Haematology

Question 1

What is the definition of anaemia?

Answer 1

Low haemoglobin (Hb) concentration due to low red cell mass or increased plasma volume

Question 2

Which symptoms can commonly present in all caused of anaemia

Answer 2

Fatigue, faintness, dyspnoea, headache, tinnitus, anorexia

Question 3

What are the signs of severe anaemia

Answer 3

Tachycardia, flow murmurs, cardiac enlargement

Question 4

List the causes of microcytic anaemia (3)

Answer 4

Iron-deficiency anaemia
Thalassaemia
Sideroblastic anaemia

Question 5

List the causes of normocytic anaemia (5)

Answer 5

Acute blood loss
Anaemia of chronic disease
Bone marrow failure
Renal failure
Pregnancy

Question 6

List the causes of macrocytic anaemia (7)

Answer 6

B12/Folate deficiency
Alcohol excess / liver disease
Reticulocytosis
Cytotoxics
Myelodysplastic syndromes
Marrow infiltration
Antifolate drugs

Question 7

What are the signs of iron deficiency?

Answer 7

Microcytic anaemia
Brittle hair and nails
Atrophic glossitis
Angular stomatitis

Question 8

A patient is diagnosed with iron deficiency anaemia. What would you expect their serum ferritin to be?

Answer 8

Low

Question 9

What are the signs of B12 deficiency?

Answer 9

Macrocytic anaemia

Neurological problems

Question 10

What are the signs of haemolysis?

Answer 10

Normo or Macrocytic anaemia
Jaundice
Gall stones
Leg ulcers

Question 11

What are the signs/symptoms of aplastic anaemia?

Answer 11

Pancytopenia
Increased susceptibility to infection
Increased susceptibility to bleeding/bruising
Fatigue, faintness, palpitations, headache

Question 12

How is aplastic anaemia treated?

Answer 12

Remove causative agent
Platelet and blood transfusions
Unresponsive: immunosuppression +/- bone marrow transplant

Question 13

What is the mechanism of sickle cell anaemia?

Answer 13

Changes in structure of alpha-haemoglobin. Faulty Hb complex. Distorted shape of RBCs when deoxygenated. Sickle RBCs are easily destroyed and occlude vessels.

Question 14

How does sickle cell anaemia present?

Answer 14

Childhood: pain in hands and feet due to vessel occlusion.
Can lead to avascular necrosis
Anaemia: fatigue, faintness, palpitations, headache

Question 15

How is sickle cell anaemia managed?

Answer 15

Folic acid supplementation
Pain relief
Bone marrow transplant (severe)

Question 16

What causes thalassaemia?

Answer 16

Defective alpha or beta haemoglobin subunit.

Question 17

How and when does each type of thalassaemia present?

Answer 17

Alpha - Neonatal
Beta - Infancy
Heterozygote can be asymptomatic
Homozygote - severe anaemia, failure to thrive, bone deformities

Question 18

What is the mechanism of glucose-6-phosphate dehydrogenase deficiency?

Answer 18

Lack of enzyme that maintains glutathione, which protects against oxidant injury in the RBCs.
G6PD deficiency therefore = increased haemolysis

Question 19

How does glucose-6-phosphate dehydrogenase deficiency present?

Answer 19

Neonatal jaundice
Haemolytic anaemia
Acute haemolysis

Question 20

What is polycythaemia vera (pathophysiology)?

Answer 20

Malignant proliferation of a clone derived from one pluripotent stem cell. Excess proliferation of RBCs, WBCs and Platelets.

Question 21

How is polycythaemia vera investigated

Answer 21

JAK2 gene mutation in 95%

High haematocrit

Question 22

How does polycythaemia vera present?

Answer 22

Incidental finding on FBC
Hyperviscocity - headaches, dizziness, tinnitus, visual disturbance
Facial plethora
Splenomegaly

Question 23

How is polycythaemia vera managed?

Answer 23

Low risk - Venesection

Older/high risk - hydroxycarbamide

Question 24

What is the mechanism of hydroxycarbamide?

Answer 24

Decreases the production of DNA.

Question 25

How does deep vein thrombosis present?

Answer 25

``` Can progress to PE as presentation Limb pain Tenderness Calf swelling Increase in limb temperature Pitting oedema ```

Question 26

What are the risk factors for DVT?

Answer 26

``` Obesity Family history Male Smoking Increased age Cancer ```

Question 27

Which score and test can be used to rule out DVT?

Answer 27

Well's score | D-dimer

Question 28

How is DVT managed?

Answer 28

Low molecular weight heparin or other anticoagulant medication

Question 29

Describe immune thrombocytopenia (ITP)

Answer 29

Caused by antiplatelet antibodies. | May be acute or chronic

Question 30

What is the course of chronic immune thrombocytopenia?

Answer 30

Fluctuating course of bleeding, purport, epistaxis and menorrhagia

Question 31

How can immune thrombocytopenia be investigated?

Answer 31

Bone marrow biopsy shows increased megakaryocytes