Haematology Flashcards
(100 cards)
1
Q
basophilic stippling of red blood cells is found in…
A
Sideroblastic anaemia
2
Q
polycythaemia rubra vera may transform to…
A
AML or myelofibrosis
3
Q
What is the most common inherited blood disorder?
A
Von Willebrand’s disease
4
Q
Which antibody type rises in acute infection?
A
IgM
5
Q
Raised inflammatory markers & osteoporosis suggests…
A
Multiple myeloma
6
Q
What is the general Hb threshold for RBC transfusion?
A
70g/L
7
Q
leukoerythroblastic blood suggests…
A
CML
8
Q
What is the duration of anticoagulation for unprovoked VTE?
A
6 months
9
Q
What is the duration of anticoagulation after provoked VTE?
A
3 months
10
Q
‘Bite cells’ suggests..
A
G6PD deficiency
11
Q
How is G6PD deficiency inherited?
A
X-linked recessive
12
Q
Which patients should be given irradiated blood life-long?
A
Those with Hodgkin’s Lymphoma
13
Q
Hypersegmented neutrophils are typical of…/
A
Vit B12/Folate deficiency
14
Q
Which medication can be used to reduce the risk of tumour lysis syndrome?
A
Allopurinol
15
Q
rouleaux formation is characteristic of…
A
Myeloma
16
Q
What is the most common type of NHL?
A
Diffuse large B cell lymphoma
17
Q
What is meant by primary haemostasis?
A
formation of platelet plug
18
Q
Problems with which components could cause a problem of primary haemostasis?
A
Platelets, vascular, vWF
19
Q
What is meant by secondary haemostasis?
A
formation of fibrin clot
20
Q
What are the Vit K dependent clotting factors?
A
II, VII, IX and X
21
Q
Raised PT and APTT suggests…
A
Multiple clotting factor deficiency
22
Q
Give causes of multiple clotting factor deficiency.
A
Liver failure, DIC, Vit K deficiency
23
Q
Which is the most common Haemophilia?
A
Haemophilia A
24
Q
Haemophilia A occurs due to…
A
Factor VIII deficiency
25
Haemophilia B occurs due to...
Factor IX deficiency
26
Isolated raised APTT suggests...
Intrinsic problem - likely haemophilia
27
How are Haemophilia A and B inherited?
X-linked recessive
28
Give an example of an extrinsic pathway problem.
Factor VII deficiency
29
Myelodysplasia may transform to...
AML
30
What is the major component of cryoprecipitate?
Factor VIII
31
In suspected DVT, what is the management if D-dimer positive but doppler negative?
stop anticoagulation and repeat scan in 1 week
32
an increase in granulocytes at different stages of maturation +/- thrombocytosis suggests...
CML
33
Which blood component have the highest risk of bacterial contamination?
Platelets
34
Where is Vit B12 absorbed?
Ileum
35
Where is folate absorbed?
Duodenum & jejenum
36
Where is iron absorbed?
Duodenum & jejenum
37
What can be given before surgery to reduced bleeding in vWF deficiency?
Desmospressin
38
What is the treatment for beta-thalassaemia major?
Lifelong blood transfusions
39
Which kind of clotting do antiplatelets target and which conditions?
Arterial clotting involving primary haemostasis (platelets)
| Used in cerebrovascular disease, coronary & peripheral artery disease
40
Which kind of clotting do anticoagulants target and which conditions?
Venous clotting involving secondary haemostasis (clotting factors)
Used in PE, DVT and AF
41
What is the MOA of Aspirin?
COX-1 inhibitor → blocking TXA2 and reducing platelet aggregation
42
What is the MOA of Ticagrelor/Clopidogrel?
P2Y12 receptor blockers on platelet surface
43
What are the main uses of antiplatelet agents?
Acute CVA/ACS
| Secondary prevention cardiovascular
44
What is the MOA of warfarin?
Inhibits production of Vit K-dependent clotting factors - II, VII, IX and X
45
What is the MOA of Heparins?
Inhibit factors IIa (Thrombin) and Xa
46
What is important to remember when starting Warfarin for VTE treatment?
Initially pro-thrombotic effect - for VTE treatment, give with heparin initially
47
Dabigatran belongs to which class of medications?
DOAC - Direct Thrombin inhibitors
48
What is the MOA of Rivaroxaban, Edoxaban, Fondaparineux etc?
Xa inhibitors
49
Which agents can be used in stroke prevention in AF?
Warfarin or DOACs
50
Which anticoagulant should be used in valvular AF?
Warfarin
51
Which medications are used in secondary prevention of stroke?
Clopidogrel 75mg
| High-dose statin
52
What is the treatment for ITP?
Oral steroids
53
What is the definitive test for sickle cell disease?
Hb electrophoresis
54
How is Heparin monitored?
Unfractionated - APTT
| LMWHs - usually none, can do Xa assay
55
How is Warfarin monitored?
INR
56
What is the reversal agent for Heparin?
Protamine sulphate
57
What is the standard therapeutic range for INR?
2-3
58
What INR is usually required for surgery?
< 2.5
59
Give examples of hereditary thrombophilias.
Factor V Leiden, Protein C/S deficiency
60
Anaemia with raised reticulocyte count suggests...
Haemolysis or blood loss
61
What are the most common causes of hypochromic microcytic anaemia?
Iron deficiency anaemia and thalassaemia
62
Give causes of Normochromic normocytic anaemia.
Anaemia of chronic disease
Bone marrow failure or infiltration
Renal impairment
63
Pernicious anaemia increases the risk of which cancer?
Gastric
64
What is the problem in thalassaemia?
Reduced globin chain production
65
What are the severities of alpha thalassamia?
alpha thalassemia trait - asymptomatic/mild anaemia
HbH disease - moderate to severe anaemia
Hydrops foetalis - fatal
66
In which areas is thalassaemia more common?
Around equator in malaria-endemic areas
67
What is the diagnostic test for beta thalassaemia trait?
Raised HbA2
68
When does beta-thalassaemia major tend to present?
Age 6 - 24 months (as HbF falls)
69
How is beta-thalassaemia major managed?
Blood transfusions at target Hb 95 - 105
70
What is the biggest cause of mortality in beta-thalassaemia major?
Iron overload
71
What is the cause of sickle cell anaemia?
Point mutation in Hb which polymerises to change shape of RBC surface
72
What is the management of sickle cell crisis?
```
Opiate analgesia
Hydration
Rest
Oxygen
Antibiotics if evidence of infection
Red cell exchange transfusion in severe crisis eg (lung) chest crisis or (brain) stroke
```
73
Which complication of sickle cell disease increases risk of infection?
Splenic infarction leading to hyposplenism
74
Which medication may reduce the severity of sickle cell disease?
Hydroxycarbamide
75
D-dimer positive, doppler negative - what is the management?
Stop anticoagulation and offer repeat scan
76
What type of blood can rhesus negative patients receive?
Rhesus negative only
77
What is the threshold for platelet transfusions in bleeding?
30 if bleeding, 100 in massive haemorrhage
78
What is the platelet threshold for prophylactic infusion (for example bone marrow failure, autoimmune thrombocytopaenia)?
10
79
What is the platelet target for patients undergoing surgery?
50
80
What does FFP contain?
clotting factors, fibrinogen, albumin, natural anticoagulants etc
81
Under what circumstances would cryoprecipitate be indicated?
Major haemorrhage with Fibrinogen < 1.5g/L
82
What are the indications for Prothrombin complex concentrate?
emergency reversal of warfarin in severe bleeding, head injury or emergency surgery
83
Give potential alternatives to blood transfusion.
Do nothing
Iron replacement - oral or IV
EPO injections
Tranexamic acid to reduce bleeding risk eg. during surgery or menorrhagia
84
Why are some patients given irradiated blood?
Reduce the chance of graft-versus-host disease
85
Which patients should receive irradiated blood?
Lifelong - Hodgkin’s Lymphoma
Bone Marrow Transplant
Aplastic anaemia
Treatment with purine chemotherapy for haem cancer
86
Which patients should receive CMV negative blood?
Pregnant women and neonates up to 6 months
87
When should observations be taken when administering a blood transfusion?
Before, after 15 mins and within 60 mins of completion
88
What signs would suggest a massive haemorrhage clinically?
BP < 90 or HR > 110
89
Which infusions would be given in major haemorrhage?
Initially 2:1 red cells: FFP, 1:1 in trauma/PPH
90
CLL may transform to...
High-grade NHL
91
What is the main differentiating feature between acute and chronic leukaemias?
Acute - block in differentiation/maturation so excess of blasts
Chronic - no block in differentiation/maturation - cells at all stages
92
> 20% lymphoblasts suggests...
ALL
93
> 20% myeloblasts suggests...
AML
94
Presence of Auer Rods suggests...
AML
95
Which testing can differentiate ALL vs AML.
Immunophenotyping
96
Philadelphia translocation – t(9:22) suggests....
CML
97
'Smudge cells' suggests...
CLL
98
'Reed Steenberg cells' suggests...
Hodgkin's Lymphoma
99
How long is a unit of RBCs usually transfused over?
90 - 120 mins
100
'Heinz bodies' suggests...
G6PD deficiency
