Haematological

Question 1

Tumour lysis syndrome

Answer 1

Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia
Hyperuricaemia/hyperuricosuria

Question 2

Antibodies in cold and warm haemolytic anaemia

Answer 2

Cold: IgM
Warm: IgG

Question 3

Causes of anaemia

Answer 3

Microcytic - TAILS:

• Thalssaemia
• Anaemia of chronic disease
• Iron deficiency
• Lead poisoning
• Sideroblastic anaemia

Normocytic - ABCD:

• Acute blood loss - trauma, GI bleed, surgery, menorrhagia
• Bone marrow failure - aplastic anaemia, leukaemia, myelodysplastic syndrome
• Anaemia of chronic disease
• Destruction (haemolysis) - sickle cell anaemia, MAHA, G6PD deficiency, autoimmune haemolytic anaemia, hereditary spherocytosis

Macrocytic - FAT RBC:

• Foetus (pregnancy)
• Alcohol
• Hypothyroidism
• Reticulocytosis
• B12/folate deficiency
• Cirrhosis

Question 4

Causes of iron deficiency anaemia

Answer 4

• Chronic bleeding - PUD, colorectal cancer, menorrhagia, angiodysplasia
• Malabsorption - coeliac disease, IBD
• Inadequate diet
• Pregnancy

Question 5

Causes of aplastic anaemia

Answer 5

Acquired:

• Idiopathic
• Infection - hepatitis, measles, parvovirus B19
• Drugs - cytotoxic drugs, gold, phenytoin, chloramphenicol
• Pregnancy

Inherited:
-Fanconi’s anaemia

Question 6

Definition of febrile neutropenia

Answer 6

Fever >38ºC for 1 hour with absolute neutophil count ≤500 cells/μL

Question 7

Pathological findings in Hodgkin’s lymphoma

Answer 7

Reed-Sternberg cells - binucleated with prominent nuclei

Disorganised structure with effacement of lymph node structure

Question 8

Ann Arbor stages

Answer 8

I - in 1 lymph node region
II - in ≥2 lymph node regions on same side of diaphragm
III - nodes on both sides of diaphragm
IV - spread beyond nodes (e.g. liver, lungs, bone marrow)

Question 9

Management of non-Hodgkin’s lymphoma (high grade)

Answer 9

R-CHOP:

• Rituximab
• Cyclosporine
• Hydroxydaunorubicin
• Vincristine
• Prednisolone

Question 10

Clinical features of thrombotic thrombocytopenic purpura

Answer 10

TMN Renal Failure:

• Thrombocytopenia - purpura
• MAHA - anaemia, jaundice, schistocytes
• Neurological symptoms - hallucinations, altered mental state, headache, stroke, seizure, coma
• Renal failure
• Fever

Question 11

HUS vs. TTP

Answer 11

HUS:
Less CNS and more renal involvement
Mostly in children

Question 12

Definition of myelodysplastic syndrome

Answer 12

Dysplastic haematopoiesis causing cytopenia and hypercellular bone marrow, with risk of developing AML

Question 13

Types of von Willebrand disease

Answer 13

1 - quantitative decrease; autosomal dominant
2 - qualitative decrease; autosomal dominant
3 - absence of production; autosomal recessive; causes factor VIII deficiency

Question 14

Clinical features of multiple myeloma

Answer 14

CRAB:

• Hypercalcaemia
• Renal failure, recurrent infections
• Anaemia
• Bone lesions

Question 15

Prognostic factors of multiple myeloma

Answer 15

ESR/CRP
β2-microglobulin
Albumin

Question 16

Diagnostic criteria for multiple myeloma

Answer 16

M protein on serum/urine electrophoresis
≥10% plasma cells on bone marrow biopsy
End-organ damage

Question 17

Factor V Leiden

Answer 17

Loss of inhibition of factor V by protein C

Question 18

Prothrombin G20210A

Answer 18

Higher levels of prothrombin

Question 19

Antithrombin III deficiency

Answer 19

Loss of inhibition of thrombin and factor Xa, causing heparin resistance and highest risk of VTE (compared to other thrombophilias)

Question 20

Protein C deficiency

Answer 20

Loss of inhibition of factor V and VIII

Question 21

Protein S deficiency

Answer 21

Loss of cofactor activity for protein C, reducing inhibition of factors V and III

Question 22

Management of von Willebrand disease

Answer 22

Type 1 and 2 - desmopressin

Type 3 - vWF-containing factor VIII concentrate