Haem path Flashcards by Jason Lim

A thalassemia patient presents with malaise and erectile dysfunction

Transfusion-related haemosiderosis

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A Lady with myelodysplastic syndrome requires regular monthly blood transfusions. 10 minutes after her latest transfusion she becomes tachycardic, has transfusion site pain, and is hypotensive

ABO incompatibility

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blood transfusion question- Alcoholic has an AAA repair and several days later develops a fever, low Hb, and jaundice

delayed transfusion reaction

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A woman after placental abruption and surgery has low fibrinogen, prolonged APTT, PT and
low fibrinogen

DIC

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Which test is used to detect beta thalassaemia

High performance liquid chromatography

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How to monitor therapy in someone with polycythaemia vera

Haematocrit

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Test for autoimmune haemolytic anaemia

Direct antiglobulin test

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Haemolysis after antimalarials / malaria treatment

G6PD deficiency

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A patient with high IgG paraprotein – (32 or 40) g/dl, back pain and loss of sensation in legs

Multiple myeloma
Monoclonal gammopathy of undetermined significance
Chronic idiopathic neutropenia
Acute myeloid leukaemia
Agammaglobulinaemia
Lymphoplasmacytic lymphoma

Multiple Myeloma

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Patient with IgM paraprotein and visual disturbances

Multiple myeloma
Monoclonal gammopathy of undetermined significance
Chronic idiopathic neutropenia
Acute myeloid leukaemia
Agammaglobulinaemia
Lymphoplasmacytic lymphoma

Lymphoplasmacytic lymphoma (Waldenstrom’s macroglobulinaemia)

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An overweight individual with diabetes has longstanding bone/back pain. They are found to have paraprotein IgA ~8g/dl, and GFR 55mls/min/1.73m^2. FBC normal and albumin normal

Multiple myeloma
Monoclonal gammopathy of undetermined significance
Chronic idiopathic neutropenia
Acute myeloid leukaemia
Agammaglobulinaemia
Lymphoplasmacytic lymphoma

MGUS

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What causes DIC in pregnancy?

Amniotic fluid embolism

Others include:
Pre-eclampsia and eclampsia
Abruption
Septic abortion or sepsis in pregnancy
Retained fetal material
Fetal demise

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HELLP Syndrome sign -
Low Plasma Volume
Neutropenia
MAHA
Increased fibrinolysis

MAHA

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What type of hypersensitivity (Gel and Coombs classification) is myasthenia gravis?

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Woman on a DOAC. Advice in pregnancy. Lady with lifelong DOAC, has never had problems, when becomes pregnant what should you do?

LMWH instead

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56 y/o lady with SLE, has spherocytes, low Hb, raised bilirubin how do you test for diagnosis? DAT or Osmotic fragility?

DAT because she has AIHA due to SLE

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A patient with renal impairment is on low molecular weight heparin, what do you measure to monitor this?

anti-Xa assay

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What 3 viruses are screened for in platelet donations to pregnant women?

HBV, CMV, HIV

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Chimeric antigen receptor T-cell therapy against CD19: what type of haematological malignancy does it target?

Leukaemia or B cell lymphoma

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Patient with low WCC and Plt and teardrop cells on film?

myelofibrosis

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HTLV1 virus is associated with which cancer?

Adult T cell lymphoma

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Which investigation would confirm a diagnosis of hereditary spherocytosis after seeing spherocytes on a blood film?

Eosin-5-maleimide dye test

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What would be the most important investigation to carry out in a 65 year old man with iron- deficient anaemia?

OGD oesophago-gastro-duodenoscopy

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Lady with Multiple myeloma and restrictive cardiomyopathy. What will you see on heart biopsy?

Amyloid deposits

Which coagulation factor is decreased first on administration of warfarin?

Which type of cell does Rituximab target?

B cells

Person who had a DVT many years ago (or recurrent DVTs), presents with recurrent dark bruising, and swelling over the course of 5 years, and now had pain in their leg. What is the possible cause?

Post thrombotic syndrome

Person who had negative direct coombs test but who has anaemia (low Hb), and jaundice (many answers)

MAHA, valve-associated haemolysis, sickle cell etc

A patient has a massive splenomegaly, and JAK2 V617F mutation with a leucoerythroblastic picture and tear-drop poikilocytes. What do they have?

Myelofibrosis

An African man with Burkitt’s lymphoma is given Rasburicase. He develops haematuria with irregularly contracted cells. What is the cause?

G6PD deficiency

A patient required an aortic valve replaced 3 months ago. They have now come back a few weeks later with jaundice, Hb-urea (haemoglobinuria), and raised reticulocytes. What is the cause?

Valve associated haemolysis

Bortezomib is a proteasome inhibitor, how does this work?

Inhibits intracellular protein degradation, build-up and amino acid shortage kills cell

What is the first-line treatment for CML

Imatinib (BCR-ABL tyrosine kinase inhibitor)

Man with cyanotic heart disease has a haematocrit of 54% (high) and is found to be negative for JAK2 mutation, what is the cause of the high haematocrit?

Secondary polycythaemia

What is the mechanism of hyperacute allograft rejection?

Pre-formed antibodies attach the graft

Treatment for CLL with p53 mutation. What is the first line treatment?

Ibrutinib BTK inhibitor

Sickle cell patient, spleen not felt. Low reticulocytes, very anaemic.

Parvovirus B19 - Aplastic crisis

Which of the following is low during pregnancy? a. Fibrinogen b. Factor 7 c. Protein S d. Plasminogen activator inhibitor 1 e. Von Willebrand’s factor

Protein S

Which drug can be used to treat some malignancies and affects T cell activity? a. Infliximab b. Pembrolizumab (anti PD-1 on lymphocytes) c. Rituximab

Pembrolizumab (anti PD-1 on lymphocytes)

Drug tx for most lymphomas

rituximab (anti CD20)

Venetoclax is a BCL2 inhibitor used in CLL. What cellular process does it affect?

venetoclax disrupts the cellular process of apoptosis by specifically targeting and inhibiting the BCL2 protein, leading to increased cell death in CLL cells

75 year old woman has neutropenic sepsis secondary to myelodysplasia. Her blood count is lower than it was 6 weeks ago, with marked panyctopaenia. Blood film shows numerous large cells of primitive appearance. What is the likely explanation? a) Development of iron deficiency b) Development of aplastic anaemia c) Progression to AML d) Progression to CML e) Progression to myelofibrosis

Progression to AML (myelodysplastic syndromes progress to AML)

DOAC monitoring

none required

Is humoral immune dysfunction associated with multiple myeloma?

yes

In obstetric practice, the maximum risk of fatal maternal thrombo-embolism occurs at which stage of pregnancy? a) 1st trimester b) 2nd trimester c) 3rd trimester d) Post partum e) Post amniocentesis

Postpartum

Chance of a sibling being HLA identical?

25%

In Hodgkin lymphoma, PET CT scan at diagnosis demonstrates disease involving the following sites only: supraclavicular fossa, mediastinum, inguinal nodes and spleen. What anatomical stage is this?

3 - lymph nodes both sides of diaphragm

Philadelphia chromosome, not CML?

ALL

Hypogranular hypolobated neutrophils

myelodysplastic syndrome (which is like AML but less than 20% blasts)

A 25 year old Greek woman who is 12 weeks pregnant attends a routine antenatal appointment, the following blood test results are obtained. Based on these results, to determine if the future health of this fetus may be at risk, what is the first action/investigation required? Hb 114 g/L (115-165) MCV 70 fL (80-96) Hb A2 concentration 5.2% (2.0-3.5) Ferritin 13ug/L (12-200) Serum transferrin 2.4u/L (1.7-3.4)

haemoglobin electrophoresis to detect thalassaemia

What medical procedure can you do to prevent hyperacute ABO rejection in the transfer of an ABO incompatible kidney?

plasmapherisis

Pelger Huet cells

myelodysplastic syndrome

Test for MM

serum protein electrophoresis

Patient with multiple myeloma, and lights chains >1000. Most likely kidney manifestation?

Cast nepropathy

In optimal circumstances, for a 70kg male, transfusion of 1unit RBC and 1 unit of platelet gives a predictable increment in the Hb and platelet count. Which statement is correct? Expected increment, Haemoglobin 10 g/L and Platelets 400 x 10^9/L. Expected increment, Haemoglobin 20 g/L and Platelets 10 x 10^9/L. Expected increment, Haemoglobin 50 g/L and Platelets 35 x 10^9/L Expected increment, Haemoglobin 50 g/l and Platelets 100 x 10^9/L. Expected increment, Haemaglobin 10 g/L and Platelets 35 x 10^9/L.

Expected increment, Haemaglobin 10 g/L and Platelets 35 x 10^9/L

In allogeneic haemopoietic stem cell transplantation for acute myeloid leukaemia. Removing all donor derived T lymphocytes (T-cell depletion) from the donor cell collection prior to infusion into the recipient has an impact on both, the incidence of acute graft, versus host disease (aGVHD) and the rate of leukaemia relapse. Which statement is true? Abolishes aGHVD risk and removes risk of leukaemia relapse . Increases aGVHD risk and increases leukaemia relapse rate. Increases aGVHD risk and reduces leukaemia relapse rate. Reduces aGVHD risk and reduces leukaemia relapse rate. Reduces aGVHD risk and increases leukaemia relapse rate.

Reduces GVHD, increases relapse

A 30 year old woman with known ITP gives birth to a healthy full term baby. Which is the correct haematological management of the newborn baby? Check daily bilirubin levels for a minimum of five days Check daily FBC for a minimum of five days. Check FBC on cord blood sample and if normal no further action required Check INK on cord blood sample and administer Vitamin K Perform DAT (direct anti-globulin test) on both maternal and neonatal red blood cells.

Check FBC on cord blood sample and if normal no further action required, if not, fbc daily for 5 days

A 41 year old woman who is 20 weeks pregnant attends a routine antenatal appointment. She has a past medical hx of venous thromboembolic disease in a previous pregnancy. BMI 31. Mx?

LMWH