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Haematology Flashcards

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1
Q

Most common type of autoimmune haemolytic anaemia?

A

Warm

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2
Q

Antibody in warm haemolytic anaemia?
Where does haemolysis tends to occur?

A

IgG
Extravascularly (e.g. spleen)

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3
Q

Antibody in cold haemolytic anaemia?
Where does haemolysis tends to occur?

A

IgM
Intravascualrly

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4
Q

Drug that can cause warm AI haemolytic anaemia?

A

Methyldopa

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5
Q

Drugs that can cause aplastic anaemia?

A

Cytotoxic agents
Phenytoin
Gold
Sulphonamides

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6
Q

Feature of autoimmune haemolytic anaemia (not just haemolytic)?

A

Positive direct Coomb’s test

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7
Q

Management of hereditary spherocytosis?

A

Folate supplementation
Splenectomy
Cholecystectomy if gallstones are problematic

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8
Q

Inheritance of spherocytosis/ellipotocytosis?

A

Autosomal dominant

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9
Q

Most common inherited haemolytic anaemia (Northern Europeans)?

A

Spherocytosis

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10
Q

Inheritance of G6PD deficiency?

A

X-linked recessive

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11
Q

Blood film in G6PD deficiency?

A

Heinz bodies
Bite and blister cells

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12
Q

Diagnosis of G6PD deficiency?

A

G6PD enzyme assay

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13
Q

Triggers of crisis in G6PD deficiency?

A

Fava beans
Anti-malarials (primaquine)
Sulphonlyureas, Sulphasalazine, other sulphonamides
Ciprofloxacin

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14
Q

What are patients with paroxysmal nocturnal haemaglobinuira predisposed to?

A

VTE - PE, DVT, hepatic vein thrombosis
Muscle dystonia - oesophageal dysmotility, erectile dysfunction

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15
Q

Causes of microangiopathic haemolytic anaemia?

A

Haemolytic Uraemic Syndrime
Disseminated Intravascular Coagulopathy
Thrombotic thrombocytopenia purpura
Systemic Lupus Erythematous
Cancer

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16
Q

Hyposplenism features?
(biochemical)

A

Howell-Jolly bodies
Siderocytes
Target cells
Pappenhiemer bodies
Acanthocytes

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17
Q

Criteria for diagnosis of acute chest syndrome in sickle cell anaemia?

A
  1. Fever or respiratory symptoms
  2. New infiltrates seen on CXR
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18
Q

Definitive diagnosis of sickle cell anaemia?

A

Haemaglobin electrophoresis

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19
Q

Vaccines in sickle cell anaemia?

A

Should receive pneumococcal vaccine every 5 years

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19
Q

Haemophillia biochemistry?

A

Prolonged APTT
Prothrombin and thrombin time normal
Bleeding time normal

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20
Q

Inheritance of thalassaemia?

A

Autosomal recessive

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21
Q

Features of thalassaemia major?

A

Severe microcytic anaemia
Bone deformities
Splenomegaly

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22
Q

Complication in thalassaemia (due to lots of transfusions)?

A

Iron overload
Require iron chelation

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23
Q

Iron chellating agent?

A

Desferrioxamine

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24
FBC in beta thalassaemia trait?
Microcytosis is characteristically disproportionate to the anaemia
25
Most common cause of thrombophilia?
Factor V Leiden (activated protein C resistance)
26
Evan’s syndrome ?
Immune thrombocytopenia with associated autoimmune haemolytic anaemia
27
Management of immune thrombocytopenia (adults)?
Prednisolone (oral)
28
Deficiency in thrombotic thrombocytopenia Purpura?
ADAMTS13 protein (this protein inactivates vWF)
29
Diagnosis of myelodysplastic syndrome?
Bone marrow aspiration and biposy
30
Blood film for myelodysplastic syndrome?
May be blasts
31
Progression of myelodysplastic syndrome?
Increased risk of acute myeloid leukaemia
32
Philadelphia chromosome translocation association?
Acute Lymphoid Leukaemia (30% adults, 3-5% children) 9 to 22 translocation = CML
33
Blood film in CLL?
Smudge or smear cells
34
Richeter's transformation?
CLL to high grade (non-Hodgkin) lymphoma Patient become very suddenly unwell
35
Complication of CLL?
Warm autoimmune haemolytic anaemia
36
Phases of CML?
Chronic: 5 years, usually asymptomatic Accelerated: 10-20% blast cells, symptomatic Blast: >30% blast cells, sever symptoms, can be fatal
37
CML features?
Increased granulocytosis at different stages of maturation Thrombocytosis Decreased leukocyte alkaline phosphatase
38
Blood film AML?
Blast cells with Auer rods (rods in cytoplasm)
39
Side effects of Erythropoietin ?
Flu-like symptoms Bone aches Rashes
40
Tumour Lysis Syndrome scoring system?
Cairo-Bishop 2 or more of the following (within 3 days before and 7 days post chemotherapy): 1. Uric acid > 475 or 25% increase 2. Potassium > 6 or 25% increase 3. Phosphate > 1.125 or 25% increase 4. Calcium < 1.75 or 25% decrease
41
Following initial investigations where myeloma is suspected?
BLIP Bence-Jones protein (urine electrophoresis) Serum free Light chain assay Serum Immunoglobulins Serum Protein electrophoresis Bone marrow biopsy is necessary to confirm diagnosis of myeloma
42
Initial investigation is myeloma is suspected?
FBC (low WCC) Calcium (raised) ESR (raised) Plasma viscosity (raised) if any of these are positive must urgent serum electrophoresis and urine Bence-Jones protein
43
Which symptoms = a poor prognosis of in lymphoma?
B symptoms
44
Mutation in polycythaemia vera?
JAK2
45
Management of polycythaemia vera?
Aspirin (75mg daily) Venesection to maintain haematocrit < 0.45
46
Management if INR is between 5-8 (patient is not bleeding)?
Withold 1 or 2 doses of Warfarin
47
Richter's transformation?
CLL to non-hodgkin lymphoma
48
Features of thrombotic thrombocytopenic purpura? (pentad)
1. Fever 2. Neuro signs 3. Throbocytopenia 4. Haemolytic anaemia 5. Renal failure
49
What are haptoglobin?
Binds to haemoglobin, decrease in HUS
50
When should vaccines be given to a patient going for elective splenectomy?
2 weeks prior to surgery
51
1st line management in warm acute haemolytic anaemia ?
Steroids +/- rituximab
52
Why is there increased risk of VTE in factor V Leiden ?
Activated factor V is inactivated more slowly by Protein C
53
Description of Reed-Sternberg cell?
Mirror image nuclei
54
Management of antiphospholipid syndrome after first VTE?
Life long warfarin
55
Warfarin PT and APTT?
Prolonged PT Normal APTT
56
Most common type of lymphoma in the UK?
Diffuse large B cell lymphoma
57
Which transfusion product has the highest risk of bacterial contamination compared to other types of blood products?
Platelets
58
Blood film in DIC?
Schistocytes
59
What needs careful monitoring in use of unfractioned heparin ?
APTT Unpredictable anticoagulant effect
60
Which heparin is high risk for HIT?
Unfractioned
61
Monitoring in LMWH?
Anti Xa assay
62
Which pathway does warfarin mostly affect?
Extrinsic (PT)
63
What is raised in beta thalassaemia major?
HbA2
64
DIC typical blood picture?
Low platelets Low fibrinogen Increased PT and APTT Increased fibrinogen degradation products
65
Blood film in autoimmune haemolytic anaemia?
Spherocytes can be found in AIHA as well as hereditary spherocytosis
66
Management of KIT positive tumours (GI stromal tumours/CML)?
Imatinib
67
What forms the major criteria for cryoprecipitate use?
Fibrinogen level (low)
68
When is irradiated blood required ?
Severe immunodeficiency History of Hodgkin lymphoma Exposure to certain drugs (bendamustine) Following stem cell transplant (allogenic for longer)
69
Starry sky appearance on lymph node biopsy?
Burrkit's lymphoma
70
C-myc gene translocation?
Burkitt's lymphoma
71
Blood film iron deficiency anaemia ?
Target clue Pencil poikilocytes
72
Myelofibrosis bloodfilm?
Tear drop piokilocytes
73
Intravascular haemolysis blood film?
Schistocytes
74
Megalobiastic anaemia blood films?
Hyper segmented neutrophils
75
Diagnosis of hereditary spherosytosis?
EMA binding
76
Drugs causing haemolysis in G6PD deficiency?
Ciprofloxacin Sulphon drugs Anti malarial drugs
77
Type of haemolysis in G6PD deficiency?
Intravascular
78
Type of haemolysis in spherocytosis?
Extravascular
79
Blood film in lead poisoning?
Microcytic anaemia and basophilic stippling
80
Most common type of Hodgkin lymphoma?
Nodular sclerosing
81
Best prognosis in Hodgkin ?
Lymphocyte predominant

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