenia
Deficiency of all blood types - red blood cells, white blood cells, platelets
92
Which form of viral hepatitis is a notifiable disease and to whom should it be reported?
Hepatitis A.
Consultant in Communicable Disease Control OR Public Health England OR local health protection team
93
Why is Hepatitis D only able to cause disease in those with Hepatitis B?
Incomplete RNA virus - needs HepB to be able to assemble
94
Name 3 management protocol for acute Hepatitis B
- avoid alcohol
- vaccinate contacts
- monitor liver function
95
What type of virus is HIV?
Retrovirus subgroup lentivirus
96
What CD4 count is the defining level for an AIDS diagnosis?
<200/ul
97
What is the overall name for treatment given to HIV patients and what sub-groups of medication are given – write in full (4 marks)
HAART (highly active antiretroviral therapy) – NRTI (nucleoside reverse transcriptase inhibitors) OR NNRTI (non-nucleoside reverse transcriptase inhibitors)
98
Nail bed flattening - what is it called? What is it a sign of?
Koilonychia
Iron deficiency anaemia
99
In iron deficiency anaemia, what 3 changes will be seen in plasma iron studies other than decreased MCV?
Decreased iron
Decreased ferritin
Increased total iron binding capacity
100
What is the most common type of myeloma?
IgG
101
What is the second most common type of myeloma?
IgA
102
What pathological feature of myeloma could cause backache backache?
Osteopathic bone lesions
103
What 3 features would you expect to see on FBC in myeloma?
Anaemia
Neutropenia
Thrombocytopenia
104
XR features of myeloma?
- lyric lesions
- punched out lesions
- pepper pot skull
- fractures
- vertebral collapse
- osteoporosis
105
COmplications of myeloma?
- hypercalcaemia
- spinal cord compression
- hyperviscosity
- AKI
- amyloidosis
- recurrent infections
106
Sickle cell disease causes what kind of anaemia?
Haemolytic anaemia
107
What is included in Warfarin reversal treatment?
- IV prothrombin complex concentrate
AND
- IV vitamin K
108
Px: sepsis, DIC, low fibrinogen
Treatment?
Cryoprecipitate
109
What is cryoprecipitate?
Derivative of fresh frozen plasma
More concentrated clotting factors
110
Describe the anaemia caused by T1DM
- pernicious anaemia -> B12 deficiency anaemia
- oval macrocytes and hypersegmented neutrophils
111
What cell is involved in myeloma?
Plasma cell
112
What is the platelet count in ITP?
Low
113
If fibrin degradation products are raised, what does this indicate?
Disseminated Intravascular Coagulation
114
D-dimer - what do?
Assesses the degradation products of cross linked fibrin
115
Antiphospholipid lipid syndrome antibodies
Lupus anticoagulant
Anti cardiolipin
Anti beta 2 GBI
116
Antiphospholipid syndrome gene association?
HLA DR7
117
SLE gene associations?
HLA B8
HLA DR2
HLA DR3
118
Intrinsic factor antibodies indicates which anaemia?
Pernicious anaemia -> B12 anaemia
119
Smudge cells on blood film indicate what ?
CLL
120
What is the inheritance pattern of β thalassaemia?
Autosomal recessive
121
What factor is affected in each type of haemophilia?
A = VIII
B = IX
C = XI
122
On blood tests, how can haemophilia C be differentiated from the others?
Partial thromboplastin time is raised in A and B but not in C
123
What are the electrolyte imbalanced seen in tumour lysis syndrome?
- hypocalcaemia
- hyperphosphatemia
- Hyperuricaemia
- hyperkalaemia
124
What is the standard management of ITP?
Watch and wait as most cases are self limiting - supportive care at home
125
If there is major bleeding in ITP, what are the management options?
- IV Prednisolone
- IV Ig
- platelet transfusion
126
What is Ann Arbor staging for?
Hodgkin’s lymphoma
127
Briefly describe what a lymphoma is
A malignant tumour causing proliferation of lymphocytes mainly in lymph nodes
128
Other than lymph nodes, give 4 sites that Hodgkin’s lymphoma affects
- bone marrow
- spleen
- liver
- blood
129
Symptoms of Hodgkin’s lymphoma:
Enlarged lymph nodes
General B symptoms i.e weight loss, night sweats, malaise, fatigue
Hepato/ splenomegaly
Easy bruising
Anaemia
Frequent infections
Enlarged abdomen
130
Give two signs that are specific to iron deficiency anaemia
Angular stomatitis and koilonychia
131
Where in the intestine is B12 absorbed? What bind to B12 in the stomach?
Terminal ileum
Intrinsic factor
132
What causes B12 deficiency in pernicious anaemia?
Atrophic gastritis
133
Neurological signs of B12 deficiency anaemia?
- irritability
- depression
- psychosis
- dementia
- paraesthesia
- peripheral neuropathy
