Haem

Question 1

What are the causes of raised APTT?

Answer 1

Haemophilia
vWD
DIC
Use of heparin

Question 2

What are the causes of raised PT?

Answer 2

Severe liver disease
Vit K deficiency
DIC
Sepsis

Question 3

What blood test abnormalities are seen in vWD?

Answer 3

Increased APTT

Decreased factor VIII and vW factor

Question 4

What tx can be given for mild vWd?

Answer 4

Desmopressin

Question 5

Which clotting factors are deficient in haemophilia A and B?

Answer 5

A = VIII
B = IX

Question 6

What are the three main causes of DIC?

Answer 6

Sepsis
Malignancy
Obstetric

Question 7

What are the three tests you would conduct to investigate for haemolytic anaemia?

Answer 7

Reticulocyte count
LDH level
Haptoglobin

Question 8

Which tests if positive will tell you that haemolytic anaemia is caused by an immune cause?

Answer 8

Coombs test

Question 9

Blood test abnormality seen in DIC

Answer 9

Low platelets
Increased PT and APTT
Low fibrinogen

Question 10

Which test is diagnostic of polycythaemia rubra vera?

Answer 10

JAK 2 mutation

Question 11

What are the secondary causes of polycythaemia?

Answer 11

COPD
Sleep apnoea
hypoxia (high altitude, smoking)
Increased EPO - renal cell carcinoma and hepatocellular carcinoma

Question 12

What is the main complication of polycythaemia vera?

Answer 12

Thrombosis

Question 13

What is the tx for polycythaemia vera?

Answer 13

Venesection or (hydroxycarbamide if high risk thrombosis)
+
daily ASPIRIN

Question 14

What conditions may polycythaemia vera progress to?

Answer 14

Myelofibrosis

Acute leukaemia

Question 15

What is a sign on blood film of G6PD deficiency?

Answer 15

Heinz bodies

Question 16

What’s the only tx for TTP?

Answer 16

Plasma exchange

Question 17

How do you distinguish AML from ALL on bone marrow biopsy?

Answer 17

Presence of AUER rods in AML

Question 18

In which condition is the Philadelphia chromosome found?

Answer 18

CML

Question 19

What would the FBC show in CML?

Answer 19

Increased myeloid cells (e.g. eosinophils, neutrophils, monocytes, basophils)

Question 20

What drugs can be used to tx CML?

Answer 20

Tyrosine kinase inhibitors (e.g. imatinib)

Question 21

What are the comps of CLL?

Answer 21

1) autoimmune haemolysis
2) Infection (hypogammaglobulinaemia)
3) Marrow failure

Question 22

How is Hodgkin’s lymphoma staged?

Answer 22

Ann Arbor system

Question 23

What two abnormalities are seen on FBC with alcohol misuse?

Answer 23

Thrombocytopenia
Raised MCV
Anaemia

Question 24

Two signs of thalassaemia

Answer 24

Skull bossing

Hepatosplenomegaly

Question 25

What sign on blood film indicates thalassaemia?

Answer 25

Target cells | Microcytic hypochromic RBCs

Question 26

Dx for thalassaemia

Answer 26

Hb electrophoresis

Question 27

Which types of immunoglobulin cause warm and cold autoimmune haemolytic anaemia?

Answer 27

``` Warm = IgG Cold = IgM ```

Question 28

What are seen on blood film in G6PD?

Answer 28

Heinz bodies

Question 29

What findings suggest intravascular haemolytic anaemia?

Answer 29

Increased free plasma Hb decreased haptoglobin Increased haemoglobinuria

Question 30

What practical measures would you instigate in a neutropenic patient?

Answer 30

Full barrier nursing Avoid IM injections Vitals 4 hourly (screen for infection, check bloods and cultures)

Question 31

What drug can help stimulate neutrophil production?

Answer 31

G-CSF

Question 32

What Ix for pernicious anaemia?

Answer 32

Parietal cell antibodies IF antibodies Schilling test

Question 33

What blood film features are consistent with AML?

Answer 33

Blast cells | AUER RODS

Question 34

How is CML treated?

Answer 34

Tyrosine kinase inhibitors

Question 35

What factor favours a more favourable prognosis in CML?

Answer 35

Presence of Philadelphia chromosome

Question 36

What is the main comp of CML?

Answer 36

Blast crisis (leads to AML and pancytopenia)

Question 37

Comps of CLL

Answer 37

1) autoimmune haemolysis 2) Infection due to hypogammaglobulinaemia 3) Marrow failure

Question 38

What staging system is used for CLL?

Answer 38

Binet

Question 39

What could cause a cough in NHL?

Answer 39

Mediastinal mass | Pneumonia

Question 40

ddx for NHL?

Answer 40

HL ALL Infectious mononucleosis

Question 41

How is lymphoma staged?

Answer 41

Ann-Arbor system

Question 42

Symptoms of hyperviscosity?

Answer 42

Headache, tinnitus. dizziness, visual disturbance, Plethoric appearance

Question 43

Which type of leukaemia are patients with myelodysplastic syndrome at risk of?

Answer 43

AML